- by Dr Gowher Pebbles n Pearl Pediatrics and Child Care
- 0 Shares
- Mar 20 2017
The Child with Obesity
Goals of therapy include: (a) Behavior goals, with the primary goal of treatment being the establishment of healthy eating and activity patterns, (b) medical goals such as resolution of any secondary e.g. abnormal blood pressure or lipid profile, and (c) weight goals (usually weight maintenance rather than weight loss unless there are complications of obesity or unless the child is over 7 years old with a BMI above the 95th percentile.
Facilitating change is difficult but success can be increased if intervention begins early and if the family is ready for change. It is important to educate families about the complications of obesity and to involve all family members and caregivers. Indeed, when dealing with pre-adolescent children, the focus should be on the parents/caretakers as the agents of change, rather than expecting young children to be responsible for any lifestyle change. The family should be told that the aim is to achieve permanent changes and not to focus on short-term diets or exercise programs for rapid weight loss. The family needs to learn how to monitor eating and activity and the intervention program should help the family to make small gradual changes. It is important for the doctor to encourage and empathize, and not to criticize. Depending on resources it is beneficial to involve a variety of experienced professionals.
Dietary Change and Food Intake
The family should be given advice on reducing calorie intake. The goal should be the provision of well balanced, healthy meals without an emphasis on a “diet”. It is recommended that the Food Guide Pyramid is helpful in selecting foods and that the family should try to eliminate 1 or 2 high-calorie food at a time. A “stoplight diet” (green/orange/red) can also be useful.
Involvement of the entire family in making a change to a sustainable and healthy food intake is usually vital. This is because changes in shopping and cooking practices, and altered attitudes to snacking and meal times, may all be required. Essentially the focus should be on behavior change and moderate fat restriction, rather than calorie restriction or a diet prescription. Families can be helped to become aware of some at risk features in their usual dietary intake, such as the following.
- Skipping breakfast or lunch
- Having regular high fat or high energy snacks.
- Snacking frequently in the after-school period.
- Having take away meals, or eating out, on a frequent basis.
- Stocking tempting high fat or high energy food (e.g. cookies) in the cupboards.
A more healthy food intake may be include some of the following elements:
- Use low fat dairy products.
- Stock a range of low fat snacks that the child enjoys eating.
- Make time to eat breakfast.
- Eat together as a family most days of the week.
Obese children may not enjoy group physical activities, such as school sports, because their performance may not be as good as their leaner peers. However, they, or their families, need to be encouraged to incorporate some opportunities for activity into their everyday lifestyle. The following suggestions may be helpful:
- Is it possible to walk part or all of the way to or from school?
- Does the family car need to be used for small chores in the neighborhood Is it possible to walk instead?
- Can some of the family go for a walk together at least once a week?
- Are there safe parks or cycle-ways nearby where young children can play?
Targeting Sedentary behavior
Interestingly, targeting a decrease in sedentary behavior may be more effective than targeting an increase in physical activity. If families and young people are encouraged to be aware of situations when they are being sedentary, they may more readily choose to be active. Families or young people should be encouraged to consider the following:
- How is television used in the household? Is it continually turned on, or does the family use it more discerningly.
- How many hours of television, videos, video games or computers are watched per day?
- Is the remote control used to change the television channels?
- Is the family car used to take children to and from school?
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