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Childhood Obesity: What Parents Need to Know

A family cooking spaghetti

Healthcare providers are taking a more proactive approach to obesity in kids and teens. Recent guidelines encourage pediatricians to treat kids earlier with evidence-backed approaches, such as healthy lifestyle, medication and surgery.

When should parents worry about a child’s weight, and when should they consider a medical approach to treating extra weight or obesity? How can they have sensitive, effective conversations about size and body image?

Seek help from a doctor to best consider your child’s options while prioritizing their mental health and safety, said Stephanie Byrne, MD, a pediatrician at Cedars-Sinai Guerin Children’s.

“Parents should address their kids’ weight as a positive, family-oriented quest for health,” she said. “It’s not about being thin. It’s about trying to be the healthiest versions of ourselves so we can have long, productive lives.”

"Sometimes patients who struggle with their weight do their very best to exercise, eat healthy foods and cut down on screentime, and it’s still not coming off. There’s a lot more to the story than just a number on a scale."

Why the Guidelines Changed

For years, doctors took a “watchful waiting” approach to childhood obesity, assuming most kids would grow out of their higher weight. But research proves that without intervention, children and teens who develop obesity are more likely to maintain a higher body weight into adulthood, and they are at higher risk for complications, such as diabetes, high blood pressure and high cholesterol.

“For many years, the advice for kids with higher body weight was to make lifestyle and dietary modifications,” Byrne said. “Doctors weren’t really doing more than counseling and monitoring, but we know now that a lot of factors go into weight and the potential for obesity.”

Obesity is a complex, chronic disease that can’t always be treated with diet and exercise alone, said Amanda Velazquez, MD, director of obesity medicine at the Cedars-Sinai Center for Weight Management and Metabolic Health. The new guidelines suggest that doctors treat obesity with medical interventions like they do other chronic diseases.

“It isn’t fair to give the same advice over and over when we know it’s not making an effective improvement in health,” Velazquez said. “We really want to see kids have their health addressed as soon as possible in the disease process, with existing treatments that are proven to work.”

Headshot for Amanda Velazquez, MD

Amanda Velazquez, MD

General Internal Medicine

Amanda Velazquez, MD

General Internal Medicine
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When to Address Your Child’s Weight

The body mass index (BMI) scale, which applies to kids who are 2 years old and older, calculates how a child’s height, weight and age compare to growth charts from the Centers for Disease Control and Prevention. Children whose size falls in the 85th-94th percentile are classified as overweight, and children in the 95th percentile and above are classified as obese.

The BMI scale is an imperfect measurement and should always be taken in context, Byrne said. The calculation doesn’t consider muscle mass or bone density, and parents and doctors shouldn’t judge a child’s weight solely by any number.

“Too much focus on a number on a graph could send the wrong message to kids,” she said.

In addition to BMI, parents should watch for behavioral signs of a health issue.

Snoring could be caused by extra fat tissue on the neck that can indicate a weight-related health concern. If your kid struggles to catch their breath during exercise, has trouble keeping up with their peers, snacks a lot, frequently returns for second or third helpings at meals, or begins to restrict what and when they eat, they might be at risk.

What to Consider Before Medical Therapy

If you have concerns about your child’s weight, see a pediatrician. They will determine whether it is or could become a health concern, and they can also rule out underlying conditions that cause weight gain, said Byrne.

One of the most important ways parents can prevent and treat obesity in children is to set up a healthy, active home and model healthy behaviors themselves, Velasquez said.

Children need at least an hour of physical activity a day, five days a week, as well as structured meals centered around protein, fruits and vegetables. Families should make healthy choices together, Byrne said—a child should never be given their own diet.

“No one should be singled out or eating on their own—it’s not fair, and it’s a set up for disaster,” she said. “It won’t work unless it’s a group effort.”

Implementing such household-level changes and considering a child’s history provide a critical foundation for healthcare professionals to build upon with weight management drugs for patients age 12 and older and bariatric surgery for children age 13 and older.

“Sometimes patients who struggle with their weight do their very best to exercise, eat healthy foods and cut down on screentime, and it’s still not coming off,” Byrne said. “There’s a lot more to the story than just a number on a scale.”

How to be Sensitive and Proactive

When it’s time to address childhood obesity, Byrne first approaches the parents alone. Adults should talk to their kids about the importance of changing their health, not their weight—and they should be mindful of the messages children receive that could impact their eating practices, body image and self-esteem.

Childhood obesity rates are increasing, but eating disorders are also on the rise in teenagers.

“There’s a really fine line between wanting to protect against obesity and not wanting to propel your child toward an eating disorder,” Byrne said.

Both children and parents can face fear, shame and social stigma whether they seek treatment for obesity or not, Velazquez said. Kids may feel pressure to lose weight, or parents might fear that new guidelines perpetuate a cultural pressure around thinness.

She emphasizes to all patients and families that the purpose of medical weight management is to help avoid the health risks of obesity.

“Weight management medications are not a form of fat shaming or encouraging anyone to conform to a certain body type,” Velazquez said. “Our only focus is health.”