Excessive weight in children and adolescents is becoming an increasingly serious problem. In the United States, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years are overweight, and among adolescents the percentage is three times higher than it was 20 years ago. Major contributors to childhood obesity include genetics, unhealthy diets, and sedentary lifestyles. Overweight children often become adults with weight problems that contribute to a wide variety of health problems, but even during childhood and adolescence, overweight can contribute to such disorders as type 2 diabetes, high cholesterol, high blood pressure, insulin resistance, and liver disease. Being overweight also has social and psychological consequences for children in terms of social discrimination, poor self-esteem, and depression.

Parents, family members, and others who are important people in a child's life can either help or harm an obese child's situation. As with all children, those with weight problems need acceptance, support, and encouragement from their family, and the eating, exercising, and other health habits of family members play important roles in influencing the same behaviors in children.

What are the symptoms of childhood obesity?

The proper weight for a growing child or adolescent should be determined with the help of a doctor or other qualified health professional, who can also determine whether any unusual medical problems might be contributing to weight gain, whether any current health problems exist that are related to overweight, and appropriate weight control methods. Treating obesity should not include overly restrictive or fad diets that are missing essential nutrients. In fact, weight loss is not necessarily appropriate for a growing child. Often the best goal for an overweight child is to maintain their current weight as they grow taller.

Dietary changes that may be helpful

Unhealthful eating patterns resulting in overconsumption of foods high in fat, calories, or added sugars are considered a major contributor to childhood obesity. Since these patterns often include habits learned from the family, attention should be paid to providing healthful food to the entire family and encouraging good role modeling by other family members.

Guiding healthful food choices when eating outside of the home is also a priority. To teach good lifetime eating habits, try the following:

• Make healthful foods easy to see at home and keep unhealthful foods out of sight
• Plan meals and snacks ahead of time so that healthy choices will be available
• Avoid using food as a reward or withholding food as punishment
• Eat slowly and pay attention to when you are hungry and when you are satisfied
• Eat at a designated location such as a dining table, rather than in front of the TV
• Aim for several servings of fruits and vegetables every day
• Drink water when thirsty instead of beverages with added sugars
• Start the day with a healthful breakfast to prevent cravings later on

There is only limited research on the prevention of childhood obesity with diet. Preliminary studies have found that breast-feeding during infancy is usually associated with a reduced risk of developing obesity during early childhood, though the reasons for this effect are unclear. In a controlled study of children between the ages of 7 and 12, a school-based education program designed to reduce carbonated-drink consumption resulted in a reduction in the number of overweight children after 12 months.

Most authorities believe that the best diet for treating childhood obesity is a heart-healthy diet low in saturated fat and cholesterol, but high in vitamins, minerals, and other important nutrients. However, few studies have actually compared different diets for their effectiveness in treating childhood obesity.

Lifestyle changes that may be helpful

Lack of physical activity is considered a significant contributing factor in childhood obesity. However, while the results of treatment of overweight children are usually enhanced by strategies to increase physical activity or decrease inactivity, attempts to improve physical activity levels have not been very successful in preventing childhood obesity according to most controlled research. Nonetheless, watching television and playing computer or video games contributes to the sedentary lifestyle of many children, and controlled research has shown that weight control is more successful when these activities are controlled and healthier alternatives provided. Children are recommended to get at least an hour of moderate physical activity most days of the week, and more may be necessary to offset genetic and other influences. Fun activities that involve other family members or other children will help make getting more exercise a positive experience.

Weight-loss efforts that involve excessive restriction of calories or protein can inhibit a child's ability to gain lean body mass (such as muscle) during the normal growth process. Consequently, weight-loss diets for children should not be excessively restrictive. In addition, an appropriate exercise program can be a useful addition to a low-calorie diet for overweight children. A controlled trial found that strength training, when added to a low-calorie diet, resulted in a greater gain of lean body mass (while still promoting weight loss), compared with diet alone in obese children. Another study of obese adolescents found that a physical exercise program combined with normal calorie intake resulted in reductions in body weight and body fat while allowing for normal growth and preservation of lean body mass.