Understanding and Preventing

CHILDHOOD OBESITY

By Ilene V. Smith, M.S., R.D., C.N.

It’s hard not to smile when you see an overweight child with a round face or chubby little thighs. But the cherubic image of an overweight child raises several important questions. Is he dangerously overweight? Will the baby fat melt away with age? Does she eat too much? Exercise too little? Is an overweight child an unhealthy child? Should we just accept this child’s weight as his or her predestined body type and focus on developing the child’s self-esteem?

Obese Child, Obese Adult?

Such concerns are valid. According to a national health survey, nearly one-third of children aged 6 to 11 are obese and that number is growing. Why worry? For one thing, chances are that the obese child will become an obese adult. About one-third of obese preschool children and about half of obese school-age children become obese adults, with the risk of adult obesity at least twice as high for obese children as non-obese children. With overweight adults facing such life-threatening health risks as high blood pressure, diabetes, heart disease, gall bladder disease and cancer, chances are that whatever we can do to prevent obesity in childhood will lengthen lives.

Childhood obesity is not only a health issue. Anyone who has played in a schoolyard is familiar with the shouts of "Fatso!" "Baby Huey!" and "Chubby Checker!" that overweight kids hear from their peers. They’re even treated as stupid or inferior by some teachers and other adults. As a result, adults who’ve been overweight as children often suffer from low self-esteem and face serious social, psychological and economic problems.

What’s a Child Care Provider to Do?
How can you help an overweight child?

Help parents recognize that their child’s weight is an issue and make recommendations for handling the child’s weight problem. Because you provide two or even three of the child’s meals each day and supervise daytime activities, you’re in an excellent position to help the child directly. You can help prevent obesity by teaching healthy eating and exercise habits that children take home.

One hotly debated issue is when a child’s weight should be considered to be a problem. After all, we often assume that the fat on a child is baby fat the child will lose as he or she gets older. For some children, that’s undoubtedly true. Yet, obesity experts disagree on when a child should have outgrown this baby fat and start slimming down. For some researchers, the age is six. Others suggest waiting until the age of eight before putting a child on a weight control program. Two strong clues to whether a child’s weight needs to be addressed:

1. The child has been in the 95th percentile in weight for height for several years.
2. One or both parents are overweight or obese.

Encourage parental involvement so the child knows that he/she has the whole family’s support.

Be sensitive to the parents’ cultural bias. Some members of ethnic groups, including African-Americans, Native Americans and Hispanics, consider overweight to be a sign of health and prosperity. Be sure these parents are aware of the risks of obesity and the importance of addressing the problem early on.

Recommend programs that emphasize nutrition, exercise and social issues. The most successful weight control programs for children are those that involve parents and treat the whole child by offering nutrition counseling, psychosocial counseling and exercise instruction. Weight loss programs that emphasize low-calorie diets should be avoided. Remember, an adequate diet is necessary to ensure a child’s growth. Programs should be designed to control the child’s weight as he or she continues to grow.

Teach healthy eating and exercise habits to all children. The best way to control obesity is to prevent it by serving nutritious snacks and leading exercise sessions. Encourage these practices at home by inviting parents to day care programs, send home news of your activities and provide handouts on activities that can be done at home.

Discourage children from teasing others.

Don’t create an eating disorder or poor self-esteem. The emphasis should be on teaching children to eat right and exercise regularly. Avoid promoting an ideal body image of thinness. Overweight children may continue to be larger than the ideal even after developing healthy habits. These children need to know that their self-worth is not tied to how much they weigh or how they look. Instead, emphasize their talents and accomplishments. Help all children to accept and appreciate their individual body shapes.

Ilene V. Smith, M.S., R.D., C.N. is a nutritionist in private practice in New York City. She is currently developing a pediatric obesity program for New York Medical College and serves on the American Heart Association-New York affiliate Task Force on Obesity and Inactivity in Youth.