Determining if a child or adolescent has a weight problem can be challenging. How do you know if the excess weight your child has is part of the natural growth process, and will your child just "grow out of?" How do you know if your child's weight may be negatively affecting his or her health?

Health Risks

Along with the rise in childhood obesity, there has been an increase in the incidence and prevalence of medical conditions in children and adolescents that had been rare in the past. Pediatricians and childhood obesity researchers are reporting more frequent cases of obesity-related diseases such as type 2 diabetes, asthma and hypertension that once were considered adult conditions.

• Read more about obesity-related health risks for children and adolescents in the AOA Fact Sheet, Obesity in Youth.
• Read about the relationship of obesity and type 2 diabetes in children at the CDC's Children and Diabetes web page.

Diagnosis

• Family history of obesity.
• Family history of obesity-related health risks such as early cardiovascular disease, high cholesterol, high blood pressure levels, type 2 diabetes.
• Family history of cigarette smoking and sedentary behaviors.
• Signs in the child of obesity-related health risks from a pediatrician's evaluation including:
  • Cardiac Risk Factors. Studies of children with obesity show higher than average blood pressure, heart rate and cardiac output when compared to children without obesity.
  • Type 2 Diabetes Risk Factors. This involves glucose intolerance and insulin levels that are higher than average.
  • Orthopedic Problems. Some symptoms include weight stress in the joints of the lower limbs, tibial torsion and bowed legs, and slipped capital femoral epiphysis (especially in boys).
  • Skin disorders. Some are heat rash, intertrigo, monilial dermatitis and acanthosis nigricans.
  • Psychological / Psychiatric Issues. Poor self-esteem, negative self-image, depression, and withdrawal from peers have been associated with obesity.
• Patterns of sedentary behavior (such as too much television viewing) and low physical activity levels.
• Taller height - children with obesity are often above the 50th percentile in height.
• Smoking initiation. Research studies show that youngsters use smoking as a method of weight control. Parents, pediatricians and schools should work together to discourage smoking as a weight control behavior for three main reasons: a) smoking is not likely to be successful in controlling weight, b) smoking is itself harmful, and c) smoking is associated with a decrease in sound nutrition and physical activity patterns.
• Read the abstract about this study. Smoking and weight loss attempts in overweight and normal-weight adolescents. Strauss RS, Mir HM.
• Read the abstract about this study. Weight concerns, weight control behaviors, and smoking initiation. Tomeo CA, Field AE, Berkey CS, Colditz GA, Frazier AL.

Treatment

An important part of treating obesity among children and adolescents is for parents and healthcare professionals to be sensitive to the youngsters and focus on the positive. Small and achievable weight loss goals should be set to avoid discouragement and to allow for the normal growth process.

Involvement of the entire family is also a motivating factor. Weight control programs that involve both parents and the child have shown improvement in long-term effectiveness compared to directing the program only to the child.

There are some structured weight loss programs such as Weight Watchers and Jenny Craig that allow older children and adolescents to participate with parental and medical permission.

Once the need for obesity treatment has been identified, your medical professional may suggest one or more options.

• Read Obesity Evaluation and Treatment: Expert Committee Recommendations, guidelines established for healthcare professionals by a committee of pediatric obesity experts brought together by The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services.

1. Dietary Therapy
According to the U.S. Department of Agriculture (USDA), there is a steady decline in the diet quality of children and adolescents as they get older.

Consultation with a dietitian / nutritionist that specializes in children's needs is often a valuable part of obesity treatment. Nutrition consultants can outline specific and appropriate nutritional needs for healthy growth.

As with adults, a nutrition consultant may or may not recommend reducing the number of calories the child eats and implementing strategies like learning to read nutrition labels and the food guide pyramid, selecting proper portion sizes, and prepared foods. Some eating behaviors that nutrition consultants typically encourage include taking smaller bites, chewing food longer, and to avoid eating too quickly by putting the utensil down between bites.

2. Physical Activity
The U.S. Surgeon General recommends moderate physical activity for children every day for at least 60 minutes. If a child is unable to meet that goal, than an individualized program should be designed according to fitness level, using the general guideline as an ultimate goal.

3. Behavior Therapy
Behavior therapy involves changes in diet and physical activity habits to one that promote a healthy weight. Some behavioral therapy strategies for children and adolescents should include parent and family involvement.

Some behavioral therapy strategies for children are to:

• Record diet and exercise patterns in a diary to keep track of types and amount of foods eaten and exercise performed as well as the location and time that foods are eaten and exercise takes place. The diary useful to determine any problem areas in eating and exercise behavior.
  

  • Use the National Heart, Lung and Blood Institute's Daily Food and Activity Diary.

• Identify high-risk situations (such as having too many high-calorie foods in the house), and consciously avoid them. Watching TV during meal times is another high-risk situation that encourages eating every time the TV is on.
• Reward specific positive actions. Examples of such actions include meeting an exercise duration goal or eating less of a certain type of food.
• Rewards for achieving goals can be decided by children and parents together, and should revolve around something that encourages positive behavior. For example, giving sporting equipment as a reward may encourage more physically active behavior.
• Avoid using food as a reward, especially high-calories foods. Making them a reward may only make them more desirable. Parents and health professionals should regularly use verbal praise.
• Change unrealistic goals and false beliefs about weight loss and body image to realistic and positive ones.
• The family can work as a team to set weekly activity goals. Making a contract and having every family member sign it encourages commitment to a goal. Parents can also help a child adopt or maintain a positive attitude about new behaviors in addition to helping the child cope with any negative remarks from peers.
• Develop a social support network (family, friends or neighbors) that can encourage weight loss in a positive and motivating manner.

4. Drug Treatment
The U.S. Food and Drug Administration has not yet approved the use of any drugs to treat obesity in children. However, clinical trials are under way.

• For information on clinical drug trials to treat obesity in children, search the ClinicalTrials.gov website.