Parents who wonder whether their child has a weight problem should ask their pediatrician to calculate the child's Body Mass Index (BMI). The BMI takes into account the child's height, weight, sex and age and compares those measurements to other children. If the child's BMI falls between the 85th and 95th percentile, he or she is at risk for becoming overweight. A child with a BMI above the 95th percentile is considered overweight.

Being overweight can have devastating consequences for a child's self-esteem. Compared to normal weight children, overweight children report greater degrees of emotional and social problems, school difficulties and impaired physical health. These findings were reported earlier this year in the Journal of the American Medical Association.

But weight is far more than an emotional and cosmetic issue. These days, we are seeing children with serious health problems related to their weight: high cholesterol, which can lead to heart disease; obstructive sleep apnea, which causes daytime fatigue and makes school performance difficult; Type 2 diabetes, which can lead to serious complications such as blindness; fatty liver disease; and musculoskeletal problems, such as hip displacement.

Many factors contribute to this problem. Children spend more time watching television, playing computer and video games and playing indoors than children of past generations. Families are more likely to eat on the go and choose fast foods and processed snack foods for convenience rather than for nutritional reasons. Our perceptions of appropriate portion size have gotten out of control as restaurants continually increase their drink and food serving sizes and promote large size servings as a better value. It is harder to make the right choices.

Also, it is difficult to address a child's weight problem. Parents sometimes take the wrong approach. For example, putting severe restrictions on the child's diet or forbidding certain foods may backfire and lead to binge eating. Imposing rules and dietary constraints on the overweight child while the rest of the family follows other eating habits is not productive either, since the child will be more influenced by the parents' example than by the guidelines they set. By focusing intensely on one small aspect such as calories consumed or the fat content of foods, some parents miss the big picture that maintaining a healthy weight requires a global approach.

Healthier lifestyle choices are needed, not a diet. Here are some tips to get started:

• Incorporate more physical activity. Children need at least 30 minutes of vigorous exercise each day. Parents can encourage biking or walking to school, playing ball instead of computer games, taking the stairs instead of the elevator, etc.
• Include more fruits, vegetables and fiber in meals. Fresh fruits and vegetables are ideal, but frozen or canned ones with low sugar are just as nutritious.
• Avoid fruit juices and soda. Water and skim milk are healthier options. Eliminating one can of regular soda each day can lead to one pound of weight loss after only three weeks.
• Offer children three meals and two snacks per day. Overweight children should consume less than 150 calories in a snack.
• Keep portion sizes reasonable. If a large portion is consumed, it should be balanced with some extra exercise.
• Read food labels. No more than 30 percent of the child's daily calories should come from fat. Saturated fat calories should be limited to less than 10 percent of daily calories.
• Plan for sit-down family dinner time without distractions or television.

Parents with children of any shape and size should incorporate healthy eating behaviors and physical activity in their family's life. It is important to start early and set good examples so children will be able to continue those good habits as they grow up.

At first it may be difficult to create new habits and learn how to select and prepare healthier foods, but it will be well worth it. Your child's health and happiness are at stake.

Lisa Martin, M.D., M.P.H.
Assistant Professor of Pediatrics,
Loyola University Chicago Stritch School of Medicine
Attending Physician, Pediatric Nutrition and Fitness Clinic

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