It is important you follow and are aware of your child’s yearly height and weight assessments. This allows a body mass index (BMI) to be calculated. If your child’s BMI is > 95% than he is severely over weight. Another term for this is obese but be cautious when this term is used. It is very important not to instill fear or a feeling of hopelessness when discussing weight issues. If he is between the 85% and the 95% he is overweight. If your child is in either of these categories an assessment by your pediatrician is needed and a decision must be made whether intervention is necessary.
The quality of every meal your child eats should be evaluated. Quantity and portion size are important but quality is just as important. Limit eating outside of your home, always eat breakfast, encourage family meals and avoid all sugar or artificially sweetened drinks. Eating whole fruit is much healthier than drinking juice. Make certain your child is eating a high fiber diet based on low caloric density that is high in fruits and vegetables. Avoid excessive consumption of foods that are high in energy density such as fat and protein.
Look at the environment your child lives in. Does it support a healthy dietary intake and an active lifestyle? Are there environmental or social barriers to physical activity? Is there excessive unbalanced media exposure to a diet high in unhealthy foods? Is adequate time spent every day away from sedentary activities such as television watching, video games and computer use?
Goals should include five or more servings per day of fruits and vegetables, less than two hours per day of screen time, one or more hours per day of moderately strenuous physical activity, no electronic devices in the bedroom and no sugar or artificially sweetened beverages.
A family history of obesity, heart disease, stroke and type 2 diabetes is important. If there is a history in your family of one or more of these then added attention to your child’s growth, activity level and dietary intake is essential. Special testing may also be required.
As a parent you must disengage from many of the minor food and activity decisions. Your child must be encouraged and allowed to self-regulate both food intake and daily exercise. This does not mean you do not discuss guidelines but rather establish a setting where success is easier to achieve and healthy choices become easier to make.
If routine interventions are unsuccessful then structured weight management protocols should be pursued under the direction and guidance of your pediatrician. This will include determination of the components of a healthy diet as well as structuring of daily meals and snacks. Activity time will also need to be supervised and screen time decreased to less than one hour per day. Structured behavior modification programs can also be used.