Overweight children are often teased and left out of activities. As a result, they suffer low self-esteem, which makes fighting the problem even more difficult. Moreover, fat children run a high risk of such medical complications as high blood pressure, diabetes and heart disease.

Formal definitions of childhood obesity vary, but in general, a child is considered obese if her weight is more than 20 percent above the average for children the same age, sex and height.

WHAT CAUSES CHILDHOOD OBESITY?
Obesity stems from a number of causes that all reinforce each other. Weight problems run in families; by one formulation, a child with one obese parent stands a 40 percent chance of becoming obese, and a child with two obese parents stands an 80 percent chance. Poor eating habits and distorted attitudes toward food also may increase the tendency to become overweight. Lack of physical activity is also an important contributor to obesity. Excessive television time and computer games are bad because they lead to lack of exercise and frequent snacking. Stress in the home may trigger overeating in some children. Harsh discipline, sibling rivalry and strife between parents can lead to feelings of insecurity that some children assuage with excess food.

WHEN SHOULD I SUSPECT THAT MY CHILD IS BECOMING OBESE?
You should be able to recognize a weight problem by comparing the child to her peers and checking the child's growth record. If weight is consistently in a much higher percentile than height, the child may be developing a problem.

Be careful not to mistake the normal roundness of infancy for a developing weight problem. If you have concerns, share them with your pediatrician.

IS MEDICAL ATTENTION NECESSARY?
Yes. The doctor will ask questions about the family's and the child's eating and play habits. Most likely, the cause will be readily apparent: Too much food and too little exercise. The doctor may want to perform blood tests to rule out hormonal disorders that can, in rare cases, trigger childhood obesity.

WHAT TREATMENTS ARE AVAILABLE?
The doctor may refer you to a registered dietician, who can help you modify your child's eating patterns to reduce overall calorie consumption. For children, the goal is not to lose weight but rather to slow weight gain until vertical growth catches up.

TIPS FOR SLOWING WEIGHT GAIN
If a child's weight falls outside the norm for her age—or if she is well above average in weight but barely average in height—the pediatrician may recommend some measures to slow the weight gain. These measures may include:

• Reducing the amount of fruit juice the child drinks. Many children drink juice instead of water, adding significantly to their daily calorie intake (Try to limit juice to no more than three or four ounces a day)

• Switching to skim milk (check with your doctor first if the child is under two)

• Avoid fried foods

• Limiting the use of butter and margarine

• Avoiding processed baked goods such as cookies, cakes and doughnuts

• Avoiding snack foods such as chips

• Serving fresh fruit instead of juice, applesauce or dried fruit

• Presenting healthful foods in fun and attractive ways (For example, arrange a few raisins, a banana slice and a peach slice into a face on a plate)

• Using less than a tablespoon of peanut butter per sandwich

• Substituting low-fat cheeses such as part-skim mozzarella for American and cheddar cheese

• Increasing the child's level of physical activity, particularly between the hours of three and six P.M., when most overeating takes place

• Avoiding use of food as a reward or witholding of food as punishment

RECOGNIZING OBESITY

Your child may be developing a weight problem if she:

• Experiences a steady increase in weight percentile with each checkup

• Eats large amounts of food or eats very frequently compared to age-mates

• Tires easily during exercise

• Uses food to soothe hurt feelings or cope with fears

GETTING HELP
Call your doctor if:

• You have any concerns about your child's weight or any questions about your child's diet

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.