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HEART Insight:
doi: 10.1097/01.HEARTI.0000359347.97356.e2
Features: Nutrition Know-Knows

Downsizing The American Child

Lippert, Joan

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How To Get Your Kid Healthier And Happier

One in three American children and adolescents is obese or overweight. You would think that being teased or picked on by other kids for their appearance would be the worst of their worries, but the real hurt is what is going on inside their bodies.

“Obesity and overweight have a negative impact on almost every organ system in the body,” says Stephen R. Daniels, M.D., Ph.D., Professor and Chairman of the Department of Pediatrics at the University of Colorado Denver School of Medicine. “The seeds of cardiovascular disease can be planted early in life. High blood pressure, for example, has been observed in overweight children as young as three years old.”

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Children who are overweight are also more likely to have high levels of bad blood fats [triglycerides and, sometimes, LDL (low-density lipoprotein) cholesterol], as well as low levels of the good blood fat HDL (high-density lipoprotein) cholesterol. “We're seeing more adult-onset diabetes [type 2] in children than ever before,” says Ronald M. Krauss, M.D., Senior Scientist and Director of Atherosclerosis Research at Children's Hospital in Oakland, CA. Excess weight can also cause asthma, fatty liver (medically known as hepatic steatosis) and sleep apnea. And when heavier kids grow up, they are at increased risk of stroke, gall bladder disease and breast, colon and kidney cancers in adulthood.

It's not the extra weight that causes the problems, though. “A child who is quite tall or an older child may have a minor increase in risk from a few pounds, but a smaller child may have a bigger increase in risk,” says Daniels, who is also Pediatrician-in-Chief at The Children's Hospital in Denver.

For this reason, doctors prefer to gauge the degree of overweight by measuring body mass index (BMI), a calculation that factors in height, age and gender as well as weight and is a reliable indicator of body fat. Children at or above the 85th BMI percentile — which means their BMI is as high as or higher than 85 percent of their peers — are considered overweight; above the 95th percentile, obese.

If your child looks heavy, your pediatrician will likely check his or her BMI (our Resources box includes an online BMI calculator). When a child's BMI is above the 85th percentile, the pediatrician may also measure blood pressure, triglyceride and cholesterol levels, blood sugar and liver enzymes to see whether and how the excess weight is affecting your child's overall health.

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“There's one — and only one — cause of obesity and overweight, and that's taking in more calories than are burned,” says Krauss. So the first step is putting your child on a diet, right? Actually, ultra-low-calorie weight-loss diets are often too difficult for a child — or anyone, frankly — to stay on for long periods. Instead, doctors often ask children to maintain their weight, since growth spurts will improve BMI and disease risk over time.

“It's generally better to talk about health than weight,” says Daniels. “And it's always best to talk about behaviors that lead to overweight than weight itself.”

Your job as parent, then, is to control the home environment and to set realistic, achievable goals; make those goals about changes in behavior, not pounds lost; and expect slow-but-steady progress over time. Easier said than done? Here are tried-and-true suggestions from the Alliance for a Healthier Generation (whose leaders include former President Bill Clinton, President of the American Heart Association Dr. Clyde Yancy, and Gov. Arnold Schwarzenegger of California).

Work with your child, not against him. Mealtime doesn't have to be a battle:

▪ Introduce healthier elements into foods your child already likes: blueberry pancakes, carrot muffins, fruit slices over a favorite cereal made with whole grains.

▪ Involve the child in food shopping for healthy food items and food preparation. Children are more likely to eat what they helped create.

▪ Stock up on healthy foods: 100 percent juice instead of soda, apples instead of chips. Hungry children will eat the good stuff.

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▪ Schedule a regular snack time and stick to it. Most kids like routine.

▪ Have healthy finger-foods like fruit and raw or cooked veggie chunks available. Kids love to eat with their hands.

▪ Repeal the “clean plate” rule.

▪ Control portion sizes. There's too much of everything on the American plate!

▪ Encourage kids to “eat their colors.” Brightly colored foods provide a greater variety of nutrients.

▪ For treats, think moderation, not deprivation. A scoop of ice cream or a serving of your child's favorite food is okay occasionally.

▪ Eat at the table, not in front of the TV, to avoid “automatic eating.”

▪ Scope out the school lunch menu together and make choices in advance. (Speak to the principal if there are no healthy choices available!)

Make fast food friendlier. Fast food can still be a part of your child's life with these strategies:

▪ Don't supersize.

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▪ Skip the fries and other fatty sides. A burger or sandwich by itself is often filling enough. If not, consider a fruit cup or side salad.

▪ Avoid double meat and bacon.

▪ Suggest the grilled chicken sandwich. Poultry without skin is significantly leaner than the meat in most burgers.

▪ Try a whole-wheat bun, if available.

▪ Nix the mayo and other calorie-laden dressings and sauces.

▪ Drink water, diet soda, fat free or low-fat (1%) milk to avoid unwanted sugar and calories.

Limit tube time. Experts recommend that kids get no more than 1 to 2 hours of TV/computer/video games a day — max (most get 4 to 6). To trim your child's sedentary time:

▪ Offer alternative activities: family game night, shooting hoops, walking the dog, exploring the park.

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▪ Position furniture so the TV isn't the main focus of the room.

▪ Remove TVs from bedrooms.

▪ Plan TV watching in advance. Turn the TV on for shows of interest, and turn it off afterwards.

▪ Do jumping jacks, pushups and crunches during commercials.

▪ Avoid using screen time as a reward or punishment.

Afraid to even broach the topic of weight with your child? Don't be. “It's very likely that your child is already thinking about it and is already worried. You can ask open-ended questions about how the child feels about his or her weight and how you can work together to improve the family lifestyle,” suggests Daniels. “Ask which changes seem easiest to make — that's where behavior change should begin.”

The pediatrician can help your child understand the health issues and offer a plan of action or recommend a nurse, dietitian, other health professional or program. In fact, “a program is a better way to go for kids who are seriously overweight,” says Krauss. The extra support can also boost self-esteem.

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You think getting your child on board is hard? Here's the real challenge: being a good role model. Your kids won't accept being restricted to two hours of TV if you watch for four. They won't eat their spinach if you won't touch yours. Experts say kids crave more time with their parents — so tear yourself away from the TV and computer, and go out to play with your kids! Then come in and share a healthy meal or snack. Getting involved increases the chances of your child's success.

And, you might just lose a pound or two yourself.

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* American Heart Association:

* To calculate body mass index:

* Alliance for a Healthier Generation:

© 2009 American Heart Association, Inc.