Obesity in children - management

Children can achieve healthy weight and growth with the help of their parents and family. The whole family will benefit from making healthy lifestyle choices. Choosing healthy foods, limiting takeaway and junk food, increasing physical activity and seeking professional advice can all help. Crash diets, appetite suppressants or humiliating and teasing an overweight child does not help.

Overweight and obesity often start during the primary school years. This is a major concern because many overweight children continue to be overweight as adults. The main influence on the diet and lifestyle of primary school children is their parents. Simple techniques in the home can have a dramatic effect.

How to assess if your child is overweight or obese

Body mass index (BMI) calculation is one of the tools used to assess whether a person is underweight, healthy weight or overweight. BMI is calculated by dividing your weight in kilograms by your height in metres squared (m²). There is a calculator on the Better Health Channel that will help you to work out BMI.

A child’s BMI changes according to their age and stage of physical development. BMI measures alone are not appropriate for children. BMI-for-age centile charts are designed specifically for children from two to 18 years of age. These are used in addition to the weight and height growth charts to give a more accurate picture of children’s development.

It is important that a child’s BMI is compared against his or her age and gender centile charts. The BMI centile range includes:

• Under 3^rd percentile – underweight
• 3^rd to 85^th percentile – healthy range
• 85^th to 95^th percentile – overweight
• 95^th percentile and above – obese.

Consult with your doctor

Growth charts and BMI for children should be used as a guide only. Your doctor can help assess whether or not your child’s weight is of concern. Consider making an appointment with your doctor to talk about your child’s weight.

Make changes to the whole family’s eating habits

Healthy food choices and being more active will benefit the whole family, so try to get everyone involved. Children who are overweight or obese will find it easier to achieve a healthy weight if the whole family makes healthy lifestyle changes.

Some suggestions include:

• Get good nutrition advice – Good nutrition advice may help to change the whole family’s eating habits. There are many fact sheets on the Better Health Channel that can guide you in making healthy choices.
• Shop carefully – stock your fridge and pantry with healthy snacks. Limit high fat or sugar treats. Switch to low fat versions of dairy foods, such as milk, cheese and yoghurt.
• Enjoy breakfast – make sure you all have a healthy breakfast every day. Choose low fat, low sugar, wholegrain breakfast cereal with low fat milk and some fruit.
• Provide healthy snacks – snacking is an important part of children’s eating habits and shouldn’t be discouraged – just make sure the snacks are mostly low in kilojoules. Fruits and vegetables make excellent snacks.
• Reduce unhealthy drinks – don’t buy sugary soft drinks. Encourage water and some low-fat milk.
• Eat more vegetables – if your child refuses to eat vegetables, try being creative with how you use vegetables; for example, finely grate carrot and zucchini into lasagne or spaghetti sauce.
• Offer smaller serves – some children will clear their plate at dinnertime, no matter how big the serving size, so give them a little less. Serving 10 or 20 per cent less over time can make a significant difference.
• Limit takeaway meals – try to have takeaway food less often. Takeaway food is often higher in salt and fat than home-cooked meals.
• Plan ahead – try cooking a dish the night before so that the meal is ready when you come home from work or cook large quantities and freeze meals for use later. If you can plan your meals, you’re less likely to opt for takeaway food, which can seem an easy option when you’re tired.
• Make mealtime a happy time – Enjoy mealtimes together whenever possible. Involve everyone in preparing healthy meals together.
• Ask the extended family to help too – encourage carers and grandparents not to give children unhealthy foods.

Become more active together

It’s much more fun to be active with others and everyone will benefit. Try to:

• Set a good example – children tend to follow their parents’ lead.
• Increase activity – children should be encouraged to be physically active. Encourage outdoor play.
• Become active as a family – go for walks together, play cricket, toss a frisbee in the backyard, go bike riding, take the dog for a walk or go swimming together. School-aged children need a minimum of 60 minutes of activity every day. Aim for everyone to be active outside school time or at least for 30 minutes each day. Encourage lots of opportunities for active play for pre-school children and toddlers.
• Reduce passive pastimes – reduce television viewing and computer games to a total of less than two hours per day for school-aged children and less than one hour per day for preschoolers and toddlers. .
• Find out as much as you can – seminars and educational activities run by teachers and community groups can help parents and children learn more about obesity and how to prevent it.
• Choose activities as rewards – instead of giving food ‘treats’ as a reward, suggest outings or a favourite game or story.

Tactics to avoid

Some weight-loss strategies are harmful or even dangerous. You should not use:

• Weight targets – don’t set specific weight targets. Instead, focus on healthy eating habits and increasing physical activity with praise for your child when they are successful in these areas.
• Crash dieting – a growing child needs a wide range of foods for healthy development. A crash diet that limits kilojoules too drastically or cuts out a food group (such as dairy foods) should be avoided. Reducing kilojoules by a small amount and doing that every day is the goal.
• Dramatic changes – family habits can’t be changed overnight. Children may resist dramatic changes to diet and lifestyle, so concentrate on changes that you can make part of your family life. Be guided by your health professional.
• Appetite suppressants – none of the current medications (pills) are safe for growing children.
• Ridicule – teasing a child for being overweight is harmful. Ridicule will only make the child feel self-conscious and upset and will not promote weight loss.

Tips for school

Suggestions include:

• Talk over your concerns with the school nurse.
• Ask your child’s teacher or principal for further information about any healthy lifestyle education offered at the school. Follow up at home to reinforce the messages.
• Don’t pack high-fat snacks (such as potato chips) in your child’s lunchbox.
• Encourage water as the main drink at school
• Educate your child about making healthier choices at the school canteen.
• Talk to the principal and other parents about the food choices available at the canteen. Suggest improvements if necessary.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• The Royal Children’s Hospital Tel. (03) 9345 5522

Things to remember

• Parents and carers can take an active role in helping their children to develop healthier habits.
• Children who are overweight or obese will find it easier to achieve a healthy weight if the whole family makes healthy lifestyle changes.
• Limit the amount of time children spend watching television or playing computer games, and encourage physical play.