PCC | Healthnotes | Childhood Obesity

Childhood Obesity

Keeping “baby fat” for too long can put a child’s health at risk. How can you help your child get fit and maintain a healthy weight into adulthood? According to research or other evidence, the following steps may be helpful:

Get your family focused on fitness
Be a positive role model by involving your entire family in a program that includes better eating and regular exercise

Find a diet that fits
Research whole foods and help your children choose healthy long-term eating habits

Turn off the tube
Provide and encourage physically active alternatives to TV and video games

Try parental training
Improve the results of treating childhood obesity by learning valuable techniques that can help you alter your child’s behavior

Get a checkup for your child
Visit a doctor to determine if any treatable health problems are developing as a result of childhood obesity

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full childhood obesity article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About childhood obesity

Excessive weight in children and adolescents is becoming an increasingly serious problem.¹ ² In the United States, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years are overweight, and among adolescents the percentage is three times higher than it was 20 years ago.³ Major contributors to childhood obesity include genetics, unhealthy diets, and sedentary lifestyles.⁴ ⁵ Overweight children often become adults with weight problems that contribute to a wide variety of health problems,⁶ ⁷ but even during childhood and adolescence, overweight can contribute to such disorders as type 2 diabetes, high cholesterol, high blood pressure, insulin resistance, and liver disease.⁸ ⁹ ¹⁰ Being overweight also has social and psychological consequences for children in terms of social discrimination, poor self-esteem, and depression.¹¹ ¹²

Parents, family members, and others who are important people in a child’s life can either help or harm an obese child’s situation. As with all children, those with weight problems need acceptance, support, and encouragement from their family, and the eating, exercising, and other health habits of family members play important roles in influencing the same behaviors in children.¹³ ¹⁴

Product ratings for childhood obesity

Science Ratings	Nutritional Supplements	Herbs
	Glucomannan
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The proper weight for a growing child or adolescent should be determined with the help of a doctor or other qualified health professional, who can also determine whether any unusual medical problems might be contributing to weight gain, whether any current health problems exist that are related to overweight, and appropriate weight control methods. Treating obesity should not include overly restrictive or fad diets that are missing essential nutrients. In fact, weight loss is not necessarily appropriate for a growing child. Often the best goal for an overweight child is to maintain their current weight as they grow taller.

Dietary changes that may be helpful

Unhealthful eating patterns resulting in overconsumption of foods high in fat, calories, or added sugars are considered a major contributor to childhood obesity.¹⁵ Since these patterns often include habits learned from the family, attention should be paid to providing healthful food to the entire family and encouraging good role modeling by other family members.¹⁶

Guiding healthful food choices when eating outside of the home is also a priority. To teach good lifetime eating habits, try the following:¹⁷

Make healthful foods easy to see at home and keep unhealthful foods out of sight
Plan meals and snacks ahead of time so that healthy choices will be available
Avoid using food as a reward or withholding food as punishment
Eat slowly and pay attention to when you are hungry and when you are satisfied
Eat at a designated location such as a dining table, rather than in front of the TV
Aim for several servings of fruits and vegetables every day
Drink water when thirsty instead of beverages with added sugars
Start the day with a healthful breakfast to prevent cravings later on

There is only limited research on the prevention of childhood obesity with diet. Preliminary studies have found that breast-feeding during infancy is usually associated with a reduced risk of developing obesity during early childhood, though the reasons for this effect are unclear.¹⁸ ¹⁹ ²⁰ In a controlled study of children between the ages of 7 and 12, a school-based education program designed to reduce carbonated-drink consumption resulted in a reduction in the number of overweight children after 12 months.²¹

Most authorities believe that the best diet for treating childhood obesity is a heart-healthy diet low in saturated fat and cholesterol, but high in vitamins, minerals, and other important nutrients. ²² However, few studies have actually compared different diets for their effectiveness in treating childhood obesity.

A recent 12-week controlled trial found that overweight adolescents lost more weight with a low-carbohydrate diet than with a low-fat diet.²³ Very-low-carbohydrate (ketogenic) diets have been shown to cause rapid weight loss in very obese children in short-term preliminary and controlled trials,²⁴ ²⁵ but the long-term safety and benefits of this type of diet are unknown. More research is needed to evaluate low-carbohydrate diets for treating childhood obesity.

Glycemic index and glycemic load describe the tendency of foods to raise blood sugar. Eating meals containing foods that are low in glycemic index or glycemic load may influence appetite and other body mechanisms that affect excessive weight gain in children.²⁶ ²⁷ A preliminary study reported that obese children using a low-glycemic-index diet lost more weight compared with a similar group using a low-fat diet.²⁸ A controlled trial found that obese adolescents eating freely on a low-glycemic-load diet lost more weight and body fat after six months than did a similar group following a typical low-calorie, low-fat diet.²⁹

Very-low-calorie “modified fasting” diets, typically using high-protein meal replacement beverages, have been tried in preliminary and controlled studies of obese children with good short-term results.³⁰ ³¹ However, weight lost with these diets is often regained and there are health risks associated with their use.³² Little is known about their effect on growth and other health issues in children.

Lifestyle changes that may be helpful

Lack of physical activity is considered a significant contributing factor in childhood obesity.³³ However, while the results of treatment of overweight children are usually enhanced by strategies to increase physical activity or decrease inactivity, attempts to improve physical activity levels have not been very successful in preventing childhood obesity according to most controlled research.³⁴ Nonetheless, watching television and playing computer or video games contributes to the sedentary lifestyle of many children, and controlled research has shown that weight control is more successful when these activities are controlled and healthier alternatives provided.³⁵ ³⁶ ³⁷ Children are recommended to get at least an hour of moderate physical activity most days of the week, and more may be necessary to offset genetic and other influences. Fun activities that involve other family members or other children will help make getting more exercise a positive experience.³⁸

Weight-loss efforts that involve excessive restriction of calories or protein can inhibit a child’s ability to gain lean body mass (such as muscle) during the normal growth process. Consequently, weight-loss diets for children should not be excessively restrictive. In addition, an appropriate exercise program can be a useful addition to a low-calorie diet for overweight children. A controlled trial found that strength training, when added to a low-calorie diet, resulted in a greater gain of lean body mass (while still promoting weight loss), compared with diet alone in obese children.³⁹ Another study of obese adolescents found that a physical exercise program combined with normal calorie intake resulted in reductions in body weight and body fat while allowing for normal growth and preservation of lean body mass.⁴⁰

Other therapies

Treatment for childhood obesity involves screening for heart disease risk and other health risk factors, and providing information on improving diet and exercise habits. No medications are approved for treating childhood obesity.⁴¹

Vitamins that may be helpful

Increased fiber intake is thought to have potential benefit in a weight-loss program since dietary fiber dilutes calories, slows down the eating process, and may make people feel more full despite eating fewer calories.⁴² However, research on using fiber in the treatment of childhood obesity has focused on using fiber supplements rather than comparing low- and high-fiber diets. Supplementation for four months with 2 to 3 grams per day of a bulking agent called glucomannan, was effective in a group of obese adolescents in one controlled trial,⁴³ but another controlled trial found no significant effect of 2 grams per day for two months.⁴⁴

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Holistic approaches that may be helpful

Behavior-change techniques are considered useful for helping people break old habits and form more healthful habits. These techniques may be learned from counseling professionals, support groups, educational programs, or books. Many controlled studies have investigated various methods for using behavior-change techniques to prevent or treat childhood obesity, with several reporting success at reducing overweight compared with either no treatment or with conventional weight-loss approaches.⁴⁵ ⁴⁶ ⁴⁷

Parental involvement in the treatment of childhood obesity is considered important for success, especially when parents are given adequate training in a wide range of behavior-change techniques that can be applied to the entire family.⁴⁸ Limited research suggests that training parents alone is superior to training either children alone or training both parents and children.⁴⁹ ⁵⁰ ⁵¹ Some authorities suggest that training parents alone produces the best results because this avoids affecting the child’s self-esteem and willingness to change, which might result from labeling him or her as “the patient.”⁵² ⁵³

Problem-solving techniques are used in some types of counseling to help people maintain changes in their behavior. In one controlled study, teaching problem-solving techniques to parents in addition to behavior-change techniques improved weight loss results in obese children compared with a group learning only behavior-change techniques.⁵⁴ However, another controlled study found no additional benefit when problem-solving training was given to either the child or to both child and parent.⁵⁵

For support and information, parents can also try the following resources:

The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents (www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm)
How Parents Can Fight the Obesity Epidemic (www.med.umich.edu/1libr/yourchild/fightobesity.htm)
Shapedown for Parents, Kids & Teens (www.shapedown.com/page2.htm)

References
(To view, roll mouse over the "References" heading; to hide, click on the heading)

1. Rudolf MC, Greenwood DC, Cole TJ, et al. Rising obesity and expanding waistlines in schoolchildren: a cohort study. Arch Dis Child 2004;89:235–7.

2. Rugg K.Childhood obesity: its incidence, consequences and prevention. Nurs Times 2004;100:28–30 [review].

3. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents. www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm. Accessed 5/1/04.

4. Clement K, Ferre P. Genetics and the pathophysiology of obesity. Pediatr Res 2003;53:721–5 [review].

5. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–82 [review].

6. Ogden CL, Carroll MD, Flegal KM. Epidemiologic trends in overweight and obesity. Endocrinol Metab Clin North Am 2003;32:741–60 [review].

7. Vanltallie TB. Predicting obesity in children. Nutr Rev 1998;56:154–5 [review].

8. Hassink S. Problems in childhood obesity. Prim Care 2003;30:357–74 [review].

9. Sullivan CS, Beste J, Cummings DM, et al. Prevalence of hyperinsulinemia and clinical correlates in overweight children referred for lifestyle intervention. J Am Diet Assoc 2004;104:433–6.

10. Schwimmer JB, Deutsch R, Rauch JB, et al. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500–5.

11. Zametkin AJ, Zoon CK, Klein HW, Munson S. Psychiatric aspects of child and adolescent obesity: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2004;43:134–50 [review].

12. Schwartz MB, Puhl R. Childhood obesity: a societal problem to solve. Obes Rev 2003;4:57–71.

13. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004;62:39–50 [review].

14. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am 2001;48:893–907 [review].

15. St-Onge MP, Keller KL, Heymsfield SB. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr 2003;78:1068–73 [review].

16. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004;62:39–50 [review].

17. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents. www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm. Accessed 5/1/04.

18. von Kries R, Koletzko B, Sauerwald T, von Mutius E. Does breast-feeding protect against childhood obesity? Adv Exp Med Biol 2000;478:29–39.

19. Armstrong J, Reilly JJ, Child Health Information Team. Breastfeeding and lowering the risk of childhood obesity. Lancet 2002;359:2003–4.

20. Grummer-Strawn LM, Mei Z. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics 2004;113:e81–6.

21. James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004 Apr 27; E-pub 2004 Apr 23.

22. Ikeda JP, Mitchell RA. Dietary approaches to the treatment of the overweight pediatric patient. Pediatr Clin North Am 2001;48:955–68 [review].

23. Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr 2003;142:253–8.

24. Willi SM, Oexmann MJ, Wright NM, et al. The effects of a high-protein, low-fat, ketogenic diet on adolescents with morbid obesity: body composition, blood chemistries, and sleep abnormalities. Pediatrics 1998;101:61–7.

25. Pena L, Pena M, Gonzalez J, Claro A. A comparative study of two diets in the treatment of primary exogenous obesity in children. Acta Paediatr Acad Sci Hung 1979;20:99–103.

26. Ball SD, Keller KR, Moyer-Mileur LJ, et al. Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents. Pediatrics 2003;111:488–94.

27. Ebbeling CB, Ludwig DS. Treating obesity in youth: should dietary glycemic load be a consideration? Adv Pediatr 2001;48:179–212 [review].

28. Spieth LE, Harnish JD, Lenders CM, et al. A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med 2000;154:947–51.

29. Ebbeling CB, Leidig MM, Sinclair KB, et al. A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 2003;157:725–7.

30. Suskind RM, Sothern MS, Farris RP, et al. Recent advances in the treatment of childhood obesity. Ann N Y Acad Sci 1993 Oct 29;699:181–99.

31. Figueroa-Colon R, von Almen TK, Franklin FA, et al. Comparison of two hypocaloric diets in obese children. Am J Dis Child 1993;147:160–6.

32. Linet OI. Long-term efficacy of medical treatments of obesity. Klin Wochenschr 1982;60:115–20 [review].

33. Livingstone MB, Robson PJ, Wallace JM, McKinley MC. How active are we? Levels of routine physical activity in children and adults. Proc Nutr Soc 2003;62:681–701 [review].

34. Reilly JJ, McDowell ZC. Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal. Proc Nutr Soc 2003;62:611–9.

35. Epstein LH, Valoski AM, Vara LS, et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 1995;14:109–15.

36. Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000;154:220–6.

37. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999;282:1561–7.

38. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents. www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm. Accessed 5/1/04.

39. Schwingshandl J, Sudi K, Eibl B, et al. Effect of an individualised training programme during weight reduction on body composition: a randomised trial. Arch Dis Child 1999;81:426–8.

40. Dao HH, Frelut ML, Oberlin F, et al. Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. Int J Obes Relat Metab Disord 2004;28:290–9.

41. Moran R. Evaluation and treatment of childhood obesity. Am Fam Physician 1999;59:861–8, 871–3 [review].

42. Kimm SY. The role of dietary fiber in the development and treatment of childhood obesity. Pediatrics 1995;96:1010–4.

43. Livieri C, Novazi F, Lorini R. The use of highly purified glucomannan-based fibers in childhood obesity. Pediatr Med Chir 1992;14:195–8 [in Italian].

44. Vido L, Facchin P, Antonello I, et al. Childhood obesity treatment: double blinded trial on dietary fibres (glucomannan) versus placebo. Padiatr Padol 1993;28:133–6.

45. Campbell K, Waters E, O'Meara S, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2002;2:CD001871 [review].

46. Epstein LH, Myers MD, Raynor HA, Saelens BE. Treatment of pediatric obesity. Pediatrics 1998;101:554–70 [review].

47. Saelens BE, Sallis JF, Wilfley DE, et al. Behavioral weight control for overweight adolescents initiated in primary care. Obes Res 2002;10:22–32.

48. McLean N, Griffin S, Toney K, Hardeman W. Family involvement in weight control, weight maintenance and weight-loss interventions: a systematic review of randomised trials. Int J Obes Relat Metab Disord 2003;27:987–1005 [review].

49. Wadden TA, Stunkard AJ, Rich L, et al. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics 1990;85:345–52.

50. Israel AC, Guile CA, Baker JE, et al. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994;19:737–49.

51. Golan M, Fainaru M, Weizman A. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998;22:1217–24.

52. Golan M, Fainaru M, Weizman A. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998;22:1217–24.

53. Dietz WH. Therapeutic strategies in childhood obesity. Horm Res 1993;39(Suppl 3):86–90.

54. Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. J Consult Clin Psychol 1988;56:246–50.

55. Epstein LH, Paluch RA, Gordy CC, et al. Problem solving in the treatment of childhood obesity. J Consult Clin Psychol 2000;68:717–21.

Learn more about Healthnotes, the company.

Learn more about the authors of Healthnotes.

The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2009.

Skip to: