Avoiding childhood obesity

Introduction

Children have high energy requirements 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.

It is estimated that up to 15% of children in the UK are overweight or obese.

It’s a serious problem

Children who are overweight tend to grow up into adults who are overweight. They therefore have a higher risk of developing serious health problems in later life, including heart attack and stroke, type 2 diabetes, bowel cancer, and high blood pressure. 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 children’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. This is now a major health concern.

Why are more children overweight?

Very few children become overweight because of an underlying medical problem. Children are more likely to be overweight if their parents are obese. But genetic factors are thought to be less significant than the fact that families tend to share eating and activity habits.

In other words, 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. And it is not unusual for children to spend hours in front of a television or computer. The National Diet and Nutrition Survey (2000) found that 40-69% of children over the age of six spend less than the recommended minimum of one hour a day doing moderate intensity physical activity.

What is a healthy weight for a child?

Parents may find it difficult to tell whether their 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 - it has to be used alongside charts that take into account the child’s rate of growth, sex and age - and is best interpreted with the help of your GP, health visitor, practice nurse or dietician.

It is possible to measure the proportion of a child’s weight that is made up of fat. Generally speaking, a child’s weight is classed as obese when their body weight is more than 25% fat in boys and 32% in girls.

Maintaining a healthy weight

Expert advice is that most children who are overweight should not be encouraged to actually lose weight. Instead they are encouraged to maintain their weight, so 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. See the separate BUPA factsheets on Anorexia nervosa and Bulimia nervosa.

No drug treatment has been proven effective in the treatment of weight problems in children.
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
• reduce physical inactivity

The good news is that all the evidence shows that it is much easier to change a child’s eating and exercise habits than it is to alter an adult’s.

A healthy well-balanced diet

Parents concerned about their child’s weight should 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 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

• 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. They will feel fuller more quickly and be less likely to overeat at mealtimes.
• Do not keep lots of high-fat, high-sugar snack foods in the house.
• Do not make outings for fast foods part of the weekly routine.
• Try to get children involved in preparing food as this will make them more aware of what they are eating.
• When children who need to improve their eating habits are old enough, it may help them to keep a food diary, recording what and when they eat. It’s important to be aware of snacking "danger times" and find strategies to divert attention away from food, or towards a healthier option.
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.
• 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

"Physical inactivity" includes pastimes such as watching TV or playing computer games. These should be reduced to no more than two hours a day or an average of 14 hours a week.
Encourage children to be selective about what they watch, concentrate only on the programmes they really enjoy.

The emotional factors

Food can take on emotional significance when used to comfort or reward children.
• Do not use food to comfort a child – give attention, listening and hugs instead.
• 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

• Studies show that breastfeeding a baby, even if only for a short period of time, may reduce the risk of obesity in later life.
• Parents who enjoy a healthy diet with plenty of fresh fruit and vegetables set a good example for their children. As children grow older they tend to stick to the eating pattern that has been established at home.