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Dr. Fred Piaser

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OLDER CHILDREN AND ADOLESCENTS Your child is overweight if he meets any of the following criteria:
  • His weight is more than 20% over the ideal weight for his height.
  • He appears overweight to an objective person.
  • The skin fold thickness (fat layer) of his upper arm is more than one inch (25 mm), as measured with a special instrument.

More than 25% of American children are overweight. The tendency to be overweight is usually inherited. If both parents are overweight, most of their children will be overweight. If one parent is overweight, half of the children will be overweight. If neither parent is overweight, the children have a 11% chance of being overweight. Heredity alone (without overeating) accounts for most mild obesity, defined as less than 30 pounds overweight in an adult. Moderate obesity usually results from a combination of heredity, overeating, and under exercising. Less than 1% of obesity has an underlying medical cause. I can easily determine this by a simple physical examination. Losing weight is very difficult. Keeping weight off is also a chore. The best time for young people to lose weight is when they are over 15 years of age. That is when they become very concerned about their appearance. The self-motivated teenager can follow a diet and lose weight, regardless of what the family eats.

Helping children between 5 and 15 years of age lose weight is very difficult because they have access to so many foods outside the home and are not easily motivated to lose weight. It is not quite as difficult to help a child under 5 years lose weight because the parents have better control of the foods the child eats. To help your older child or teenager lose weight without losing self-esteem, try the following: Protect your childís self-esteem. Self-esteem is more important than an ideal body weight. If your child is overweight, she is probably already disappointed in herself. She needs her family to support her and accept her as she is. Parents who become overly concerned about their childís weight can reduce or destroy self-esteem. Avoid these pitfalls:

  • Donít tell your child sheís fat. Donít discuss her weight unless she brings it up.
  • Never try to put your child on a strict diet. Diets are unpleasant and should be self-imposed.
  • Never deprive your child of food if she says she is hungry. Withholding food eventually leads to overeating.
  • Donít nag your child about her weight or eating habits

Help your child develop readiness and motivation to lose weight. Teenagers can increase their motivation by joining a weight-loss club such as TOPS (Take Off Pounds Sensibly) or Weight Watchers. Sometimes schools have classes to help children lose weight. A childís motivation can often be improved if diet and exercise programs are undertaken by the entire family. A cooperative parent-child weight-loss program with individual goals for each family member is usually more helpful than a competitive program focused on who can lose weight faster.

Set weight-loss goals. Help your child pick a realistic target weight, depending on his bone structure and degree of obesity. The loss of one pound a week is an attainable goal, but your child will have to work quite hard to maintain this rate for several weeks. Have your child weigh himself no more than once a week; daily weightings generate too much false hope or disappointment. Keeping a weekly record may provide added motivation. When losing weight becomes a strain, have your child take a few weeks off from the weight-loss program. During this time, try to help him stay at a constant weight through exercise and moderation in eating.

Once your child has reached the target weight, the long-range goal is to stay within five pounds of that weight. Maintaining a particular weight is possible only through permanent moderation in eating and a reasonable exercise program. Your child will probably always tend to gain weight easily, and it is important that he understand this. Help your child consume fewer calories . Your child should eat three well-balanced meals a day of average-sized portions. There are no forbidden foods; your child can have a serving of anything family or friends are eating. There are forbidden portions, however. While your child is reducing, she must leave the table a bit hungry. She cannot lose weight if she eats until sheís full. Encourage average portions, and discourage seconds. Short cuts such as fasting, crash diets, or diet pills rarely work and may be dangerous. Liquid diet preparations are only safe if used according to directions (consult a dietitian if you have any questions).

Calorie counting is helpful for some people, but it is usually too time-consuming. Instead, consider some general guidelines on what to eat and drink:

* Fluids. Because milk has lots of calories, your child should drink no more than 16 ounces of skim, 1%, or 2% milk each day. He can also drink up to eight ounces of fruit juice and fruit drinks a day; they have about 15 calories per ounce, similar to the calories in 2% milk. All other drinks should be either water or diet drinks. Encourage your child to drink six glasses of water each day.
* Meals. Serve fewer fatty foods (eggs, bacon, sausage, butter). Fat has twice as many calories as the same amount of protein and carbohydrate. Trim the fat off meats. Serve more baked, broiled, boiled, or steamed foods and fewer fried foods. Serve more fruits, vegetables, salads, and grains. Serve smaller portions.
* Desserts. Encourage smaller-than-average portions of dessert. Do not serve seconds. Encourage more Jello and fresh fruits after meals; avoid serving rich desserts.
* Snacks. Serve only low-calorie foods such as raw vegetables (carrot sticks, celery sticks, raw potato sticks, pickles), raw fruits (apples, oranges, cantaloupe), popcorn, or diet soft drinks. Limit snacks to two a day.
* Vitamins. Give your child one multivitamin tablet daily during the weight-loss program.

Preventing Overweight Infants An overweight baby is one whose weight gain is far out of proportion to height gain. If your family has problems with easy weight gain, consider the following precautions to prevent your baby from becoming overweight. The goal for growing children is always to slow the rate of weight gain, not lose weight. Breast feed your baby it at all possible. In addition to the many other benefits of breast-feeding, breast-fed babies tend to weigh less than bottle-fed babies. From the beginning, try to teach your child to stop eating before she reaches the point of satiation. Help her stop before she has a sense of complete fullness and a reluctance to eat another bite. When she closes her mouth, turns her head, or wants to play, sheís losing interest in feeding.Ē Donít feed your baby every time he cries. Most crying babies want to be held and cuddled, or they may be thirsty and just need some water. Teach your infant to use human contact, rather than food, to relieve stress and discomfort. Feed your baby no more often than every two hours from birth to 2 months of age, and no more often than every three hours from 2 to 6 months of age. Change this schedule to three meals a day by 6 months of age. Donít assume a sucking baby is hungry. Your baby may just want a pacifier or help with finding her thumb. Feed your child slowly rather than rapidly. Donít do anything to hurry your childís pace of eating. Donít enlarge the hole in the nipple of a baby bottle, for example. The formula will come out too fast. It takes 15 to 20 minutes for the sensation of fullness to develop. The rapid eating habit in adults has been associated with obesity. Avoid giving solid food until your baby is 4 months old if she is bottle fed and 6 months if she is breastfed. Discontinue breast-feeding and bottle-feeding by 12 months of age. Avoid giving sweets until at least 12 months of age. Donít give your child food to distract him or keep him occupied. Instead, give him something to play with when you need some free time. Use praise and physical contact instead of food as a reward for good behavior. Donít use teething biscuits or other foods in place of a teething ring. CAUTION: Donít feed your baby low fat or skim milk before 2 years of age. Your babyís brain is growing rapidly during the first two years of life and needs the fat content of whole milk. While overfeeding is more common during infancy than underfeeding, underfeeding is more harmful to the child.

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