nutrition program services home

Weight Loss Methods for Children

Introduction

No matter how many new weight loss methods and products are developed, basic concepts about weight and calories do not change. The "calories in - calories out" concept summarizes the basic message, which is: if you eat more calories than you need, you will gain weight. If you eat fewer calories than you need, you will lose weight. And if you eat exactly as much as you need, you will maintain your weight.

There are no magic pills for weight loss. FDA-approved weight loss medications can be valuable tools for weight loss, but individuals taking these medications must still make diet and lifestyle changes or they won't lose weight. Over-the-counter medications continue to be unsafe, ineffective or both.

Fad diets help some people lose weight, but the weight is often re-gained when the diets are discontinued.  Many fad diets are based on the fact that water weight is lost first when calories are reduced. Once the diets are discontinued, water weight is quickly regained. These diets are ineffective for long term weight loss (which involves fat loss), and they do not teach people how to make the long term changes that are necessary to keep the weight off after it has been lost.

Bariatric surgery is one of the newest weight loss methods. It has received positive media attention; nonetheless, all types of bariatric surgeries have risks and require very stringent post-operative diets. Individuals who do not follow the post-operative diets run the risk of serious health consequences and the likelihood of regaining weight.

For most people, weight loss is best achieved through gradual changes in diet and lifestyle. The good news is that these changes can be made in many different ways, allowing individuals to choose the specific steps that work best for them.

Determining Overweight Status

Determining weight status is not as easy as you might think! Some children carry extra weight well, so it may not be obvious that they are overweight. And because so many children are heavier now than children were in the past, parents may think their heavier children look "normal".

Growth charts are the most common tool used to evaluate weight in children and adolescents. For infants and children up to 3 years of age, the weight-for-length or weight-for-stature charts are used. (Length is measured lying down, stature is measured standing up). For children 2 - 20 years of age, the body mass index-for-age chart is used.

Body mass index (BMI) is a ratio of weight to height and is an indirect measure of body fatness. The higher the BMI, the heavier the child is for his particular height. Children whose BMIs fall below the 85th percentile are usually considered to have normal body weights.  Children and adolescents whose BMIs are between the 85th and 95th percentiles (meaning that their BMIs are heavier than 85 - 95% of other children the same age) are considered to be overweight.  Children whose BMIs are at or above the 95th percentile (meaning their BMIs are heavier than 95% or more of other children the same age) are considered to be obese.

Growth charts are useful, but they have limitations. Some children are larger than their peers, not because they have more body fat, but because they have more bone and muscle mass at earlier ages than is typical. The BMIs of these children sometimes plot at or above the 95th percentile although the children are thin in person. And although most children with BMIs below the 85th percentile are at appropriate weights, it is possible to have a BMI below the 85th percentile and be overweight. Therefore, any growth chart evaluation must be accompanied by a visual assessment. (The use of skinfold calipers to assess fat stores is inaccurate and not recommended).

Any child who has a BMI between the 85th - 94th percentiles, is visually overweight, and has health risks, should be referred to a physician and dietitian. Any child visually overweight, with a BMI at or above the 95th percentile, with or without health risks, should be referred to a physician and dietitian.

Children and Adolescents with Unusual Body Shapes

For children with unusual body shapes, missing limbs, or atrophied limbs, BMI may be of limited usefulness. In these cases, weight evaluation will depend on each clinicians's personal judgment. The face and torso are key factors to evaluate.

In general, if the torso appears to be fat and if the face appears fat or has a double chin, weight loss might be considered. If scoliosis or kyphosis are present, the face may be a more reliable indicator than the torso.

Step 1: Prevent Further Weight Gain

Some children can outgrow being overweight if their growth is allowed to catch up to their weight. To accomplish this, children do have to make some diet and lifestyle changes. In general, it is a good idea for families to meet with a dietitian or other weight management counselor to discuss ahead of time how best to implement diet and lifestyle changes and how to manage some of the problems that may occur. For example, children may become upset when their foods, snacks, television or video game times are changed or reduced. Siblings who don't have weight problems may resent having to make dietary changes.  Alternatively, singling out the overweight children and implementing new diet and exercise rules for only those children may also be difficult.

Strategies to prevent further weight gain in children are listed below. Parents can start with one or two strategies and add additional ones if needed. The strategies can also be used to promote weight loss. For weight loss, parents may need to adopt more strategies and follow them more strictly.

Strategies to Prevent Further Weight Gain (for children older than 2 years of age)

  • Eat regular balanced meals everyday. Serve regular meals, especially breakfast and lunch, to help children avoid overeating later in the day. A "balanced" meal includes a protein food, starchy food, fruit or vegetable and a healthy beverage. Some children may do better with 4 - 5 smaller meals than 3 larger ones.
  • Eat all meals and snacks at the table. Eating at the table teaches children and adolescents to pay attention to what and how much they are eating. This step can also help parents better supervise meals and snacks and make sure portion sizes are reasonable. When a meal or snack is over, food should not be offered again until the next regularly scheduled meal.
  • Eat slowly.  People who eat slowly have been shown to consume fewer calories overall. Eating slowly is an excellent habit for all children and adolescents to learn and may help them avoid gaining back excess weight in the future.
  • No food after dinner. Help children find enjoyable things after dinner that do not involve food.
  • Switch to low calorie substitutes, These include: low calorie mayonnaise, light salad dressings, reduced fat dairy products, low calorie spaghetti sauce and others.
  • Offer healthy and low calorie beverages. Limit sweetened beverages. Serve low fat milk, 100% fruit juice (small amounts), water, and other calories free and low calories beverages.
  • Eat fewer snacks or switch to low-calorie snacks.
  • Eat more home prepared meals and fewer fast food and restaurant meals.
  • Choose healthy, low calorie foods for school breakfast and lunch Teach your child, your child's teacher or your child's school aide how to choose appropriate foods. Or send you child to school with foods prepared at home.
  • Avoid buying foods that are easy to overeat, such as chips, candy, ice cream, etc. Get rid of open bowls of candy, chips, etc. in any room of the house.
  • Reward your child in ways that do not involve food.
  • Limit sedentary television and computer time to 2 hours or less each day. Get children away from the television and computer and involved in more physical activities.
   

Step 2: Lose Weight Safely

Children: Birth to 2 years

This is a period of significant growth and brain development in children. Brain growth requires a diet high in fat. The American Academy of Pediatricians recommends breast milk or full fat formula in the first year of life, and whole milk for children 12 over 12 months of age. Fat intake should comprise 35 - 40% of calories.  Children in this age group are sometimes overweight when parents allow them to have "junk" food such as chips, cookies, cakes, doughnuts, etc., or give them constant access to bottles or sippy cups filled with sweetened drinks. In these cases, parents need to be educated about appropriate foods for their children. Often, eliminating the "junk" foods solves the problems.

Children who are overweight despite being fed appropriate foods require individual evaluation. New guidelines from the American Academy of Pediatrics state that overweight children who are 12 months and older may be given reduced fat milk. However, these changes should be undertaken only after consultation with a physician or dietitian. In general, reduced calorie diets are not commonly prescribed for children this age.

Older Children

For children who have BMIs at or above the 95th percentile and health risks associated with being overweight (high blood pressure, high lipid levels, etc.), weight loss may be necessary. The "Preventing Further Weight Gain" strategies listed above can be used for weight loss.  Specific strategies are also listed in the "Actions Steps for Weight Loss". But before beginning a weight loss diet, all children should follow the guidelines listed below.

Weight Loss Guidelines for Children

  • All children should see a physician or dietitian before trying to lose weight. Health care practitioners can determine appropriate weight loss goals and diets, and set safe rates of weight loss for each child. Children with special needs may have additional health problems and needs that may have to be taken into consideration before weight loss programs can be started.
  • Children must have the active support and involvement of their families in order to succeed at weight loss. Without active parental and family involvement, children will not succeed at weight loss goals. Parents may have to change their own diets and lifestyles in some cases, if they want their children to be successful at weight loss.
  • Diet and lifestyle changes should be made in positive ways. When appropriate, children should be given choices about which low calories foods they will eat and which physical activities they want to try. They should be praised for good behaviors and good choices and re-directed away from bad choices. Parents should be pleasant and consistent in carrying out new rules but should not let bad behavior allow their children to escape the new rules.
  • Physical activity is an essential component of preventing further weight gain or promoting weight loss. All children who are healthy enough and physically capable of participating in physical activities should do so.
  • Children who are significantl;y overweight or obese require active medical management and structured weight loss programs in which they and their families can learn to make effective dietary and lifestyle changes. Programs should be chosen in consultation with each child's physician and dietitian.

Essential Tips for Weight Loss

  • Set reasonable weight loss goals. Weight loss goals must be individualized for most children. The general approach is to set small weight loss goals so that children have every chance to succeed. Success can then motivate children to meet the next small weight loss goal, and so on.  Children should be rewarded each time they meet a weight loss goal. Involve children in determining what rewards they will receive.
  • Weight needs to be lost at a safe rate. Losing weight too quickly can cause gallstones, electrolyte imbalances, loss of heart muscle, heart attack and death. The amount of weight each child should lose per week should be determined by the weight loss practitioner or weight loss team working with each child.
  • Find the weight loss approach(es) that work best for each child and family. In general, weight loss is achieved by:
    • Changing eating habits (eating more home prepared meals, eating more slowly, etc.)
    • Changing kinds of foods eaten (eating more low-calorie foods and fewer high calorie foods).
    • Changing the amount of foods eaten (reducing portion sizes or number of meals, snacks, or beverages).
    Some children will need to make only a few changes in one or two categories in order to lose weight. Others may need to make changes across the board.
  • Take setbacks in stride. Weight loss is a process, not a test that a child passes or fails. Parent should learn when and where their children are most likely to overeat and develop strategies to prevent overeating in those situations.

Step 3: Keeping the Weight Off

All the data that has been collected on this topic applies to adults; however, it seems logical to assume that what adults do to keep the weight off should also work for children and adolescents

   

Based on what works for adults, children and adolescents should:

  • Eat home cooked meals most of the time. Choose healthy school meals. Fast food restaurants and other types of restaurants should be avoided for the most part.
  • Be physically active almost every day of the week.
  • Eat diets moderately low in fat.
  • Weight should be monitored regularly to make sure children and adolescents do not gain more weight than appropriate. If extra weight is gained, weight loss measures should be implemented right away so that small gains do not become larger.

   

Weight Loss Information for Adolescents

Adolescence covers a lot of ground, beginning at age 10 - 13 and ending at age 20. Although nutrition needs for growth and development vary greatly during this period, growth and development do continue during this entire phase. Therefore, it is very important that nutrient needs continue to be met, especially during weight loss. Adolescents should consult a dietitian or physician to determine whether weight loss is appropriate, how much weight should be lost and which methods would be most appropriate for each individual.

Healthy weight loss strategies for adolescents include:

Are any adult weight loss products or methods appropriate for adolescents? What about some of the currently popular diets, such as low carbohydrate diets, low glycemic diet, etc? The following section answers these questions.

Weight Loss Approaches That Do and Do Not Work

 

Health Risks for Overweight Children and Adolescents

Being overweight can cause problems during childhood, adolescence or early adulthood. Some of these problems include: 

       
  • Diabetes
  • Heart disease - high blood pressure, elevated lipid (cholesterol and triglyceride) levels, early adult onset of heart disease, stroke and blood clots.
  • Shortness of breath, fatigue
  • Sleep apnea
  • Reflux (heartburn)
  • Depression and social isolation
  • Reproductive Problems
  • Early adult onset of some cancers
  • Early adult onset of arthritis, disk problems, hip, knee, and foot pain
  •      

   

Children and Adolescents With Special Needs

Down syndrome

Because they have lower metabolic rates than other people, children and adolescents (and adults) with Down syndrome require fewer calories than other people and easily become overweight. Once excess weight is gained, it can be difficult to lose. Therefore, it is important to teach good eating habits to children and adolescents with this syndrome in order to prevent undesirable weight gain.

Exercise should be a regular routine for individuals with Down syndrome whenever possible. Children may be motivated to exercise regularly if they can do so with friends or family members. Exercise and physical activities that require coordination, balance and agility are good choices. Aerobic activities are also important in keeping weight down. Team sports such as basketball, softball soccer and volleyball may also be good choices as long as they are played with other children who are not overly agressive.

Overweight children and adolescents may require unusually low calorie intakes in order to promote weight loss. Vitamins and minerals may have to be added back into the diet separately. Parents should consult a dietitian for appropriate weight loss diets and suggestions.

Myelomeningocele (spina bifida)

The risk of excess weight gain is especially high in non-ambulatory children with this diagnosis. Because these children cannot exercise to burn calories, their only other option is to go on a reduced calorie diet. Calories may have to be reduced significantly before weight loss is seen, which can make weight loss a difficult process.

Prader-Willi syndrome

In individuals with Prader-Willi syndrome, the satiety center of the brain is not working properly. Consequently, children with this syndrome never feel full. They are always hungry and always trying to eat. The satiety problem is not present at birth; it develops after age three or four. But once it develops, it is there for life. Strict diets and exercise are likely to be necessary. Locking the kitchen cabinets and refrigerator may also be necessary.  Behavioral therapy may help individuals learn appropriate eating patterns, but unfortunately, they will still have a lifelong struggle with food.

Prader-Willi syndrome predisposes children to have low muscle tone. By late childhood, however, regular exercise should be a part of each child's routine. Exercises and activities should be chosen based on each child's cognitive abilities. Most children with PW syndrome can participate in school physical education classes. They should avoid jumping, twisting and other high impact activities but can participate in exercise that improves posture, strength and bilateral hand use.  Aerobic exercise is also very important in keeping the weight down.

Beckwith-Wiedeman syndrome and other gigantism syndromes

Children and adolescents with any of these syndromes will be unusually large and heavy for age.  Being larger does not always mean being overweight.  However, when children and adolescents are overweight, they can follow the same weight loss strategies as other children and adolescents.

Syndromes that predispose to obesity

Turner syndrome, Alström syndrome, Proteus syndrome, Cohen syndrome, and others predispose children and adolescents to obesity.  The best approach for individuals with these syndromes is to limit excess weight by limiting calories and encouraging physical activity when possible.

Corticosteroids

Any child or adolescent taking corticosteriods for more than a few weeks is likely to gain weight.  Steriods cause extra fluid and fat retention in the body.  It is difficult if not impossible to lose weight while steriod use continues. However, careful calorie restriction and regular exercise may limit the amount of weight that is gained. Weight loss can be accomplished if steriod use is discontinued.

Corticosteriods cause bone thinning over time; therfore, extra calcium and vitamin D may be needed, and weight bearing exercise (which stimulates and strengthens the bones) is important.  Many common activities provide weight bearing exercise such as walking, jogging, dancing, swimming, yoga, martial arts, gymnastics, weight lifting, bowling and team sports. One important exception is bicycling, which is a good aerobic exercise but is not a weight bearing exercise. Therefore, biking should not be a frequent for of exercise for this population. Children and adolescents should be medically cleared for exercise by their physicians before beginning exercise programs.

Other Medications

Other medications besides corticosteriods can cause weight gain, increased appetite, or both in some individuals. It is a good idea for parents to be forewarned about this side effect so they can prevent undesirable weight gain when children start taking these medications. Zyprexa, Risperdal, Depakote and Paxil are a few of the commonly used medications in the special needs populatio that can cause undesirable weight gain.

Dysphagia

Children and adolescents who have dysphagia (difficulty swallowing) may require thickened liquids and/or thickened solids in some cases.  All thickeners, whether homemade or commercially made, contain calories and add extra calories to the diet.  Weight gain is likely to result unless other parts of the diet are reduced.  Sometimes overall diet quality suffers when reductions are made, and vitamin supplements may be needed to compensate.  Children and adolescents who can exercise should do so, to keep undesirable weight gain to a minimum.

Newly acquired disabilities

New amputees and new wheelchair users often require fewer calories than they required previously. Parents should be made aware of this so they can help children reduce their calorie intake and prevent undesirable weight gain.

Physical Activity & Exercise for Children

Important Information About Physical Activity and Exercise for Children

All children and adolescents should be encouraged to be active. Where safety is not a problem, children and adolescents should be sent outside after school to engage in age-appropriate activities. Extracurricular school activities should include some activities that require movement. Sedentary television, computer and video game time should be limited to two hours or less each day.

Children and adolescents who have medical problems or conditions should be cleared by their physicians for exercise and referred to physical therapists who can design appropriate exercise plans for them.

There are no hard and fast rules for the number of minutes per day that children and adolescents should be active. However, a good rule of thumb is to aim for at least an hour per day. Examples of good activities include: walking, biking, dancing, team sports or games, etc. Computer games that promote physical activity and exercising in front of the television (on stationary bicycles, treadmills, steppers, etc.) are also acceptable choices.

Easy Ways to Help Children Increase Activity

  • When taking children to the store, park further away from the entrance so that everyone walks a little more.
  • Encourage children to take the stairs instead of the elevator whenever possible.
  • Find a few easy games and activities children would enjoy that require some physical activity. These can be done with friends or family.

Make Exercise Fun

  • Take a 10 minute walk with your child after dinner.
  • Toss a ball or Frisbee® back and forth.
  • Play "Simon Says", tag or hide and seek.
  • Learn a few dance steps or martial arts moves together.
  • Ride bikes together
  • Have children participate in chores such as washing cars, working in the garden, etc.

Physical Activity Goals for Children

  • Help children build up to at least 60 minutes of physical activity every day, most days of the week. Children who are not used to being active should become more active gradually.
  • Get children involved in a variety of different activities that require movement so they do not get bored with just one activity! Activities can include computer games that promote physical activity, exercise while watching television (on stationary bicycles, treadmills, steppers, etc.), as well as other indoor and outdoor activities.
  • Children with medical problems or special needs should be cleared by their physicians for physical activity. If specific exercise plans are needed, children should be referred to physical therapists.

Good web sites for children and adolescents who need to get more active:

Different Kinds of Physical Activity - Children

This is not a complete list. Use it to start thinking about activities you might enjoy.

Games and Leisurely Sports

  • Ping Pong
  • Shuffleboard
  • Pool (Billiards)
  • Table hockey
  • Golf
  • Miniature golf
  • Riflery
  • Archery
  • Bowling
  • Horseshoes

Activities That Can Be Done at Low Intensity

  • Walking
  • Aerobics
  • Pilates
  • Dance
  • Yoga
  • Swimming
  • Ice skating
  • Stationary bicycling
  • Tai Chi
  • Badminton

   

Build Up To 30 Minutes of Brisk Walking Five Days a Week

 

  Warm Up Time Fast Walk Time Cool Down Time Total Time
Week 1 walk slowly 5 min walk briskly 5 min walk slowly 5 min 15 min
Week 2 walk slowly 5 min walk briskly 8 min walk slowly 5 min 18 min
Week 3 walk slowly 5 min walk briskly 11 min walk slowly 5 min 21 min
Week 4 walk slowly 5 min walk briskly 14 min walk slowly 5 min 24 min
Week 5 walk slowly 5 min walk briskly 17 min walk slowly 5 min 27 min
Week 6 walk slowly 5 min walk briskly 20 min walk slowly 5 min 30 min
Week 7 walk slowly 5 min walk briskly 23 min walk slowly 5 min 33 min
Week 8 walk slowly 5 min walk briskly 26 min walk slowly 5 min 36 min
Week 9 walk slowly 5 min walk briskly 30 min walk slowly 5 min 40 min

References

Information in this newsletter was adapted from: 

           
  • Recommendations for Treatment of Child and Adolescent Overweight and Obesity, Bonnie Spear, PhD, MD, FACEP, David Ludwig, MD, PhD, et al; Pediatrics vol. 120, supplement Dec, 2007; S254-S288.; published online Nov 30, 2007.
  •    
  • Childhood and Adolescent Weight Management, Commission on Dietietic Registration, 2007-2008.
  •  
  • Evaluation and Treatment of Childhood Obesity, Rebecca Moran, MD, American Family Physician, February, 1999, http://www.aafp.org/afp/990215ap/861.html.
  •  
  • Obesity Evaluation and Treatment: Expert Committee Recommendations, Sarah Barlow and William Dietz, MD, PhD; Building Block for Life, Vol. 23, winter 2000; Pediatric Nutrition Practice Group, American Dietetic Association.
  •  
  • Physical Activity and Exercise for Children With Special Health Care Needs; Pat Vehrs, PhD; Nutrition Focus, vol. 22, no. 4 and 5.
  •  
  • Nutrition Issues in Down Syndrome; Betty Lucas, MPH, RD, CD; Nutrition Focus, vol. 23, number 3.
  •  
  • "Supplements Used in Weight Management," George Bray, MD and Donna Ryan, MD; Obesity Management, volume 2, number 5, October, 2006, 186-189.
  •  
  • "Prescribing Exercise for Obese Youth in the Primary Care Setting," Thomas Rowland, MD; Obesity Management, Volume 4, number 4, August 2008, 184-188.
  •  
  • Pediatric Nutrition in Chronic Diseases and Developmental Disorders, Prevention Assessment, and Treatment, 2nd edition, edited by Shirley Ekvall and Valli Ekvall, Oxford University Press, 2005.