September 17th, 2010
11:11 AM ET
Every weekday, a CNNHealth expert doctor answers a viewer question. On Friday, it's Dr. Melina Jampolis, a physician nutrition specialist.
Question asked by Asked by Lisa
How do I put my 11-year-old daughter on a diet? She is 50 pounds overweight, though she only looks about 20 pounds over. She has a lot of muscle. She plays sports year-round.
She is a picky, picky eater. She has asked to go on a diet, but I don't think that an 11-year-old should, even though it's unhealthy to be so overweight. I have told her she will need to give up sweetened drinks, sweet snacks and white bread products.
Any other ideas that will not be too drastic but will show results?
Hi Lisa. I answered your question a couple of months ago but I received some excellent feedback from pediatric endocrinologist Craig Rudlin MD, FAAP, so I wanted to expand on my answer and make a slight correction based on the information that Dr. Rudlin provided.
A 2005 paper from the Pediatric Endocrine Society about childhood obesity suggested a more aggressive approach based on the associated health complications of overweight children, including high cholesterol, high blood pressure and pre-diabetes.
Specifically, for children with a BMI (body mass index– here's a calculator) of 85-95 percent, rather than focusing on weight maintenance, as I previously stated, the paper recommends "a modified diet with decreased sedentary activities."
They go on to recommend an even "more aggressive approach toward children and adolescents with BMI at or above the 95th percentile or in less obese children who suffer metabolic, orthopedic, or cardiopulmonary complications and/or psychological distress."
Dr. Rudlin, who treats overweight and obese children, says the weight loss goal should be about 1 pound per week, and that some older children and teens can safely lose 2 pounds per week.
When I expressed concerns about losing weight while children are still growing, he explained that a nutrient dense, portion-controlled diet, which he advocates rather than avoiding any particular food group, could actually improve growth.
"If they are eating a balanced diet of all five food groups, they are getting all the nutrients, protein, calcium, vitamins they need and the weight loss is from the loss of adipose tissue, which is desirable."
He also suggested measuring height every three months if this is a concern.
Regarding my suggestion to eat more vegetables, he suggested that I emphasize that parents try to increase their children's consumption of non-starchy vegetables, especially green vegetables.
If your child refuses to eat vegetables, try to re-introduce foods over the years as taste buds change. It is also critical to be a good role model and consume a variety of vegetables yourself on a regular basis.
In addition to my previous suggestions, which included eating breakfast daily, increasing fiber intake and limiting juice consumption, here are a few more suggestions from the childhood obesity consensus paper that I think would be useful for you to adopt as a family to support your daughter's weight loss efforts.
1. Eat meals as a family in a fixed place and time.
2. Do not skip meals, especially breakfast.
3. No TV during meals.
4. Use small plates and keep serving dishes away from the table.
5. Avoid unnecessary sweet or fatty foods and soft drinks.
6. Remove televisions from children's bedrooms; restrict times for TV viewing and video games.
And finally, although you mentioned that your daughter was very active in sports, make sure that she gets at least 60 minutes per day of exercise per the latest exercise guidelines for children.
In case you need the reference, here is the consensus statement regarding childhood obesity.
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