Many parents ask me if their child is overweight, or at risk of becoming overweight, and they want to know what to do about it. The most important thing I tell them: Obesity is a family event, not an individual event.

Some people within the family may be more prone to gaining weight, while others might seem to stay slim no matter what they eat -- but to support a child in achieving a healthy weight, the entire family may need to change its ways. Healthy eating, regular exercise, and other good habits will bring about positive results for everyone.

Lesley Stanford, a registered dietitian at Duke Children’s Health Center, tells us more about what parents can do to help children achieve a healthy weight.

-- Dennis Clements, MD, PhD, MPH

If your child is overweight or at risk of becoming overweight and you want to take action, start with a visit to your child’s pediatrician -- he or she can give you many of the tools you’ll need to help.

The visit may begin with a look at your child’s growth chart. The pediatrician can use the height and weight measurements to calculate your child’s Body Mass Index (BMI) -- a measurement used to assess whether the child is underweight, normal, overweight, or obese, based on guidelines for children adapted from the Centers for Disease Control (see chart below).

In some cases, the best goal may not be to lose weight, but to allow your child to grow into his or her current weight. Keeping your child’s weight stable is often the right advice.

If your child needs weight management, your doctor will help you develop a program to help your child reach a healthy weight goal.

The Obesity Epidemic

Over the last 25 years, the rate of obesity has doubled for children ages six to 11 and has tripled for teens. Today about 10 percent of two- to five-year-olds and 15 percent of six- to 19-year-olds are overweight.

The Academy of Pediatrics described the rise in childhood obesity as an “unprecedented burden” on children’s health.

Obesity in childhood has been associated with hypertension, diabetes, sleep apnea, and psychosocial and orthopedic problems. Overweight teens have a 70 percent chance of becoming overweight or obese adults.

In North Carolina, the numbers are more alarming than the national average. Childhood obesity is an epidemic in this state. Data from the 2004 NC Nutrition and Physical Activity Surveillance System (NC-NPASS) show that childhood obesity affects:

• More than one in four (27.2 percent) youth 12 to 18 years of age
• More than one in five (23.8 percent) children five to 11 years
• One in eight (14.9 percent) preschool children

If your child is overweight or at risk for being overweight, look closely at what your family routines are. Do you eat out more than you did last year? Do you buy chips and cookies and other high-fat snacks each trip to the grocery store? Do you rely on fast food?

What Parents Can Do

If you and your child’s doctor determine that weight has become an issue for your child, it’s not too late to start working on healthy habits. Be a positive role model. While weight management is hard work, it is possible.

Follow these tips to help keep your child from becoming overweight.

Limit intake of sweetened beverages.

• Offer water between meals.
• Offer water when children express thirst.
• Buy low or nonfat milk for all family members above age two.
• Choose sugar-sweetened beverages as an occasional treat only.
• Limit 100-percent juice to four to six ounces a day for children two to six years of age and eight to 12 ounces a day for older children. These are new guidelines from the American Academy of Pediatrics.

Limit TV/video time to one to two hours a day.

• Help children to prioritize what they watch.
• Encourage active play instead of sedentary time in front of the computer, watching television, or playing video games.
• Some children eat a larger snack while watching TV than sitting at the table.
• Discourage watching television in a child’s room.

Encourage daily physical activity.

• Set a good example. Exercise with your children. Plan times for family fitness.
• Be active together as a family. Assign active chores like raking leaves, washing the car, or vacuuming.
• Buy a Frisbee, jump rope, or a kickball. Physical fitness does not have to be expensive.

Provide portion sizes of foods that are appropriate for the age.

• Measure food and learn what ½ cup looks like.
• Serve food on your child’s plate instead of family-style.
• Help children learn to eat when hungry and stop when full. Do not encourage the “clean plate club.”
• Avoid all-you-can-eat buffets and super-sized meals. Sometimes a meal deal or combo meal means larger portions.
• Ask for a take-out container when there is extra food.
• Watch the portions of beverages when eating out.

Prepare and eat more meals at home.

• Reduce the amount of meals eaten away from home. Meals eaten at home usually contain more fruits and vegetables.
• Choose restaurants with healthy options.
• Resist "eating from the bag." When snacking, place a few chips, crackers, or cookies in a bowl to help prevent overeating.

Create a healthy eating environment.

• Fill your pantry and refrigerator with healthy foods.
• Offer vanilla wafers, graham crackers, animal crackers, canned fruit packed in its own juice, fresh fruit, saltines, baked chips, and pretzels for snacks.
• Purchase low-fat or nonfat dairy products.
• Keep fruits and vegetables available.
• Plan healthy meals and eat together as a family. Eating together at meal times help children learn about portion size.
• Grow a garden.

-- Lesley Stanford, MS, RD, CSP, is a pediatric nutritionist in the Division of Pediatric Gastroenterology and Nutrition. She is board-certified as an expert in pediatric nutrition by the American Dietetic Association.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.