Childhood obesity: time for action, not complacencyBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7231.328 (Published 05 February 2000) Cite this as: BMJ 2000;320:328
Childhood obesity: additional information
Characteristics of an ideal weight-loss programme for children
Controlled weight loss at about 1 pound per week
No deceleration of height growth
Preservation of lean body mass
Lack of metabolical alterations
Abscent or minimal hunger sensation
Tailor-made in order to meet personal, familial and social circumstances
Reasons for failure
Lack of specificity of recommendations
Inflexibility (same diet and recommendations for all)
Lack of equal emphasis on increasing physical activity
No attention on behaviour modification strategies
Lack of maintenance phase
Cornerstones of childhood obesity management
1. Dietary assessment and treatment
Assess the child's and family's eating patterns and establish which food groups are being over- or under-consumed (food records may identify food preferences, portion sizes, snacking habits, etc).
Promote consumption of food high in complex carbohydrate, low in fat and low in energy density; encourage children, whether overweight or not, to adopt healthy eating habits from an early age and to continue with these into adulthood.
2. Physical activity
Encourage an increase in general levels of physical activity and a decrease in sedentary lifestyles (20 minutes of walking, dancing, swimming or cycling, or 10 minutes of running burn off around 0.42 MJ (100 kcal) or more).
Provide the child with specific guidelines, including type, frequency, duration and intensity of exercise:
*Take into account that motor ability mirrors closely the biological maturity of the child; for example, the time taken to complete a 2 mile walk decreases dramatically between the ages of 6 and 12 years and then plateaus at around the age of 13 in girls and 14 in boys.
*Decisions should be made in consultation with the child; compliance will increase if the child views the activity as "fun."
Innovative solutions may be required in the presence of orthopaedic problems.
3. Behaviour-modification steps
Ask the child to keep a careful record of food intake, body weight and physical activity.
Educate the child and parents in basic key nutrition concepts such as:
*Energy balance depends on the final outcome of energy intake (provided by food intake) and energy expenditure (attributable to resting metabolic rate and physical activity). The average 9 to 10 year old child takes in around 8.4 MJ (2000 kcal)/day. Older teens, especially boys, may be consuming as many as 12.54 (3000 kcal)/day.
*Energy density (1 g fat produces (37 kJ) 9 kcal; 1 g of carbohydrate or protein produce approximately 17 kJ (4 kcal)).
*The components of a healthy, balanced, high-carbohydrate, low-fat diet (30% of energy intake or less coming from fat).
*The importance of dietary fibre (children should consume an amount of fibre equivalent to their age plus 5-10 g/day).
*How to read food labels.
*Implementation of the diet may require an understanding of portion sizes and allowable food exchanges.
Educate the family to limit the amount of high-calorie foods kept in the house:
*Purchase very small quantities of these foods, if at all.
*Store such foods out of sight.
*Avoid situations where overeating may be a prominent issue.
Introduce modifications aimed at taking smaller bites of food, putting down the fork between bites, chewing food longer, and leaving food on the plate at the end of the meal.
Change negative statements about the self into positive ones.
Help children to cope with the negative remarks that peers make about their weight.
Reinforcement and rewards
Performance of targeted behaviours should be rewarded through verbal praise by parent, physician, dietitian, etc. It may also consist of tangible rewards predetermined by the parents
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