How to prevent obesity -- for babies on up
Copyright Jessica Snyder Sachs, as first appeared in Parenting magazine
At 7 months, Zachary Miller was a happy and healthy, but not especially active, baby. "The pediatrician told me, 'The big ones don't like to move,'" says Zach's mom, Ellie, of Somerset, New Jersey. "She told me to put him on the floor and on his tummy as often as possible. He hates that. But it does get him to push up on his arms and roll over."
At 20 pounds and 27 inches long, Zach was already overweight. His height was in the 50th percentile for boys his age, but his weight was in the 75th (pediatricians like both numbers to be close together). But does it really make sense to be so concerned about a baby this young?
Yes, say an increasing number of health experts. The more weight a baby gains before age 2, the heavier she's likely to be as an older child and adult, studies show. If one or both parents are overweight, the concern is even greater.
And the eating and activity patterns learned in childhood -- for good or ill -- tend to persist for a lifetime. Some overweight kids as young as 3 or 4 can already have elevated levels of cholesterol, insulin, or blood pressure.
But many people miss the signs that a child (especially a boy) is too chubby. In one study, only 21 percent of the moms of overweight preschoolers knew it. As more and more kids get heavier -- the average child's waist has gone up two sizes in the past 20 years -- kids who are overweight increasingly look "normal" to us.
Pediatricians can miss the signs, too, even though the American Academy of Pediatrics (AAP) recommends that they check a child's body mass index (BMI) -- a measure of fatness -- annually starting at age 2.
So it's up to you to be alert to the signs that your child's overweight or gaining too quickly. "Our current lifestyle is putting kids at risk for serious health problems," says pediatrician Sheila Gahagan, M.D., of the University of Michigan's Department of Pediatrics and Center for Human Growth and Development in Ann Arbor, "but we can turn it around." The hard part: Improving their lifestyle usually means changing yours, too.
That means neither obsessive eating nor quick weight-loss plans, which are especially dangerous for children, whose growing bodies require nutrients from a broad variety of foods, including healthful fats. Instead, what's needed is a return to good nutrition centered on family meals, says Naomi Neufeld, M.D., a pediatric endocrinologist and director of KidShape, a family-based pediatric weight-management program in four states.
Here, what you need to know to set your child -- from birth through grade school -- on a path toward maintaining a healthy weight:
Babies: 0 to 1 year
Eating well: Nursing reduces the risk of obesity in later childhood and beyond. Not only do compounds in breast milk help regulate appetite and body fat, but breastfed babies also take in only as much as they need, and milk production adjusts accordingly.
For a bottle-fed baby, resist the urge to encourage him to finish that last ounce -- whether it's formula or expressed breast milk -- after he's signaled he's full. And whether you're nursing or bottle-feeding, don't automatically feed your baby every time he cries, says Dr. Neufeld: "Sometimes all he needs is attention."
Nor should you rush solids. While it's acceptable to start as early as 4 months, it may be best to wait until 6 months -- especially if your baby's a little heavy to start with. When you do start, don't invite him into the clean-plate club. "When he turns his head away, the meal's over," says Christine Wood, M.D., the author of How to Get Kids to Eat Great and Love It!
Getting active: Infancy is a critical time for new brain-muscle connections, but all you need to provide are soft, safe toys and an unrestricted space, such as a five- by seven-foot rug, where your baby can safely roll over, push and pull up, sit, crawl, and play movement games like patty-cake with you. (But don't force his body into extreme positions, such as feet over head.) "I put Samantha, who's nine months old, where she can watch her older siblings playing," says Anna Toma, of Monmouth Junction, New Jersey. "I can tell by the way her eyes light up and her arms go up in the air that she's going to be right in there running around with them as soon as she can."
Toddlers: 1 to 3 years
Eating well: Toddlerhood is a time when many parents, without realizing it, set the stage for mindless consumption of empty calories. Even 100 percent juice should be limited to four to six ounces a day for kids ages 1 to 6, according to the AAP; fruit "drinks" and sugary sodas don't belong on toddler menus. The best beverages are low-fat milk -- and water.
Try not to start hard-to-quit habits, like snacking on fast food, eating in front of the TV, or pacifying a full but restless (or crying) toddler with convenience snacks when you're in the checkout line or car, or just too busy to play. Instead, find a self-directed activity, book, or other noncaloric distraction.
On the other hand, toddlers need to eat between meals -- when they're hungry -- and should be offered healthful snacks, such as soft, bite-size pieces of fruits and vegetables, string cheese, or a tube of low-fat yogurt. (Avoid choking hazards such as whole grapes, nuts, and hard chunks of fruits and vegetables.)
Getting active: Once your child is walking, let him act on his natural desire to keep moving. Whenever you can, slow down so he can walk and climb the stairs, and make sure his days include outside play. "When my daughters were two, four, and six, we all loved to go out in the yard, pretend we were the Powerpuff Girls, and chase each other around," says Hannah Storm, coanchor of The Early Show on CBS and author of Go Girl! Raising Healthy, Confident and Successful Girls Through Sports. (Now that they're a few years older, they all play soccer and T-ball in the yard.)
When it's raining, explore ways to be active indoors --
dancing or wrestling on the rug, or climbing on sturdy furniture. Kids under 2
should watch very little TV; those 2 and up, no more than an hour or two a day.
And when it's time to shop for daycare or a preschool program, look for a daily
schedule that includes both structured games like Duck, Duck, Goose and
unstructured run-around time. Experts recommend that toddlers get at least 30
minutes of structured activity and one to several hours of unstructured
activity daily.
Preschoolers: 3 to 5 years
Eating well: Practice portion control. Serve your child one tablespoon per year of age. A typical meal for a 3-year-old might be three tablespoons each of pasta (try whole-wheat), peas, chicken, and fruit. (If your child doesn't want it all, that's fine.)
What about the child who wants only carbs (the infamous "white diet") while leaving everything else on his plate? Saying "veggies first before seconds of pasta" is tempting, but using food as a reward can backfire -- kids tend to like the reward food even more and the have-to-eat food even less. One solution: Make just enough for one or two toddler-size servings.
Whatever you do, keep offering a variety of healthful choices at every meal. "Tastes mature," says early-childhood educator Harriet Worobey, director of Rutgers University's Nutritional Sciences Preschool, in New Brunswick, New Jersey, which combines early-childhood education with research on childhood nutrition and family development. "Don't stop serving broccoli just because your child rejects it once."
Getting active: Frisbee, hopscotch, bike riding, kickball,
dancing -- the joy of movement takes dozens of wonderful forms in the preschool
years. (Watching a screen isn't one of them.) By age 3, kids need an hour of
structured and one to several hours of unstructured play -- and shouldn't be
sedentary for more than an hour at a time. You don't need to do much to get
kids moving at this age: If the weather's nice, just open the door and go
outside, or take a nature hike with a plastic bucket, which your child can fill
with found "treasures."
Schoolkids: 5 and up
Eating well: Find fun ways to teach your child about nutrition. Here's what Joy Bauer, a registered dietitian in private practice in New York City, does with her kids: She helps each make a list of the favorite treats that, in quantity, would not be good for their "teeth or insides." She then allows one or two a day, any time they choose. And she keeps the portions within reason by stocking up on small versions, such as "fun-size" candy bars.
Bauer also suggests having kids use sticker charts to log each time they eat fruit, veggies, or other healthful foods. If you've already let sugar and other empty calories swamp your child's diet, gradually start to dial it back. Bauer recommends cutting sugary cereals, fifty-fifty, with healthful look-alikes.
Getting active: Your child can now share more fully in family outings such as hiking, biking, and skating. The early grade-school years, of course, are also a great time to sample a variety of sports and dance, from team sports like soccer and softball to individual ones like karate and gymnastics, hip-hop and ballet. By this age, kids should get about an hour of moderate to vigorous activity a day, with rest breaks. It doesn't have to be all at once, either -- 10 or 15 minutes at a time is fine. Now's the time to find creative ways to rein in the mounting temptations of electronic entertainment: TV, DVDs, video games, and Internet sites. "Since my boys were six and nine, they've known that they need to spend a half hour moving for every half hour on the computer or Xbox," says LynnAnn Covell, an exercise physiologist at Green Mountain at Fox Run, a nondiet weight-loss resort in Ludlow, Vermont.
In the older grade-school years, sports and dance can become
highly competitive. "That's unfortunate, as it means that less
athletically inclined kids tend to drop out," says pediatric exercise
physiologist Randy Claytor, Ph.D., of Cincinnati Children's Hospital and
Medical Center. If that happens to your kid, he suggests, try setting up social
situations in which she can play sports with friends "just for fun."
Walking or riding bikes to school together can also be an opportunity to chat
and bond. (For tips on making it safer in your town, go to the CDC's Walk to School website. And if you're looking
for ways to make your child's school healthier,
check out Action for Healthy Kids.)
Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World and Corpse: Nature, Forensics and the Struggle to Pinpoint Time of Death.
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