Overweight and obesity are nationwide problems—and not just for adults. Over the past 30-40 years, the rates of overweight and obesity in children have increased substantially. Since the beginning of the COVID pandemic, kids and teens have seen an even more significant increase in weight gain.

Dr. Melanie Bean, co-director of our Healthy Lifestyles Center explains how families can help kids develop and maintain good habits for a healthy future.

It’s not all about the scale

What’s considered a healthy weight varies based on a child’s age and sex. Weight also needs to be assessed in relation to height. To do this, we typically use body mass index. A BMI between the 5^th and 85^th percentile in considered the healthiest range for kids. A BMI greater than the 85^th percentile is consistent with overweight and greater than the 95^th percentile in consistent with obesity.

We want to pay attention to the rate of change over time too. For example, we might have greater concern about a child whose BMI percentile has been increasing over several months—such as from 65^th to 80^th—compared with a child who has remained steady at the 85^th percentile. The scale doesn’t tell the whole story—it’s also important to assess children’s eating and exercise behaviors to identify those that are health promoting, or those that have potential to lead to health concerns.

The risks behind the rising statistics

Kids with overweight and obesity are at higher risk of developing health complications compared with their peers of healthy weights, and this can continue into adulthood. These complications include type 2 diabetes, high blood pressure and high cholesterol—all of which used to be considered adult diseases but are now being diagnosed much more frequently in childhood. Overweight and obesity can also lead to other concerns such as arthritis, liver inflammation and disrupted sleep.

It’s important to recognize that obesity is a complex chronic health condition, like asthma or diabetes. It can impact overall quality of life and well-being, both physically and emotionally.

Helping kids develop healthy habits

Kids are going to be most successful when everyone in the family practices healthy habits together, regardless of their body size. We don’t want to single anyone out or have different rules for different people. How can your family put this into practice?

• Be a role model. Parents’ actions speak much louder than words and have the greatest impact on their children’s behaviors. Model healthy eating and exercise habits.
• Participate in fun activities together—walk to the library, play a game of tag or make an obstacle course.
• Set your home environment up for success and make the healthy choice the easy choice. Limit things like sugar-sweetened beverages and junk food, and make sure there are healthy snacks like pre-portioned fruit or cheese sticks that are out at eye level and easy to grab. Have things like balls and other exercise equipment easily accessible and visible—and make screens less accessible. It’s also strongly recommended to keep screens out of kids’ rooms, especially at night, as they can really disrupt sleep.
• Set limits but avoid being overly restrictive. Research suggests that kids respond best when parents provide age-appropriate structure, while also supporting their ability to make choices when appropriate. Being overly restrictive (like saying “we never have dessert”) is likely to backfire and can increase the risk of sneak-eating or over-eating when an adult isn’t around. A healthier approach might be, “Our family shares a sweet treat once a week. What day should we enjoy it this week?”
• Avoid using food as a punishment or reward. It can send mixed messages about establishing healthy habits around food and create emotional ties to food rather than viewing it as a way to nourish our bodies.
• Highlight and reinforce when family members are making healthy choices as opposed to being critical of less healthy ones.
• Enjoy family meals at home as much as possible. Sitting down together with phones and TVs off is associated with many benefits including healthier eating patterns and weight—as well as greater emotional connection. Kids thrive on routines and this is a great one.

Positively approaching a sensitive subject

It’s important for adults to be thoughtful about how we talk about our own and other people’s weight. Kids pick up on what we say and do, and we want to make sure we’re creating a positive environment and outlook for them. Praise your children for what their bodies can do, not for what they look like. It’s also helpful to focus on healthy behaviors rather than weight specifically. There are many factors that influence a person’s weight and BMI, including genes and environmental factors. Behaviors like healthy food choices and getting enough physical activity are important for everyone, regardless of shape or size.

If your child or teen expresses a concern about their weight, take it seriously. Encourage a discussion about what’s behind it and how you can help. These may not be easy conversations, but they’re important ones. It’s possible for caregivers to support healthy self-esteem and body acceptance while also promoting healthy habits and weight.

If you have concerns about your child’s weight, talk with their pediatrician or primary care provider. They routinely track growth, including weight and BMI – one of the many reasons annual well visits are so important. By looking at growth over time, they can help gauge if there is a concerning trend and provide recommendations as needed. If your child is a CHoR patient, you can track their growth in MyChart, our online patient portal.

If your child is underweight

Some kids struggle with underweight, which is typically defined as being in the bottom 5^th percentile for BMI. There are many factors that can contribute to being underweight, including:

• Catching up from a low birth weight
• Medications that suppress appetite
• Picky eating
• Food allergies
• Hormonal or digestive problems that make it difficult for the body to absorb nutrients
• Genetic make-up

The pediatrician is a key resource in this case as well, keeping an eye out for plateaus or declines in growth over time. They may make dietary recommendations, such as focusing on nutrient-dense foods and healthy fats, and/or refer your child to a dietitian for advice specific to your family’s situation and needs.

Healthy food and activity habits, along with a sensitive approach to discussing weight goals are just as important here.

Concerned about your teen’s weight? Find out if the TEENS weight management research program for 12-16-year-olds is a good fit for your family.