By Christine L. Williams, MD, MPH
Successful weight control for children involves the combination of diet, physical activity, and behavior modification. The following three steps incorporated together provide a successful strategy.
Step 1: Check in with your child's doctor.
If you believe that your child is overweight, make an appointment for a medical check-up with the pediatrician. Ask about your child's height, weight, and overall growth,
and tell the doctor you are concerned that he or she seems to be gaining extra weight. Write down the height and weight for future reference. Ask the
doctor if your child's BMI falls in the overweight range.
If your child's BMI is at or above the 95th percentile, and if he is 7 years of age or older, then the doctor should suggest some changes to slow down weight gain or achieve some weight loss. The doctor
may instead refer your child to a specialist for further evaluation and treatment, or to a registered dietitian for diet counseling.
Step 2: Try to increase the amount of time your child spends each day in moderately strenuous physical activity.
Goals will vary depending on your
child's age and other limitations but regardless of the goal, all children should get an hour a day of moderately strenuous physical activity, which can be
an hour of active free play or sports. All children should limit television time to two hours or fewer a day.
If weight maintenance is the goal for your child, try to increase physical activity so that an additional 100 calories are "burned off" each day. The number of calories that children "burn off" during physical activity depends on:
- how much he or she weighs (heavier children will expend more calories than lighter children),
- how vigorously he or she exercises, and
- how many minutes he or she is engaged in the activity (duration).
Table 1
provides a rough estimate of how many calories a 75-pound child might burn off during different types of physical activities. For example, jumping rope for 15 minutes would burn about 100
calories for this child. This strategy, in addition to reducing the intake of food or beverage calories by 100 a day, should help to keep weight steady, or at
least slow down the rate of weight gain.
If weight loss is the goal for your child, try to increase physical activity so that an additional 250 calories a
day are "burned off" each day.
This strategy, in addition to reducing the intake of food and beverage calories by 250 a day, could translate into a 1 pound of weight loss per week (250 calories less of food + 250 calories burned off = 500 calories less per day. A decrease of about 3,500 calories is needed to lose 1 pound of body weight, and 500 calories x 7 days = 3,500
calories.). Weight loss in a child should be monitored by the child's doctor or other health professional.
Step 3: Devise a healthful eating plan
A healthful eating plan that is right for your child's age is the cornerstone of treatment for a child who is
overweight. The major goal for every child is to get the right amount of nutritious foods each day so that they include all the important nutrients for their health and growth, and to adopt and practice beneficial eating habits. From a technical perspective, the most recent Dietary Reference Intakes (DRI's)
recommend:
- A fat intake of 30% to 40% kcal in young children 1- to 3-years old, with a reduction to 25% to 35% in children 4- to 18-years old
(compared with 20% to 35% in adults);
- A carbohydrate intake of 45% to 65% kcal in all children and adults;
and
- Protein intakes of 5% to 20%
kcal in children 1- to 3-years old with gradual increase to 10% to 30% kcal in children 4- to18-years old (compared with 10% to 35% kcal in adults).
Not surprisingly, the recommended percentages of different nutrients listed above are confusing to many people. We need some way to translate this information into real food and beverages. That's where the
USDA Food Pyramid is a big help. The latest version is called MyPyramid, http://www.mypyramid.gov/kids/ and
there is an easy way to compare your child's usual diet to
the recommended dietary goals. Just download the "MyPyramid" Worksheet for Children at
the USDA website http://teamnutrition.usda.gov/resources/mpk_worksheet.pdf. This worksheet is for 1,800 calories a day, which is about right for many children who are 6-10 years of age, although a child who burns off more calories
in vigorous sports may need more calories each day, and an inactive or overweight child may need less.
Christine L. Williams, MD, MPH is professor of Clinical Pediatrics, and director of the Children's Cardiovascular Health Center in the Department of Pediatrics and Institute of Human Nutrition at Columbia University, College of Physicians and Surgeons.