Weight Control and Obesity Prevention in Children
People who maintain a healthy weight throughout life stay healthier
and live longer than those who are overweight. The lifestyle habits
that help keep us slim—exercise and a healthy diet—also
cut our risk of diabetes, heart disease, high blood pressure, and
some cancers.
The prevalence of obesity among our nation's youth has more than
doubled in the past 20 years, with close to five million youths
aged 6 to 17 seriously overweight or obese. The prevalence of obesity
in nine-year-old children in a recent study was about 12 percent
for boys and 7 percent for girls.1 Even the number of
young overweight four- to five-year-old girls nearly doubled between
the early 1970s and the early 1990s.2
The problems caused by overweight go way beyond
appearances. Childhood obesity leads to all manner of health problems,
such as adult-onset diabetes and heart disease.3
A number of risk factors for heart disease, stroke, and diabetes,
including high blood pressure, high blood cholesterol, and insulin
resistance, are sometimes grouped together and called the metabolic
syndrome. In one study, obese seven-year-olds had nearly four and
a half times the risk of having metabolic syndrome in adulthood
than their non-obese peers.4 The Centers
for Disease Control and Prevention recently found that 60 percent
of overweight five- to ten-year-olds already have at least one risk
factor for heart disease, such as raised blood pressure or insulin
levels.5
Many overweight children become overweight adults. This is in part
because the number of fat cells a child has is determined by the
time he or she reaches adolescence. Generally, heavier children
have more fat cells, which makes it more difficult for them to lose
weight as adults. And, sadly, children who are overweight maintain
some added health risk even if they eventually lose the weight.6
Family plays a major role in determining a child's body size. Genetics
give us our eye and hair color, but when it comes to body size and
shape, genes are no match for how we live life. Doctors agree that
environmental influences are very important to a child's chances
of staying slim and fit. For example, a child with a family history
of adult-onset diabetes has double the risk of having diabetes as
an adult. However, if the same child remains inactive, eats fatty
foods, and becomes obese, he or she has a significantly greater
chance of developing diabetes. We are all born with a set of genes,
but we have the ability to influence how those genes are expressed
simply by choosing healthy actions.
For all these reasons, it is important not to wait for children
to grow out of their chubbiness, but instead to help them choose
a healthy eating style and incorporate fun physical activity into
their lives right away.
Food Choices for a Healthy Body
Choosing a plant-based eating style is a simple way to achieve
or maintain a healthy weight because such dietary patterns require
no calorie counting and contain the nutrients a fit body needs.
Vegetarians have been shown to be leaner than their meat-eating
peers in a number of scientific studies.7,8
Dr. Benjamin Spock, pediatrician, medical researcher, and teacher,
advised in his book, Dr. Spock's Baby and Child Care, that
weight-loss programs for children should be based upon changing
the type of food children eat, rather than the amount of food they
eat. He encouraged shifting the entire family away from oily fried
foods, meats, and dairy products and toward low-fat, plant-based
foodsgrains, pasta, vegetables, legumes, and fruit. When this is
done, he stated, "weight loss typically occurs without anyone going
hungry."9 This is the key to life-long weight maintenance.
The scientific evidence is clear: the closer a family gets to a
pure vegetarian diet, the healthier they'll be.
- Experiment and broaden food options. Try new foods, recipes,
and places to eat to keep it interesting and enjoyable. Sometimes,
when people change their food intake because of concerns about
health, body size, or personal beliefs, they focus too narrowly
on just a small number of foods. Exploring the broad range of
healthful foods now available makes a menu change fun, nutritious,
and sustainable.
- Choose low-fat, healthful options whenever possible. Choosing
lower fat recipes and foods and eating a variety of colors are
good ways to ensure that your child's diet is a healthy one. For
example, oven-roasted potatoes should be chosen over French fries,
pasta with marinara sauce is a better option than spaghetti with
meatballs, and fruit sorbet is just as refreshing but much more
healthful than ice cream. The net effect is usually a reduction
in the number of calories and, of course, fat consumed in any
given portion of food that isn't easily detected. Plus, the introduction
of new foods adjusts the taste buds and develops an appreciation
for good, wholesome food. It's best to avoid foods and beverages
that have lots of energy but few or no nutrients, such as candy,
soda, punch, cookies, and fried snack foods. Fatty condiments
like creamy salad dressings, mayonnaise, butter, and margarine
are best left off the plate. Instead of centering meals around
fatty meats and cheese, meals should be built from healthy grains,
legumes, and vegetables.
Key Steps to Fitness
Fitness has four dimensions: cardiovascular, strength, flexibility,
and body composition. Activities that get the heart pumping, such
as running, swimming, bicycling, aerobics, and playing sports or
outdoor neighborhood games, improve cardiovascular fitness. Strength-training
activities, such as weightlifting, push-ups, and sit-ups, as well
as many daily tasks, such as digging in the garden, lifting boxes,
carpentry work, and so forth, improve muscular development and bone
strength. Stretching, yoga, gymnastics, dancing, and martial arts
all promote flexibility. A healthy body composition balances muscle
and other lean tissue with an appropriate amount of fat tissue for
a child's age and sex. Healthy body compositions are achieved through
a combination of an active lifestyle and a healthy menu of grains,
vegetables, legumes, and fruit.
What If a Child Is Already Overweight?
Action should be taken now. The two main contributors to overweight
are low activity level and diets based on meat, dairy products,
and high-calorie, low-nutrient-density foods. The first step is
assessing a family's lifestyle by looking at eating patterns and
activities to determine what changes are needed to promote fitness
and achieve a healthy weight. The easiest and most effective method
is for all members of the family to shift together-if possible-to
a healthier lifestyle. The same healthy habits will benefit the
rest of the family as well as the overweight child.
A "get-healthy" approach is a better choice than embarking on a
low-calorie diet for achieving fitness and a healthy weight. The
idea is to focus on what is being eaten, not so much on quantity.
The healthiest diet avoids animal products completely and is built
from grains, legumes, vegetables, and fruit.
Parents, teachers, and guardians can work with children toward
an understanding that food is a fuel for health and fitness rather
than a comfort, friend, enemy, or boredom reliever. Reading books
to children that present nutrition in a fun and interesting manner
is a good way to teach them the value of good nutrition. Under most
circumstances, restricting the calorie intake of children is not
recommended. Children continue to grow and develop into their early
twenties, so they can't afford to be short-changed of nutrients.
It is, however, all right to limit the quantities of highly processed
foods and sugary beverages (otherwise known as "empty calorie" foods)
and to help children understand reasonable portion sizes.
Children and adults benefit from learning to pay attention to
their natural hunger and fullness cues, rather than focusing on
"cleaning their plates." There are natural internal signals that
keep people from overeating. If a child does not want to finish
his or her meal now, the plate can be wrapped and saved for when
the child is hungry later. Promising dessert as a reward is best
avoided as well, as it encourages overeating and makes less healthful
foods seem special.
It's important for parents to talk with children about their eating
and activity patterns. Children should be active for at least 60
minutes on most days, and they should eat three to five healthy
meals and snacks a day. Sedentary activities, such as TV watching
and computer time, should be limited except when homework requires
it. It is estimated that, on average, U.S. preschoolers spend 23
hours a week in front of the television and grade-school students
watch for 29 hours each week. Add to this the time spent playing
video games, using the Internet, doing homework, and eating dinner-and
kids spend a lot of time sitting still.
Parents can encourage their children to play with other children
and to do active things with family members. Most communities have
locally organized activity programs after school, on the weekends,
and during the summer. Since gym class and team sports are not every
child's cup of tea, encouraging individual interests such as ice
skating, ballet dancing, or skateboarding are important, too. Both
encouraging children to adopt a healthy, vegetarian eating style
and teaching them to enjoy being active are likely to be the most
important lessons children can learn for their long-term health.
Many schools are under financial pressure to downsize health and
physical education programs, so support school districts in their
efforts to promote wellness and physical education and to promote
healthier lunches in the cafeteria. School lunch programs are required
to provide nutritious, low-cost meals to students; parents and teachers
can help school officials understand what options should be available
for children. See www.HealthySchoolLunches.org
for more information.
Staying Clear of the Food Fight
Children learn very early that what they eat is important to their
parents, and they often use this knowledge to their advantage. Parents
may sit for hours at the dinner table with their children until
they finish their last asparagus spear. Food can be used as a reward,
a way to exert control, or a way to rebel. Rewarding kids for good
grades or good behavior with sweets can set up internal conflicts
about food. This is especially true if the rewards are in opposition
to current goals for health or body image. If not dealt with early,
these food fights may extend into adult life as well. Finding a
way to sidestep the food fight is a priority. If a child is having
trouble sticking to healthful foods, the following strategies may
be helpful.
- Stock the kitchen with healthy foods. Having plenty of fruits,
vegetables, grains, and beans on hand and keeping unhealthful
foods out of the house are simple ways to eliminate conflict over
which type of food to prepare or eat.
- Focus on food as a fuel for health. Choosing a simple, health-giving
way of eating like the one suggested in these pages and explaining
to children why it is important to eat this way will help them
to appreciate and choose healthful foods.
- Reduce the emphasis on food in daily life. When people solve
problems by eating or congratulating themselves with food, the
importance of food has gotten out of control. Finding other solutions
to problems, such as talking about them, writing about them in
a journal, or taking a walk or a bike ride to figure out possible
steps to take, are much healthier and productive. Families should
become accustomed to using non-food treats as rewards, such as
a warm conversation, reading, going to a movie or the park, making
something, calling Grandma or a friend, or engaging in other physical
activities.
- Set clear divisions of responsibility. If a "food fight" develops,
parents should define responsibilities around foods. The parent
is responsible for providing appropriate food choices. The child
is responsible for choos-ing what to eat amongst the choices offered.
- Allow for healthy treats. Occasional treats are a good idea,
but they should be healthful items. Fresh-fruit smoothies, a colorful
cup of berries in season, or a vegetable dish prepared a favorite
way can all be special treats and prevent a family from feeling
trapped by their healthy diet.
The Problem with Dieting
A recent study found that roughly half of American adults are
currently trying to lose weight and adolescent boys and girls are
close behind at 36 and 44 percent, respectively. Roughly 20 to 30
percent of dieting adolescents practice unhealthy or even dangerous
diets.10 In another study of five- to twelve-year-olds,
45 percent of the girls and 20 percent of the boys reported having
been on a diet.11
Cutting calories is often effective at lowering weight for the
short term, but usually results in overeating or binge eating and
regaining of any lost weight. This is a natural anti-starvation
response to dieting. Caloric restriction alters body chemistry to
try to push the dieter to seek out food and makes the body conserve
stored energy or hold on to its fat. Some other weight-loss schemes
are similarly ineffective or destructive. Diet pills, for example,
contain caffeine or other stimulants, laxatives, or diuretics that
simply cause water loss. Crash diets usually leave a person aggravated,
discouraged, and the same size.
Instead of limiting calories for the purpose of weight loss, adults
and children merely need to switch to healthy foods. When the diet
is built from fruits, vegetables, grains, and legumes, weight management
is much easier, and putting limits on calories is unnecessary. For
example, a veggie burger has 0.5 grams of fat saving 20 grams of
fat and 180 calories (compared to hamburger at 21 grams). A bean
burrito with lettuce, tomato, and salsa has three grams of fat,
for a savings of 99 calories and 11 grams of fat (compared to a
chili cheese burrito with 14 grams of fat). And choosing a pineapple
and tomato pizza without the cheese over a pepperoni pizza saves
14 grams of fat per slice and a total of 126 calories! It's easy
to make the switch and well worth the time.
When people eat healthful foods and stay physically active, their
bodies find their way to a healthy size and shape in a pleasurable
and sustainable way.
For More Information
Physicians Committee for Responsible Medicine. Healthy Eating
for Life for Children, John Wiley & Sons, 2002.
PCRM Reports and Fact Sheets:
References
1. Dywer JT, Stone EJ, Yang M, et. al. Prevalence of marked over-
weight and obesity in a multiethnic pediatric population: findings
from the Child and Adolescent Trial for Cardiovascular Health (CATCH)
study. J Am Diet Assoc 2000;100(10):1149-56.
2. Ogden CL, Troiano RP, Briefel RR, Kuczmarski RJ, Flegal KM, Johnson
CL. Prevalence of overweight among preschool chil-dren in the United
States, 1971 through 1994. Pediatrics 1997; 99(4):E1.
3. Vanhalla M. Childhood weight and metabolic syndrome in adults.
Ann Med 1999;31:236-239.
4. Hulman S, Kushner H, Katz S, Falkner B. Can cardiovascular risk
be predicted by newborn, childhood, and adolescent body size? An
examination of longitudinal data in urban African Americans. J Pediatr
1998;132(1):90-7.
5. Centers for Disease Control and Prevention. CDC Surveillance
Summaries, July 7, 2000. MMWR 2000;49 (No. SS-6).
6. Must A, Jacques PF, Dallal Ge, Bajema CJ, Dietz WH. Long-term
morbidity and mortality of overweight adolescents: A follow-up of
the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992 327(19):1350-5.
7. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence
of diabetes? Am J Publ Health 1985;75:507-12.
8. Melby Cl, Goldflies DG, Hyner GCl, Lyle RM. Relations between
vegetarian/non-vegetarian diets and blood pressure in black and
white adults. Am J Publ Health 1989;79:1283-88.
9. Spock B, Parker SJ. Dr. Spock's Baby and Child Care. 7th edition,
Simon & Schuster, New York, NY, 1998.
10. Neumark-Stainzer D, Rock CL, Thornquist MD, Cheskin LJ, Neuhouser
ML, Barnett MJ. Weight-control behaviors among adults and adolescents:
associations with dietary intake. Prev Med 2000; 30(5):381-91.
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