In the U.S., at least one out of five kids is overweight. The number of overweight children continues to grow. Over the last two decades, this number has increased by more than 50% and the number of "extremely" overweight children has nearly doubled.

A doctor determines if children are overweight by measuring their height and weight. Although children have fewer weight-related health problems than adults, overweight children are at high risk of becoming overweight adolescents and adults. Overweight adults are at risk for a number of health problems including heart disease, diabetes, high blood pressure stroke, and some forms of cancer.

Did You Know That...

• Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes, also known as adult-onset diabetes.
• Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease.
• One of the most severe problems for obese children is sleep apnea (interrupted breathing while sleeping). In some cases this can lead to problems with learning and memory.
• Obese children have a high incidence of orthopedic problems, liver disease, and asthma.
• Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. In rare cases, a medical problem, such as an endocrine disorder, may cause a child to become overweight. Your doctor can perform a careful physical exam and some blood tests, if necessary, to rule out this type of problem.

• Genetic Factors: Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
• Lifestyle: A child's total diet and his or her activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child spends approximately 24 hours each week watching television-time that could be spent in some sort of physical activity.

TALK TO YOUR DOCTOR

If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. doctors will measure your child's weight and height to determine if your child's weight is within a healthy range. A doctor will also consider your child's age and growth patterns to determine whether your child is overweight. Assessing overweight in children is difficult because children grow in unpredictable spurts. Based on your child's height and weight, they will calculate a body mass index (BMI). If your child's BMI is greater than 95% of children their age and gender, they are considered to be overweight

For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.

BE SUPPORTIVE

One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that he or she has a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.

FOCUS ON THE FAMILY

Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.

INCREASE YOUR FAMILY'S PHYSICAL ACTIVITY

Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:

• Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
• Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
• Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
• Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
• Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.

The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.

TEACH YOUR FAMILY HEALTHY EATING HABITS

Teaching healthy eating practices early will help children approach eating with the right attitude-that food should be enjoyed and is necessary for growth, development, and for energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat.

DON'T PLACE YOUR CHILD ON A RESTRICTIVE DIET

Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons. Limiting what children eat may be harmful to their health and interfere with their growth and development.

To promote proper growth and development and prevent overweight, parents should offer the whole family a wide variety of foods from each of the food groups.

• Most of the foods in your diet should come from the grain products group (6-11 servings), the vegetable group (3-5 servings), and the fruit group (2-4 servings). (See chart for suggested serving sizes.)
• Your diet should include moderate amounts of foods from the milk group (2-3 servings) and the meat and beans group (2-3 servings).
• Foods that provide few nutrients and are high in fat and sugars should be used sparingly. Fat should not be restricted in the diets of children younger than 2 years of age.

EXAMPLES OF ONE SERVING

Bread, cereal, rice, pasta

• 1 slice of bread
• 1 ounce of ready to eat cereal
• 1/2 cup of cooked cereal, rice, or pasta

Milk, yogurt, cheese

• 1 cup of milk or yogurt
• 1 1/2 ounces of natural cheese
• 2 ounces of processed cheese

Vegetables

• 1 cup of raw vegetables or 1/2 cup of frozen leafy leafy vegetables (cooked)
• 1/2 cup of other vegetables - cooked or chopped raw
• 3/4 cup of vegetable juice

Meat, poulty, fish, beans, nuts

• 2-3 ounces of cooked lean meat, poultry, or fish
• 1/2 cup of cooked dry beans or 1 egg counts as 1 ounce of lean meat
• 2 tablespoons of peanut butter or 1/3 cup of nuts count as 1 ounce of meat

Fruits

• 1 medium apple, banana, or orange
• 1/2 cup of chopped, cooked, or canned fruit
• 3/4 cup of fruit juice

Serving sizes are for children and adults ages 2 years and older. A range of servings is given for each food group. The smaller number is for children who consume about 1,300 calories a day, such as 2-4 years of age. The larger number is for those who consume about 3,000 calories a day, such as boys 15-18 years of age.

CUT DOWN ON FAT

Reducing fat is a good way to cut calories without depriving your child of nutrients. Simple ways to cut the fat in your family's diet include eating lowfat or nonfat dairy products, poultry without skin and lean meats, and lowfat or fat-free breads and cereals.

Making small changes to the amount of fat in your family's diet is a good way to prevent excess weight gain in children: however, major efforts to change your child's diet should be supervised by a health professional.

In addition, fat should not be restricted in the diets of children younger than 2 years of age. After that age, children should gradually adopt a diet that contains no more than 30 percent of calories from fat by the time the child is about 5 years old.

DON'T OVERLY RESTRICT SWEETS OR TREATS

While it is important to be aware of the fat, salt, and sugar content of the foods you serve, all foods -- even those that are high in fat or sugar -- have a place in the diet (in moderation, of course). However, children should be taught to limit high-calorie soft drinks and foods such as candy and deserts, and salty snacks such as potato chips and french fries.

GUIDE CHOICES RATHER THAN DICTATE FOODS

Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.

ENCOURAGE YOUR CHILD TO EAT SLOWLY

A child can detect hunger and fullness better when eating slowly.

EAT MEALS TOGETHER AS A FAMILY

Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.

INVOLVE CHILDREN IN FOOD SHOPPING AND PREPARING

These activities offer parents hints about children's food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.

PLAN FOR SNACKS

Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at mealtimes. You should make snacks as nutritious as possible, without depriving your child of occasional chips or cookies, especially at parties or other social events. Below are some ideas for healthy snacks.

EXAMPLES OF HEALTHY SNACKS

• Fresh, frozen, or canned vegetables and fruit served either plain or with lowfat or fat-free cheese or yogurt
• Dried fruit, served with nuts or sunflower or pumpkin seeds
• Breads and crackers made with enriched flour and whole grains, served with fruit spread or fat-free cheese
• Frozen desserts, such as nonfat or lowfat ice cream, frozen yogurt, fruit sorbet, popsicles, water ice, and fruit juice bars

Warning: Children of preschool age can easily choke on foods that are hard to chew, small and round, or sticky, such as hard vegetables, whole grapes, hard chunks of cheese, rasins, nuts, and seeds, and popcorn. It's important to carefully select snacks for children in this age group.

DISCOURAGE EATING WHILE WATCHING TV

Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.

DON'T USE FOOD TO PUNISH OR REWARD

Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.

MONITOR MEALS OUTSIDE THE HOME

Find out more about your school lunch program, or pack your child's lunch to include a variety of foods. Also, select healthier items when dining at restaurants.

SET A GOOD EXAMPLE

Children are good learners, and they learn best by example. Setting a good example for your kids by eating a variety of foods and being physically active will teach your children healthy lifestyle habits that they can follow for the rest of their lives.

ADDITIONAL HELP

If you need to make changes to your family's eating and exercise habits, but are finding it difficult, a registered dietitian (RD) may be able to help. Your doctor may be able to refer you to an RD, or you can call the National Center for Nutrition and Dietetics of The American Dietetic Association at 800-366-1655 and ask for the name of an RD in your area.

If your efforts at home are unsuccessful in helping your child reach a healthy weight and your doctor determines that your child's health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program. To locate a weight-control program for your child, you may want to contact a local university-based medical center.

Look for the following characteristics when choosing a weight-control program for your child. The program should:

• Be staffed with a variety of health professionals. The best programs may include RDs, exercise physiologists, pediatricians or family doctors, and psychiatrists or psychologists.
• Perform a medical evaluation of the child. Before being enrolled in a program, your child's weight, growth, and health should be reviewed by a doctor. During enrollment, your child's weight, growth, and health should be monitored by a health professional at regular intervals.
• Focus on the whole family, not just the overweight child.
• Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those developed for children 8 or 12 years of age in terms of degree of responsibility of the child and parents.
• Focus on behavioral changes.
• Teach the child how to select a variety of foods in appropriate portions.
• Encourage daily activity and limit sedentary activity, such as watching TV.
• Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to overweight.

The overall goal of a successful treatment program should be to help the whole family focus on making healthy changes to their eating and activity habits that they will be able to maintain throughout life.

Created by the National Institute of Health. NIH Publication No. 97-4096 and NIH Word on Health, June 2002