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Home > Living Well > Health Library > Childhood Obesity (Holistic)
Be a positive role model by involving your entire family in a program that includes better eating and regular exercise
Research whole foods and help your children choose healthy long-term eating habits
Provide and encourage physically active alternatives to TV and video games
Improve the results of treating childhood obesity by learning valuable techniques that can help you alter your child's behavior
Visit a doctor to determine if any treatable health problems are developing as a result of childhood obesity
Excessive weight in children and adolescents is becoming an increasingly
serious problem.1, 2 In the United States, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years
are overweight, and among adolescents the percentage is three times higher than it was 20 years ago.3 Major contributors to childhood obesity include genetics, unhealthy diets, and sedentary lifestyles.4, 5 Overweight children often become adults with weight problems that contribute to a wide variety of health problems,6, 7 but even during childhood and adolescence, overweight can contribute to such disorders as type 2 diabetes, high cholesterol, high blood pressure, insulin resistance, and liver disease.8, 9, 10 Being overweight also has social and psychological consequences for children in terms of social discrimination, poor self-esteem, and depression.11, 12
Parents, family members, and others who are important people in a child's life can either help or harm an obese child's situation. As with all children, those with weight problems need acceptance, support, and
encouragement from their family, and the eating, exercising, and other health habits of family members play important roles in influencing the same behaviors in children.13, 14
The proper weight for a growing child or adolescent should be determined with the help of a doctor or other qualified health professional, who can also determine whether any unusual medical problems might be contributing to weight gain, whether any current health problems exist that are related to overweight, and appropriate weight control methods. Treating obesity should not include overly restrictive or fad diets that are missing essential nutrients. In fact, weight loss is not necessarily appropriate for a growing child. Often the best goal for an overweight child is to maintain their current weight as they grow taller.
Lack of physical activity is considered a significant contributing factor in childhood obesity.15 However, while the results of treatment of overweight children are usually enhanced by strategies to increase physical activity or decrease inactivity, attempts to improve physical activity levels have not been very successful in preventing childhood obesity according to most controlled research.16 Nonetheless, watching television and playing computer or video games contributes to the sedentary lifestyle of many children, and controlled
research has shown that weight control is more successful when these activities are controlled and healthier alternatives provided.17, 18, 19 Children are recommended to get at least an hour of moderate physical activity most days of the week, and more may be necessary to offset genetic and other influences. Fun activities that involve other family members or other children will help make getting more exercise a positive experience.20
Weight-loss efforts that involve excessive restriction of calories or protein can inhibit a child's ability to gain lean body mass (such as muscle) during the normal growth process. Consequently, weight-loss diets for children should not be excessively restrictive. In addition, an appropriate
exercise program can be a useful addition to a low-calorie diet for overweight children. A controlled trial found that strength training, when added to a
low-calorie diet, resulted in a greater gain of lean body mass (while still
promoting weight loss), compared with diet alone in obese children.21 Another study of obese
adolescents found that a physical exercise program combined with normal calorie intake resulted in reductions in body weight and body fat while allowing for normal growth and preservation of lean body mass.22
Behavior-change techniques are considered useful for helping people break old habits and form more
healthful habits. These techniques may be learned from counseling
professionals, support groups, educational programs, or books. Many controlled studies have investigated various methods for using behavior-change techniques to prevent or treat childhood obesity, with several reporting success at
reducing overweight compared with either no treatment or with conventional weight-loss approaches.23, 24, 25
Parental involvement in the treatment of childhood obesity is considered important for success, especially when parents are given adequate training in a wide range of behavior-change techniques that can be applied to the entire family.26 Limited research suggests that training parents alone is superior to training either children alone or training both parents and children.27, 28, 29 Some authorities suggest that training parents alone produces the best results because this avoids affecting the child's self-esteem and willingness to change, which might result from labeling him or her as "the patient."30, 31
Problem-solving techniques are used in some types of counseling to help
people maintain changes in their behavior. In one controlled study, teaching
problem-solving techniques to parents in addition to behavior-change
techniques improved weight loss results in obese children compared with a
group learning only behavior-change techniques.32 However, another controlled study found no additional benefit when
problem-solving training was given to either the child or to both child and
For support and information, parents can also try the following resources:
Most authorities believe that the best diet for treating childhood obesity
is a heart-healthy diet low in saturated fat and cholesterol, but high in
vitamins, minerals, and other important nutrients. However, few studies have actually compared different diets for their effectiveness in
treating childhood obesity.
Unhealthful eating patterns resulting in overconsumption of foods high in fat, calories, or added sugars are considered a major contributor to childhood obesity. Since these patterns often include habits learned from the family, attention should be paid to providing healthful food to the entire family and encouraging good role modeling by other family members.
Guiding healthful food choices when eating outside of the home is also a priority. To teach good lifetime eating habits, try the following:
There is only limited research on the prevention of childhood obesity with
diet. Preliminary studies have found that breast-feeding during infancy is usually associated with a reduced risk of developing obesity during early
childhood, though the reasons for this effect are unclear. In a
controlled study of children between the ages of 7 and 12, a school-based
education program designed to reduce carbonated-drink consumption resulted in
a reduction in the number of overweight children after 12 months.
A recent 12-week controlled trial found that overweight adolescents lost more weight with a low-carbohydrate diet than with a low-fat diet. Very-low-carbohydrate (ketogenic) diets have been shown to cause rapid weight loss in very obese children in short-term preliminary and controlled trials, but the long-term safety and benefits of this type of diet are unknown. More research is needed
to evaluate low-carbohydrate diets for treating childhood obesity.
Glycemic index and glycemic load describe the tendency of foods to raise blood sugar. Eating meals containing foods that are low in glycemic index or glycemic load may influence appetite and other body mechanisms that affect excessive weight gain in children. A preliminary study reported that obese children using a low-glycemic-index diet lost more weight compared with a similar group using a low-fat diet. A controlled trial
found that obese adolescents eating freely on a low-glycemic-load diet lost more weight and body fat after six months than did a similar group following a typical low-calorie, low-fat diet.
Very-low-calorie "modified fasting" diets, typically using high-protein meal replacement beverages, have been tried in preliminary and controlled studies of obese children with good short-term results. However, weight lost with these diets is often regained and there are health risks
associated with their use. Little is known about their effect on growth and other health issues in children.
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Increased fiber intake is thought to have potential benefit in a weight-loss program since dietary fiber dilutes calories, slows down the eating process, and may make people feel more full despite eating fewer calories. However, research on using fiber in the treatment of childhood obesity has focused on using fiber supplements rather than comparing low- and high-fiber diets. Supplementation for four months with 2 to 3 grams per day of a bulking agent called glucomannan, was effective in a group of obese adolescents in one controlled trial, but another controlled trial found no significant effect of 2 grams per day for two months.
1. Rudolf MC, Greenwood DC, Cole TJ, et al. Rising obesity and expanding waistlines in schoolchildren: a cohort study. Arch Dis Child 2004;89:235-7.
2. Rugg K.Childhood obesity: its incidence, consequences and prevention. Nurs Times 2004;100:28-30 [review].
3. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents. Surgeon General [cited 2004 May 1]. Available from URL: www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm.
4. Clement K, Ferre P. Genetics and the pathophysiology of obesity. Pediatr Res 2003;53:721-5 [review].
5. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473-82 [review].
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10. Schwimmer JB, Deutsch R, Rauch JB, et al. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-5.
11. Zametkin AJ, Zoon CK, Klein HW, Munson S. Psychiatric aspects of child and adolescent obesity: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2004;43:134-50 [review].
12. Schwartz MB, Puhl R. Childhood obesity: a societal problem to solve. Obes Rev 2003;4:57-71.
13. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004;62:39-50 [review].
14. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am 2001;48:893-907 [review].
15. Livingstone MB, Robson PJ, Wallace JM, McKinley MC. How active are we? Levels of routine physical activity in children and adults. Proc Nutr Soc 2003;62:681-701 [review].
16. Reilly JJ, McDowell ZC. Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal. Proc Nutr Soc 2003;62:611-9.
17. Epstein LH, Valoski AM, Vara LS, et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 1995;14:109-15.
18. Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000;154:220-6.
19. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA 1999;282:1561-7.
20. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents. Surgeon General [cited 2004 May 1]. Available from URL: www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm.
21. Schwingshandl J, Sudi K, Eibl B, et al. Effect of an individualised training programme during weight reduction on body composition: a randomised trial. Arch Dis Child 1999;81:426-8.
22. Dao HH, Frelut ML, Oberlin F, et al. Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. Int J Obes Relat Metab Disord 2004;28:290-9.
23. Campbell K, Waters E, O'Meara S, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2002;2:CD001871 [review].
24. Epstein LH, Myers MD, Raynor HA, Saelens BE. Treatment of pediatric obesity. Pediatrics 1998;101:554-70 [review].
25. Saelens BE, Sallis JF, Wilfley DE, et al. Behavioral weight control for overweight adolescents initiated in primary care. Obes Res 2002;10:22-32.
26. McLean N, Griffin S, Toney K, Hardeman W. Family involvement in weight control, weight maintenance and weight-loss interventions: a systematic review of randomised trials. Int J Obes Relat Metab Disord 2003;27:987-1005 [review].
27. Wadden TA, Stunkard AJ, Rich L, et al. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics 1990;85:345-52.
28. Israel AC, Guile CA, Baker JE, et al. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994;19:737-49.
29. Golan M, Fainaru M, Weizman A. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998;22:1217-24.
30. Golan M, Fainaru M, Weizman A. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998;22:1217-24.
31. Dietz WH. Therapeutic strategies in childhood obesity. Horm Res 1993;39(Suppl 3):86-90.
32. Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. J Consult Clin Psychol 1988;56:246-50.
33. Epstein LH, Paluch RA, Gordy CC, et al. Problem solving in the treatment of childhood obesity. J Consult Clin Psychol 2000;68:717-21.
Last Review: 06-08-2015
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