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Futures in Practice: Physical Activity |
OBESITY
Treatment
The primary
goals of a program to treat uncomplicated obesity are for
children and adolescents to achieve healthy eating behaviors,
participate in regular physical activity, and achieve psychological
well-being, instead of ideal body weight. The first step
toward weight control for children older than 2 years of
age and adolescents who are overweight is weight maintenance,
which can be achieved by making modest changes in food intake
and by participating in physical activity.
If weight loss
is recommended by a health professional for medical reasons,
the child or adolescent should lose only about 1 pound per
month.1 An appropriate goal
for children and adolescents who are overweight is a BMI
at or below the 85th percentile, although such a goal should
be secondary to the primary goal of practicing healthy eating
behaviors and participating in regular physical activity.
Counseling
Health professionals
can use the following guidelines for counseling children
and adolescents who are overweight, and their families,
to help children and adolescents obtain and maintain a
healthy weight:1
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Begin
intervention early. Health professionals should initiate
treatment suggestions described when children 3 years
of age or older become overweight.
-
Tell
parents that children or adolescents should never be
placed on a restricted diet to lose weight, except when
a health professional recommends one for medical reasons
and supervises it.
-
Recommend
that parents focus on gradually changing the entire family's
eating and physical activity behaviors instead of singling
out the child or adolescent who is overweight.
-
Help
children and adolescents who are overweight deal with
teasing.
-
Encourage
parents to monitor their child's or adolescent's eating
and physical activity behaviors.
-
Start
slowly. Ask parents to suggest one or two eating or physical
activity behaviors to change, and help them monitor the
changes.
-
Encourage
parents to promote physical activity in their children
and adolescents, and make it fun.
-
Encourage
children and adolescents to participate in physical activities
they enjoy.
-
Recommend
that parents plan activities each week to encourage all
family members to participate in physical activity.
-
Encourage
parents to be sensitive to the needs of their children
and adolescents who are overweight. For example, some
children and adolescents who are overweight may have
difficulty with certain physical activities or may feel
embarrassed when participating in them.
-
Encourage
children and adolescents to incorporate physical activity
into their daily lives (e.g., by using the stairs instead
of taking an elevator or escalator, by walking or riding
a bike instead of riding in a car).
-
Encourage
parents to be positive role models by practicing healthy
eating behaviors and participating in regular physical
activity themselves.
-
Encourage
parents to participate in physical activity with their
children and adolescents.
-
Encourage
children and adolescents to reduce sedentary behaviors
(e.g., watching television and videotapes, playing computer
games). En-courage parents to limit these activities
to 1 to 2 hours per day.
-
Encourage
parents to praise their children and adolescents who
have obtained or maintained a healthy weight.
-
Inform
parents, children, and adolescents about the health consequences
of obesity.
-
Recommend
that parents focus on permanent behavior changes to help
their children and adolescents obtain and maintain a
healthy weight. Children and adolescents should avoid
short-term diets and physical activity programs aimed
at rapid weight loss.
-
Norms
for a healthy appearance vary across cultures. Counsel
parents, children, and adolescents within the context
of their culture.
Referral
Children and adolescents
with serious complications of obesity need to be referred
to a physician or pediatric obesity treatment program. Complications
that indicate referral include pseudotumor cerebri, sleep
apnea, obesity hypoventilation syndrome, Blount's disease
(tibia vara), slipped capital femoral epiphysis, severe overweight
(above the 99th percentile), and severe overweight in children
younger than 2 years of age.1
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