Obesity in Kids & Teenagers—

Do you know when to be concerned about your child's weight? Of course, all kids gain weight as they grow older. But extra pounds — more than what's needed to support their growth and development — can lead to childhood obesity.

The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of kids and teenagers are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion. Overweight kids are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

A few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. Kids, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume the calories needed for daily activities, growth and metabolism, they add pounds in proportion to their growth. But kids who eat more calories than needed gain weight beyond what's required to support their growing bodies.

The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the kids will also be obese. However, when both moms & dads are obese, the kids have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

• depression or other emotional problems
• family and peer problems
• family history of obesity
• lack of exercise (i.e., couch potato kids)
• low self-esteem
• medical illnesses (endocrine, neurological problems)
• medications (steroids, some psychiatric medications)
• overeating or binging
• poor eating habits
• stressful life events or changes (separations, divorce, moves, deaths, abuse)

Far less common than lifestyle issues are genetic diseases and hormonal disorders that can predispose a child to obesity. These diseases, such as Prader-Willi syndrome and Cushing's syndrome, affect a very small proportion of kids. In the general population, eating and exercise habits play a much larger role.

There are many risks and complications with obesity. Physical consequences include:

• breathing problems
• diabetes
• high blood pressure
• increased risk of heart disease
• trouble sleeping

Many factors — usually working in combination — increase your child's risk of becoming overweight:

• Diet. Regular consumption of high-calorie foods, such as fast foods, baked goods and vending machine snacks, contribute to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts also can cause weight gain. Foods and beverages like these are high in sugar and calories.

• Family factors. Most kids don't shop for the family's groceries. Indeed, moms & dads are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods in the store. You can't blame your kids for being attracted to sweet, salty and fatty foods; after all they taste good. But you can control much of their access to these foods, especially at home.

• Genetics. If your child comes from a family of overweight people, he or she may be genetically predisposed to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged.

• Inactivity. Sedentary kids are more likely to gain weight because they don't burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.

• Psychological factors. Some kids overeat to cope with problems or to deal with emotions, such as stress or boredom. Their moms & dads may have similar tendencies.

• Socioeconomic factors. Kids from low-income backgrounds are at greater risk of becoming obese. Poverty and obesity often go hand in hand because low-income moms & dads may lack the time and resources to make healthy eating and exercise a family priority.

Child and adolescent obesity is also associated with increased risk of emotional problems. Teenagers with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety, and obsessive-compulsive disorder can also occur.

Whether your child is at risk of becoming overweight or currently at a healthy weight, you can take proactive measures to get or keep things on the right track.

• Avoid food-related power struggles with your child. You might unintentionally lay the groundwork for such battles by providing or withholding certain foods — sweets, for instance — as rewards or punishments. As a general rule, foods aren't recommended for behavior modification in kids.

• Be patient. Many overweight kids grow into their extra pounds as they get taller. Realize, too, that an intense focus on your child's eating habits and weight can easily backfire, leading a child to overeat even more, or possibly making him or her more prone to developing an eating disorder.

• Emphasize the positive. Encourage a healthy lifestyle by highlighting the positive — the fun of playing outside or the variety of fresh fruit you can get year-round, for example. Emphasize the benefits of exercise apart from helping to manage their weight, for example, it makes their heart, lungs and other muscles stronger. If you foster your child's natural inclination to run around, explore and eat only when hungry — not out of boredom — a healthy weight should take care of itself.

• Schedule yearly well-child visits. Take your child to the doctor for well-child checkups at least once a year. During this visit, the doctor measures your child's height and weight and calculates his or her BMI. Increases in your child's BMI or in his or her percentile rank over one year, especially if your child is older than 4, is a possible sign that your child is at risk of becoming overweight.

• Set a good example. Make sure you eat healthy foods and exercise regularly to maintain your weight. Then, invite your child to join you.

Obese kids need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the child's or adolescent's level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.

Ways to manage obesity in kids and teenagers include:

• attend a support group (e.g., Overeaters Anonymous)
• change eating habits (eat slowly, develop a routine)
• control portions and consume less calories
• do not use food as a reward
• eat meals as a family instead of while watching television or at the computer
• increase physical activity (especially walking) and have a more active lifestyle
• know what your child eats at school
• limit snacking
• plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
• start a weight-management program

Moms & dads play a crucial role in helping kids who are obese feel loved and in control of their weight. Take advantage of every opportunity to build your child's self-esteem. Overweight kids are at increased risk of low self-esteem because of the social emphasis on appearance and being slim. Don't be afraid to bring up the topic of health and fitness, but do be sensitive that a child may view your concern as an insult. Talk to your kids directly, openly and without being critical or judgmental.

In addition, consider the following advice:

• Find reasons to praise your child's efforts. Celebrate small, incremental changes, but don't reward with food. Choose other ways to mark your child's accomplishments, such as going to the bowling alley or a local park.
• Help your child focus on positive goals. For example, point out that he or she can now bike for more than 20 minutes without getting tired or can run the required number of laps in physical education class.
• Talk to your child about his or her feelings. Help your child find ways to deal with his or her emotions that don't involve eating.

Obesity frequently becomes a lifelong issue. The reason most obese teenagers gain back their lost pounds is that after they have reached their goal, they go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight. Moms & dads of an obese child can improve their child's self esteem by emphasizing the child's strengths and positive qualities rather than just focusing on their weight problem.



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