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Med J Aust 2000; 173 Suppl 7 August: S10

General advice

Nutritional advice aimed at optimal growth and development, including prevention of overweight, and advice used as a starting point for the overweight child, is very similar. Firstly, children's eating patterns should be based on cereals, fruit and vegetables. Aim for smaller serves with variety rather than larger serves with fewer choices. Meat, dairy foods, legumes and nuts are needed to provide calcium, protein, iron and other nutrients. Avoid frequent inclusion of foods with large amounts of added sugar, such as soft drinks and confectionery, and consider fat intake and fat type.⁴ Secondly, regular meals, including breakfast, are essential, along with nutritious snacks between meals.^10,11,53-55 Finally, it is important that parents assume responsibility for decisions about the range and availability of food items in the home; children should have the option not to eat a food if they wish.^56,57

Fat restriction
Rigid fat restriction is neither necessary nor desirable in children. Overzealous fat restriction has been known to result in inadequate energy intake and growth restriction.⁵⁸ For chidren aged less than five years it is not necessary to choose reduced fat dairy foods or to limit foods which are natural sources of fat, such as meat or cheese, or grain-based snacks. While foods with high levels of saturated or added fats, such as fried snacks and cream, are not necessary in a child's diet, many foods with a significant fat content are rich in nutrients and are important components.⁵⁹ Younger children often require the more concentrated energy source which fat offers. However, if a child is overweight, more specific advice about limiting fat intake may be required, even at under five years of age.^8,60

Children of normal weight aged over five years can be offered reduced fat dairy products. The NHMRC's Dietary guidelines for children and adolescents suggest that fat should provide 35% of total energy. This should include the mono-unsaturated and polyunsaturated oils from olives, seeds, nuts and other vegetable sources and some fish. Saturated fat should be limited to 10% of total energy intake.^4,60

Diet modification
Changes to diet for overweight children should be based on changes in eating for the whole family, guided by the NHMRC's Dietary guidelines for Australians,⁶¹ with some modification for children in accordance with the guidelines for children and adolescents.⁴ Strict "diets" of any type are not recommended. Health professionals should stress the health benefits of suggested dietary change for the whole family, as parents often believe that other family members do not need, or may be disadvantaged by, the suggested changes.

The family diet needs to focus on choosing lower-fat cooking methods, and the choice of lower-fat products when shopping; lower-fat snacks and water, as the preferred drink, should be offered. Treats should occasionally be included in the family plan, and eating a wide variety of breads and cereals, fruit and vegetables should be encouraged. Eating high-fat fast foods more than seven times a week is reportedly related to the incidence of obesity (data from the Health of Young Victorians Study, 1997, Kylie Hesketh, Centre for Community Child Health, Royal Children's Hospital, Melbourne, personal communication).

Weight loss strategy
Rapid weight loss in children may result in growth failure, and is associated with lower intake of the nutrients essential for development. Maintenance of weight as height increases may allow the overweight child to eventually achieve an appropriate weight. Some initial weight loss (no more than 1-2 kg/month) and then weight maintenance would be a very satisfactory outcome. In practice, slowing weight gain would be a realistic goal. For example, for an 11-year-old boy at the 90th height centile, expected weight gain would be 7 kg over 12 months. A weight gain less than this represents a relative loss.

Limited food choice is often noted in the eating patterns of overweight children. Many parents are concerned if a child, even an obese child, refuses a meal or particular food. Health professionals should reinforce a child's prerogative to refuse a meal without the need for parental concern.⁵⁷

Kay L Gibbons

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