Adverse effects and compliance should be considered when choosing a therapy. Bariatric surgery has been widely used in morbidly obese adults. There is very little experience related to surgical therapy in children. However, a recent study evaluated trends with bariatric surgery in adolescents. Recommendations have been published to establish guidelines in the evaluation of adolescents for bariatric surgery, in an effort to reduce the risk of adverse medical and psychological outcomes and improve to compliance. Epstein and colleagues conducted a study on the effect of behavior treatment on weight loss among obese parents and their overweight children.
This year study compared the number of parents and children who maintained at least a twenty percent weight loss at 6, 60, and months. However, a decline in treatment response occurred in both groups from 6 months to 60 months. Thereafter, children tended to stabilize their relative weight change while adults continued to increase their overweight percentage in the time between 60 and months. A recent study by Wrotniak and Epstein evaluated the effectiveness of family-based behavioral weight control management.
They found that the parental BMI change was a significant incremental predictor of child BMI change at 6 and 24 months. This study supports the inclusion of parents in programs for their children.
Childhood Obesity: A New Menace
Concurrent treatment of both parents and children is a cost-effective way of improving the health of all family members. The Centers for Disease Control CDC recently published its recommendations for weight loss and weight management in children. For children 2 to 7 years of age, weight maintenance is advocated.
It is recommended that the child lose no more than one pound per month. The goal for a child is an age-specific BMI less than the 85th percentile. The prevalence of childhood obesity has greatly increased in the recent decade. Physicians caring for children are now encountering chronic illnesses resulting from obesity in children.
Primary prevention is still the most cost-effective solution. Primary care physicians should routinely assess a child's BMI, evaluate the patterns of eating and activity, identify risk factors for obesity, and monitor comorbidities in any child deemed overweight. Pharmacists can assist in giving proper advice on other treatment options such as weight loss medications and in raising parental awareness on childhood obesity prevention, treatment, and morbidity.
Obesity & Overweight: Your Child: University of Michigan Health System
Every effort should always be made in educating both parents and their children on proper nutrition, modification of eating behaviors, and increased physical activity. In terms of advocacy, general public support should be raised for programs that support increased physical activity and proper nutrition in schools, day-cares and community centers. At the national level, policies should be supported that regulate the marketing of energy-dense foods with little nutritional value and for research that may help in the understanding and treatment of obesity.
Medications are second-line agents for weight loss after therapeutic lifestyle changes have failed. Bariatric surgery, a last-line therapy, is only recommended for a select type of patient. National Center for Biotechnology Information , U. J Pediatr Pharmacol Ther. Salazar , MD 1 and Lea S. Eiland , PharmD 1, 2. Author information Copyright and License information Disclaimer. Abstract Childhood obesity is increasing in prevalence in the United States. BMI-for-age weight status categories and the corresponding percentiles. Open in a separate window. Body-mass-index for age growth chart for boys age 2—20 years.
Body-mass-index for age growth chart for girls age 2—20 years. Nature Parental obesity is a strong predictor of a child's subsequent obesity as an adult. Nurture The environment is hypothesized to play a large role in the increase in prevalence of childhood obesity. Comorbidities of childhood obesity. Diets Diets for children have advantages and disadvantages. Weight Loss Medication Although sibutramine and orlistat are the only two weight loss medications approved by the Food and Drug Administration FDA for use in children, the long-term data and risks associated with their use are unknown in this population.
Surgery Bariatric surgery has been widely used in morbidly obese adults. Modification of Eating Behaviors Epstein and colleagues conducted a study on the effect of behavior treatment on weight loss among obese parents and their overweight children. Wang G, Dietz WH. Economic Burden of Obesity in youths 6 to 17 years: Childhood and adolescent obesity: Pediatr Clin North Am. Centers for Disease Control and Prevention. Standardized percentile curves of body mass-index for children and adolescents. Am J Dis Child. Body mass index as a measure of adiposity in children and adolescents: Overweight children and adolescents recommendations to screen, assess and manage.
Guidelines for over-weight in adolescent preventive service: Am J Clin Nutr. National Center for Health Statistics. Prevalence of overweight among children and adolescents: United States, —, — J Clin Endocrinol Metab. The insulin resistance syndrome in 8 year old Indian children: Relation between weight and length at birth and body mass index in young adulthood: Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: Adiposity rebound in children: Early adiposity rebound and the risk of adult obesity.
Tracking body mass index in children in relation to overweight in adulthood. AM J Clin Nutr. American Academy of Pediatrics Committee on Nutrition Prevention of pediatric overweight and obesity. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. Nationwide Personal Transportation Survey.
INTRODUCTION
Federal Highway Administration; Youth risk behavior surveillance—United States, Relationship of physical activity and television watching with body weight and level of fatness among children: Television watching and television in bedroom associated with overweight risk among low-income pre-school children. Early determinants of childhood overweight and adiposity in a birth cohort study: Duration of breastfeeding and risk of overweight: Am J Clin Epidemiol. Nutrient intakes and food choices of infants and toddlers participating in WIC. J Am Diet Assoc. Meal and snack patterns of infants and toddlers.
Nutrient intakes of infants and toddlers. Gleason P, Suitor C. Children's diets in the mids: US Department of Agriculture; Mrdjenovic G, Levitsky D. Nutritional and energetic consequences of sweetened drink consumption 6 to 13 year old children. Preventing childhood obesity by reducing consumption of carbonated drinks: The relation of overweight to cardiovascular risk factors among children and adolescents: Prevalence of metabolic syndrome phenotype in adolescents: Arch Pediatr Adolesc Med.
Obesity and the metabolic syndrome in children and adolescents. Waist circumference percentiles in nationally representative samples of African-American, European American and Mexican-American children and adolescents. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth.
Waist circumference is an independent predictor of insulin resistance in black and white youths. J Clin Endocr Metab. Physical activity recommendations for school-age youth. Relation between dieting and weight change among preadolescents and adolescents. Make sure the goals you set are realistic. For example, exercising an hour every day is unrealistic for a child who is de-conditioned, and not used to even minimal physical activity. Use rewards when your child meets their weekly goals. Rewards could be special time with you doing an activity your child enjoys or a special toy.
Have your child keep a record of their food intake and exercise. This will allow them to be more self-aware of their behavior. Then look at the record together, one-on-one, and go over it. Give them positive feedback. Praise your child for healthy food choices and physical activity. Make sure your child understands that they can make a difference in their weight and that you will support them all the way.
Help your child recognize hunger and fullness signals. Help your child do the same. Help your child figure out what kinds of emotions and situations trigger overeating for them. Think about all the media your child uses: These are all activities that replace physical activity in your child's daily routine. Placing time limits on them will free up time for a more active lifestyle. Watching TV can use less energy than simply sitting and resting! Also, we tend to snack on high calorie foods during these inactive times. Teach your child to be media savvy.
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The media bombards us with images of thin people having fun while eating and drinking high calorie foods. Kids don't necessarily have the cognitive abilities to process this paradox. Limit inactive things like TV , video games and computer time. Have structured mealtimes and snacks on a schedule. Model and insist on good meal habits— eating less breakfast and more dinner or skipping breakfast increase the risk for obesity.
Don't mistake healthy eating for dieting. Eating large amounts of high calorie foods "Want to super-size that? Bad eating habits become accepted as normal eating habits. Eating healthful foods in a healthy manner is not the same as dieting. The food pyramid is a thing of the past. Use MyPlate to help guide your food choices for your family. The emphasis should be on a variety of vegetables, with half your plate being vegetables and fruits. Grains should be whole grains. Keep only healthy foods in your home. The American Dietetic Association offers information on eating healthy—check out their daily tips and nutrition fact sheets.
Children under 2 may need a little more fat in their diet for proper brain development. Between ages you can gradually transition your child to the lower-fat diet that is healthiest for the rest of the family. Pay attention to snacks. Lots of snacking leads to a higher calorie intake, and many typical snack foods are not very nutritious. Keep healthy snacks on hand, like fruit and cut up veggies. Allow your child easy access to them. As kids move into adolescence, their levels of activity tend to drop too low. Do active things together as a family, like bike riding, hiking, walking and swimming.
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Here are some great ideas in print, audio and Spanish for helping to get your child and your family more active. Build activity into your family's daily life with household chores, walking to school, parking farther from buildings and taking the stairs. Decreasing inactivity works better for long-term weight loss than focusing on vigorous aerobic exercise. It's also an easier lifestyle change for your family to make! Make sure your kid gets outside during daylight hours. You could make it a policy in your family that unless the weather is bad, your children play outdoors after school.
This encourages physical activity, and rules out the inactive pursuits of TV and other media. For more information and tips: For more practical tips, see what our own Dr. Gahagan has to say about how parents can fight obesity in their kids. It includes many useful tips and resources. A weight-control program should: Have the overriding goal of helping the whole family make and maintain healthy changes in their eating and activity habits. Have dieticians, exercise physiologists, doctors, and either psychiatrists or psychologists on staff.
Perform a medical evaluation of your child—including weight, growth, and health—before starting the program, and at regular intervals throughout the program. Be developmentally appropriate for the age and capabilities of your child. Focus on behavior changes. Teach your child how to choose a healthy variety of foods and the right size portion.
No significant relationships between parental concern about child weight and PA- or media-related variables of interest were observed. This study first described parent perceived child weight and concern about child weight and examined their demographic correlates. Consistent with prior research in this area, 11 - 14 we found that parents overwhelmingly perceived their children as average weight.
We observed overall low levels of parental concern regarding child weight, though concern was greater among parents of girls, older children, and overweight children. These findings are similar to several studies that have found a relationship between parental concern about child weight and child measured weight status, 16 , 21 parent perceptions of child weight status, 15 , 21 child sex, 21 and child age. This study then examined the relationship between parental concern about child weight and weight-related child behaviors, parenting practices, and household characteristics in the following 3 domains: Our findings provide support for the association between parental concern about child weight and parent feeding practices, 21 - 24 , 37 and provide preliminary evidence for a relationship between parental concern and child dietary intake.
Additionally, household food and play equipment availability was not associated with parental concern about child weight. With the exception of the association between parent concerns about child weight and parent use of restrictive feeding practices, 21 - 24 , 37 our findings differ from prior research. These results suggest it may be appropriate to provide parents with information and behavioral guidance to help support them in enacting effective strategies to prevent their child from becoming overweight. Results of this study are relevant to efforts to prevent childhood obesity.
Our findings indicate that the high level of parental misclassification of child weight and low level of concern about child weight observed in prior studies persists, even among parents of children at-risk for obesity. In our study, higher concern about child weight was not related to several key parent and child behaviors and household characteristics that influence child weight.
Parental use of restrictive feeding practices has been associated with several negative outcomes, including child overweight, 37 child preference for restricted foods, 39 increased snack intake, 37 - 39 and decreased eating self-regulation 37 among girls 37 - 39 and boys. Additionally, there is an opportunity for interventions to first activate parental concern about child weight to encourage management of child dietary intake, and then support parents in developing effective strategies to encourage healthy child dietary intake and develop adaptive child eating behaviors. This study has several limitations and strengths that should be considered when interpreting our findings.
Study limitations include the restricted range of child weight in our sample. The sample was comprised of children toward the upper end of the BMI spectrum, but who were not yet obese th BMI percentile , so we were not able to assess the relationship between parental concern about child weight and weight-related behaviors of interest among parents of children who were obese. In addition, we did not examine the relationship between parental perceptions of child weight status and parent and child weight-related behaviors because of statistical and conceptual concerns; there was limited variability in parent perceived child weight i.
This is a limitation, as parental perceptions of child weight status are likely to be related to parental concern about child weight, further influencing parent behaviors supporting child diet, PA, and media usage. Parents were asked whether their child ate a typical amount on the day of the recall, and dietary data were included in analyses if parents reported their child ate a typical amount of food on the recalled day.
Another limitation is that constructs measuring parenting practices related to family restaurant use and media use are comprised of one item, which may not fully capture these parenting dimensions. Lastly, our analyses were cross-sectional, and as such we cannot make causal inferences about the relationships between parental concern about child weight and the variables of interest.
Limitations aside, our consideration of weight-related variables across three domains is an important strength; baseline HHHK data allowed us to examine the relationship between parental concern about child weight and child-, parent-, and household-level factors related to child diet, PA, and media use, all of which may influence child weight.
Second, child and parent height and weight were measured by trained study staff, and child minutes of MVPA were measured using the gold standard method of assessing PA, accelerometer. Future analyses using HHHK follow-up data will provide an opportunity to investigate these relationships prospectively in an obesity prevention intervention targeting young children at-risk for overweight and obesity.
Without providing parents support and strategies to effectively manage child weight, parental concern about child weight may contribute to unproductive parenting practices. Human Subjects Approval Statement. Parent informed consent and child assent were obtained from all parent-child dyads, and study protocol and procedures were approved by the HealthPartners Institute for Education and Research Institutional Review Board A National Center for Biotechnology Information , U.
Health Behav Policy Rev. Author manuscript; available in PMC May 1. Author information Copyright and License information Disclaimer. See other articles in PMC that cite the published article. Measures Demographic characteristics Parents reported child, their own, and sociodemographic characteristics, such as ethnicity, race, and free or reduced price school lunch eligibility. Parent classification of child weight and concern regarding child weight One item from the perceived child weight subscale of the Child Feeding Questionnaire CFQ 26 was used to determine the accuracy of parent perceived child weight.
Media-related variables Four items separately assessed child computer and video game use and child TV use on an average weekday and weekend day. Open in a separate window. Totals may not add to due to missing data. Concern about Child Weight: Relationship with Diet-, PA-, and Media-Related Variables The role of parental concern in diet-, PA-, and media-related child behaviors, household characteristics, and parenting practices is presented in Table 3.
Footnotes Human Subjects Approval Statement Parent informed consent and child assent were obtained from all parent-child dyads, and study protocol and procedures were approved by the HealthPartners Institute for Education and Research Institutional Review Board A Prevalence of obesity and trends in body mass index among US children and adolescents, Health consequences of obesity in youth: Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. The relation of overweight to cardiovascular risk factors among children and adolescents: Stigma, obesity, and the health of the nation's children.
Reilly JJ, Kelly J.
Your Child
Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Int J Obes Lond ; 35 7: The importance of parental beliefs and support for physical activity and body weights of children: Can J Public Health. Association of family environment with children's television viewing and with low level of physical activity. Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children.
Influences on the Development of Children's Eating Behaviours: From Infancy to Adolescence. Can J Diet Pract Res. Maternal perceptions of overweight preschool children.