Helping Your Overweight Child

WebMD Live Events Transcript

You know your child needs help. You know that obese kids become obese adults without some kind of intervention. What you don't know is where to start. What works? What doesn't? And who can you turn to for professional support? Lakshmi Kolagotla, MD, from the Boston Medical Center Nutrition and Fitness for Life clinic, answered those questions and more when she joined us on Sept. 9, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Dr. Kolagotla, what are the first steps a parent can take to help an overweight child?

KOLAGOTLA:
First, consult with your child's pediatrician. Quite a few studies show that people are not very good at estimating whether a child is overweight or underweight. Your child's pediatrician can calculate your child's body mass index and should then tell you whether your child needs to do anything about their weight. But in general, regardless of your child's weight, focus on keeping your children active. The No. 1 way to do this: minimize exposure to television.

MODERATOR:
Why is TV such a culprit?

KOLAGOTLA:
Studies have shown that the most effective intervention has been limiting television. The American Academy of Pediatrics recommend children not be exposed to TV at all. We believe television does a number of [negative] things:

  • Children who watch TV spend less time in more active behaviors.
  • Children's television often exposes them to TV ads for foods that are high in sugar and low in nutritional quality.
  • Recent data has pointed out that TV can also interfere with a child's ability to perform in school.

MEMBER QUESTION:
My daughter is 9 and is overweight. I don't think my pediatrician has a clue how to help me help her. Who do I turn to for professional advice?

KOLAGOTLA:
Your pediatrician may be able to point you in the right direction. They should be able to refer you to a nutritionist, who can analyze your child's nutritional or dietary intake, and provide pointers on minimizing calories and providing foods that are of more nutritional value.

MODERATOR:
What kind of discussion should/could you have with your child about being overweight?

KOLAGOTLA:
Instead of focusing on weight, focus on health. Talk about having more nutritious meals, making more nutritious choices, and becoming more active. Individualize it. You know your child best. Young boys often like to be involved in football, so you could say that eating healthier and being more active will improve the sport for them. Girls want to look better, so you can talk about how eating more healthfully will help them. Children often can't identify with future health goals, so speak in terms of what they can do that's more immediately helpful.

"Regardless of your child's weight, focus on keeping your children active. The No. 1 way to do this: minimize exposure to television."

MEMBER QUESTION:
One daughter is overweight and the other isn't. How can we deal with her weight without making her feel bad? We try to avoid comparisons, but it is so obvious.

KOLAGOTLA:
The key: remember that eating healthier and being active is beneficial for the entire family. So don't target nutritional messages to the overweight child. Stock foods that are nutritious for everyone. Diets that are rich in fruits and vegetables ultimately lead to healthier lives and reduce risks for cardiovascular disease, diabetes, and certain types of cancers.

MEMBER QUESTION:
So we shouldn't just restrict dessert for the one girl but everyone should skip dessert? It seems like punishing everyone.

KOLAGOTLA:
In stead of restricting dessert for everyone, focus on healthier desserts. Fruit with low-fat yogurt; try to focus on something everyone in the family will enjoy.

MODERATOR:
Maybe food shouldn't be a punishment or a reward?

KOLAGOTLA:
Exactly. There's been a lot of research about restricting foods -- it oftentimes leads to the opposite results. For instance, parents may allow children to finish their dessert if they have their vegetables. Studies have shown that this then leads children to value the desserts over vegetables. Instead, parents should use activities as rewards.

Children value the time they spend with their parents and the attention they get from their parents. You shouldn't overestimate the power of activities such as family walks.

MEMBER QUESTION:
Just how young can a child be and be considered obese? How do you tell whether it's "baby fat" or excess weight?

KOLAGOTLA:
In 2000 the Centers for Disease Control and Prevention created standards of body mass index for children 2 years and above. Using these standards, your pediatrician can diagnose whether your child is overweight. Children whose body mass index is above the 85th percentile for age and sex are considered overweight; children whose body mass index is above the 95th percentile are considered obese.

MEMBER QUESTION:
I always heard you shouldn't put kids on a diet. Now everyone is upset about the obesity "epidemic." What's a parent supposed to do?

KOLAGOTLA:
It's true, instead of putting your child on a diet the focus should be on providing well-balanced meals. Focus on providing meals that are low in fat and rich in fruits and vegetables. Children also need calcium for strong bones and teeth. And they should receive two to three servings of low-fat dairy products, as well.

MEMBER QUESTION:
I don't think my brother and his wife notice that their son is overweight. They're all kinda "big" people, but this little boy is headed for serious weight problems, in my mind. Should I butt out, or is there a correct way to intervene and get my nephew's eating habits adjusted while he's still young?

KOLAGOTLA:
Oftentimes obesity in children is mirrored by obesity in their parents. I think if your nephew's parents aren't aware of his weight, pointing it out to them may help them realize this. Another way that might be more helpful: take your nephew out, doing things more active.

MEMBER QUESTION:
How can parents model good weight management when they don't do well for themselves? We are trying, but are overweight.

KOLAGOTLA:
Take a multistep family approach:

  • Provide meals that are healthy for everyone.
  • Model good behaviors, taking part in activities such as hiking or family walks.
  • When you go to the store, park far away from the stores so you walk more.
  • When running short errands, walk rather than drive.
  • Use the stairs rather than taking the elevator.

MEMBER QUESTION:
Any advice on helping a child who has asthma and cannot be as active as he should? Lots of video games and TV are in this child's life right now.

KOLAGOTLA:
Consult with your child's pediatrician and find out what activities he can do. Often kids with asthma can benefit from swimming and some health centers offer special clinic swim programs for kids with asthma.

"Rewards should be not food-related. Focus on activity , no video games, trips to the movies, or other sedentary activities."

MEMBER QUESTION:
Is it OK to use a reward system for being active? We don't use anything like that with food, but think it might help with activity and exercise.

KOLAGOTLA:
Reward systems can be helpful in shaping behaviors in young children. Hopefully getting them started in the activity will get them hooked. But rewards should be not food-related. Focus on activity , no video games, trips to the movies, or other sedentary activities.

MEMBER QUESTION:
Can you suggest some fun ways to increase activity that won't cause my overweight child embarrassment?

KOLAGOTLA:
Start with simple stretches; also have her participate in activities around the house -- helping you with chores. Make it fun! Most children can walk, so short walks are a good start. Gardening or going out and picking flowers, things that focus on activity.

MEMBER QUESTION:
Is 1 to 2 pounds a week a realistic goal for weight loss in a child, as it is in adults?

KOLAGOTLA:
We don't focus on weight loss goals for children. The goals are to increase active behaviors and decrease unhealthy behaviors, and to make healthy choices when it comes to nutrition.

MODERATOR:
Does it help to teach a school-aged child how to read food labels?

KOLAGOTLA:
It depends on the child's maturity. It's better for them to learn to choose the low-fat yogurt rather than figuring out how much fat is in the other brand, for example. For older children it's beneficial for them to realize what they're eating, especially the teenagers. Helping them understand how much fat they should be taking in, or pointing out the things they should be eating would be helpful.

MEMBER QUESTION:
What's the right age to switch from whole milk to skim?

KOLAGOTLA:
Children under the age of 2 require whole milk for brain development, but children above age 2 can switch to skim or low-fat milk.

MODERATOR:
What are some other switches we can make for the entire family that will help an overweight child?

KOLAGOTLA:
A few things:

  • Switch to oils such as olive or safflower
  • Cook more healthfully, grilling meat, for example
  • Decrease sodium in the diet (you can do this by using fresh or frozen vegetables rather than canned)
  • Buy carbohydrates that are whole-grain

MODERATOR:
What about soda pop? Should it be banned from the home?

KOLAGOTLA:
I believe so. It provides very little nutrition and can add a lot of calories. Oftentimes calories from drinks simply are added on to what we eat, they don't fill us up enough that we're not limiting our intake of other foods. Children should drink water, not enough do. Instead they're exposed to drinks high in sugar, such as juice and soda.

MEMBER QUESTION:
I like to give my kids a drink that's about 90% water, with a splash of juice to give it some flavor. They are much more willing to drink that than plain water. Is this a good compromise?

KOLAGOTLA:
An excellent compromise. In fact, older teenagers who I see in clinic, who absolutely can't live with soda, find that diet soda is a good compromise as long as it's caffeine free (because caffeine can be associated with loss of calcium).

MODERATOR:
What about special occasions? Birthday parties? Halloween? If we don't treat food as a reward, how do we handle the foods that are associated with special occasions?

KOLAGOTLA:
Stress that these are special occasions. Moderation is the key. Let children have a small slice of cake at birthday parties. At Halloween, maybe the child can choose a few pieces of candy, and then put the rest away, to be eaten over time, rather than all on one day. Don't restrict overweight children from sharing in the fun.

MEMBER QUESTION:
My kids come home from school starving! What can fill them up fast but not make them too full for dinner?

KOLAGOTLA:
Providing snacks that have a lot of fiber leads to feeling full, such as celery with low-fat cheese or carrot sticks, both high in fiber. The fact they're so hungry after school may mean they're not getting enough at lunchtime. Make sure they're getting enough at lunch and pack an extra piece of fruit.

Another thing: Many children skip breakfast, often because they say they're not hungry or there's no time. In that case, pack something for them to take to school, a piece of fruit and yogurt, or a sandwich to take for breakfast. Breakfast does not have to be traditional breakfast foods.

"Moderation is the key. Let children have a small slice of cake at birthday parties. Don't restrict overweight children from sharing in the fun."

MEMBER QUESTION:
What are the signs of compulsive eating in a child? How early in life can a problem like this start?

KOLAGOTLA:
Signs of compulsive eating would include:

  • Eating rapidly to the point of vomiting
  • Complaining of an uncomfortable fullness after eating
  • Feelings of lack of control while eating

I've seen compulsive eating behavior in children as young as 7 or 8.

MODERATOR:
How much activity should a child get to maintain health?

KOLAGOTLA:
The goals: half an hour of activity a day. For overweight children you should start slowly -- behaviors are not going to be changed overnight.

MODERATOR:
What can you do to prevent obesity in your child?

KOLAGOTLA:
Breastfeeding has been shown to be protective against obesity, and I think we need to help mothers start and maintain breastfeeding for at least the first six months of life.

Remember, the same things we've talked about with overweight kids should be promoted in normal weight children. All children should:

  • Have at least five servings of fruits and vegetables
  • Consume two to three serving of low-fat dairy
  • Minimize TV watching
  • Have a half hour to an hour of activity a day

Losing weight is difficult for adults, much less children. Being positive and persistent is key. Weight loss takes time, and the focus should be on changing behaviors and maintaining them. We want to teach children to be fit for life.

MODERATOR:
Thanks to Lakshmi Kolagotla, MD, from the Boston Medical Center Nutrition and Fitness for Life clinic, for sharing her expertise with us today. Goodbye and good health.



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