Pediatric Endocrinology Nursing Society
Plotting Off the Chart:
Obesity in Children

Obesity in children (as well as adults) is increasing at an alarming rate. There is also a dramatic increase in complications from excessive weight occurring in children, including the early appearance of type II diabetes during the teenage years. By far, the most common cause of obesity is taking in more calories than the body regularly uses, which results in the storage of those calories and a subsequent increase in weight. Limited physical activity also contributes, but is not the only cause of increases in weight. Underlying medical problems as a cause of excessive weight are quite rare, but endocrine conditions such as hypothyroidism, Cushing's syndrome, and Prader-Willi should be ruled out.

There are a number of myths about childhood obesity including:

* The obese child will outgrow his or her weight problem.
* Obesity is caused by massive overeating.
* Obese children eat because they are upset.
* Obese children gain weight easier than non-obese children.
* Obese children feel bad about being overweight and, most importantly,
* Childhood obesity is an untreatable condition.

These myths are simply not true. Often the difference between weight gain and no weight gain is only a few extra calories a day. Over a long period of time, these calories add up. Concentrated sweets (regular pop, fruit juice, regular Kool-aid) and convenience snacks (potato chips and cookies) often account for some of these differences.

It is important to address weight concerns early, before complications develop. Further, since children are still growing, they have the opportunity to grow into their weight allowing for weight stabilization rather than weight loss as an appropriate treatment. With growth, the weight shifts from stored calories to lean tissues such as muscle and bone. The best approach will include a meal plan and consultation by a registered dietitian to achieve weight stabilization. The dietitian can also provide recommendations for healthy snacks, food preparation, and lifestyle changes. The long-term goal is to change the eating behavior of the obese child and their family.

Although a number of medications have recently appeared for the treatment of obesity, none are approved in children or adolescents. Their impact on growth and development is unknown and the risk of complications from the medication is far greater than the benefits they may provide. The best solution for both short-term and long-term results is behavior modification.

Obesity in children and adolescents is a family problem. Dietary changes implemented for the control of weight in one member will benefit the rest of the family. Inappropriate snacks and drinks should not be available for anyone in the household, because everyone will eat them. It is best to keep only healthy snacks available and save the sweets or treats for special occasions, purchasing only enough for each person to have one serving. Restricting the overweight child from certain foods kept in the house, while allowing everyone else to have them, encourages other family members to become the "food police." As anyone who has worked in diabetes knows, the presence of the "food police" is not helpful and only encourages sneak-eating and conflict within the family.

Finally, the overweight child and their family should be encouraged to increase the physical activity of the entire family. Many activities can accommodate the varying athletic abilities of each family member. It will take the support of the family to achieve the long-term improvement in weight, but the result is the sustained improvement in overall health as well.

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