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I get lots of letters about overweight preteens. Parents worry whether they should put a growing child on a diet and they should worry about it. Parents also worry about the short and long term effects of obesity.

Everybody knows that kids come in different sizes and shapes. All kids, except the real skinny ectomorphs, look chubby before the pubertal growth spurt which often starts at age 10. But, when preteens are “off the growth chart” which is the term pediatricians use to describe a child who weighs more than the highest weight on the chart for a child of that age and height, that is a red flag.

So what, you might ask. After all if kids come in different sizes someone has to be the biggest. The problem is that too rapid a weight gain in childhood, even after accounting for tallness, can herald adult obesity. And we know that 1) Obesity is associated with serious health problems. 2) It is very difficult to lose weight once the pounds are gained. 3) Adipose (fat) tissue itself doesn’t just stick there on your hips and belly, it produces harmful substances that can cause or worsen problems we try to prevent especially cardiovascular diseases. 4) Diets don’t work–a life style change is required.

Thus prevention of excess weight gain in childhood is a major public health initiative right now, just as preventing polio was once a major issue. This means that pediatricians are no longer telling parents to ignore weight gain in childhood although that is what we used to do.

Putting a child who is still growing on a diet is not the best way to go. Still there are lots of things pediatricians and parents can do to help the overweight child make healthy life style choices. Parents can create a healthy food environment so that their children can make wise food choices.

Here are the Heins suggestions for preventing obesity. They could well be adopted in ALL households because they are health-promoting and good health should be every family’s goal.

• DE-JUNK YOUR HOUSE. Nobody can make wise food choices from a house full of junk food. Get rid of all the processed foods consisting of hydrogenated fats, trans-fats, and refined carbohydrates. You know what they are.

Don’t be so fanatic that you never let your children eat junk as that is counterproductive. When they have money in their pockets they might gravitate toward what the other kids are eating and what is still widely available in schools. Of course you will celebrate birthdays and holidays with cake and candy but you won’t have cake and candy in your house the rest of the year.

If you or your kids get a junk food attack, a major craving to eat some of the stuff, get out of your healthy house and head for some junk, preferably walking rather than driving to the local fast food emporium. If there is unavoidable junk in your house (like after Hallowe’en or a birthday party) simply bundle it up and give it away.

• INCREASE EXERCISE. Get your children moving. Encourage sports, outdoor play, chores (you can dust or sweep the patio to fast music which both cleans the house and burns up some calories). Get the whole family moving by organizing hikes and bike rides. Make a habit of parking at the far end of the lot not the space next to the mall.

• DECREASE TV. The correlation between TV watching and obesity is high. You want your kid to be an active child exercising both brain and body not a couch potato just vegetating there.

• DECREASE MINDLESS EATING. Mindless eating is when you are doing something else like watching TV or a movie and you keep shoving the popcorn in long after you have ceased to be hungry for it. New family rule: all snacks will be eaten at the table. Fringe benefit: you and the ants won’t find food under the couch and beds.

If I were the parent of a child who is gaining weight too rapidly I would have a family meeting and say, “This family is going to have some life style changes. Life is sweet and we want to be as healthy as we can to enjoy it for as long as we can.”

What I would NEVER do is talk about dieting, comment on the child’s appearance, count calories or carbs, or nag the child about food choices. It ain’t cool to micromanage your kid’s eating.

Cyd Ludt, Tucson nutritionist says that, “Children eat when they are hungry and stop eating when they are full.” She hates to see parents “mess with what their child is eating” as the parent’s job is to make it possible for children to make healthy food choices. “A parent should never restrict a child’s food because this could make your child feel too dumb to pick the right foods.”

Is it ever appropriate for a child to diet? Yes if the child is motivated to do so, if the reasons are to promote health not change appearance, and if a doctor approves and supervises the weight loss. The diet should be balanced, contain all essential nutrients, and reduce calories only very moderately. The major thrust should be increased exercise and activity. In most cases the doctor would wait until the child stopped growing before prescribing a diet but the Heins Plan can be started right away as it is not a diet but rather four healthy life style principles suitable for all families to observe.