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Q  What advice do you have to gain control of my five-year-old daughter's weight? Despite eliminating fried foods, refined sugar, etc., she still puts on approximately ten pounds yearly. As a side point, my daughter is active, but she is now up to 70 pounds. I asked her pediatrician and her response was, "You can't go far from genetics." I don't believe this because I wasn't heavy until my adult years, and my 15-year-old is thin. I'm at my wit's end. What can I do?

[ANSWER {You are wise to be concerned about your daughter's excess weight. She is at least 25 percent over her ideal weight for her age, which puts her in the category of serious medical obesity. This means unless she makes major changes in the way she lives and eats, she has a high chance of developing major disease consequences of obesity, such as diabetes, high blood pressure, arthritis, and poor self-esteem. According to the Surgeon General, childhood obesity is the number one public health concern. Because of the obesity epidemic, we have started a program in our pediatric practice we call THE LEAN KIDS PROGRAM, which means making major changes in Lifestyle, Exercise, Attitude, and Nutrition. Here are some practical ways you can help your daughter shed a lot of her excess body fat and maintain her ideal weight.

Become a LEAN family. Excess weight in children is often a total family problem, which needs a total family change. What changes can you make in your overall lifestyle that contribute to leanness? ("Lean" does not mean skinny. Rather, it means having just the right amount of body fat for your individual body type.) Do you exercise, as a family? Do you have an attitude that health and weight control is a family priority? Do all family members, including your daughter, have a good attitude about their body and how to take care of it? Are there nutritional changes you can make that will help the whole family get and stay lean?

Set a no-gain goal. Unlike adults who get into yo-yo dieting to shed pounds quickly and then just as quickly regain them, children do not need to be in any hurry to shed excess body fat. In fact, a healthier and more realistic goal is: "Stay the same weight for two years." A no-gain goal takes the pressure off a child to "lose weight." However, since your daughter fits in the category of medically obese, it would help if she could actually lose around ten percent of her body weight (approximately seven pounds) over the next year.

Feed her right for her body type. There are four general body types: "bananas" (tall and lean), "apples" (large around the middle), "pears" (large around the hips and thighs), and "yams" (just plain big all over). "Banana" body types tend to be calorie-burners, which is why some lean children seem to overeat and not put on excess weight. "Apples" and "yams" tend to be calorie-storers, meaning they burn fewer calories from the same amount of food and therefore are more prone to store excess fat than do "bananas." If the predominant family genes, and your daughter's body type, is that of a calorie-storer, you need to be more concerned than if you have a family tree that has a bunch of "bananas."

Present the program. When putting a child on the LEAN KIDS PROGRAM in our office, I never talk about "weight control" or "fat." Children are performance and appearance-oriented. Find out what your daughter's major change-wish is. Ask her, "Honey, what would you like to do better that you can't do now?" Lead her into answers, such as: "I'd like to run faster and not get so tired ¿" Play show and tell. Show her that the excess fat that she carries around her middle is like lugging around a bunch of weights while you run. (To illustrate the point, have her walk around for a few minutes holding a five-pound bag of canned goods in each hand.) You can then tell her, "We're going to go on a run-faster program."

Teach her about "grow foods." "Grow foods" are fruits and vegetables, lowfat yogurt, and fish. These are "free foods."  -- she can eat all she wants of them. Tell her: "Grow foods make you strong, give you pretty skin, help your hair grow, and help you run faster ¿" (or whatever change she wants to make). Non-grow foods (those that keep you from running fast) are packaged foods such as french fries, pastries, and sweetened beverages. Teach her to recognize the two "bad words" on food labels: "corn syrup" (or "high fructose corn syrup") and "hydrogenated." These additives contribute to a lot of weight gain in children. For most families, if they make a simple change, such as banning all foods that contain these "bad words" on the label, their children will lean out. In fact, the overconsumption of sweetened beverages seems to be the prime contributor to childhood obesity.

Get her moving. Besides eating too much of the wrong foods, sitting too much is another major contributor to childhood obesity. Once upon a time, children ran for entertainment, now they sit and play videogames. You mentioned she is already active, but she needs to add some strength-training to her activity. Children who are genetically calorie storers ("apples" and "yams") tend to have a lower resting metabolic rate (RMR). You can help her go from becoming a calorie-storer to a calorie-burner by helping her increase her muscle mass. The more muscle a person has, the higher that person's RMR. While certainly she is too young to "lift weights," stretch bands (rubber exercise bands available at sporting good stores) is a practical way to increase muscle mass on a five year old. Have the house rule "moving equals sitting." If she wants to watch TV or play a videogame, she has to spend the same amount of time that day in physical exercise. Even better, get her moving while watching TV  -- she can use her exercise stretch bands or jump on a mini trampoline. If she loves to play video games, get her an attachment (e.g. Dance Revolution) in which the controller is a pad that she dances on and controls the video by dancing on her feet instead of just sitting and using her hands.

Downsize her food portions. Out of sight is out of tummy. Ban the buffets. Serve small portions of nutritious foods on her plate from the stove or counter rather than placing bowls on the table. She can then refill as needed. Having a bowl full of potatoes in front of you triggers overeating. Play "chew-chew." Encourage her to take smaller bites and chew them longer. This trick discourages overeating.

Remember, you want her to have a healthy attitude about eating  -- that good food creates good health. Besides the above weight-control tips, you will find many other practical suggestions for a total family weight-control program in my new book: Dr. Sears' L.E.A.N. Kids: A Total Health Program For Children Ages Six to Twelve Years, Penguin Books, 2003.

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