It is crucial for children who are obese to lose weight.  In extreme cases, they will not tolerate exercise for very long, and dietary intervention will be one of the first steps in treatment.  An obese body requires a lot more calories each day than a lean body (if activity levels are the same).  Any changes made must be gradual.  Children will respond poorly to sudden, dramatic changes in their diet, and may feel they are being punished.  Family support is important and changes made to the child’s diet should be made to all the family’s diet.  Gradually reducing junk foods while introducing, trialling and experimenting with whole grains (to satisfy appetite and prevent hunger re-appearing rapidly as it does when sugary foods are eaten), fresh fruits and vegetables and legumes are the best approach. 
Fresh fruit and vegetables are important to help build levels of vitamins and minerals that the child will most likely be quite deficient in.  Salt should not be added to cooking or at the table as most obese children will be consuming far too much sodium, which is found in high levels in processed meats, snack foods and just about all pre-packaged items.  High sodium levels increase the risk of hypertension, cardiac problems and accelerate development of atherosclerosis. 

As with diet, changes in exercise patterns and levels should be made gradually.  Putting an obese child on a treadmill and insisting they run can lead to fainting or irregular heart beat, joint damage or in severe cases even a heart attack.  Start with walking – walk to school or home again, walk the family dog (or get one to walk from a neighbour or friend), park further away from shops or other destinations and walk.  Spend time outdoors, kick a ball, throw a Frisbee, walk along the beach or do gentle walking trails.  Swimming is also a good exercise, as the water helps support the body weight and takes the stress off joints.  Walking in water is an excellent resistance exercise. 

As fitness improves, try bike riding, longer or faster paced walks, slightly higher intensity games and sports and continue to increase intensity and duration in line with the child’s improving cardiovascular fitness and reduced weight. Try to keep exercise fun, try to avoid arguments and having to force the child to exercise.  If they aren’t interested, try something else.  Try to combine with activities they already enjoy.  Again, don’t single children out, have the whole family participate.  Find a sporting team or a class (yoga, karate, dancing etc), that the child can join with friends and so on.

It is important to avoid crash dieting and don’t set goal weights.  Teasing children, mocking or belittling them for their size and inability to perform activities or for cravings or secret snacking is not appropriate and will serve only to alienate the child and make them feel even worse than they likely already do.  Parents, friends and care-givers need to be supportive.  Young children don’t instinctively over-eat, choose poor quality foods and lie on the couch all day.  Obesity in young children is not their fault but a product of poor nutrition, role-models and availability of foods, lack of knowledge of nutrition, depression and many other factors. 

To encourage continued improved diet look for improvements in the child’s overall health, physical and psychological condition. Comment on improvement in school work, condition of hair and skin, increased mood and energy levels, as well as their weight loss.  Help them to notice the positive changes occurring because of their dedication to dietary change and increased activity.  Remind them of how far they have come (from puffing after walking a block to riding comfortably to and from school for example).  When children feel better, look better (in terms of their physical condition) are aware of their improvements and feel those around them appreciate the efforts they are making they are more likely to lose weight healthily and to develop long term healthy habits that will see them remain at a healthy weight long term.  When children slip, or go backwards, don’t focus on it, but rather, focus on encouraging them to keep trying.

When dealing with parents of obese children it is important to remain non-judgemental and to assume they have good intentions and desire to help assist their child to lose weight, while improving the family’s nutritional habits and activity levels.  It is important firstly to inform parents about nutrition and the nutritional requirements of children, to provide information in a friendly and understandable way and to suggest changes to diet and lifestyle that seem easy for the family to make.  If parents feel overwhelmed are burdened by guilt or feel changes are going to be too hard to make they can feel helpless and will be less able to help their children.  Parents need support and encouragement (but not appear patronising) to make changes.

Nutritionists need to be tactful and compassionate and focus on the future and the changes that need to be made, rather than past mistakes, misunderstandings or misconceptions.  Issues such as time management will need to be addressed as so many families have sedentary lifestyles rely on take out foods and packaged foods because they can’t seem to find time to prepare meals from scratch or attend exercise classes etc.  Creativity can be needed to find ways to incorporate changes into family life.

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