Because nutrition behaviors are learned, it's important to help children start making healthy choices early on. Approximately 17.1% of children and adolescents between the ages of 2 and 19 are overweight, according to the U.S. Department of Health and Human Services. The number of overweight children and adolescents ages 6 to 19 has nearly tripled since 40 years ago. Overweight adolescents have a 70% chance of becoming overweight or obese adults.
For insight on the latest research and suggestions on keeping your child at a healthy weight, the editors of Scholastic's Parent and Child Magazine spoke with Dr. William Dietz, the director of the Division of Nutrition and Physical Activity in the Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. Surprisingly, the greatest threat to your child's weight isn't too much fast food. It's too much television and not enough physical activity.
Parent & Child: What is the main cause of obesity in children?
Dr. Dietz: Common sense tells us that if you eat a lot of meals at fast-food restaurants, or drink soda every day, you'll gain weight. But there's no data yet that proves food choices affect the likelihood of being overweight. The one conclusive thing we know is that TV viewing is associated with increased weight. In fact, studies show that cutting back on TV time is quite effective in reducing the risks of weight gain and helping an overweight child lose weight — mainly because kids become more active and spend less time eating snacks when the set is turned off.
P&C: Does infant care come into play?
Dr. Dietz: We know that children with a birth weight greater than nine pounds are at greater risk for obesity, so good control of type 2 diabetes during pregnancy is important. We also know that there is a lower rate of obesity in breast-fed infants.
P&C: How important is diet? A recent study by Mathematica Policy Research Inc. found that one-third of all children under 2 years of age consume virtually no fruits or vegetables.
Dr. Dietz: While we should be thinking of ways to increase the amount of highly nutritional foods, such as fruits and vegetables, offered to kids, the real issue here is one of parenting. Adults — not children — need to be in charge of what food is served at mealtime, and children can choose whether to eat it or not.
P&C: Sometimes I think I'm feeding my child too much food. How do I know what's the right amount?
Dr. Dietz: Research shows that the larger a portion is, the more food an individual will consume. But this is age related: A 3 1/2 year old will generally eat the same amount of food, whether he's given a large or small portion. At 5, however, the amount of food consumed increases when portion size does. One of your mealtime strategies should be to put a little food on a child's plate, rather than loading it up, and let the child ask for more if he wants it.
P&C: How do I know if my child is becoming overweight?
Dr. Dietz: In adults, a body mass index (BMI) of 30 constitutes obesity; that is about 175 pounds for a five-foot-four-inch-tall person, or 220 pounds for a six-foot-tall person. We use a percentile in pediatric definitions, instead of an absolute measure, because children are growing. The pediatric definition of obesity is any child with a BMI higher than the 95th percentile, which is about the same as a BMI of 30 in an adult.
P&C: What can I do to help manage my child's weight?
Dr. Dietz: It's important to establish rules about eating. For one thing, children should not have free access to the fridge. They need to ask before they get something out of it. If they are thirsty, you should offer them a glass of water, not a high-calorie soda. Control of television viewing throughout childhood and adolescence is very helpful. One of the most important steps is moving the television out of your child's room. A recent report from the Henry J. Kaiser Family Foundation shows that 30 percent of children under the age of 6 have a TV in their room; almost 70 percent of all children have one in their room — which makes it hard for a parent to monitor and control viewing time.
P&C: Do video games have the same effect?
Dr. Dietz: Playing a video game is actually different from watching TV. We have proof that minor motor movements account for a substantial amount of daily energy expenditure, and it was shown years ago that you can increase metabolic rate by playing a video game — not by much, but it's still more activity than a child would get by simply watching a TV show.
P&C: What risks should I be concerned about if my child is overweight?
Dr. Dietz: Over 60 percent of overweight children ages 5 to 10 years old have at least one risk factor of cardiovascular disease, such as elevated insulin, high cholesterol, or high blood pressure; 25 percent have two or more of these risk factors. In addition, studies have shown that children who are overweight before the age of 8 tend to go on to become overweight adults. Studies show that the early onset of obesity contributes to class 3 obesity, which is being more than 100 pounds overweight as an adult.
P&C: How do I talk about obesity without making my child feel bad?
Dr. Dietz: The term that I use is overweight, instead of obesity. Weight is a non-loaded term. Saying "I want to talk to you about your weight" is much different than saying "I want to talk to you about your obesity." People — especially children — can't relate to that term. What people consider overweight — an adult who weighs 225 pounds, for example — is often what constitutes obesity. Some other terms I like to use are nutrition and physical activity instead of diet and exercise. If you think about those terms, you can see there is a visceral aversion to diet and exercise, because they sound restrictive and not terribly comfortable. The words nutrition and physical activity are much more appealing.
P&C: What role can teachers and other educators play in helping to prevent my child from becoming overweight?
Dr. Dietz: School offers an important opportunity for physical activity — with recess and outdoor play — in a safe, secure environment. We are quite concerned about the decline in physical-education programs, which results, sometimes, from a concentration on academic programs. My opinion is that physical education improves classroom behavior and performance. I think children are going to do better in school if they are physically active.
P&C: How can I get my child moving?
Dr. Dietz: Formal exercise classes or working out in a gym are certainly not activities we would recommend for children under the age of 8. Look for opportunities for physical activity after school and on the weekends. It's not necessary for kids to do sit-ups or push-ups or run laps. Just the chance to play and be children in a game of tag or hide-and-seek can do the trick.
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