Q: How do I know if I need to put my child on a weight-loss diet? What is appropriate for a
9-year-old?

A: Interestingly, 20 years ago, there was little interest in weight loss in a 9-year-old child. It was assumed that this was the “husky” age and that he would slim down with the impending start of pubertal height gain. We have regrettably learned that is too often a false assumption.

You begin with a visit to your health care provider to document the true weight, weight percentile, height percentile and the Basal Metabolic Index (BMI) — a weight for height marker — all adjusted by age and sex. You also need to look at the rate of weight gain over the past few years. Together you will then discuss the BMI percentile that best reflects the extent of obesity. If the BMI is above the 85th percentile for age, we are dealing with an “overweight” child. If it is above the 95th percentile, we are dealing with an “obese” child. A child with a BMI above the 99th percentile is “severely obese,” and aggressive intervention is indicated — as in, beginning yesterday!

It will help to take with you a three- to five-day diet diary of true intake, serving sizes, snacks, desserts, sugar-based beverages and frequency of eating meals away from home. Be sure to include what grandparents and aftercare providers are offering. Family history of obesity, family lifestyle and the child’s sleep history also play major roles. Include a summary of physical activity, interests and local options to improve exercise. Your provider may begin with a behavioral motivation interview, allowing you and your family to acknowledge areas of concern and options for realistic intervention.

If obesity is confirmed to be a concern, the whole family must commit to a supportive lifestyle change. Keys to success include eating all meals as a family at least six days a week, eliminating high-sugar snacks and drinks, getting more than nine hours of sleep a night, reducing “screen time” of video in any form to less than one hour a day and getting television out of the child’s bedroom. Try to provide more than one hour a day of aerobic strenuous exercise — walk to school and the park, ride bikes in safe areas, sign up for weekend and after-school sports or dance activities.

You and your provider will set realistic weight-loss goals, and weight/progress checks should be held at least monthly at the beginning. If there is limited or no success, there are multi-specialty programs in the area to provide more aggressive team approaches. Children are not candidates for weight-loss surgery until at least the midteens. Failure to address early childhood obesity greatly increases your child’s risk for early type 2 diabetes, hypertension, lipid abnormalities and literally dozens of other preventable concerns.

Dr. Alan M. Lake, Maryland Pediatric Group in Lutherville
Chairman, Maryland Academy of Pediatrics Taskforce on Childhood Obesity