Obesity in children - management

Children can reach a healthy weight and grow well with the support of their parents and family. The whole family benefits from making healthy lifestyle choices. Choosing healthy foods, limiting takeaway and junk food, increasing physical activity and seeking professional advice all help. Crash diets, appetite suppressants and teasing or humiliating an overweight child do not.

Why early action matters#

Overweight and obesity often begin during the primary school years. This is a major concern because many children who are overweight go on to be overweight as adults. At this age, the main influence on a child’s diet and lifestyle is their parents, so simple changes at home can have a large effect.

Assessing a child’s weight#

Body mass index (BMI) is one of the tools used to assess whether a person is underweight, a healthy weight or overweight. BMI is calculated by dividing weight in kilograms by height in metres squared (m²).

A child’s BMI changes with their age and stage of physical development, so BMI figures alone are not appropriate for children. Instead, BMI-for-age centile charts, designed for children from about two to 18 years, are used alongside weight and height growth charts to give a more accurate picture of a child’s development. It is important that a child’s BMI is compared against age- and sex-specific centile charts.

As a general guide, BMI-for-age centiles are interpreted as:

• below the 3rd percentile – underweight
• 3rd to 85th percentile – healthy range
• 85th to 95th percentile – overweight
• above the 95th percentile – obese

These charts should be used as a guide only. Your doctor can help assess whether your child’s weight is a concern, so consider making an appointment to talk it through.

Healthy changes for the whole family#

Healthy food choices and being more active benefit everyone, so try to get the whole family involved. Children who are overweight or obese find it easier to reach a healthy weight when the whole family makes changes together. Some suggestions include:

• Get good nutrition advice – sound advice can help change the whole family’s eating habits.
• Shop carefully – stock the fridge and pantry with healthy snacks.
• Limit high fat or sugary treats – consider switching to lower-fat versions of dairy foods such as milk, cheese and yoghurt.
• Enjoy breakfast – make sure everyone has a healthy breakfast each day, for example a low-fat, low-sugar wholegrain cereal with low-fat milk and some fruit.
• Provide healthy snacks – snacking is a normal part of children’s eating and need not be discouraged; just keep snacks mostly low in kilojoules. Fruit and vegetables make excellent snacks.
• Reduce unhealthy drinks – avoid sugary soft drinks and encourage water and some low-fat milk.
• Eat more vegetables – if your child refuses vegetables, be creative; for example, finely grate carrot and zucchini into a lasagne or pasta sauce.
• Offer smaller serves – some children clear their plate no matter how big the serving, so give a little less. Serving 10 to 20 per cent less over time can make a real difference.
• Limit takeaway meals – takeaway food is often higher in salt and fat than home-cooked meals.
• Plan ahead – cooking the night before, or making large batches to freeze, means you are less likely to reach for takeaway when you are tired.
• Make mealtimes happy – enjoy meals together when you can, and involve everyone in preparing them.
• Ask the extended family to help – encourage carers and grandparents not to give children unhealthy foods.
• Set a good example – children tend to follow their parents’ lead.

Getting active together#

Children should be encouraged to be physically active, and it is much more fun to be active with others. Try to:

• Encourage outdoor play for younger children, and lots of active play for toddlers and pre-schoolers.
• Be active as a family – go for walks, play ball games, ride bikes, walk the dog or go swimming together.
• Aim for enough daily activity – school-aged children need at least 60 minutes of activity every day. Aim for everyone to be active outside school time, or at least 30 minutes each day.
• Reduce passive pastimes – limit television and computer games to less than two hours a day for school-aged children, and less than one hour a day for toddlers and pre-schoolers.
• Choose activities as rewards – instead of food “treats”, suggest an outing, a favourite game or a story.
• Find out more – seminars and educational activities run by teachers and community groups can help parents and children learn about preventing obesity.

Tactics to avoid#

Some weight-loss strategies are unhelpful or even dangerous. You should not use:

• Weight targets – do not set specific weight goals. Focus on healthy eating and being more active, and praise your child for their efforts.
• Crash dieting – a growing child needs a wide range of foods. Avoid diets that cut kilojoules too drastically or cut out a food group such as dairy. The goal is to reduce kilojoules by a small amount, consistently.
• Dramatic changes – family habits cannot change overnight, and children may resist sudden change. Concentrate on changes you can make a lasting part of family life, and be guided by your health professional.
• Appetite suppressants – none of the current weight-loss medications are safe for growing children.
• Ridicule – teasing a child for being overweight is harmful. It only makes the child feel self-conscious and upset, and does not promote weight loss.

Tips for school#

• Talk over any concerns with the school nurse.
• Ask your child’s teacher about any healthy lifestyle education offered at the school, and follow up at home to reinforce the messages.
• Do not pack high-fat snacks such as potato chips in your child’s lunchbox.
• Teach your child about making healthier choices at the school canteen, and encourage water as the main drink at school.
• Talk to staff and other parents about the food choices available, and suggest improvements if needed.

Key points#

• Overweight and obesity often start during the primary school years, and many overweight children remain overweight as adults.
• Parents are the main influence on a young child’s diet and lifestyle.
• A child’s BMI should be compared against age- and sex-specific centile charts, not adult figures.
• The whole family benefits from healthier eating and more activity, and changes work best when everyone takes part.
• Avoid crash diets, appetite suppressants and ridicule, and be guided by your health professional.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).