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How can parents help prevent or reverse childhood obesity? 

Last month brought some rare good news about childhood obesity. The U.S. Centers for Disease Control and Prevention reported that obesity rates among low-income preschoolers dropped in 19 states for the first time ever. Vermont was not among them, in part because the state's percentage of overweight kids is already relatively low: 12.9 percent.

Still, childhood obesity remains a serious problem with potentially long-term consequences. This month, Dr. Lewis First, head of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, has the skinny on healthy dietary and exercise habits that can last a lifetime.

KIDS VT: How serious is childhood obesity?

LEWIS FIRST: What we're seeing now is a national epidemic, where one in three kids between the ages of 2 and 19 in the United States is considered obese. If you're obese as a teenager, you're about 16 times more likely to remain obese into adulthood.

KVT: How do we define obesity?

LF: It's measured by what we call the body mass index, which is based on your child's height and weight. Your child's health care provider should calculate this. In fact, the American Academy of Pediatrics now recommends that a child's BMI be measured at every wellness visit after age 2 to detect any signs of a child becoming overweight.

KVT: Why is measuring the BMI so important?

LF: We now know that everything from high blood pressure to high cholesterol to what's now called Type 2 diabetes — it was once called adult-onset diabetes — is occurring in school-age and adolescent children. That didn't happen years ago. In addition, overweight children can develop problems in their joints and bones, as well as obstructive sleep apnea. Down the road, children who are overweight or obese are at heightened risk for heart failure, stroke and serious cardiovascular disease. Psychologically, these kids are more prone to being bullied, which can lead to low self-esteem, depression and increased risk of substance abuse.

KVT: How much of our weight is genetic?

LF: While genetics do play a part, genetic and hormonal disorders that can result in children being overweight represent only 2 percent of the total number of kids considered obese.

KVT: So what are the true culprits of weight gain?

LF: It's diet, sedentary behavior and the choices people make about how active they are.

KVT: What can parents do to keep their kids' BMI in a healthy range?

LF: When a family member is obese, their weight loss is more successful when the family works on the problem together. At the national level, Michelle Obama's Let's Move campaign promotes healthier schools, more affordable and healthier meals, more physical activity, and families making better choices. Let's Move recommends a "five, two, one, zero" prescription.

KVT: What does that mean?

LF: First, a child needs to eat at least five servings of fruits and vegetables every day. Second, limit a child's recreational screen time — including TVs, computers and handheld electronics — to two hours or less per day. Third, a child should engage in at least one hour of physical activity daily. Even babies and toddlers should be active at least 15 minutes of every hour they're awake. Finally, children should have zero sugary drinks, including sodas, juices and sweetened sports drinks.

KVT: What bad practices should we drop?

LF: Oversize portions, especially at fast-food restaurants, are one problem — and the fact that more than 80 percent of parents take their kids to a fast-food restaurant at least once a week. The portion size of meat or protein should be about the size of your palm, and the amount of condiments should be no bigger than the size of the top of your thumb. Also, the idea that a child must clean his or her plate before leaving the table contributes to overeating.

KVT: Does breast-feeding babies affect their weight later in life?

LF: Yes. Breast-feeding has been associated with preventing excess weight gain. It's felt that breast-fed babies are better able to control their intake and follow their own internal hunger cues versus those who are given a fixed quantity of milk or formula in a bottle. It's believed that breast-fed babies develop a better sense of when they're full.

KVT: What food myths should we dispel?

LF: Be very careful of fad diets, especially for children and adolescents. These can result in all sorts of metabolic changes and can be very hazardous to a young person's health. There is no magical diet that's going to "fix" your child.

There's also a myth that, if you're bigger, you need to eat more to stay healthy. Not true.

Finally, no matter what size your children are, love them for who they are inside and do all you can to build their self-esteem. Blaming anyone for being overweight is the wrong approach. This is something we all have to work on together.

To calculate your child's body mass index, visit letsmove.gov/obesity.
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