Is Your Child a Healthy Weight?
For pediatricians, it’s not all about earaches and runny noses. Pediatricians treat all sorts of serious childhood and adolescent illnesses and ailments. The most prevalent pediatric chronic condition, says Einstein Healthcare Network pediatrician Brad Feldstein, MD, is childhood obesity.
“I’ve been in practice since 1984,” Dr. Feldstein says. “In my 30 years in practice, I have definitely seen an increase in children who are obese or overweight.”
Childhood obesity is a worry for pediatricians for a number of reasons, starting with its effect on mental health. Kids struggling with an unhealthy weight—Dr. Feldstein goes out of his way not to use the words “obese” or “overweight” with kids or parents—are often teased or bullied. “They sometimes experience low self-esteem, poor body image, social isolation and depression. That all comes to the surface.”
But even more worrisome are the long-term and sometimes immediate health concerns. Children and teenagers who are obese are at risk for developing type 2 diabetes, heart disease, strains on bones and joints, high blood pressure, high cholesterol, asthma and other serious health issues. They have a higher risk of going on to become obese adults.
Over the past 30 years, Dr. Feldstein notes, obesity rates have tripled. One in three American kids is overweight or obese. The incidence of childhood obesity is also higher in low-income communities.
Catching Childhood Obesity Early
In Dr. Feldstein’s office, they first start to track Body Mass Index (BMI) at age 2. BMI—a ratio of weight to height—is used to determine if a child is overweight, obese, underweight, or at a normal weight for height. Overweight is defined as a BMI at or above the 85th percentile for age. Obesity is a BMI at or above the 95th percentile for age. Dr. Feldstein begins the discussion with kids “by talking about being at a healthy weight for your height.” That’s less judgmental, he says, than using words like “obese” and “overweight.”
“We tend to begin the conversation right when we see it,” he says. “A child’s or adolescent’s well exam is a great time to intervene. We want to get them to a healthy weight over time.”
There’s no single number that defines a healthy weight, he says. Instead, there’s a range, which gives kids some leeway to account for such factors as growth. “Our focus is not so much on weight loss but rather on putting the brakes on weight gain. For an adolescent who isn’t at a healthy weight now, if they gain 10 or 15 pounds over the following year, they’re going to be at a similar unhealthy BMI next year, too.”
How do kids get to an unhealthy weight? A non-nutritious diet and insufficient activity are two primary causes, and they can be interrelated. Cable television, video games and computers often keep kids indoors and sedentary, says Dr. Feldstein. In some neighborhoods, there are few safe places to play. “With all those things that keep kids inside,” he says, “they tend to snack more. They’re bombarded with commercials for junk food. They’re eating more, and they’re eating foods that are not healthy.”
We also live in a society where people are eating out more, he adds. And when they do, they often turn to fast food.
Gaining access to healthy foods in some neighborhoods can be difficult, too. “Rates of obesity are higher in low-income communities,” Dr. Feldstein says. “Low-income families struggle more to provide a healthy diet.” Grocery stores can be few and far between, leaving parents to shop at corner mini-marts and bodegas, where the offerings are often far from nutritious.
“It may be hard to find fresh fruits and veggies,” Dr. Feldstein says. “Plus, healthy food choices can be more expensive and time-consuming to prepare than less nutritious food.”
And finally, some parents struggle with their own weight problems, which has a ripple effect on the weight of the kids. Often, they may not even recognize the problem. Parents who are obese are more likely to have children who are obese.
Enlisting Parental Support
When Dr. Feldstein sees kids who have a weight problem, he focuses not so much on weight loss, but on healthy diet and activity. Enlisting the support of parents is crucial, especially if they share the same struggle.
“It takes a partnership between the parents and the child, especially when you’re talking about a younger child,” he says. “Often the child’s choices are dictated by the parents. Sometimes, you’re also dealing with grandparents. In their house, food means love.”
The solution, he says, is multi-tiered. “We point out the problem, we do a lot of education. We explain the benefits of being physically active and what it means to make healthy food choices. It all starts in the pediatrician’s office, but again, the families need to get involved. The parents have to make healthy food choices and promote physical activity. Often, it’s a group effort.”
To help children and families achieve their goals of a healthy weight, Dr. Feldstein uses the numbers 5-2-1 as a useful guide. That means five servings of fruits and veggies daily—for children, a serving is about the size of their hand—along with two hours or less of recreational screen time (TV, video games, etc.) and one hour or more of physical activity. He also advises parents to eliminate all sugar-sweetened beverages from their child’s diet.
Getting a child to a healthy weight isn’t always easy, particularly when you’re dealing with families with established lifestyles that are unhealthy. Adolescents, Dr. Feldstein says, are inclined to make their own choices, so he directs the conversation toward them. But for younger children, it can be a different story.
“Parents may not be making healthy food choices for themselves,” Dr. Feldstein says. “If they’re not modeling healthy behavior for their kids, it can be very difficult to make changes. So even though we’re talking to the child, it’s really the parents who need to get the information.”
Additional Healthy Tips
- Remove high-calorie temptations. It might be a hard adjustment at first, but removing junk food from the house can help kids develop healthier habits.
- If you’re a parent, model healthy behavior. Walks, tag, Frisbee, bike riding, dancing, swimming and other sports or activities are good examples. Make sure to involve the kids.
- Just try three bites. Kids often don’t like (or don’t think they like) new fruits and vegetables. Encourage them to try at least three bites. Learning to like new foods doesn’t always happen right away.
- Eat together as a family … and ask the kids to help plan the meals.
- Keep computers and other electronics out of the kids’ rooms. Help them avoid temptation.
- Keep books and other reading materials around the home, along with board games. These are good distractions from the world of electronics.
- Make your physical activity changes gradual. Rome wasn’t built in a day.
Dr. Feldstein sees patients at the Dresher, Montgomery County, location of Holland Pediatrics on Limekiln Pike.