Adolescent Medicine 

         Is Your Child Too Heavy?       

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by Ellen Lane for Daily Press

Nicknames, teasing and jokes — overweight children get more than their share of all three. But kids who carry around extra pounds also are setting themselves up for more serious problems down the road.

Overweight children are at risk for joint problems, diabetes and depression with onset during adolescence and high blood pressure, heart disease with onset in early adulthood, says Dr. Gilberto Velez-Domenech, chief of adolescent medicine at the Children’s Hospital at Westchester Medical Center.

There are about twice as many overweight children in the United States as there were 30 years ago. Roughly 25 percent of all children and adolescents are considered overweight, and just one percent has a specific medical condition that triggers weight gain. 

“It’s really disturbing, because we know exactly what these kids can run into," Dr. Velez-Domenech says.

So what’s to blame? There are two main culprits: Not enough exercise and too many high-calorie foods. Instead of playing outside, many children are spending hours a day glued to TVs, playing video games and surfing the Internet.

They’re also munching on fast food, chips and other fatty snacks. With more two-career families, parents often don’t have time to watch what their children are nibbling on, or to cook healthy meals every day, Dr. Velez-Domenech says.

It can be hard to tell if a child is too heavy because a child's body is always changing. Children often gain weight just before the growth spurt and they also put on more fat as they enter puberty.

Most doctors rely on an index called the body mass index. The BMI is a calculated number — weight in kilograms divided by height in meters squared. Doctors compare that with results from children of the same sex and age.

Generally, a child with a BMI in the 95th percentile or higher — meaning the child’s index is higher than 95 percent of other children — is considered overweight.

Doctors differ in how they define morbid obesity, or a weight high enough to put a child at greater risk for serious health problems. Generally, that’s when a child is 100 pounds or more above ideal body weight.

Parents shouldn’t panic if their child looks a little chubby. But rolls of fat and lots of extra padding on the abdomen, thighs and cheeks — common areas where fat deposits — often mean trouble. A weight gain that’s much faster than a height gain also isn’t normal.

“A lot of it is just plain common sense,” Dr. Velez-Domenech says. “If you’re suddenly buying bigger and bigger clothes and it’s not because of the growth spurt, there probably is something wrong.”

Medical Center doctors who treat overweight children check for metabolic problems and endocrine disorders that can trigger weight gain. In girls, doctors also have to rule out abnormalities of the reproductive system, particularly if menstrual irregularities are present.

Helping children lose weight can be tricky because cutting calories too drastically can interfere with normal muscle and bone growth. Children also end up hungry, miserable and more likely to quit trying to lose weight. And an outright ban on sweets like chocolate can make the child crave them even more.

In younger children, the strategy is to hold weight steady so they will thin out as they grow taller. In teen-agers who have reached puberty and have already gone through a growth spurt, Dr. Velez-Domenech typically starts by cutting their calorie intake by about 50 percent.

With all ages, doctors emphasize fitness and health instead of weight. That emphasis helps children keep a positive attitude and can prevent eating disorders from striking down the road.

“You don’t want them to get hung up on the numbers,” Dr. Velez-Domenech says. “Kids are constantly bombarded with the message that fat is bad. If they hear the same message from a doctor who is pushing for quick results, they can get carried away. You don’t want to get it in their heads that something is wrong with them or that it is their fault.”

Exercise is key. Children can start by walking 30 minutes a day, at a brisk pace, and build from there, Dr. Velez-Domenech says. Parents can set a good example by staying active themselves.

 It's also never too early for children to learn good eating habits. Even very young children shouldn’t be forced to eat if they aren’t hungry — meaning plates don’t always have to be clean, as long as the child is eating nutritious foods.

By the time a child is 2 years old, extra fat shouldn’t be shrugged off as normal baby fat. Young children who are overweight are more at risk for staying that way. 

“If the whole family is involved in staying fit and healthy, the child is much more likely to be successful,” Dr. Velez-Domenech says. “It should be a whole lifestyle approach.”  

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Last modified: November 04, 2004