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I am frequently asked questions about children who are too fat. All the questions end with something like, “How can I help my child lose weight?”

There is no magic solution. If there were a “fat fairy” who took pounds off if properly rewarded, millions of people would leave billions of dollars under the pillow.

As a matter of fact, millions of people DO spend billions of dollars trying to lose weight. A recent editorial in the New England Journal of Medicine estimates that in our national preoccupation with being thin we spend $30 to $50 billion dollars annually on diet clubs, special foods, and worthless and/or dangerous over-the-counter fat-removal remedies.

Sometimes it seems that all teenage girls are either overeating or starving themselves. In our culture food is easily obtained, widely advertised, and often considered a source of comfort rather than nutrition. We live in a land where being thin is valued, where fat people are ridiculed, and where being overweight is always considered a failure of will.

Weight gain at the time of puberty is common. Usually it’s only a few pounds and should be ignored by both the teen and the parents.

Teens who are obese (the definition of obesity is a weight 20% over what the average person at the same height would weigh) are that way for three reasons.

There is obesity in the family and they have INHERITED a tendency to be overweight. They are UNDERACTIVE preferring by temperament or habit to be sedentary. They OVEREAT, often compulsively, using food to meet other than nutritional needs. Or all three.

We now know that diet alone is never a “cure” for obesity. Although calorie restriction will lead to weight loss, all but a handful of dieters will gain all the weight back–and more–when previous eating habits are resumed. Doctors today, recognizing the futility of maintaining a low calorie diet, are recommending their patients eat “healthy” and exercise.

A low fat diet combined with exercise can lead to a modest weight loss without hunger. And, best of all, such a regime can be followed for life while severe calorie restriction is both impossible and unhealthy to follow.

Let me make a few suggestions about how to help children change their life style and head towards better health and happiness.

o Start with a visit to the pediatrician to rule out any of the rare, but possible, diseases that cause obesity.

o If your child expresses a desire to lose weight, the pediatrician can recommend a diet with moderate reduction of calories. Severe calorie restriction has no place in children and adolescents.

o The regimen likely to be suggested for the child will be good for the entire family as it will cut down fat intake. A low fat, low sugar, high-complex-carbohydrate diet with attention to portion control will help your child prevent further weight gain and slowly lose weight.

o Recommended diet in hand, next go to a registered dietician or nutritionist to learn the best ways to implement the diet regimen in your house. Many pediatricians work closely with a nutritionist and these professionals can be extremely helpful in teaching how to make correct food choices (especially for a kid when out with his or her friends) and in advising about portion control.

o The whole family can and should help. Keep the cabinets and refrigerator stocked with healthy–rather than junk–food and snacks. Nearly every overweight child in one study reported they thought their excess weight could be attributed to snacking.

o If your child is a compulsive overeater, as important as calorie reduction is “self-concept enhancement”. Concentrate on the child’s strengths. Find ways to enhance the child’s sense of self-worth. You can’t give self-esteem like a present but self-esteem becomes part of a person who feels loved and competent. Express love and be creative in finding special things done well so the child will dwell on competencies not weight.

o Because we now know that EXERCISE IS THE MOST IMPORTANT ASPECT OF WEIGHT REDUCTION, encourage the child to increase physical activities. A friend of mine who was successful in losing weight and keeping it off said the secret is to “Double your exercise and halve your food”. Aerobic exercise (running, biking, fast walking, swimming) should be a part of your child’s daily routine. Because there is a correlation between TV and obesity in children and adolescents I would encourage the whole family to become gym or playground enthusiasts rather than TV watchers.

o Because overeating may be associated with compulsive behavior or depression, therapy may be in order. Group therapy which provides peer support can be very helpful.

o Neither you or your child should expect too much. Weight loss should be gradual. The goal should be a HEALTHY body and the wisdom to be HAPPY with that body.