Labeling a child obese can seem harsh, creating embarrassment, fear and guilt. There should be no more shame, however, in the disease of obesity than there is in cancer or asthma.
Obesity is medically defined as a child having a body mass index (BMI) greater than the 95th percentile as appropriate for his or her age and sex. One in every five kids today is obese — that’s up from 1 in 20 kids just 35 years ago.
Obesity is not limited to your child’s physical appearance. It is associated with medical conditions including hypertension, diabetes, fatty liver disease and depression.
While it is true that an obese child has an 80 percent chance of becoming an obese adult, all is not lost. Studies show that children respond better to treatment interventions than adults, and there are many things parents can do to prevent their child from becoming another statistic, because obesity is almost always preventable, with less than 1 percent of cases attributed to an underlying medical condition.
Diet is by far the most important factor for obesity in kids. High-sugar foods and drinks plague our kids’ diets. Sugar in our food and drinks is quickly absorbed and does little to cause a feeling of being full, leaving your kids still hungry after consuming a 200-calorie drink.
Although fruit juice and sports drinks are marketed as healthy drinks, parents should check the label for the nutrition in these drinks. These so-called health drinks have very high sugar content, equal to or greater than that of soda. They are also high in calories, but equally low in nutrients like protein and healthy fats that help kids grow bones and muscles. Many healthy snacks marketed as low fat also have very high sugar content, which promotes obesity.
A cup of apple juice has about 100-150 calories. You can therefore cut about 400 calories — the equivalent of running about three miles — from your kid’s diet if you simply eliminate three cups of juice a day.
On the other hand, healthy fats and protein in our diet help promote feelings of fullness, so our children eat less but more nutritious foods, without excessive weight gain. Fruits and vegetables are also critical to a healthy diet. While fruits contain sugar, they also have important fiber in the pulp and skin, which helps promote good digestive health and fullness.
Parents should encourage children to eat fruits and vegetables and drink only water. Specifically, fruits and vegetables should make up half of the plate of food at each of our three daily meals.
Physical activity is important for your child’s overall health. Daily physical activity reduces weight while also lowering blood sugar and blood pressure. It also positively affects self-esteem and decreases anxiety and depression. Activity that involves the whole family and includes lifestyle changes — such as going to the neighborhood playground, playing a sport, biking to school or doing activity-filled household chores — is better than formal exercise classes.
Active children have less than two hours of screen time per day and about 60 minutes of daily moderate exercise. A fun way to track physical activity is using a pedometer to measure steps taken per day. Adolescents and adults should aim for 10,000 steps a day, while children should seek about 13,000 steps. Such goals help us follow a healthy lifestyle and can increase family bonding.
Be mindful, though, that it is nearly impossible to exercise away a bad diet. Physical activity is most beneficial when done in conjunction with a healthy diet.
When lifestyle changes fail
Orlistat is the only medication approved for use in children over 12 years old, once lifestyle modifications have failed. It is taken three times daily with meals. Orlistat binds the fat in your food before it is absorbed, so it passes in feces. While it is effective in reducing BMI, it has been associated with diarrhea, abdominal discomfort and vitamin deficiencies.
Another option is bariatric surgery, most commonly gastric bypass, and it has been performed in morbidly obese pediatric patients since the 1980s. Gastric bypass is effective but requires a lifelong commitment by adolescents to a strict nutritional regimen after surgery. Without compliance, patients can suffer severe deficiencies in nutrients such as iron, vitamin D and B12 during a crucial stage of growth during adolescence.
If your child is obese and lifestyle interventions have failed, it might be time to seek medical help, under the care of a doctor dietician and social worker. For children at high risk of complications after unsuccessful attempts at lifestyle modifications, your nutrition team may recommend medications and ultimately surgery. Talk to your pediatrician about a specialized nutrition program for your child, or call 305-243-3166 to schedule an appointment.
Amanda C. Fifi, M.D., is a pediatric gastroenterologist at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.