Category: obesity

Your teenager is a different person than she once was. As an adolescent, she may not be capable of assuming adult responsibilities quite yet. As she has grown and matured, she’s now much more able to understand the implications and consequences of being overweight. You can reason with her much more effectively. As a result, you should address the issue of obesity differently than you once did.

Here’s an example of how your approach might change. When your teenager was younger, did you sometimes use rewards to motivate her to make health-promoting changes? As a school-aged child, did she respond to your offers of stickers or a few more minutes of TV watching if, in return, she agreed to spend an hour playing on the playground with friends? As effective as that strategy may have been, it probably won’t work anymore. Yes, perhaps a younger adolescent (13 or 14 years old) may be willing to change her behavior if you offer her small amounts of money in return (face it—stickers just aren’t going to work at this age!). Yet by the time she’s 15 years or older, you need to shift gears. When her weight is concerned, appeal to her sense of reason. Help her understand the social and health consequences of being obese in a world that’s often unfriendly to people who are overweight.

For instance, if your youngster is 15 years old, you might ask her, “What do you think will happen if you just keep gaining weight?” Don’t expect her to respond by saying, “Well, I might get diabetes or high blood pressure, and I don’t want that to happen.” However, she might open up and begin talking about the way students who are overweight are teased at school. Or she might describe how hard it can be for kids who are heavy to keep up with their peers in physical education classes. Like all teenagers, she’s also probably conscious of and concerned about her body image, and she knows what classmates might be saying about the way she looks. Those kinds of situations might motivate her to change in ways that will allow her to effectively attack the problem of excess weight.

Stay Supportive

In the process, let your adolescent know that despite her growing independence, you’re still her parent and you’ll still be there when she needs you. You might say, “Let’s continue to work on your weight together. We can still go on family hikes on the weekends. We can still go on bike rides. I’ll continue to prepare nutritious meals when you’re home, and there’ll be plenty of healthy choices in the refrigerator for snacking. I’m not willing to completely back away just because you can make a lot more decisions on your own now.”

At the same time, let your teenager know, “I’m always available to talk with you about any problems you may be having with food away from home—maybe bad choices you’re making in the school cafeteria or at friends’ houses.” Make suggestions, gently offer advice, but also give your teenager some space to make choices on her own, and let her know that you trust her to make good ones. Sure, there will be times when she doesn’t make the best decisions​, but at her age, putting more control in her hands works better than saying, “Here’s what you need to do—turn off the TV and go outside right now!” or “I don’t care where your friends like to go—you’ve got to stop eating at fast-food restaurants!”

Keep the dialogue open with your youngster. Ask questions like, “What’s been the hardest part about managing your weight this week?” “What can I do to help?” “What can we think of together that will keep you moving in the right direction?”

Explain to your teenager that, in a sense, you’ve become something akin to her coach. Remind her that even the most elite athletes need coaches, and it isn’t a sign of weakness or failure. Don’t offer advice at every turn, or she’s liable to shut the door without even listening. Just let her know that you’re available to talk and give guidance when she wants it. By all means, create a home environment that’s conducive to success.

Stay Realistic

The bottom line is that your role is changing, and that means posing some questions to yourself, too. For example, are you asking your teenager to make changes in her eating or activity level that you’re not doing yourself? Are you sabotaging her efforts to eat healthy by keeping junk food in the pantry or baking holiday cookies and leaving them out where she can’t help but be tempted?

Are you framing your comments to your youngster in a supportive manner? For instance, rather than asking, “Why are you so lazy when it comes to exercising?” you could say, “Why don’t we get the entire family to go play tennis this afternoon?”

One additional thought:

Even though your teenager is much more capable of taking the weight issue into her own hands, she can still use all the support that’s offered. So you and your other family members should join forces to become your teenager’s most loyal support team. Let your adolescent know that the entire family will provide what she needs to help her make wise decisions about her weight. Sometimes, teenagers may act as though their friends are much more important to them than family. You and the rest of your family will continue to be much more indispensable to her than she’s sometimes willing to admit.

Children with obesity have to deal with many challenges beyond pressures to lose weight. They may also be teased at school, often unmercifully, because of their body weight. Over time, this taunting can take an emotional toll, making them feel isolated, embarrassed and sad. 

Some of these children eventually dread going to school, and are more likely to skip going to class. According to research, youth who are teased about their body weight are also likely to avoid physical activities at school, like gym class or sports, often because these are settings where they feel vulnerable to teasing.

In a new jointly written policy statement, the American Academy of Pediatrics (AAP) and The Obesity Society offer guidance for pediatricians and other health care professionals about the negative consequences of such weight-based teasing and bullying.

How Parents & Children Should Respond to This Type of Bullying

• Emphasize that no one deserves to be teased. Regardless of whether it is because of weight, skin color, or any other reason – bullying is never ok.
• Tell an adult. Encourage your child to talk to a trusted teacher or coach at school.
• Stay in a group. Help them to identify at least one other friend that they can be with when they walk the school hallways, sit in the cafeteria, or take the bus.
• As much as she possibly can, she should not react to the taunting. If the school bully sees her becoming anxious or even start to cry, the teasing may get worse. Encourage your child to maintain her composure, turn around, and walk away.
• Let your child’s teacher know about the bullying. The teacher may be able to step in and put an end to it. If the teasing continues, ask the school principal or your child’s school counselor to get involved. Your child may be embarrassed to have you talk to the principal, but you can’t afford to let her be mistreated any further. Many schools now have anti-bullying policies, but weight-based teasing isn’t always on the radar. It is generally better to let the teacher and principal handle the situation, rather than contacting the bully or the bully’s parents yourself.
• Convince your child to try bonding more closely with the friends that she does have at school. If she hangs out with a group on the playground or in the lunch room, she is less likely to be singled out for mistreatment.
• Don’t forget about computers and phones. Weight-based bullying through social media is very hurtful. Monitor your child’s social media activity and take seriously any cyber-bullying against your child.
• Find activities outside of school that your child can participate in, where she can develop a new friend group that may be less inclined to tease.
• Spend time with your child and treat her as an important person. Help maintain your child’s self-esteem by demonstrating respect and acceptance and telling her often, “I believe in you.”
• Reinforce your child’s strengths and admirable qualities that have nothing to do with body weight. 

When the Bullying Happens at Home

When evaluating the teasing your child is experiencing, don’t overlook what may be going on in your own home. Sadly, some children are teased by their own siblings. Even some parents use negative comments about their child’s weight, often with statements like, “I’m telling you what to do—why aren’t you doing it?” If this is happening in your home, you need to put a stop to it. Have a family discussion about it, and set some sensible ground rules for treating each other in more supportive and positive ways.

Commercial weight-loss programs generally are not designed with children or adolescents​ in mind. However, some new programs do address children’s problems. As you evaluate a program, go through the following checklist:

Is it staffed with a variety of health professionals?

The best programs include one or more registered dietitians or qualified nutritionists, exercise physiologists, pediatricians or family physicians, and psychiatrists or psychologists.

Does the program focus on behavioral changes?

This includes how to select healthful foods in appropriate portions or how to exercise more while limiting sedentary behavior.

Does it include a medical evaluation?

Before your child is enrolled in a program, her weight, growth, and general health should be reviewed by a pediatrician. In addition, a health professional should monitor the child’s weight, growth, and general health at regular times during the course of the program.

Does the program encompass the whole family and not just the child?

The most effective programs are family based, focusing on food and activity environment, not just the affected child.

Is the program appropriate for your child’s age and abilities?

A program for 8 to 12-year olds, for example, differs from programs for 13 to 18-year-olds in terms of the responsibilities placed on the child and parents.

Does the program include a maintenance program?

Support and referral resources are essential for reinforcing behavior and dealing with the underlying issues that led to becoming overweight.

Numerous camps offer weight-control programs for young people. One advantage of such places is that all the campers struggle with their weight so there is less fear of being teased or stigmatized. But like other marketed weight-loss programs, they have a high relapse rate. If you pick a camp program, make sure that the family environment​ changes so the child does not return home from a camp to the same unhealthy set of problems.

A lot of diet programs ask people to transform the way they eat and make these major changes overnight. Not surprisingly, most individuals have trouble sticking to those kinds of dramatic shifts in their diets, particularly over the long term. Eating habits develop over many years, and they can be hard to change. For that reason, our recommendations here are quite different. When it comes to your child, you need to help her make gradual, small changes in her eating habits over a period of time. Introduce 1 or 2 changes a week. She’ll find those kinds of changes—a little at a time—are the easiest kinds to make. Here are some ideas to help make this transition in slow and steady increments. For example, it could mean eating out at restaurants less often—perhaps twice a week rather than 4 or 5 times a week. Or you might order a small hamburger or grilled chicken sandwich for your child rather than the titanic-sized burger. Here are some other suggestions for incremental dietary changes.

• Introduce new, healthier foods over a period of time. Some children are resistant to try any new food; it may take multiple attempts before they develop a taste for it.
• Evaluate what snack foods your family is eating, and gradually move them in the direction of healthier alternatives—for example, unsalted pretzels rather than potato chips, air-popped popcorn instead of cookies, and frozen juice bars (without added sugar) instead of ice cream.
• Serve salads more often, and choose low-fat salad dressing. Teach children about an appropriate amount of salad dressing to use and how they can order it on the side at restaurants.
• When making sandwiches, use low-fat meats (eg, turkey ham, turkey) and see if your child notices the difference.
• Switch from mayonnaise and other high-fat spreads to reduced-fat varieties. Use spreads sparingly and teach your child to do the same.
• Try out a child-friendly vegetarian recipe for spaghetti or lasagna, using vegetables instead of meat, along with lower fat cheeses.
• Gradually substitute water or low-calorie beverages for higher calorie drinks.

All in the Family

Helping your child lose weight should be a family project. You can’t expect one child to change her eating habits on her own while others in the household are showing no self-restraint and continuing to reach for candy and high-fat ice cream. Children are just too smart to accept a “Do as I say, not as I do” attitude from their parents and other family members. So your entire family needs to get on board. That means modeling healthy eating behaviors that you want your child to adopt, now and in the future. It means recruiting all the adults in your child’s life as well as your other children as active members of the support team who are setting a good example, day by day. Everyone should be adopting the same eating plan, or you’ll risk making your child feel singled out, isolated, and even resentful and increase the chances of failure. Now, what if you have one child in your family who is overweight, but your other children are not? How do you explain to a thin child that the entire family is adopting a new way of eating, even if she has no need to lose weight herself? Here is the approach that we recommend. Explain that the entire family is going to work at getting healthier and that the nutritional changes being made are for the well-being of the entire family, from the thinnest to the most overweight (“We’re going to have strawberries for dessert tonight instead of chocolate cake because it’s a lot healthier for all of us.”). 

The Importance of the Family Meal

At the same time, turn mealtime​ into family time whenever possible. Try eating most of your meals together. Children learn more about good food choices and healthy nutrition when family members join one another for breakfast, lunch, and dinner. Research also shows that kids eat more vegetables and fruits and consume fewer fried foods and sugary drinks when they eat with the entire family.
 As you use the recommendations you find to change the way your child eats, she’ll find that this new nutritional approach becomes easier with time. Remember, you don’t need to count calories or fat grams, and you don’t need to panic if your child has a bad day or even a bad week. A little backsliding isn’t going to derail a good eating plan if she gets back on track as soon as possible. Remember that energy balance is the long-term goal.

Pediatricians are very concerned about the growing number of children who are overweight for a number of reasons. Not surprisingly, obesity can limit a child’s physical activity on the playground and athletic field. But more worrisome, there are many health risks associated with being too heavy.

For example, one recent report stated that among children 5 to 10 years of age with obesity, 60% already had at least one risk factor for cardiovascular disease, such as high cholesterol levels, high triglycerides (another type of blood fat), and high blood pressure. Cardiovascular-related conditions aren’t the only health problems associated with childhood obesity.

Diabetes, for example, is another increasing concern among pediatricians and parents of children who are overweight. That’s because a fast-growing number of newly diagnosed cases of childhood diabetes are the so-called type 2 form of the disease. Type 2 diabetes used to be called adult-onset because it almost always affected adults, but now this form of diabetes is increasingly evolving into a disease of children and teenagers, as well. In fact, recent research has shown that between 25% and 60% of newly diagnosed diabetes in children is now type 2. Particularly if your child is obese and inactive, he has an increased risk of developing this form of the disease.

To make matters worse, if your child is overweight, he is much more likely to become an adult who is overweight. The statistics are unsettling—about 20% of 4-year-olds who are obese will grow up to become adults who are obese. That figure rises to 80% among teenagers who are overweight. And once your child is an adult, he’ll be more likely to have the same obesity-related health problems from high blood pressure to joint problems, as well as a greater risk of death as his weight increases. The bottom line is that obesity can cause a lifetime of very serious health concerns.

One other point is important to make: Some children become so obsessed with their excess pounds and have such a distorted body image that they begin to try unusual diets, skip meals, or eliminate food groups, further adding to unhealthy eating and poor nutrition. Rarely, some children can become so focused on their weight and body image that they may develop eating disorders such as bulimia and anorexia​, all because they’re trying to get their weight under control in an unhealthy way.

Environmental Factors

Your youngster’s day-to-day environment—at home, at school, at friends’ homes, and virtually everywhere else he spends time—can affect his risk of becoming and remaining overweight. The fast-food restaurants where he eats, TV programs he watches, and video games he plays can contribute to his likelihood of developing obesity. For example, the risk of being overweight is more than 4 1⁄2 times greater for children who watch more than 5 hours of TV a day, compared with children who watch no more than 2 hours a day. That’s because children are not only inactive while watching television, but they also tend to snack at the same time, often eating high-fat foods like cookies or potato chips rather than an apple or a pear. Even so, except for sleeping, most US children spend more time (outside of school hours) watching TV than participating in any other activity.

Plenty of children sneak food, often believing (or hoping) that they’ll never get caught. In most families, sneaking food doesn’t go undetected for long.

If your child sneaks food, the following tips may help.

Why Kids Sneak Food

It’s important to understand why a child might feel the need to sneak food. Sometimes children find emotions simply too hard to handle, and they find food soothing and comforting. Other times, children might be feeling anxious, stressed, bored, or sad.

What You Can Do

• Explain that you know your child is sneaking food. Encourage your child to talk to you about why. Let your child do most of the talking and really listen to what he or she has to say.
• Reassure your child that you love him or her and that you will do anything you can to help with the problem.

Ask; Don’t Sneak

Rather than simply telling your child, “Don’t sneak!” encourage your child to ask for food when wanted. Set up a reward system to encourage your child to stop sneaking.

What You Should Do

• For a young child, provide a sticker or star as a reward each time he or she asks you for something to eat. Other ideas are to read an extra bedtime story or give points the child can put toward a low-cost toy or school supplies.
• For an older child, set up a point system and let the child build up points for a ticket to the movies, a day at the skating rink or zoo, or a DVD or video game rental.
• Suggest other things to do instead of eating, such as going for a bike ride, going for a walk, playing with friends, or exercising to a workout video.

Remember

It is very important to help your child adopt healthy eating and activity habits that can last a lifetime. By taking steps like serving your child appropriate foods and encouraging physical activity every day, any weight concerns that exist now will become less of a problem as your child gets older.

You’ve heard the stories about the happy fat person, right? Well, as comforting as they might be, particularly if your own child is heavy, they may be more myth than reality in most children’s lives. Not only are there health costs associated with childhood obesity, but your child’s weight problem is also intimately entangled in his emotional world.

Social Stigma

For children who are overweight, living with excess pounds can be heartbreaking. In its own way, the social stigma attached to being overweight can be as damaging to a child as the physical diseases and conditions that often accompany obesity. In a society that puts a premium on thinness, studies show that children as young as 6 years may associate negative stereotypes with excess weight and believe that a heavy child is simply less likable.

Self-Esteem & School Bullying

True, some children who are overweight are very popular with their classmates, feel good about themselves, and have plenty of self confidence. But in general, if your child is obese, he is more likely to have low self-esteem than his thinner peers. His weak self-esteem can translate into feelings of shame about his body, and his lack of self-confidence can lead to poorer academic performance at school. You probably don’t need a detailed description of how difficult the day-to-day life of children who are overweight can sometimes be. These youngsters may be told by classmates (and even adults) that being heavy is their own fault. They might be called names. They could be subjected to teasing and bullying. Their former friends may avoid them, and they may also have trouble making new friends. They could be the last one chosen when teams are selected in physical education classes.

Depression

With all of this turmoil, he may feel as though he doesn’t belong or fit in anywhere. He may see himself as different and an outcast. He’ll often feel lonely and is less likely than his peers to describe himself as popular or cool. And when this scenario becomes ingrained as part of his life—month after month, year after year—he can become sad and clinically depressed and withdraw into himself.

Emotional Eating

In an ironic twist, some children who are overweight might seek emotional comfort in food, adding even more calories to their plates at the same time that their pediatricians and parents are urging them to eat less. Add to that the other emotional peaks and valleys of life, including the stress of moving to a new community, difficulties in school, or the death of a parent or a divorce, and some children routinely overindulge in food.

Discrimination

There are other obesity-related repercussions that continue well into adolescence and beyond. Heavy teenagers and adults might face discrimination based solely on their weight. Some research suggests that they are less likely to be accepted for admission by a prestigious university. They may also have a reduced chance of landing good jobs than their thinner peers. Women who are overweight have a decreased likelihood of dating or finding a marriage partner. In short, when heavy children become heavy adults, they tend to earn less money and marry less often than their friends who are of average weight.

As you might guess, when you have a child trying to lose weight, you need to pay particular attention to mealtimes. They should be firmly structured, not only for your obese youngster, but for the entire family.

In general, 3 meals and 1 to 2 snacks per day, without any meal skipping, are optimal (if your child skips a meal, she’ll become over hungry and set herself up for overeating). Also, if she knows that dinner is going to be served at 6:00 pm, she’ll be less likely to start searching for a snack at 5:30 pm, whereas if dinner is served at a different time every night (for example, sometimes at 6:00 pm, but other times at 8:00 pm), she might grab a snack at 5:30 pm rather than risk having to wait 2 or 3 hours for her hunger pangs to be satisfied. There’s another very important element to structured eating, and that’s ensuring that the family eats together as often as possible with no distractions. In too many homes, families rarely sit down for a meal together, and when they do, the TV is on and no one (except maybe for a sitcom star or the local newscaster) says a word throughout the dinner hour. The TV is a disruption that you should avoid while you’re eating.

Just how important are family meals? In many households, they’re the only period of the day when the family is together, giving every adult and child an opportunity to talk about what happened at school or work. It’s a time when the family can grow closer to one another. It’s also a time to teach your child about healthy, balanced meals and optimal portion sizes and when you can serve as a role model for healthy eating. You can also offer encouragement to your youngster, celebrate her successes, and reassure her if she’s having difficulties. As an added benefit, you’ll be able to keep an eye on what and how much she is eating.

One other note—these family meals will probably become less common as your child enters adolescence. Once she’s involved in rehearsals for the high school play or is gone because of a part-time job at the local pharmacy, you’ll covet those days when the family could be together at the dinner table. Treat these opportunities as precious moments that will become some of your sweetest family memories many years down the road.

Weekend Perils

Some parents feel they’ve got good control over how their children’s lives unfold during the week. There’s a structure to the day, Monday through Friday, incorporating school and extracurricular activities that helps them effectively manage their children’s nutrition and activity levels.

Then the weekend arrives. The routine that they relied on during the previous 5 days simply isn’t there, and that’s when trouble often rises to the surface. On Saturdays, the kids might end up watching TV from sunup to exhaustion (if you let them). In the process, they’re not getting any exercise, and they’re probably overindulging on snacks when they’re not playing with the remote control. Then there are the weekend dinners at the family’s favorite all-you-can-eat restaurant, or the afternoon at the baseball stadium where everyone has one hot dog too many.

What’s the solution? Saturdays and Sundays need to be planned as carefully as the rest of your child’s week. Help schedule her time so that at least part of every Saturday and Sunday is devoted to physical activity. Sign her up for a Saturday afternoon sports program at the community center. At home, make sure that only healthy snacks are available for her to grab. There’s no need for your child to backslide on the weekends, but it will take some consistent parental planning to ensure that it doesn’t happen.

​​Polycystic ovary syndrome (PCOS) is common disorder in girls. Symptoms may include excess body hair (hirsutism), severe acne, and menstrual cycle problems. The excess body hair can be on the face, chin, neck, back, chest, breasts, or abdomen. The menstrual cycle problems include months without any periods, heavy or long-lasting periods, or periods that happen too often. Polycystic ovary syndrome has also been called ovarian hyperandrogenism.

Many girls with PCOS have overweight or obesity, but some girls are of normal weight or thin. Girls may have mothers, aunts, or sisters who have had irregular menstrual periods excess body hair, or infertility. Some family members may have type 2 diabetes. 

Polycystic ovary syndrome has also been called ovarian hyperandrogenism.​ During puberty, the androgen (male-like) hormones made in the adrenal gland cause underarm hair, pubic hair, and body odor to develop. During and after puberty, ovaries normally make 3 types of hormones: estrogens, progesterone, and androgens. In PCOS, the ovaries make too many androgen hormones. The elevated androgen hormone levels can cause increased body hair growth, acne, and irregular menstrual cycles in teens and adults.

What causes PCOS?

The causes of PCOS are not completely known. Polycystic ovary syndrome seems to “run” in families. Although the specific genes that cause PCOS are unknown, some genetic differences may increase the risk of developing PCOS. In many girls, PCOS also seems to be related to being insulin resistant, which means that a girl’s body must make extra insulin to keep blood sugar levels in the normal range. Higher insulin levels can influence the ovaries to make too many androgen hormones. Some girls may have elevated blood pressure, elevated blood glucose levels, or elevated blood cholesterol levels.

How is PCOS diagnosed?

No single laboratory test can accurately diagnose PCOS. The typical symptoms of PCOS include irregular menstrual periods, acne, or excess body hair on the face, chest, or abdomen. Blood tests are obtained to measure blood androgen hormone levels and to rule out other disorders with similar symptoms. For some girls, an oral glucose tolerance test is helpful to check for elevated blood glucose and insulin levels.

Menstrual periods are often irregular for the first 2 to 3 years after menarche (the first menstrual period). Thus, it may be difficult to diagnosis PCOS in early adolescent girls. Nevertheless, it is important to treat the symptoms even if the diagnosis cannot be confirmed.

How is PCOS treated?

Treating PCOS focuses on treatment of the specific symptoms of PCOS, including acne, excess body hair, and abnormal menstrual periods. Oral contraceptives are pills that contain estrogen- and progesterone-type hormones and are often used to treat abnormal menstrual cycles. Other treatment options include a pill containing only progesterone, which is given for 5 to 10 days every 1 to 3 months to bring on a period; combined estrogen and progesterone patches; or an intrauterine device. Some girls cannot use these medications because of other health conditions, so it is important to share your child’s whole medical and family history with your child’s doctor.

Acne can be treated with medication applied to the skin, antibiotics, a pill called spironolactone, or oral contraceptives. Spironolactone is typically used to treat high blood pressure, but it also blocks some of the effects of androgen hormones. Pregnant women should never take spironolactone because of the possibility of birth defects in newborn boys.

Removal of excess body hair involves cosmetic methods such as bleaching, waxing, shaving, electrolysis, laser hair removal, or topical depilatories. Some women develop cutaneous allergic reactions to topical depilatories. Using oral contraceptive pills and/or spironolactone can slow the rate of hair growth. A cream medication called Vaniqa® (eflornithine hydrochloride; 13.9%) can be applied twice a day to unwanted areas of hair to prevent new hair from growing. It is usually not covered by insurance and must be used every day, or the hair will grow back.

In patients who have overweight or obesity, losing weight may decrease insulin resistance and improve the signs and symptoms of PCOS. At least 150 minutes of a physical activity that raises the heart rate every week helps for weight loss. A healthy diet without sweet drinks, such as soda and juice, and with limited concentrated carbohydrates, reduced simple sugars and processed carbohydrates, and portion control will help to achieve weight loss and decrease insulin resistance.

Metformin is a medication commonly used to treat type 2 diabetes mellitus. It may be used in the treatment of PCOS. It helps to reduce insulin resistance and can be associated with a small amount of weight loss. Metformin has not yet been approved by the US Food and Drug Administration (FDA) for the treatment of PCOS. However, metformin is generally safe and often helps.

Can girls with PCOS become pregnant?

A girl with PCOS can become pregnant, even if she is not having regular periods. Any girl with PCOS who is having sexual intercourse should use contraception if she does not wish to become pregnant. If a woman with PCOS wants to have a child and is having difficulty becoming pregnant, many options are available to help achieve pregnancy. Some PCOS medications cannot be used during pregnancy, so discuss your plans honestly with your doctor.​

Let’s see how overweight and overuse are linked. Obesity has reached epidemic proportions, but people often do not realize that pushing your kids to overuse injuries has also reached similar epidemic proportions. Many children who struggle with being overweight are randomly thrown onto sports teams or into exercise programs and the same thing happens—they get pushed too quickly and end up with an overuse injury. These poor youngsters have now become part of not only 1, but 2 epidemic groups. It takes special guidance to respond to the challenge to help kids who are overweight slowly begin the process of adapting to exercise. With the 2 extremes on the exercise continuum, we seem to find ourselves somewhere between fat, phat, and fanatic. Balance becomes important to take advantage of the advancing progress of skill development without overloading the process during its course.

In a perfect world, obesity and overuse injuries would not exist, but because that is not the world of kids I see, awareness and knowledge of how to avoid these problems becomes your vaccination against them. In previous years, sports and obesity were words rarely seen in the same sentence. Now with the national push to combat the overweight problem, more people are turning to exercise activities and sports for help. It is very important to understand that children who are overweight do pose specific challenges physically and developmentally.

If they start a new activity to become more active and are treated just like every other youngster in that activity, the result may be an overuse injury and a defeated attempt to learn healthy lifestyle patterns. The focus of exercise and fitness in youth who are overweight differs from adults and from other non-overweight youth, and exercise programs should reflect that difference to help prevent a negative outcome and produce a positive experience.