Overweight and obesity are now impending health crises in the Philippines. For decades we considered our children’s weight in terms of normal growth and development. If our children were on the fat side we believed it will be outgrown as they grow older.

However, a local surveillance among kindergarten boys in a private school shows that overweight and obese children often remain so at follow-up after 5 years. Some even gained more weight. Researchers agree that the longer a child remains overweight, chances are he will become an obese adult. They also predict that, instead of seeing heart disease in the mid-years, the present children may succumb to heart attacks and stroke as early as their 20s.

What causes children to be obese?

Despite the complexity of genes and hormones, obesity is basically an energy imbalance , between calorie intake and calorie output, between food eaten and food burned. Calorie is a unit of measurement of energy in foods consumed and burned in physical activities. When a child eats more than his body and physical needs, the unburned calories from excess food are stored as fatty tissues. Consequently , body weight goes over what is right for his age ,sex , and activities. If unchecked, the overweight child could go on to become an obese child.

What are the contributing factors?

Fast food chains with their high fat sweet salty meals ? Softdrink and sugary “fruit” drinks manufacturers? Schools which allow calorie-dense and “empty calorie” foods in cafeterias and vending machines ? TV networks and makers of video games that have brought about a sedentary lifestyle to our children? Education policymakers who limit physical education in schools? Health professionals who do not educate parents and children about healthy lifestyle? Or could the parents themselves be blamed ?

Interestingly, data from a new survey of parents by ACNielsen show two thirds of parents blame themselves . After all , parents have control over eating patterns and activities of their young children.

A UK Survey reports 30% of mothers and 57 % of fathers as failing to recognize overweight in their children. Some parents show no concern at all for their overweight child . Parents from the high socio-economic strata were no different from those in the lower bracket.

What can parents do?

Treatment of child obesity includes not only the child but the family as well. Parental involvement is an integral component of its management. Family eating and activity habits have a much stronger influence on weight than heredity.

The first step is for parents to monitor their children’s weight. If they see that their child seems to be gaining weight much faster than his playmates or peers at school and his clothes don’t seem to fit especially around the waistline, then it’s about time to see a pediatrician .

If the child is found to be overweight, a healthy weight goal is determined. The best goal is not to lose weight but to lower the rate of weight gain as child grows taller and develops muscle. However, if the child is found to be obese or has health problems related to weight, a realistic weight loss is planned. A dietitian will be most helpful in setting how many pounds to lose and in tracking the progress every day.

In monitoring weight gain or weight loss, the basic principle of calorie intake equals calorie output is followed.

Stop Weight Gain !

Calorie/ energy Intake = Calorie / energy Output
                                 = Get active !

Reducing added sugar, fat , oils and cutting down on food portions ( i.e. 1 scoop ice cream instead of 2 scoops) are healthy ways to cut down on a child’s calorie intake. Keeping a daily food and activity log helps parents know what their child is eating ,where his calories are coming from and how he is burning them. When combined with regular weight monitoring, a balance can be worked out through physical activity, thereby preventing weight gain.

For example, a gain of l pound a week is equivalent to taking in 3500 more calories. Cutting a child’s diet by 500 calories a day will lead to no weight gain. Consult a dietitian for help in calorie counting.

Calorie Intake < calorie output
Calorie output > calorie intake

Eat less
Move more
Be committed

Losing weight is to deplete fatty stores in the body by eating less and being more active. This means the child has to decrease the amount of calories he is eating and drinking, or exercise to burn more calories, and better yet , do a combination of both. If a child at his steady weight lessens his eating by 250 calories each day or indulges in activities that burn 250 calories more , he could lose one-half pound in one week or 2 pounds in a month’s time. Or the child could eat 125 fewer calories and burn 125 calories more. For example, instead of his usual Big Mac ( 560 calories) for lunch, he takes cheeseburger ( 320 calories). Or he eats one-third of a Big Mac ( 187 calories) and plays ball for 30 minutes.

Maintaining or losing weight involves full commitment from the child and the parents. It means changing lifestyle, educating themselves on healthy eating and controlling the external environment. In addition, behavioral experts advise focusing on specific positive goals. Instead of emphasizing on pounds to lose which sounds negative, choose a specific action like drink cold refreshing water in place of soft drinks.

Lifestyle changes include eating breakfast every morning. Without breakfast, the body’s metabolism slows down to conserve the food. Whereas, eating breakfast signals the body to use the food rather than store it. In addition eating fast foods should be cut down. A recent Harvard study shows that overweight teeners tend to overeat in fast food chains than their lean peers .

Sit-down family dinners are highly recommended . A 2003 study has shown that eating food away from home contributes to excess weight in many school-age kids. Family togetherness helps develop a positive attitude towards food, ensures that nutritious foods are served in regular intervals and controls snacking of high-calorie foods like French fries, doughnuts, pastries, etc. As nutritionists often say, the family that eats together stays healthy together.

Family meals are also best served in the kitchen or dining area, not in front of the computer or television. Doing so prevents the child from paying attention to his feeling of fullness. Eating while playing games or doing homework makes eating an unconscious activity which shouldn’t be . Make eating an activity in itself - enjoyable and fun.

Small changes such as reducing sugary fatty foods and drinks are achievable targets at the start . “Cold turkey” is one approach found effective to eliminate sugar. Note that children have an innate preference for sweet taste. Lots of fruits , vegetables and drinking lots of water are not only nutritious but they are less calorie-packed and an effective way in “ tricking” the stomach into feeling full.

Children can be taught the value of a nutritious healthy diet. Studies show that the child who understands the meaning of calories , the burning of calories during physical activity, their relation to body fitness and health are more committed and motivated to shed off excess pounds.

Will special diets work?

Many quick-fix weight loss programs and diets are promoted today . Are they safe for children ? The popular low carbohydrate foods and diets like Atkins, The Zone, South Beach, LA. Shape focus on good food and bad food, not on the overall eating pattern. Hence, carbohydrate-rich nutritious foods like fruits, grains, beans, pasta, leafy and starchy vegetables rich in essential vitamins , minerals, fiber and beneficial plant compounds are limited . A missed opportunity - because these are high volume foods filling to the stomach, yet low in calories.
High protein foods like meat, poultry, fish, eggs are in . According to experts , the initial short-term weight loss is due to water and muscle loss , decreased appetite and reduced calories. No one knows the long-term health effects of low carbohydrate diets. No child should be deprived of an important foundation of a healthy diet.

The Challenge to Parents

Parents should set a good example. It is important in establishing good eating habits among their children. Many studies report that parental overweight and obesity can predict adult obesity in their overweight/obese children.

One study shows that mothers who restrict their overweight daughters’ eating resulted in overeating in the absence of hunger. An overweight child needs support, acceptance, reassurance, and encouragement from parents. What children should learn are : to prefer those foods that , taken together in the right portion sizes, lead to a healthy body weight.

It must be clearly understood that obesity cannot be blamed on specific foods as there are no good or bad foods. The eating pattern over time is the main consideration. . Eating a meal of fast food can be compensated by eating less at other meals and /or exercising so that the overall pattern in a day or two is balanced calorie intake and output.

Parents need to show patience. Change takes time. Healthy eating doesn’t become a habit overnight. It takes time and effort to make it a part of a daily routine. It also takes time to notice a change in a child’s weight.

By modeling healthy-living habits , talking to your children openly and without judgment, and letting them know they are loved, no matter what, then you are on the road to successful parenting of an overweight/obese child.

WHO/FAO release Expert Report on diet and chronic disease. World Health Organization. March 2003.
Childhood Obesity: Parenting Advice. Mayo Clinic.com. 11/27/04
Summary of the Presentations at the Conference on Preventing Childhood
Obesity . Pediatrics.114:1146. October 2004.
American Obesity Association: Childhood Obesity. 10/16/03. www.obesity.org
Ludwig D et al. Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. Lancet. 357:505. 2001.
Janssen I. Et al. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 79:379. Mar 2004.
d overweight mothers. The New England Journal of Medicine. 318:462. 1988.
Stewart Agras W. et al. Interactions between parents and kids may contribute to overweight in children. Journal of Pediatrics. July 2004.
American Diabetes Association Annual Convention. Jeffery A., Kaufman F., Katz D. Early Bird Survey at Plymouth, England / Studies to treat or prevent pediatric type 2 diabetes study group . June 4, 2004.
Gillis L. Eating food away from home contributes to excess weight in many school-age kids. Journal of the American College of Nutrition. December 2003.
Asian Food Information Center. Preventing Childhood Obesity. 5/17/99.
Jeffrey A. UHI: 28 ( Suppl 1) S33. 2004.
Childhood Obesity. Consensus in Pediatrics. Vol 1:4. 2004.
Position of the American Dietetic Association : Dietary Guidance for Healthy Children Ages 2 to 11 Years. J Am Dietet Assoc. 104:660. April 2004.
Grimm GC. et al. Factors associated with soft drink consumption in school-aged children. J Am Dietet Assoc. 104:1244. August 2004.
Regidor PB, Cua SS et al. Five year surveillance of the body mass index of school entrants in an urban private school 2002. ( poster presentation at the Second Obesity in Childhood and Adolescence. Nestle Nutrition Workshop Series Pediatric Program. Vol 49. Lippincott Williams & wilkins. 2002.
McConahy KL et al. Portion size of common foods predicts energy intake among preschool-aged children. J Am Dietet Assoc. 104: 975. June 2004.
Agras WS et al. Interactions between parents and kids may contribute to overweight in children. Journal of Pediatrics. July 2004.
Birch LL et al. Learning to overeat: maternal use of restrictive feeding practices promotes girls’eating in the absence of hunger.Am J Clin Nutr 78:215. August 2003.

back to abstracts