Step By Step: Kids Trimming Down
• NOTES from Part 1 •

Pediatrician — Stewart Gordon, MD

 Defining overweight and obesity

• Overweight generally applies to excess pounds that can be the result of either fat or muscle, or a combination of both. Healthy muscle is not nearly as disturbing as a buildup of fat. In fact, muscle can be desirable.
• However, there are times when a child is overweight because of a disproportionate amount of fat based on his over-all weight and height. If the child and his or her family don’t intervene, the fat will continue to pile on, leading to obesity.
• The word obese refers to an excess in body fat, not muscle. A pediatrician or family doctor can distinguish between fat and muscle by doing a routine physical exam and evaluating the child’s medical history.

Most doctors plot the development of children on growth charts. The charts allow physicians to compare the child’s weight and height to that of other kids his or her own age. The charts allow doctors to easily determine whether a child’s weight is normal, low or high for his age. The charts also help in determining trends in child development.

• There are separate charts for girls and boys as they grow differently.
• There are gender specific charts that are used from birth to 36 months and charts that track growth from the age of two to 20.

You can get a copy of your child’s growth chart from his or her doctor. Or, you can start plotting your child’s growth yourself by getting a chart off the Center for Disease Control’s website.

To plot a child’s growth chart, you’ll need to know his or her age, height and weight. I like to use their age in years and quarters, for example—3, 3¼, 3 ½, or 3 ¾.The bottom curve is for weight and the top curve is for height. Find the child’s age on the bottom of the chart. Move up the side of the chart to find his weight. Move across the weight line to the intersection with the age line. Place a dot there. That dot will be near a percentile line. That percentile line will show you how the child stacks up with other children his or her age.

To check growth, go the child’s age once again. Look at the side of the chart for stature/height. That intersection of height or stature and age is the point in which you plot your chart. That percentile line shows the child’s height compared to others his/her age. You must then compare the weight and height lines. The child may be fine if he is both taller and heaver than 75 percent of the children his age. However, if he is the same height, but much heavier, you may have reason for concern, and should consult with the child’s physician.

Remember, the weight could be muscle. It could be fat or both. You will want to start helping your child develop a healthier lifestyle if it’s fat. We generally allow for a child’s weight to be 20-percent greater than what’s considered ideal, before we say he or she is overweight.  

Psychologist — Denise Sellers, Ph.D.

The most important step in losing weight and staying healthy is developing the right attitude. Children will not succeed in trimming down and living healthier lifestyles if they don’t have strong motivation. That desire can come from many places.

• Wanting to wear clothes designed for children or teens
• Wanting to end teasing
• Wanting to feel better
• Wanting to avoid illnesses older relatives suffer

Children must realize that it takes a serious commitment and changes in lifestyle to lose weight. Next, children need to realize life is a bunch of tradeoffs. We all make sacrifices to obtain certain benefits. Losing weight is no different.

Once your child decides to lose weight, have him or her take a sheet of paper. Draw a vertical line down the center of the paper. Tell the child to outline the benefits of losing weight as opposed to the sacrifices. Some of the most common sacrifices we see in our clinical setting include:

• Giving up junk food, desserts, and fast food.
• Becoming more active. They don’t like, walking more and playing more.
• Watching less television and spending less time on computer games.

However, once kids begin a healthier lifestyle, they find they feel better for several reasons.

1. They are healthier because they eat healthier meals.
2. They exercise more.
3. They start losing weight.
4. They look better.
5. They can get around better, running and moving faster.

You may notice, many of the sacrifices involve food. But, the rewards involve emotional and physical health. The kids’ dilemmas with food may be difficult, but they are manageable.

There are some things you can start doing right away to help your children start living a healthier lifestyle.

1. Have them set up a schedule of when they can eat. Write it down and stick with it. For example, make sure the child gets breakfast, a morning snack, lunch, an afternoon snack and dinner.
2. The child should always eat in the same place while at home, preferably at the kitchen or dining room table. Make this a requirement for all meals, drinks and snacks. Water is the only exception. The child can drink it anywhere. We don’t want children to get use to eating all over the house. They should only associate one place with food.
3. We don’t want children to do anything else while eating. No watching television, studying, reading or playing. Chances are, they’re not paying attention to what or how much they’re eating if they are doing other things while snacking or having a meal. Children may be inclined to over-eat.

Sometimes the child will feel like eating when it’s not time based on his or her schedule. The child should make a list of things he can do both inside and outside to take his mind off eating ahead of schedule, things like riding his bike, drinking a glass of water or reading a book.

A tremendous amount of emphasis is put on what you eat. But, the way you eat equally as important. There are techniques for eating that will help you become healthier, and eat in a more healthy way.

Let’s call them the “rules for eating.”

1. First of all, practice chewing more, fifteen to thirty times per bite. This will help you eat slower and digest your food better.
2. Eat slowly. Taste your food and enjoy each bite. This helps your brain know when your body is full.
3. Take smaller bites. This will help in eating slowly.
4. Don’t take seconds, except for vegetables which are usually low in fat.
5. Leave some of every type of food on your plate. It’s okay. You don’t have to be a member of the clean-your-plate-club. Stop eating when you are full.
6. Take smaller portions. Generally speaking, a serving is about the size of your fist.
7. Leave the pots or serving bowls of food in the kitchen. If you put them on the dinner table, you’ll be tempted to eat more food.
8. Use a smaller plate. This will cause you to fill it with smaller portions.
9. Put your fork down after every bite. This will cause you to slow down.
10. Eat at least three bites of every food. That way you can really focus on the taste of each food, before deciding what you like or dislike.
11. Drink a large glass of water about 15 minutes before each meal. This serves two purposes. You’ll meet your body’s requirements for water and the water will help you feel full sooner. You’ll be less likely to overeat.
12. And, another reminder, eat only at the table... not in front of the T.V. You need to focus on enjoying your food and making sure you don’t overeat.
13. Parents and children you can’t under-estate the importance of paying closer attention to when, where, and how you eat.

Registered Dietitians — Heidi Schumacher and Denise Delphin

Diet is a primary area of focus for anyone who commits to eating a healthier lifestyle. All foods can be included in a healthy eating plan, including foods that are high in fat and sugar. The key is to find balance. Many parents find they need to add more fruits, vegetables and whole grains to meal plans. In addition, parents should serve more meats and dairy products that are low in fat. You can still serve foods that are high in fat and sugar, and even processed foods as long as you don’t serve them often and children get smaller quantities. Parents should get a copy of the food pyramid to learn more about how to plan balanced meals.

Dairy Products

According to the pyramid, children should eat three to five servings of dairy products; milk, yogurt and cheese each day. Note the range...three to five servings of a dairy product. If a child is trying to lose weight, he should only have three servings each day.

Most dairy products are now available in low-fat varieties. You should shop for those products. Pay close attention. Servings for adults and children are different. A serving of milk or yogurt for a toddler or pre-school aged child is one-half cup instead of one cup.

Meats, Fish, Beans, Nuts, Eggs

The pyramid says kids should eat two to three servings of meat, poultry, fish, dry beans, eggs or nuts. Again, you should go with the two servings. If you decide to go with three servings, use smaller servings.

Two ounces of meat is an adequate serving for many school-aged children. However, the appropriate meat serving for adults is generally three to four ounces. Some people may be tempted to skip some of these foods all together. But, you shouldn’t. This is where you get your protein, calcium, iron and zinc.  

Vegetables and Fruit

We should have three to five servings of vegetables and two to four servings of fruit. We don’t recommend that you cut back too much in this area. Most fruits and vegetables are low in fat and sugar while they are good sources of zinc, iron, calcium and protein.

It’s sometimes difficult to get children to eat more fruits and vegetables. It sometimes helps to have washed, peeled fresh fruits and veggies in bags in the refrigerator where they are convenient and ready to serve. It also helps to have low fat dips for these foods.

Carbohydrates

The remainder of your child’s diet should include low fat carbohydrates such as breads, cereals, pasta and rice. Whole wheat items and lower sugar cereals are more nutritious. They provide good sources of energy with lots of vitamins, minerals and fiber.  

Exercise Physiologist — Melinda Sothern, Ph.D.

Children can achieve a healthier lifestyle through play, exercise, and helping with the chores around the house. Movement is essential to maintaining strong bones, a healthy heart and a strong immune system. It’s also necessary to burn off unwanted calories.

You expend only 30 to 50 calories and hour when you sit down. You burn twice that many when you stand up. You expend 200 calories and hour by just walking slowly. Children generally burn more calories playing than they do with structured exercise

Encouraging play

You can encourage children to play by surrounding them with things like a swing set, a sand box, a sprinkler, a wading pool, balls, wagons, ladders that lead to tree houses, badminton, croquet, and miniature golf sets. Store toys where children can see them and have easy access to them.

Sometimes the kids don’t need toys at all to get them to play. One of their favorite games is “tag”. It works well for the kids’ immature metabolic system. One child runs after another until he touches him or her. Kids’ bodies are not mature enough for long periods of physical exertion. They prefer short spurts of intense activity. Tag answers this physiological need to run very fast for very short periods of time then stop and rest. Just by doing this, children can burn off 350 to 400 calories an hour.

If you don’t have a yard

Parents who don’t have yards for children to play in should take the kids to the park. Encourage them to play with kites, monkey bars, swings, teeter-totters, tunnels, and all of the other wonderful playground equipment. Parents should play with their children. Throw Frisbees. Pitch balls or ride bikes.

Inside activities

If it’s too cold, too hot, too dark, or too wet to play outside, find things to do inside. Get your children a boom box and some C.D.’s of their favorite music. If your kids are younger, make sure they have balls that are soft enough for them to play with inside. Clear a space that’s big enough for the kids to play jump rope and Hula Hoop in a bedroom, hall or playroom.

When your children watch television, encourage them to play/work with a stretchy band or do squats or crunches during commercial breaks. If your children enjoy the telephone, get them a cordless phone and make them walk for as long as they talk.

Doing chores

• NOTES from Part 1 •
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LEGAL DISCLAIMER: This information is for general information purposes only and does not address individual circumstances. It may not be right for you and should not be relied upon in making decisions about your health. Always consult your doctor for medical advice.