Bright Futures in Practice: Physical Activity

OBESITY

Nutrition

Parents need information on how to encourage their children and adolescents to practice healthy eating behaviors, beginning in childhood.² Suggestions include

Gradually weaning infants from the bottle at about 9 to 10 months of age.
Switching children from whole milk to reduced- fat, low-fat, or fat-free milk after 2 years of age.
Gradually reducing children's fat intake to no more than 30 percent of their daily calories by age 5.¹⁰
Limiting the consumption of high-sugar foods, including juices.
Being aware of portion sizes, especially of high-fat and high-sugar foods.
Limiting the consumption of convenience and fast foods.
Encouraging family members to drink water.
Encouraging children and adolescents to make healthy food choices based on the Dietary Guidelines for Americans and the Food Guide Pyramid. (See the Nutrition chapter.)

Physical Activity

Moderate amounts of physical activity are recommended on all, if not most, days of the week.¹¹ Children and adolescents can achieve this level of activity through intense activities (e.g., hiking for 30 minutes) or through shorter, more intense activities (e.g., jogging or playing basketball for 15 to 20 minutes). Parents, recreation program staff, and health professionals need to promote physical activity in children and adolescents and help them increase their physical activity levels and decrease sedentary activities. For example, parents can playfully chase their children around the yard or playground, or encourage their children and adolescents to dance to music before dinner or ride a stationary bike while watching television.² Parents can also get their children and adolescents involved in physical activity programs or organized sports, which can help increase skill levels and self-confidence, foster teamwork, and increase energy expenditures.

Screening

Body mass index (BMI) can be used to screen children and adolescents for obesity (Figure 6). BMI is calculated by dividing weight by the square of height (kg/m²) and can be plotted on a standard growth chart (see Tool H: CDC Growth Charts). BMI reflects body mass rather than body fat but correlates with measures of subcutaneous and total body fat in children and adolescents. Some children and adolescents have a high BMI because of a large, lean body mass resulting from physical activity, high muscularity, or frame size. An elevated triceps skinfold (i.e., above the 95th percentile on the CDC growth chart) can confirm excess body fat in children and adolescents.¹

Health professionals can use the following screening guidelines to determine whether a child older than 2 years or an adolescent is overweight:¹

Children and adolescents with a BMI at or above the 95th percentile for age and sex are considered overweight and should receive an in-depth assessment.
Children and adolescents with a BMI between the 85th and 95th percentiles for age and sex are considered at risk for becoming overweight and should be screened and evaluated, with attention focused on family history and secondary complications of obesity, including hypertension and dyslipidemia.
Children and adolescents with an annual increase of 3 to 4 BMI units should be evaluated.

Figure 6. Recommended Overweight Screening Procedures

Figure 6 is available only in the print version of this publication.

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