Raise a Healthy Kid in a Supersize World

One-third of all kids -- including 24 percent of 2- to 4-year-olds -- are now overweight or obese, according to the Robert Wood Johnson Foundation. In an age when the most common vegetable eaten by toddlers is a french fry, experts say that the way we are feeding our children is laying the groundwork for a lifetime of heart disease, diabetes, and other serious health problems. It's frustrating that many of the factors contributing to the obesity epidemic -- from huge restaurant portions to vanishing phys ed classes -- seem to be out of our control. Fortunately, research has revealed these simple ways to help prevent kids from putting on too many pounds.

Doctors never used to worry about children being overweight before age 2, but that's changing. A new Harvard study found that babies who gained weight more quickly in their first 6 months -- going from the 50th to the 90th percentile, for example -- were significantly more likely to be obese at age 3. Based on the weights of breastfed babies in many countries, they're the new standard for optimal health -- and can identify babies at risk of obesity earlier.

And don't start solids too soon. Formula-fed babies are more likely to be heavy than those who are breastfed because they typically consume up to 20 percent more calories. While a nursing baby usually lets his mom know if he's no longer hungry, parents are more likely to coax their baby to finish a bottle. Babies who start eating solid food before 4 months also tend to weigh more. If possible, breastfeed for your baby's first year, and hold off on solids until 6 months.

This height/weight ratio, which takes into account a child's age and sex, is the best measure of healthy weight for kids ages 2 and up. Children who fall between the 85th and 95th percentile are overweight, and those above the 95th percentile are obese. "Unlike adults, heavy kids often don't look fat, they just look a little older -- so it's important to check a child's BMI," says Marc Jacobson, MD, professor of pediatrics and epidemiology at Albert Einstein College of Medicine. In fact, a national poll from the University of Michigan found that 40 percent of parents of obese kids described their child as being "about the right weight." And a study in the Journal of the American Medical Association found that pediatricians assess BMI for no more than 28 percent of their patients.

Kids should be active for an hour a day, and it's best to spend at least some of that time outside. "They're more likely to run and jump outdoors than in the living room, and one high-energy activity leads to another," says Sandra Hassink, MD, chair of the American Academy of Pediatrics' (AAP) obesity task force. Start with just 15 minutes a day. Store jump ropes and tennis rackets in plain sight, and keep rain gear handy, so kids can go out on rainy days, too. Try to inject more physical activity into all aspects of daily life: Get your toddler out of his stroller more, have a limbo contest after dinner, play hopscotch while waiting for the school bus.

The most effective way to improve children's habits is to make lifestyle changes as a family -- and emphasize wellness rather than weight. If your kids question new menu items, just say, "We're trying to be a healthier family now, so we can all have more energy." That way, a heavier child won't feel singled out, and normal-weight kids will get the important message that they need to pay attention to their nutrition and fitness too. "Research has shown that if parents don't change their habits, kids won't change," says Dr. Jacobson.

The more you serve them (and eat them yourself), the more likely your kids will be to grow to love them. Keep plastic containers of cut-up fruit and veggies on a low shelf in the fridge where your kids can see them when they're hungry. Be patient, since a child may need to try a new food up to 10 times before accepting it. Research has also shown that gardening makes kids more interested in eating the fruits (and vegetables) of their labor -- so follow Michelle Obama's lead and get sowing.

Parents often try to soothe their crying baby with a bottle or breast, even if she really wants to cuddle or take a nap. But pushing food on kids who aren't really hungry overrides one of their body's primary weight-control mechanisms. "If we're not careful, we give the message that eating fixes every problem," says Dr. Hassink. If your child wants a snack, try distracting her with something else and her "hunger" may vanish until mealtime. In fact, helping her learn to manage her cravings may have a long-term benefit: Two recent studies in the Archives of Pediatrics & Adolescent Medicine found that preschoolers who had trouble waiting several minutes to get candy or other treats were significantly more likely to be overweight by their preteen years.

A healthful diet contains minimally processed foods like whole-grain pastas, breads, and cereals, along with vegetables, fruits, and legumes. These foods have what experts call a "low glycemic index." Because they have more fiber than other carbohydrates, they are metabolized in the body at a slower rate, keeping blood-sugar levels more stable and making kids feel more satisfied. Some children may reject denser grains at first, so start with whole-wheat-blend pasta and "lighter" wheat breads.

Studies have shown that children who don't get enough shut-eye are more likely to be heavy because sleep regulates the hormones that control appetite. "Tired kids also may be less active, and that increases their chance of being overweight," says Parents advisor Judith Owens, MD, associate professor of pediatrics at Brown University. Babies who don't sleep enough tend to be fussier, so parents may overfeed them in an effort to soothe. Infants need about 15 hours of sleep a day in the first 6 months and 14 hours from 6 to 12 months. Kids ages 1 to 3 need 10 to 13 hours, and kids ages 4 to 9 still need 10 to 12 hours.

For many children, weight problems start because of picky eating. Parents end up caving in on almost every food issue, buying unhealthy foods ("It's all that he'll eat!") or giving up on introducing new ones. You need to decide to take charge of the situation because it's a health issue. For example, instead of serving chicken nuggets, you can serve bite-size pieces of grilled chicken. "If your child refuses to eat, relax -- sooner or later, he'll get hungry and adjust to (and even like) the new choices," says Dr. Hassink.

Lots of families give children round-the-clock access to the TV -- and a third of kids ages 6 and under have a television in their room, according to the Kaiser Family Foundation. Kids who watch four or more hours per day have a significantly higher BMI than those who watch two hours or less. If your kids gets mad when you take the TV away, Dr. David Ludwig suggests putting in a music system, which will get them dancing.

Kids who regularly eat with their parents are less likely to gain weight and more apt to choose nutritious foods. Between busy work and childcare schedules, it's impossible to eat together all the time, so start by trying to add just one more relaxed, TV-free meal a week, and serve everyone the same food.

Many parents have developed a warped sense of how much kids should eat. If you give your child too much food and then urge her to finish it, that overrides her natural inclination to say, 'I'm full.' A 2- or 3-year-old needs about 1,000 calories a day, which means serving sizes should be tablespoons, not ladlefuls. Kids ages 4 to 8 need 1,800 to 2,000 calories, depending on their height and activity level. Their serving of protein should be about the size of their fist, no matter how old they are.

Drinking soda, sweet tea, sports drinks, or too much juice can increase a child's risk of becoming overweight -- and even whole milk now is under the microscope. The AAP now recommends low-fat milk starting at age 1 for toddlers who are heavy or have a family history of obesity, high cholesterol, or heart disease. As long as your child is drinking enough milk, offer water with some meals, as well as when your child says she's hungry -- kids often misread their thirst cues as hunger.

New research from Cincinnati Children's Hospital Medical Center shows that many kids in childcare get little physical activity during the day. And a study from the University of Illinois found that 9-month-olds in daycare tend to be heavier than those cared for by their parents. Some of the difference may have to do with a lower level of breastfeeding among working moms, but it may also reflect a lack of communication about what babies eat when parents aren't there. Be clear about what you want your child to be fed and when, and encourage your caregiver to make time for active play.

Giving your child a treat can seem like a quick and easy way to get him to cooperate, stop misbehaving, or feel better. Indeed, a recent study of more than 2,000 Taiwanese children published in the Journal of Happiness Studies suggests that kids who had more fast food and soft drinks were indeed more likely to be happy -- and overweight. Certainly, there are plenty of other ways to boost kids' spirits. Develop a list of nonfood rewards -- such as special time with Dad or a trip to a water park -- to use as treats or to celebrate accomplishments.

Many schools are fighting the obesity problem, with varying degrees of success. A BMI-report-card initiative that started in Arkansas is now used in many states and school districts. Other schools are experimenting with salad bars, gardens, and bans on cupcakes. No tactic is perfect: Some parents feel that mandatory reports hurt kids' feelings by labeling them; others think food bans are unfair. If you've got time, your school probably needs your input. If you don't, at least make sure that the administration is working to ensure a healthy atmosphere.

While you can't always protect your children from unhealthy foods in the outside world, you can avoid bringing them home. "You don't need to ban all sweets and splurges, but limit them to special occasions," says Suzanne Rostler, RD, coauthor, with Dr. Ludwig, of Ending the Food Fight. "After all, it's much more fun for the whole family to go out for real ice cream once a week than to keep low-fat ice cream in the freezer and eat it every night."

Copyright &copy 2009 Meredith Corporation.