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How can I help my overweight child eat less?
Q: I have a 5-year-old daughter who is very tall for her age, but she weighs 57 pounds. Her doctor says she is obese. My question is how do I get her to eat less (she loves food)?
Sally Lakewood
A: Sally, you're not alone. Being overweight is now the most common childhood health problem. The numbers of overweight children have doubled over the past 20 years. Currently, one in four school-age children are overweight, and one in eight are very overweight or obese. Studies show that at least half of obese children over 6 years old become obese adults. While some children can outgrow being overweight, those who stay overweight have higher risks for diabetes, heart disease, stroke, and even some cancers.

It's good that you want to help your daughter reach an appropriate weight for her height. Ask the doctor to show you your daughter's "growth curve" charting her height and weight over time. If she weighs 57 pounds at 5 years old, she is above the 95th percentile in weight, meaning that she weighs more than 95% of children her age. But, as you say, it's also important to know how her weight relates to her height. If she is very tall, above the 95th percentile in height (e.g., one of the tallest in her class), then her weight may be okay for her height; if, however, her height is only in the 75th percentile (i.e., taller than 75% or ¾ of the children), then ideally her weight should be closer to the 75th percentile—according to the chart, she would be overweight by about 10 pounds.

A newer measure, called Body Mass Index (BMI), makes it easier to determine if children are overweight relative to their height. Ask your doctor to calculate and chart your daughter's BMI.

If the growth chart and BMI confirm that your daughter is overweight, be sure to work with your doctor on a plan for healthy weight control. When young children are overweight, the goal is usually not to have them lose weight but rather to slow their weight gain as they grow taller so they can grow into their weight and reach a healthy weight for their height. The two keys to this are healthy eating and exercising. It might also be helpful to consult with a nutritionist who can look at your family's eating and exercise habits to help find how you can improve them. Here are some basic tips:
  • Plan a balanced diet: The "food pyramid" shows that children and adults should eat mostly grains, cereals, starches, fruits, and vegetables; and fewer fatty foods and sweets. After age 2, children can drink low-fat or non-fat milk products. Make meals at home from fresh ingredients rather than eating out at fast-food restaurants which typically serve high-fat, high-calorie meals.

  • Offer reasonable portion sizes: Start with small portions on the plate. Eat slowly so you can feel when you're getting full, and stop eating when you're full.

  • Encourage drinking lots of water: Water is very healthy and helps fill you up so you don't overeat. A glass of water with each meal, and a glass in between meals is good.

  • Keep junk food and soda out of the house: If there are sweets at home, it's tempting to eat them. Have healthy snacks on-hand at home such as fruit slices, raw vegetables with a low-fat yogurt dip, and low-fat cheese and crackers. Go out for sweets only occasionally.

  • Limit TV viewing: Children who watch more than 1-2 hours of TV each day are more likely to be overweight. Make sure there's no TV in your daughter's room, and limit the time she watches TV. Also, don't let her snack in front of the TV because it encourages her to overeat.

  • Encourage exercise every day: Exercise is the key to weight control, fitness, and overall health. Get the whole family on an exercise plan&—walk, jog, dance, bike ride, play sports, jump rope, throw a ball, swim, etc. Try to build exercise into your family's daily activities, e.g., walking to school instead of driving or taking the bus; taking the stairs instead of elevators; and dancing to music as you clean the house.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician