Image for child obesity When talk focuses on childhood obesity in the US, words like “critical” and “epidemic” have become unfortunately common. The tried-and-true prescription of more exercise and better nutrition still holds true, but overweight children face unique challenges when it comes to weight loss.

The Problem

The statistics are disturbing. Over the past thirty years, childhood obesity has tripled for children aged 5-17 years old. Not only are the overall obesity rates increasing, the heaviest kids are heavier than they were thirty years ago. Why is this happening?

Experts who have studied childhood obesity attribute it to a change in lifestyle. The active lifestyle of the past—walking to school, playing outside, and engaging in after-school activities—has been replaced by a sedentary lifestyle of TV and computer games. Eating habits have changed noticeably, with convenience foods that are higher in fat and calories replacing fruits and vegetables.

The health consequences of obesity—physical, emotional, and social—are significant. Type 2 diabetes is common among obese children, along with elevated cholesterol, high blood pressure, sleep problems, gallstones , orthopedic problems, impaired balance, and other physical problems. Emotionally, obese kids can suffer from low self-esteem, negative body image, and depression . Socially, obese kids may encounter bullying, discrimination, and stigmatization.

The Impact of Exercise

Not only does exercise make sense intuitively, the research supports its benefits. In a study, the school day physical activity of 9,751 kindergartners was studied over two years. As kindergartners, the majority of children had physical education 16-30 minutes per day, while as first graders, physical activity shifted to include more children in the 31-60 minutes per day range. The researchers found that the additional exercise reduced the body mass index (BMI) among overweight girls or those at risk for becoming overweight. The researchers conclude that expanding physical education may be an effective means of combating obesity, especially among girls.

In another study, researches at the University of Athens examined the effect of cardio-respiratory fitness on overall fatness in children. A total of 1,362 children ages 6-13 were examined. Body fat was calculated, as well as cardio-respiratory fitness (CRF). The researchers found that body fat was lower in obese, overweight, and non-overweight children who exhibited a high CRF. The researchers conclude that a high CRF may reduce the hazards of obesity in children.

A Sports Medicine Approach

Sports medicine centers its practice on the prevention and treatment of sports related injuries, so it would seem logical to approach exercise for obese children through sports medicine or injury prevention.

In an article in the American Council on Exercise Certified News, Paul Stricker MD, FAAP, suggests a gradual approach to exercise adoption for obese children. Stricker, a pediatric and adolescent sports medicine specialist, explains that obese children may be more prone to certain types of injuries (eg, knee problems, shin splints, stress fractures, and hip problems) because of excess weight.

Heat illness is another challenge faced by obese children. Children in general have a tough time adapting to heat because of lower blood volume, poor thirst, and a high body surface area to body mass ratio. As a result, obese children generate more body heat when they exercise, further increasing their risk for heat illness.

Stricker suggests starting an exercise routine slowly and incorporating some amount of basic conditioning and stretching. Strength training using lighter weights and more repetitions is a good way to burn calories for kids who find high-impact exercise difficult. Of course, any kind of strength training must be done using the proper technique and under strict supervision. Non-impact exercises like cycling, walking, swimming, and water aerobics are also good ways to increase a child’s fitness level.

Pronation of the foot (when the foot is rotated inward) is common in heavy kids, and Stricker suggests using inexpensive orthotics to help prevent injury when exercising.

Rewarding kids based on the amount of exercise accomplished, not how fast it was accomplished, is crucial. Also, it may be helpful to encourage children to avoid watching the scale, and instead focus on body composition changes.

Finally, any weight loss program needs to include proper nutrition. Children trying to lose weight need a diet that helps them lose fat and also supports proper bone and muscle development. Adding more fresh fruits and vegetables while reducing unhealthy fats and sugars can be productive toward both of these ends.

Changing a Lifestyle

It is never too late to change eating habits and start exercising regularly. If your child is obese, build gradually by making small changes. Start by limiting TV and computer time, join in on the exercise, and allow your child to help pick out healthy meals. Change is never easy, but the health consequences of obesity are far too serious to ignore.