The percentage of overweight children in the U.S. is growing at an alarming rate, with 1-in-3 kids now considered overweight or obese. From fast food to electronics, quick and easy is the new normal for many people; and preventing your kids from becoming overweight might mean changing the way your family eats, exercises, and spends time together. Helping kids adopt healthy lifestyles begins with parents who lead by example.

Is Your Child Overweight?

Body mass index (BMI) uses height and weight measurements to estimate body fat [utilize a calculator at KidsHealth.org]. Kids ages 2 to 19 fall into one of four categories: underweight (below 5^th percentile), normal weight (5^th to 84^th percentile), overweight (85^th to 94^th percentile), and obese (95^th and above percentile). For kids younger than 2, doctors use weight-for-length charts to determine how a baby’s weight compares with his length. Any child who falls at or above the 85^th percentile may be considered overweight.

BMI is not a perfect measure of body fat and can be misleading in some situations. For example, a muscular person may have a high BMI without being overweight (extra muscle adds body weight, but not fat). Also, BMI might be difficult to interpret during puberty when kids are experiencing periods of rapid growth. BMI is usually a good indicator — but not a direct measurement — of body fat. If you’re worried that your child may be overweight, make an appointment with his pediatrician who can assess lifestyle habits, make suggestions for positive changes, and screen for medical conditions that can be associated with obesity.

Depending on your child’s BMI (or weight-for-length measurement), age, and health, the doctor may refer you to a registered dietitian and, possibly, recommend a comprehensive weight management program.

The Effects of Obesity

Obesity increases the risk for serious health conditions (once considered exclusively adult diseases) which affect present and future health and quality of life, including:

• high blood pressure, high cholesterol and abnormal blood lipid levels, insulin resistance, and type 2 diabetes
• bone and joint problems
• shortness of breath that makes exercise, sports, or any physical activity more difficult and may aggravate the symptoms or increase the chances of developing asthma
• restless or disordered sleep patterns, such as obstructive sleep apnea
• tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look, not as old as they are; overweight girls may have irregular menstrual cycles and fertility problems in adulthood)
• liver and gall bladder disease

Kids who are unhappy with their weight may also be more likely to:

• be prone to low self-esteem that stems from being teased, bullied, or rejected by their peers

• develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia
• be prone to depression
• be at risk for substance abuse

In addition, cardiovascular risk factors present in childhood can lead to heart disease, heart failure, and stroke in adulthood. Conversely, preventing or treating overweight/obesity in children may reduce the risk of developing cardiovascular diseases when they get older.

Causes of Overweight

A number of factors contribute to becoming overweight: genetics, lifestyle habits, or a combination of both. In some instances, endocrine problems, genetic syndromes, and medications can be associated with excessive weight gain.

Much of what today’s busy families eat is quick and easy — from fast food to prepackaged meals. Daily schedules are so jam-packed that there’s little time to prepare healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, have grown greatly. Plus, now more than ever, life is sedentary — kids spend more time playing with electronic devices than actively playing outside.

Screen time is a major culprit! Kids younger than 6 spend an average of 2 hours a day in front of a screen, mostly watching TV, DVDs, or videos; while older kids and teens average 4.5 hours a day. When computer use and video games are included, screen time increases to over 7 hours a day! Kids who watch a screen for more than 4 hours a day are more likely to be overweight than those who watch 2 hours or less. Not surprisingly, having a TV in the bedroom is linked to increased likelihood of being overweight. For many kids, once they get home from school, all of their free time is spent viewing a screen of some sort. The American Academy of Pediatrics (AAP) recommends that kids (over 2) not spend more than 1-2 hours a day in front of a screen and discourages any screen time for children younger than 2.

Many kids don’t get enough physical activity. Many schools are eliminating physical education programs or cutting down the time spent on fitness-building activities. One study showed that gym classes offered third-graders just 25 minutes of vigorous activity each week. Current guidelines recommend that kids get at least 60 minutes of moderate to vigorous physical activity on most, preferably all, days of the week. Babies and toddlers should be active for 15 minutes every hour (a total of 3 hours for every 12 waking hours) each day.

Genetics play a role as well since genes help determine body type and how your body stores and burns fat. Genes alone, however, cannot explain the current obesity crisis. Because both genes and habits are passed down from one generation to the next, multiple members of a family may struggle with weight control. People in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight. Studies have shown that a child’s risk of obesity greatly increases if one or both parents is overweight/obese.

Preventing Overweight and Obesity

The key to keeping kids at a healthy weight is taking a whole-family approach… the “practice what you preach” mentality. Make healthy eating and exercise a family affair. Get your kids involved by letting them help plan and prepare healthy meals, and practice making healthy choices while grocery shopping together. Avoid falling into these common food/eating behavior traps:

• Don’t reward kids for good behavior or try to stop bad behavior with sweet treats. Come up with other behavior modification solutions.
• Don’t maintain a clean-plate policy. Be aware of kids’ hunger cues. Even babies who turn away from the bottle or breast are signaling that they’re full. If kids are satisfied, don’t force them to continue eating. Reinforce the idea that they should only eat when hungry.
• Don’t talk about “bad foods” or completely eliminate all sweets and snacks from kids’ diets. Kids may rebel and overeat these forbidden foods outside of the home or sneak them on their own.

Additional Recommendations by Age

• Birth to age 1: In addition to its many health benefits, breastfeeding may help prevent excessive weight gain. Though the exact mechanism is not known, breastfed babies are more able to control their own intake and follow internal hunger cues.
• Ages 1 to 5: Start good habits early. Help shape food preferences by offering a variety of healthy foods. Encourage kids’ natural tendency to be active and help them build on developing skills.
• Ages 6 to 12: Encourage kids to be physically active every day, whether through an organized sports team or a casual game during recess. Keep your kids active at home too through daily activities, such as walking and playing in the yard. Let them be involved in making good choices, such as packing a balanced lunch.
• Ages 13 to 18: Teens like fast food, but try to steer them toward healthier options like grilled chicken, salads, and smaller sizes. Teach them how to prepare healthy choices at home. Encourage teens to be active every day.
• All ages: Cut down on TV, computer, and video game time and discourage eating while watching the tube. Serve a variety of healthy foods and eat meals together when possible. Encourage kids to have at least 5 servings of fruits & vegetables a day, limit sugar-sweetened beverages, and eat breakfast.

If you eat well, exercise regularly, and incorporate healthy habits into your family’s daily life, you are modeling a lifestyle for your kids that will last. Talk to them about the importance of eating well and being active, but make it a family affair that will become second nature for everyone. Let your kids know you love them — no matter what their weight — and that you want to help them be happy and healthy.

© Nemours/KidsHealth.org. Reprinted with permission.