Preventing childhood obesity: What parents should know

By Monica Evans, clinical dietitian at CHOC

Childhood obesity has been on the rise in the United States for the past 20 years. Although there are a variety of reasons why, the most modifiable ones are poor diet and lack of physical activity.

For children and teens, being overweight or obese is defined as body mass index (BMI) greater than or equal to the 85th percentile on a growth chart. BMI is weight in kilograms divided by the square of height in meters and considers sex and age. It is a measure that can easily be performed in a pediatrician’s office which is why it is often used as a screening tool for obesity.

Promoting healthy weight throughout childhood is much easier than treating obesity later in childhood.  Let’s discuss how to prevent obesity in childhood through diet and physical activity.

Childhood obesity prevention through diet

For infants less than 12 months old, research shows that breastfeeding and not overfeeding are important for preventing excessive weight gain. Additionally, waiting until 6 months of age to start solid foods; allowing for positive experiences with eating and drinking like touching and playing with their food; and recognizing “all done” cues when the infant is ready to end the meal encourages infants to self-regulate their intake. 

For children between ages one to four years old, following a daily meal schedule — with three meals and two to three snacks centered around fruits and vegetables not only provides adequate nutrition for growth but also begins to shape eating later in life.

From ages 5 to 10 years old, children become more independent and will likely make their own food choices based on what’s available in their home and at school. Purchasing nutrient-dense foods like fruits, vegetables, nuts, whole grains and low-fat dairy more often than high-calorie, poor-nutrition foods like chips, cookies and soda teaches children what foods are good for their bodies.

For the 11 to 21-year-old adolescent, parents can best help promote healthy weight by continuing to purchase healthful foods, encouraging family meals and allowing their teen to learn about choosing, purchasing and preparing foods on their own.

Additionally, to help children develop healthy eating habits, parents can:

• Purchase healthy, nutrient-dense foods from the grocery store, and limit high calorie foods and drinks. For example, buy fruits and vegetables for snacks instead of chips and crackers.
• Have family meals at least 3 times per week.
• Create a meal and snack time schedule to avoid grazing or snacking throughout the day.
• Reward good behaviors with something other than food.
• Limit eating out to twice weekly
• Eat breakfast daily. Preferably as a family!

Childhood obesity prevention through physical activity

Physical activity looks different at all stages of childhood. In infancy, tummy time helps strengthen a baby’s body. For toddlers, walking, jumping and running most of the day (except for nap time) is encouraged. Playing and being active all day should continue until age 5 when school starts.

Once children start school, more of an effort must be made to ensure at least one hour of physical activity is achieved. After-school activities or sports can usually help with this goal.

To encourage more physical activity for kids, parents can:

• Plan fun family activities that involve being physically active, such as hikes, bike rides, walks, and swimming.
• Limit screen time to less than or equal to two hours for children ages 2 and over. For children less than 2 years, screen time should be avoided entirely.
• Enroll children in afterschool sports.

How to treat childhood obesity

For infants to children ages 5 years

The approach for treating obesity in infants to 5-year-olds is different than treating older children. For children less than 2 years, BMI is not a valid measure, but weight for length measuring greater than the 98^th percentile is a similar qualification for being overweight or obese.

Calorie restriction should never be used in the infant to 5-year-old age group. Instead, the focus should be on weight maintenance in the setting of a height increase.

For children ages 6-18 years

For children ages 6 to 18 with a BMI between the 85^th and 94^th percentiles, weight maintenance in the setting of continued height growth is appropriate.

For those with a BMI at the 95^th percentile or higher, gradual weight loss of one to two pounds per month is acceptable. Weight management in this age group should be achieved in a family-centered fashion, with the focus being on living a healthy lifestyle through balanced, nutritious meals and plenty of physical activity. 

Hear from Dr. Alexandra Roche, CHOC pediatrician, on more ways to prevent childhood obesity.

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