Contents | eMJA Home     

Med J Aust 2000; 173 Suppl 7 August: S9-S10

Weight management in children is similar to that in adults (but with even less evidence base),⁴² and, in the long term, children may be more successful than adults.⁴³ Early intervention is important as overweight is unlikely to remit spontaneously.⁴⁴ Parents are the prime agents of this change⁴⁵ and it is often not necessary for children to attend weight management sessions. A single visit for medical assessment is useful for defining and treating any of the medical complications of obesity.³⁷ Gross obesity of early onset, particularly if accompanied by physical abnormalities, must always be assessed by an expert. Successful management requires a reduction in overall energy intake, particularly fat, and a reduction in sedentary behaviours, an increase in physical activity and behaviour change. There must be an individualised and sustainable practical approach.⁴⁶ The overall goal for growing primary school children is to maintain (rather than reduce) weight, allowing them to grow into their weight. Healthy eating is the same for both overweight and normal weight children, although the amounts consumed may need to be different.

Activity should never be regarded as an optional extra. Physical activity in children is generally falling,⁴⁷ and television viewing and childhood obesity are positively associated.⁴⁸ If sedentary pursuits are made less available, children are more likely to take up more active play, with a positive effect on body fat and areobic fitness.⁴⁹ Wriggling and just moving about are normal for children and parents should avoid requesting too much stillness. Increasing lifestyle activity for children means increasing play. Play is often "stop and start" and not intense. Play needs time and parental input -- praise, transport to the park, inviting a friend. Increased lifestyle activity also involves walking instead of driving, using stairs and helping in household tasks.⁵⁰ Planned physical activity has a role in weight management, as well as teaching skill, teamwork, socialisation and improving self-esteem, but should never substitute for an increase in incidental activity in a weight management program.⁵¹

Many of the standard skills in positive parenting are needed in weight management, including praise, support, encouragement and flexibility.⁵² Parents need to be consistent and to model the desired behaviours. Fathers are particularly powerful agents in modelling physical activity. Parents need to be encouraged to set limits and say "no", to observe and to praise appropriate behaviours. However, excessive parental control may have a negative effect on weight management. Self-monitoring of behaviour change is important and star or sticker charts (which are understood by children) are useful for monitoring positive and sustained change. The goals set in weight management must be clear, few in number, simple, and with reciprocal goals for the parents. Achievement of these goals should be rewarded, but not by food. Families need to plan to manage difficult or risky situations (such as parties, holidays, staying with grandparents) in advance -- problem solving is a part of parenting.

Relapse management is also part of obesity management. Relapse will almost certainly occur, and forward planning as to how to reinstitute healthy lifestyle choices and behaviours is important. Emotionally laden words like "bad" or "failure" should be avoided. Childhood obesity management is all about long term change. Families need commitment and the strength for permanent change. Thus, if families are too heavily stressed with other issues, weight management should be revisited at a better time (in three to six months). The currently available pharmacotherapeutic agents, very low energy diets and surgery generally have no place in the management of childhood obesity.

Kate S Steinbeck

   to next question...

Readers may print a single copy of these pages for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company
Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>".

<URL: http://www.mja.com.au/> © 2000 Medical Journal of Australia.