Achieving a healthy weight in childhood: A paediatric doctor’s guide

What if I said you could help prevent your child from developing low self esteem, depression, type 2 diabetes, high blood pressure and joint problems? Furthermore, what if by the same actions you could help your child sleep, concentrate and learn better?

This powerful intervention is weight management through nutrition and exercise.

Where I work in Northern Ireland, 28% of children in year 8 are classified as overweight or obese. Since there are many factors in our society that have contributed to the increase in childhood obesity such as the availability of calorie dense foods and increasingly sedentary lifestyle, addressing this issue requires an understanding of the specific barriers each family is facing to enable targeted advice and support.

Recognition

All parents want the best for their children but often it can be hard to recognise excess weight. So how can parents and healthcare professionals alike identify if their child is overweight or obese?

UK NICE Guidelines define overweight as a Body Mass Index (BMI) greater than the 91st centile and obese as a BMI above the 98th centile.

The following resources can be helpful to identify where a child’s weight lies:

● Child Growth Tracker app. Allows you to track trends in your childrens’ weights

https://play.google.com/store/apps/detailsid=com.abqappsource.childgrowthtracker&hl=en_GB

● NHS Children’s BMI checker: https://www.nhs.uk/health-assessment-tools/calculate-your-body-mass-index/calculate-bmi-for-children-teenagers/

Excess weight should be discussed with families or a young person sensitively using non-blaming, factual language. Start by asking if they have any worries about their weight and exploring why that is and what they’d like to do to change it. If you are a healthcare professional using visual cues such as growth charts can be helpful to explain where a healthy weight lies.

Small changes are key

Telling someone to eat less and exercise more is pointless! We need to think practically about the small, manageable changes we can make to our routines that together will make a positive impact that’s truly sustainable.

Exercise suggestions

1. Make the school commute more active. Swap the car for walking or cycling where possible or consider parking further away from the school to facilitate a short walk. If you use public transport, consider getting off a stop early and walking a little further.

2. Make being active a family activity. Plan weekend walks around a local forest park, the beach or even just to a playpark.

3. Encourage children to pick a sport or active hobby and attend regular training sessions. Joining clubs is also a great way of encouraging social connection and an improved sense of wellbeing.

4. Prioritise physical activity over screen time.

Dietary suggestions

1. Ensuring good hydration. Switching from fruit juices and fizzy drinks to no-added sugar alternatives such as water or diluting juice is an easy way to reduce calorie consumption.

2. Use smaller plates. Not only does this make it easier to avoid giving children adult sized portions but it also changes how our brains perceive portion sizes allowing us to feel fuller sooner.

3. Eat slower. This allows our body time to recognise that we are full and avoid overeating.

4. Remove temptation - don’t keep high calorie snacks such as crisps, chocolate and biscuits in the house. Provide alternative healthy snacks such as fruit, yogurt, popcorn and veg sticks with hummus.

5. No screen time during mealtimes. This also helps our brains focus on what we are eating and recognise when we are full.

6. Reduce processed foods and takeaway meals.

7. Recognise triggers for snacking habits such as stress or boredom and try to redirect your child away from food as a coping mechanism for these.

In addition to the above, research shows that getting enough sleep can aid weight loss through supporting our metabolism, improving our satiety levels and also our energy available for exercise.

When diet and exercise isn’t enough

Sometimes there can be underlying metabolic or genetic reasons for why a child is overweight.

These should be suspected if

● There is a lack of family history of obesity

● There has been rapid weight gain

● There are developmental delays or dysmorphic features

● The child’s growth is stunted

● The child has hyperphagia - extreme food seeking behaviour

First line investigations are based on the presence of other symptoms but may include blood tests to assess thyroid function and blood sugar and a urine test for free cortisol. Genetic testing is recommended for some children under five years old with extreme obesity (BMI z-score >3.5/more than 3.5 standard deviations above the mean) and also when a genetic syndrome such a Prader Willi or Bardet Beidel is being considered.

 Final thoughts

Hopefully the tips provided here will help to empower you to recognise excess weight and take action to create healthy habits so that children can thrive physically and emotionally. Every step towards a healthier lifestyle is a step towards a brighter future for our children.

Resources for families: 

Henry Program provides a wide range of support for families from pregnancy to age 12 including workshops, programmes, resources and online help. Some trusts in Northern Ireland have active programs parents can link in with.

https://www.henry.org.uk/about

Unicef: How to support your child if you are worried about their weight
https://www.unicef.org/parenting/food-nutrition/how-support-your-child-if-you-are-concerned-about-their-weight#:~:text=Refrain%20from%20using%20stigmatizing%20language,speaking%20about%20overweight%20and%20obesity.

NHS Advice for Parents of Overweight Children:
https://www.nhs.uk/live-well/healthy-weight/childrens-weight/advice-for-parents-overweight-children/

Healthier Families. A great website with ideas on how to eat better and move more.

https://www.nhs.uk/healthier-families/

References:
1. The Children’s Health in Northern Ireland 2022/23 report breaks down indicators such as birth weight, maternal BMI, maternal smoking, breastfeeding status by various geographies and by deprivation status. https://www.publichealth.hscni.net/publications/statistical-profile-childrens-health-northern-ireland-202223

2. Public Health England. Childhood obesity: applying All Our Health. Public Health England, 2020. Available: https://www.gov.uk/government/publications/childhood-obesity-applying-all-our-health/childhood-obesity-applying-all-our-health

3. Fifteen minute consultation: The child with obesity: https://ep.bmj.com/content/107/3/182#ref-1

Post written by Dr Natalie Catherwood, Paediatric Registrar

Image on blog post courtesy of the World Obesity Federation which works to ensure non-biased respectful images are used in the media when discussing obesity.