Helping a Chubby Child

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Q: My 11-year old daughter is chubby and I'd like to help her slim down without making her feel bad about herself. She takes dance classes every week and comes to the gym with me and stretches or plays on the balance ball. How can I help her lose some of her excess fat safely?

A: Putting your child on a diet or forcing her to exercise is a tricky proposition. Kids need calories to fuel the growth of their bodies, and getting too few could put them at risk. Not only that, focusing on weight loss and making food or fitness feel like punishment can backfire, inviting a lifetime of a negative issues with food or a reluctance to work out.

Your daughter is still growing. While it's always a good idea to encourage more exercise and more healthful eating in a kid of any size, make sure that your child is truly overweight before deciding that her size needs to be addressed. "Chubby" may or may not indicate a potential weight problem. Has your doctor expressed concern that her weight for her height is in an undesirable range? If not, she may be entering puberty and simply accumulating more fat to create womanly curves, which is normal. There is a chance that she will have continued growth that normalizes her size over the next few years.



Still, you're right to be concerned because if she is seriously overweight, fat kids often become fat adults, and the risk of obesity-related diseases such as diabetes, heart disease and emotional American Academy of Pediatrics, among others.

While genetics may play a role in a kid's tendency to be overweight, there's no doubt that the lifestyle habits can make a big difference. So it makes sense that the best approach, as with adults, is to diet and exercise. Too much TV-watching, video-game playing and Internet use-along with too many sweetened drinks (including fruit juice), too much fast food, and not enough physical activity-all play a powerful role in a child's weight.

To date, it's unclear what the best diet and fitness prescription for kids should be. But key factors have been identified. A 2006 meta-analysis of seven weight-loss interventions for 356 overweight children who were mostly between the ages of 8 to 12 found that the longer the program went on (more than four months), So, rather than go for a two-week diet, incorporate healthier lifestyle changes long-term for your child and whole family. The weight-loss programs studied tended to include dietary, exercise, and behavioral strategies as well as parental involvement. Since parents control many of the influences a child is exposed to, their participation in learning how to eat better and becoming more active themselves, and encouraging their child to do so too, is key.

So, how do you do it right?

As you attempt to address this issue with your child, keep in mind that her body weight is only one indicator of her health. The American Dietetic Association advises not to focus too much on changing a child's body, but instead to emphasize changing their food and fitness behaviors. But watch how you do so. Make sure that exercise is always fun, not a chore. And make eating a positive experience. Family-feeding therapist Ellyn Satter, M.S., R.D., points out that it's easy to instill shame with eating. One way to do this is to give your child "the look" everytime he or she is nibbling on something that you disapprove of.

The USDA's My Pyramid for Kids Web site provides interactive computer games and tips. You're on the right track allowing her to play at the gym with you. Not only do you seem to be avoiding planting her on a tedious cardio machine, you are acting as a role model by showing how exercise is a part of your normal routine. One thing you might try to be extra conscious of is to not only avoid disparaging remarks about her extra fat, but about your own, too. Research has found links between moms who diet excessively and disordered eating in their daughters. If you display a positive view and acceptance of your own body, your daughter will learn to do so, too.

Working your kid out

It's best to encourage more physical play. The 2008 Physical Activity Guidelines for Americans from the DHHS recommends that children get at least 60 minutes of activity daily, including aerobic exercise (riding bikes, playing tag), muscle- and bone-strengthening exercises (jumping, racket sports, climbing and pulling). You don't need to count her cardio minutes or monitor reps of an exercise: Just get her body moving more during the day. Suggest playing hopscotch, jump-rope, Twister or tag instead of a video game or watching a cartoon. (You can get some exercise in this way, too!)

Structured activities are a good idea, too. Dance lessons are already part of your daughter's life, so you might find out if there is any other activity she might be interested in trying (gymnastics? tennis? swimming? tae kwon do?) Investigate local kids' gyms to find out what programs they offer. Or have her try a more aerobic form of dancing; if she's currently doing ballet, have her try hip-hop classes.

But keep in mind that some kids feel like klutzes and are inclined to give up, rather than persevere, when it comes to a new sport that requires skills like hand-eye coordination or complex movements. And make sure she's fit enough to participate; It's hard to get better if you don't have much stamina. Often, a child's poor fitness level can quickly lead to fatigue, and this is a recipe for losing motivation. If your child has poor cardiovascular fitness or strength, put her through some sort of basic training by playing with her at home. Go bike riding or hiking as family, and practice basic skills like jumping rope, and throwing and kicking in the park, before you put her in a competitive and overly challenging sports environment.

Feeding your kid

The big question is whether you should ban soda, chips, cupcakes and candy, or stop fast-food nights out altogether? Satter recommends taking the power of out of tasty junk foods. One way is to present dessert along with the rest of the meal, and allow a child to eat it at will, rather than present it as a prize (or punishment) for eating (or not) their leafy greens. In her new book that is packed with great ideas, Your Child's Weight: Helping Without Harming , she addresses the complex dilemmas encountered when feeding your child and trying to watch their weight.

She suggests that children gain weight not because of what they eat, but because of how they are fed. Satter is known for her concept of the division of responsibility: The role of the parent is to provide appropriate food, and it is the child's responsibility alone to decide to eat as much (or as little) of that food as they feel like at the time. (To find out why you don't need to freak out about whether they are eating too much or too little of the healthful food you provide, read the book.)

Keep in mind that this process may need to be as educational for you as it is for your child. You may need to retrain yourself as to the types of foods your feed your family, and also the rewards you give. Rather than offering a trip to the ice cream parlor as a treat, why not offer a trip to walk through a botanical garden instead? You may need to confront your own food issues and make sure they are not on display, and you may need to experiment with a wide variety of new snacks and meals.

Here are some tips to encourage positive eating practices:

Teach your child to cook and let him or her make healthful recipes (fruit smoothies, salads, creative veggies).

Stick with structured mealtimes and snacks.

Include all kinds of tasty foods for snacks (including treats) to take the negative power away from them.

Allow your child to pack their own lunch or prepare their own breakfast (just make sure the food options that you provide are nutritious ones).

Do you have a fitness or weight-loss question for Martica? Send e-mail to experts@microsoft.com. Please include Ask Martica in the subject line. Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Martica Heaner, Ph.D., M.A., M.Ed., is a Manhattan-based exercise physiologist and nutritionist, and an award-winning fitness instructor and health writer. She has a Ph.D. in behavioral nutrition and physical activity from Columbia University, and is also a NASM-certified personal trainer. She has written hundreds of articles for publications such as Self , Health , Prevention , The New York Times and others. Martica is the author of eight books, including her latest, Cross-Training for Dummies

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