New Guidelines on Children’s Weight

Q: My 5-year old is pretty chubby, but I looked this way too when I was young. Then, when I was a teenager I dieted and remained thin. Should I be worrying about her weight? How old should a child be before going on a diet?

A: With every passing year an overweight child increases the probability that she will have a lifelong struggle with weight. There is a window of opportunity, between 8 and 12, which is the critical developmental period to make a difference in a child’s future weight. This is a time when children are cognitively ready to understand the relationship of good nutrition and exercise to their health, and yet they are still highly influenced by their parents’ rules and values. As they enter their teen years, children eat more meals away from home and they are more susceptible to influences from the media and the barrage of commercials for soda and junk foods. This is also a time that children often cut down on their physical activity (with the exception of children who are in organized sports who tend to remain active through high school).While the tween years are an important time for parents to help their children develop a healthy and permanent lifestyle, we also know that good eating habits must begin in infancy and concern about nutrition and exercise is a concern at every age.A panel convened by government health agencies and the American Medical Association called for improved guidelines for monitoring weight in children including: weight checks at least yearly, counseling about weight even if children aren't overweight, and a four-stage treatment plan that could end in medication or surgery for the most persistently obese children.The study also noted that children need an hour of physical activity a day, along with limits on sweetened beverages, computer and TV time, as well as fast-food meals. Doctors are advised to get a family history of obesity, diabetes and heart disease. Doctors also are advised to check cholesterol levels of overweight children.For overweight kids (85th to 94th percentile) and the obese (95th percentile and above), diet and exercise guidelines are more specific and follow-up times are shorter.Despite concerns about soaring childhood obesity—roughly 17% of American children are considered obese-- diagnosis still lags, with studies showing only half of overweight kids are diagnosed as such by their doctors. While being overweight is a concern for any age child, “dieting” is never recommended for children under 12. Children need good nutrition and should never be put on a diet that restricts any major food group. Less soda and junk food and more exercise is the prescription for most children, but if children are seriously overweight, you should certainly consult your pediatrician or a nutritionist. Dietary guidelines for infants and children can be found at the web site of the American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4575.
Overweight teens may benefit from dieting, but given the risk factors for depression and eating disorders in teens, dieting should always be done with caution and supervision. I strongly recommend a new book based on the highly acclaimed Sierra School (the only high-school in the U.S. specifically designed as a weight loss program): http://www.parentchild411.com/s.nl/it.A/id.803/.f