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Avoiding childhood obesity

This factsheet is for parents who have obese children or want to know more about childhood obesity.

Children need lots of energy because they are growing. A varied and nutritious diet is essential for their development. However, like adults, if they take in more energy - in the form of food - than they use up, the extra energy is stored in their bodies as fat.

In the UK an estimated one in four 11 to 15 year olds are overweight or obese - and the problem is growing every year.

• A serious problem
• Why are more children overweight?
• What is a healthy weight for a child?
• Maintaining a healthy weight
• The emotional factors
• Prevention
• Further information
• Sources

A serious problem

Research shows that obese children are at increased risk from a number of serious health problems more usually seen in adulthood, including hardened and blocked arteries (coronary artery diseases), high blood pressure, and type 2 diabetes. When they grow up, they are more likely to be obese.

This means a higher risk of heart attack and stroke, type 2 diabetes, bowel cancer, and high blood pressure in adulthood. The risk of health problems increases the more overweight a person becomes.

Being overweight as a child can also cause psychological distress. Teasing about their appearance affects a child's confidence and self-esteem, and can lead to isolation and depression.

The number of overweight and obese children in the UK has risen steadily over the past 20 years. The obesity epidemic is now a major health concern.

Why are more children overweight?

Very few children become overweight because of an underlying medical problem. Research indicates that children are more likely to be obese if their parents are obese. It isn't known whether this is because of genetic factors which the child inherits, if its because families tend to share eating and activity habits, or a combination of them both.

However, it's thought that most children put on excess weight because their lifestyles include an unhealthy diet and a lack of physical activity.

It is certainly easier than ever before for children to become overweight. High-calorie foods, such as fast food and confectionery, are abundant, relatively cheap and heavily promoted, specifically at children.

Exercise is no longer a regular part of everyone's day - some children never walk or cycle to school, or play any kind of sport. It is not unusual for children to spend hours in front of a television or computer. According to the National Diet and Nutrition Survey (2000), 4 out of 10 boys and 6 out of 10 girls do not do the minimum one hour a day of physical activity recommended by the then health education authority.

What is a healthy weight for a child?

You may find it difficult to tell whether your child has temporary "puppy fat" or is genuinely overweight. In adults, a simple formula (the body mass index, or BMI) is used to work out whether a person is the right weight for their height.

However, BMI alone is not an appropriate measure for children, because they are still growing. Factors such as rate of growth, age and sex, and the BMI of other children of the same age must be taken into account when assessing your child's weight. BMI is best interpreted with the help of your GP, health visitor, practice nurse or dietitian.

Maintaining a healthy weight

In most cases, experts recommend that overweight children should not be encouraged to actually lose weight. Instead they should be encouraged to maintain their weight, so that they gradually "grow into it" as they get taller.

Children should never be put on a weight loss diet without medical advice as this can affect their growth. Unregulated dieting - particularly in teenage girls - is thought to lead to the development of eating disorders. For more information, see the separate BUPA health factsheets, Anorexia nervosa and Bulimia nervosa.

There isn't much evidence for the best ways to treat weight problems in children, but research indicates that focusing on making long-term improvements to diet and increasing physical activity may be the effective solution.

Helping children to achieve and maintain a healthy weight involves a threefold approach that encourages them to:

• eat a healthy, well-balanced diet
• make changes to eating habits
• increase physical activity - in 2004 the Chief Medical Officer recommended at least 60 minutes of at least moderate physical activity a day for children

The good news is that it is probably easier to change a child's eating and exercise habits than it is to change an adult's.

A healthy well-balanced diet

If you are concerned about your child's weight, encourage a variety of fresh, nutritious foods in his or her diet.

• Starchy foods which are rich in complex carbohydrates are bulky, relative to the amount of calories they contain. This makes them both filling and nutritious. Sources such as bread, potatoes, pasta, rice and chapatti should provide half the energy in a child's diet.
• Instead of high-fat foods like chocolate, biscuits, cakes and crisps, try healthier alternatives such as fresh fruit, crusty bread or crackers.
• Try to grill or bake foods instead of frying. Burgers, fish fingers and sausages are just as tasty when grilled, but have a lower fat content. Oven chips are lower in fat than fried chips.
• Avoid fizzy drinks that are high in sugar. Substitute them with fresh juices diluted with water or sugar-free alternatives.
• A healthy breakfast of a low-sugar cereal (eg wholemeal wheat biscuits) with milk, plus a piece of fruit is a good start to the day.
• Instead of sweets, offer dried fruit or tinned fruit in natural juice. Frozen yoghurt is an alternative to ice cream. Bagels are an alternative to doughnuts.

Changes to eating habits

To achieve lasting effects, the whole family attitudes and habits towards food and exercise need to change.

• Try to set a good example with your own eating habits.
• Provide meals and snacks at regular times to prevent "grazing" throughout the day.
• Don't allow your children to eat while watching TV or doing homework.
• Make mealtimes an occasion by eating as a family group as often as possible.
• Encourage children to 'listen to their tummies' and eat when they are hungry rather than out of habit.
• Teach children to chew food more slowly and savour the food, as they will feel fuller more quickly and be less likely to overeat at mealtimes.
• Don't keep lots of high-fat, high-sugar snack foods in the house.
• Don't make outings for fast foods part of the weekly routine.
• Try to get your children involved in preparing food as this will make them more aware of what they are eating.

Physical activity

Doctors recommend a gradual increase in physical activity, such as brisk walking, to at least an hour a day.

• Encourage walking to places such as school and the shops, rather than always jumping in the car or bus.
• Suggest going to the park for a kick around with a football, or a game of rounders, cricket or frisbee.
• Visit a local leisure centre to investigate sports and team activities to get involved in.
• Make exercise into a treat by taking special trips to an adventure play park or an ice skating rink, for example. Involve the whole family in bike rides, swimming and in-line skating.
• When it is safe to do so, teach your child to ride a bike.

Reducing physical inactivity

Physically inactive pastimes such as watching TV or playing computer games should be limited to around two hours a day or an average of 14 hours a week. Encourage children to be selective about what they watch and concentrate only on the programmes they really enjoy.

The emotional factors

Food can take on emotional significance when used to comfort or reward children.

• Don't use food to comfort your child - give attention, hugs and listen.
• Avoid using food as a reward as this can reinforce the idea of food as a source of comfort. Instead of having a fast-food meal to celebrate a good school report, for example, buy a gift, go to the cinema, or have a friend to stay overnight.

Prevention

• Some research suggests that breast feeding your baby may reduce childhood obesity, although the evidence is not conclusive.
• Other studies indicate that smoking during pregnancy increases the risk of having an overweight child.

Further information

• British Nutrition Foundation
  www.nutrition.org.uk

• Food Standards Agency
  www.foodstandards.gov.uk/healthiereating

Sources

• Rise in childhood obesity rates - new statistics from health survey for England. The Information Centre.
  www.ic.nhs.uk
  accessed 1 November 2006
• Consequences of childhood obesity. SIGN.
  www.sign.ac.uk
  accessed 22 November 2006
• Interventions for preventing obesity in children. The Cochrane library, 2006(4).
• Being big or growing fast: systematic review of size and growth in infancy and later obesity. Baird, J., et al. BMJ 2005, 331:929
  www.bmj.com
  accessed 22 November 2006
• Food promotion and children Action Plan 2005 - The facts. Food Standards Agency
  www.food.gov.uk
  accessed 22 November 2006
• Obesity and health. Bandolier. Publication 85.
• Obesity - Background Information - Complications and prognosis. Prodigy Knowledge Guidance.
  www.prodigy.nhs.uk
  accessed 22 November 2006
• Reilly, J.J., et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005; 330: 1357.
  www.bmj.com
• Management of obesity in children and young people. Scottish Intercollegiate Guidelines Network.
  www.sign.ac.uk
  accessed 22 November 2006
• Edmunds, L., E. Waters, and E.J. Elliott. Evidence based paediatrics: Evidence based management of childhood obesity. BMJ 2001; 323:916-919
• Interventions for preventing obesity in children. The Cochrane collaboration. The Cochrane library.
  www.cochrane.org
  accessed 22 November 2006
• Li, L., Breast feeding and obesity in childhood: cross sectional study. BMJ 2003. 327: 904-905

Published by BUPA's health information team, healthinfo@bupa.com, February 2007.

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