TreatmentOverweight children and their parents may be
referred to a registered dietician or nutritionist who
can help them develop a plan for eliminating empty
calories and increasing the amount of nutrient-rich,
low-calorie foods in their diets. Nutrition education
usually involves the entire family. Children may be
asked to keep a food diary to record everything that
they eat in order to determine what changes in behav-
ior and diet need to be made. Typically, children are
encouraged to increase their level of exercise rather
than to drastically reduce calories.
Drug therapy and weight-loss surgery are very
rarely used in children, except in the most extreme
cases of health-threatening obesity when other meth-
ods of weight control have failed. Some teenagers
benefit from joining a structured weight-loss program
such asWeight Watchersor Jenny Craig. They should
check with their physician before joining.Nutrition/Dietetic concernsTeaching children how to eat a healthy diet sets a
framework for their lifetime eating habits. A nutrition-
ist or dietitian can help families to understand how
much and what kinds of food are appropriate for their
child’s age, weight, and activity level.
The American Heart Association has adapted the
following dietary suggestions from the federal Dietary
Guidelines for Americans 2005. These guidelines
apply to people over age 2. Separate guidelines exist
forinfant nutrition.
For children ages 2–3, no more than 35% of their
calories should come from fats.
Children over age 3 should limit their fat intake to
about 30% of their total calories. These fats should
be monounsaturated or polyunsaturated. Saturated
fats andtransfats should be avoided.
Fruit and vegetable intake should be increased, but
fruit juice should be limited.
At least half of all grains eaten should be whole
grains.
Sugary drinks, such as carbonated soft drinks,
should be extremely restricted.
Dairy products should be fat-free or low fat after age- Before age 2 children need milk fats for proper
growth and development of the nervous system.
A variety of foods should be offered children, includ-
ing fish and shellfish.
Overfeeding children or making them ‘‘clean their
plates.’’ should be avoided.
It is often difficult for parents to understand how
much food their child should eat at a particular age.
Parents tend to overestimate the amount of food small
children need. The daily amounts of some common
foods that meet the American Heart Association
guidelines for different ages are listed below. These
amounts are based on children who are sedentary or
physically inactive. Active children will need more
calories and slightly larger amounts of food.
children age 2– 3 years: Total daily calories 1,000;
milk 2 cups; lean meat or beans 2 ounces, fruits 1 cup;
vegetables 1 cup; grains 3 ounces.
girls ages 4–8 years: Total daily calories 1,200; milk 2
cups; lean meat or beans 3 ounces; fruits 1.5 cups;
vegetables 1 cups; grains 4 ounces.
boys ages 4–8 years: Total daily calories 1,400; milk 2
cups; lean meat or beans 4 ounces, fruits 1.5 cup;
vegetables 1.5 cups; grains 5 ounces.
girls ages 9–13 years: Total daily calories 1,600; milk
3 cups; lean meat or beans 5 ounces, fruits 1.5 cups;
vegetables 2 cups; grains 5 ounces.
boys ages 9–13 years: Total daily calories 1,800; milk
3 cups; lean meat or beans 5 ounces, fruits 1.5 cups;
vegetables 2.5 cups; grains 6 ounces.
girls ages 14–18 years: Total daily calories 1,800;
milk 3 cups; lean meat or beans 5 ounces, fruits 1.5
cups; vegetables 2.5 cups; grains 6 ounces.
boys ages 14–18 years Total daily calories 2,200; milk
3 cups; lean meat or beans 6 ounces, fruits 2 cups;
vegetables 3 cups; grains 7 ounces.TherapyChildren who are overweight often have psycho-
logical and social problems that can be helped with
psychotherapy in addition to nutritional counseling.
Cognitive behavior therapy (CBT) is designed to con-
front and then change the individual’s thoughts and
feelings about his or her body and behaviors toward
food, but it does not address why those thoughts or
feelings exist. Strategies to maintain self-control may
be explored. This therapy is relatively short-term.
Family therapy may help children who eat for emo-
tional reasons related to conflict within the family.
Family therapy teaches strategies to reduce conflict,
disorder, and stress that may be factors in triggering
emotional eating.
Although drugs are rarely prescribed for weight con-
trol in children, many overweigh children have
depression and anxiety. Drug therapy to treat these
conditions may help the child to better deal with hisChildhood obesity