In the last two to three decades, the number of overweight children has doubled. Almost one child in five is considered overweight.

Obesity can lead to risk factors for heart disease, such as high cholesterol and high blood pressure, sleep apnea, orthopedic problems, liver disease, asthma, as well as low self-esteem and depression.

The likely cause of the increase in the amount of overweight children is more than likely the same reason that adult obesity is on the rise — overeating and lack of physical activity.

Because of these findings, new guidelines have been developed by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents appointed by the National Health, Lung and Blood Institute and endorsed by the American Academy of Pediatrics.

The recommendations is regardless of family history: All children between the age of 9 and 11 years undergo lipid screening for nonfasting non-HDH-cholesterol levels or a fasting lipid panel.

This is to be repeated with another full lipid screen between 18 and 21 years of age.

It is unclear in children what the treatment should be when an elevated LDL-cholesterol is found.

However, there is strong evidence that healthy eating and increased activity is associated with a healthy heart.

The following are a few suggestions to help your family start a program to improve eating habits and increase physical activity:

• Focus on gradual changes in both eating and exercise patterns, rather than enforcing immediate changes.

• Encourage your child to exercise. Make physical activity part of your family’s daily routine.

Children should exercise for at least one hour every day. Plan family activities that involve exercising, such as biking, hiking, walking in the neighborhood or washing the car.

• Limit the amount of time spent watching television and playing video games.

• Supply healthy snacks, such as yogurt, fruits and vegetables, to help your child learn to make healthy food choices.

• Give your child water or milk rather than soda or other drinks high in sugar.

• Provide balanced meals when eating at home and limit the amount of times that your child eats fast food per week.

• Let your child help you plan and prepare meals with you. If your child helps decide what’s for dinner, they will gradually learn about nutrition and may be more willing to try new foods that they helped you make.

• Try not to use food as a punishment or reward. For example, don’t offer dessert as a reward for finishing a meal. This teaches your child that sweets are more valuable than other foods.

• Encourage your child to eat slowly and eat together as a family, if possible. Try to make mealtime a time for sharing what your child did at school that day, etc.

• Don’t force your child to eat if he or she is not hungry.

• Involve the entire family, rather than just focusing on an overweight child, when it comes to changes in eating habits and physical activity.

• Be supportive and let your child know that they are OK no matter what they weigh. Your child may realize that he or she has a weight problem and therefore, needs your support and acceptance.

The goal of promoting a family eating and exercise program is to get healthier, rather than to reduce your child’s weight.

Children should not be put on restrictive diets because they need calories to develop properly, but changing eating and exercise patterns helps children grow into their weight without adding extra pounds.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital, and Keith Bly is an associate professor of pediatrics and director of the UTMB Pediatric Urgent Care Clinics. This column isn’t intended to replace the advice of your child’s physician.

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