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Childhood Obesity

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Keeping “baby fat” for too long can put a child’s health at risk. How can you help your child get fit and maintain a healthy weight into adulthood? According to research or other evidence, the following steps may be helpful:

What you need to know

  • Get your family focused on fitness
  • Be a positive role model by involving your entire family in a programme that includes better eating and regular exercise
  • Find a diet that fits
  • Research whole foods and help your children choose healthy long-term eating habits
  • Turn off the tube
  • Provide and encourage physically active alternatives to TV and video games
  • Try parental training
  • Improve the results of treating childhood obesity by learning valuable techniques that can help you alter your child’s behaviour
  • Get a check-up for your child
  • Visit a doctor to determine if any treatable health problems are developing as a result of childhood obesity

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full childhood obesity article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About childhood obesity

Excessive weight in children and adolescents is becoming an increasingly serious problem.1 2 In the United States, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years are overweight, and among adolescents the percentage is three times higher than it was 20 years ago.3 Major contributors to childhood obesity include genetics, unhealthy diets, and sedentary lifestyles.4 5 Overweight children often become adults with weight problems that contribute to a wide variety of health problems,6 7 but even during childhood and adolescence, overweight can contribute to such disorders as type 2 diabetes, high cholesterol, high blood pressure, insulin resistance, and liver disease.8 9 10 Being overweight also has social and psychological consequences for children in terms of social discrimination, poor self-esteem, and depression.11 12

Parents, family members, and others who are important people in a child’s life can either help or harm an obese child’s situation. As with all children, those with weight problems need acceptance, support, and encouragement from their family, and the eating, exercising, and other health habits of family members play important roles in influencing the same behaviours in children.13 14

Product ratings for childhood obesity

Science Ratings Nutritional Supplements Herbs
2Stars

Glucomannan

  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The proper weight for a growing child or adolescent should be determined with the help of a doctor or other qualified health professional, who can also determine whether any unusual medical problems might be contributing to weight gain, whether any current health problems exist that are related to overweight, and appropriate weight control methods. Treating obesity should not include overly restrictive or fad diets that are missing essential nutrients. In fact, weight loss is not necessarily appropriate for a growing child. Often the best goal for an overweight child is to maintain their current weight as they grow taller.

Medical options

Treatment for childhood obesity involves screening for heart disease risk and other health risk factors, and providing information on improving diet and exercise habits. No medications are approved for treating childhood obesity.15

Dietary changes that may be helpful

Unhealthy eating patterns resulting in overconsumption of foods high in fat, calories, or added sugars are considered a major contributor to childhood obesity.16 Since these patterns often include habits learned from the family, attention should be paid to providing healthy food to the entire family and encouraging good role modeling by other family members.17

Guiding healthy food choices when eating outside of the home is also a priority. To teach good lifetime eating habits, try the following:18

  • Make healthy foods easy to see at home and keep unhealthy foods out of sight
  • Plan meals and snacks ahead of time so that healthy choices will be available
  • Avoid using food as a reward or withholding food as punishment
  • Eat slowly and pay attention to when you are hungry and when you are satisfied
  • Eat at a designated location such as a dining table, rather than in front of the TV
  • Aim for a few servings of fruits and vegetables every day
  • Drink water when thirsty instead of drinks with added sugars
  • Start the day with a healthy breakfast to prevent cravings later on

There is only limited research on the prevention of childhood obesity with diet. Preliminary studies have found that breast-feeding during infancy is usually associated with a reduced risk of developing obesity during early childhood, though the reasons for this effect are unclear.19 20 21 In a controlled study of children between the ages of 7 and 12, a school-based education programme designed to reduce carbonated-drink consumption resulted in a reduction in the number of overweight children after 12 months.22

Most authorities believe that the best diet for treating childhood obesity is a heart-healthy diet low in saturated fat and cholesterol, but high in vitamins, minerals, and other important nutrients. 23 However, few studies have actually compared different diets for their effectiveness in treating childhood obesity.

A recent 12-week controlled trial found that overweight adolescents lost more weight with a low-carbohydrate diet than with a low-fat diet.24 Very-low-carbohydrate (ketogenic) diets have been shown to cause rapid weight loss in very obese children in short-term preliminary and controlled trials,25 26 but the long-term safety and benefits of this type of diet are unknown. More research is needed to evaluate low-carbohydrate diets for treating childhood obesity.

Glycaemic index and glycaemic load describe the tendency of foods to raise blood sugar. Eating meals containing foods that are low in glycaemic index or glycaemic load may influence appetite and other body mechanisms that affect excessive weight gain in children.27 28 A preliminary study reported that obese children using a low-glycaemic-index diet lost more weight compared with a similar group using a low-fat diet.29 A controlled trial found that obese adolescents eating freely on a low-glycaemic-load diet lost more weight and body fat after six months than did a similar group following a typical low-calorie, low-fat diet.30

Very-low-calorie “modified fasting” diets, typically using high-protein meal replacement drinks, have been tried in preliminary and controlled studies of obese children with good short-term results.31 32 However, weight lost with these diets is often regained and there are health risks associated with their use.33 Little is known about their effect on growth and other health issues in children.

Lifestyle changes that may be helpful

Lack of physical activity is considered a significant contributing factor in childhood obesity.34 However, while the results of treatment of overweight children are usually enhanced by strategies to increase physical activity or decrease inactivity, attempts to improve physical activity levels have not been very successful in preventing childhood obesity according to most controlled research.35 Nonetheless, watching television and playing computer or video games contributes to the sedentary lifestyle of many children, and controlled research has shown that weight control is more successful when these activities are controlled and healthier alternatives provided.36 37 38 Children are recommended to get at least an hour of moderate physical activity most days of the week, and more may be necessary to offset genetic and other influences. Fun activities that involve other family members or other children will help make getting more exercise a positive experience.39

Weight-loss efforts that involve excessive restriction of calories or protein can inhibit a child’s ability to gain lean body mass (such as muscle) during the normal growth process. Consequently, weight-loss diets for children should not be excessively restrictive. In addition, an appropriate exercise programme can be a useful addition to a low-calorie diet for overweight children. A controlled trial found that strength training, when added to a low-calorie diet, resulted in a greater gain of lean body mass (while still promoting weight loss), compared with diet alone in obese children.40 Another study of obese adolescents found that a physical exercise programme combined with normal calorie intake resulted in reductions in body weight and body fat while allowing for normal growth and preservation of lean body mass.41

Vitamins that may be helpful

Increased fibre intake is thought to have potential benefit in a weight-loss programme since dietary fibre dilutes calories, slows down the eating process, and may make people feel more full despite eating fewer calories.42 However, research on using fibre in the treatment of childhood obesity has focused on using fibre supplements rather than comparing low- and high-fibre diets. Supplementation for four months with 2 to 3 grams per day of a bulking agent called glucomannan, was effective in a group of obese adolescents in one controlled trial,43 but another controlled trial found no significant effect of 2 grams per day for two months.44

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Integrated approaches that may be helpful

Behaviour-change techniques are considered useful for helping people break old habits and form more healthy habits. These techniques may be learned from counselling professionals, support groups, educational programmes, or books. Many controlled studies have investigated various methods for using behaviour-change techniques to prevent or treat childhood obesity, with a few reporting success at reducing overweight compared with either no treatment or with conventional weight-loss approaches.45 46 47

Parental involvement in the treatment of childhood obesity is considered important for success, especially when parents are given adequate training in a wide range of behaviour-change techniques that can be applied to the entire family.48 Limited research suggests that training parents alone is superior to training either children alone or training both parents and children.49 50 51 Some authorities suggest that training parents alone produces the best results because this avoids affecting the child’s self-esteem and willingness to change, which might result from labeling him or her as “the patient.”52 53

Problem-solving techniques are used in some types of counselling to help people maintain changes in their behaviour. In one controlled study, teaching problem-solving techniques to parents in addition to behaviour-change techniques improved weight loss results in obese children compared with a group learning only behaviour-change techniques.54 However, another controlled study found no additional benefit when problem-solving training was given to either the child or to both child and parent.55

For support and information, parents can also try the following resources:

  • The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents (www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm)
  • How Parents Can Fight the Obesity Epidemic (www.med.umich.edu/1libr/yourchild/fightobesity.htm)
  • Shapedown for Parents, Children & Teens (www.shapedown.com/page2.htm)

References

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54. Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. J Consult Clin Psychol 1988;56:246–50.

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