Diane Kramer-Pavelich of Littleton, CO, saw it coming. When her daughter Sophie was 5 years old, Diane noticed she was bigger than her older sister had been at the same age. Nothing extreme—even her pediatrician said that Sophie was in the normal range—but it was something to monitor. Diane herself had been an overweight child and didn’t want the same fate for her daughter. “While I was at work, their nanny would take the girls out to eat, so Sophie was introduced to fast food much earlier than her sister was,” says Diane, who is vice president of claims for a national insurance agency. Junk food, overeating, genetics: Any or all can play a role. By the time she was 7, Sophie weighed 20 to 30 pounds more than most of the other girls in her class, despite being physically active with ballet and gymnastics lessons.   At this point, her doctor referred her to a program called Shapedown, which took a whole-family approach to altering eating and exercise habits. The changes, including making healthier food choices and being active as a family, worked. Ten weeks into the program, Sophie had lost two pounds and gained half an inch in height. (Unlike adults who need to lose weight, the goal for many overweight young children is to slow weight gain so they can grow into their weight.) “Sophie is only eight, so I know time is on her side,” says Diane. “We’ve made small changes, but I hope they’ll make a big difference in Sophie’s lifetime health.”

Childhood Obesity Today

In the last three decades, child obesity—defined by the American Academy of Pediatrics as having a body mass index (BMI, a measure of body weight adjusted to height) in the 95th percentile or higher—has more than doubled among 2- to 5-year-olds in the United States and more than tripled among kids 6 to 11. In addition, about 17 percent of children ages 12 to 19 are obese. Many more kids of all ages are overweight, with a BMI in the 85th to 94th percentile. Both overweight and obesity commonly begin in childhood between ages 5 and 6 or during adolescence, and experts are seeing it in even younger children as well. The social stigma that haunts an overweight child is well known, but excess pounds may have health consequences, too. Sixty percent of overweight 5- to 10-year-olds have at least one risk factor for cardiovascular disease, including elevated blood cholesterol, blood pressure or insulin levels (a marker for diabetes risk). Heavy adults who were overweight in their youth are more likely to be extremely obese than those who were not pudgy kids. “Depending on their age, overweight children have a thirty to seventy percent chance of being overweight adults,” says Nazrat Mirza, MD, medical director of the obesity clinic at the Children’s National Medical Center in Washington, DC. “Preventing lifelong obesity is most likely when strategies begin as early as possible and the whole family is involved.” Catching it early means recognizing signs that your child is overweight. But to do this you have to be aware, as well as honest with yourself. Often parents don’t see or admit it when their child weighs more than she should. In fact, more than 40 percent of parents with obese grade schoolers describe their child as “about the right weight,” and fewer than 10 percent of the same parents say they are “very concerned” about their child’s weight, according to a national poll from the University of Michigan C.S. Mott Children’s Hospital. So keep an eye out for signals that your child may have a problem, such as appearing overweight, having trouble exercising, hoarding food or binge eating. And have your child’s BMI calculated yearly by your pediatrician.

What to Do

If your child is overweight, discuss your concerns with your pediatrician, who can suggest ways to turn things around. Fewer than 5 percent of overweight kids have a metabolic, hormonal or genetic problem; for the rest, overweight or obesity is caused by poor eating and/or exercise habits—and shaking these up can help kids get and stay healthy.  “Focus on helping your child make small, permanent changes in lifestyle habits, because dramatic changes are usually ineffective in children,” says Jamie Calabrese, MD, a Pittsburgh-based pediatrician and a member of the American Academy of Pediatrics task force on obesity. “Be guided by the top three causes of childhood obesity: eating fatty food in large portions, drinking sugary beverages and doing too little physical activity.” Drs. Mirza and Cala-brese offer these weight-control strategies for kids:

Emphasize the foods your child can and should eat rather than focusing on foods she shouldn’t eat.

Make nutrient-dense, low-fat foods as accessible as potato chips. Offer cut-up fruit, veggies with fat-free dressing, whole-grain crackers with low-fat cheese or small handfuls of nuts.

Play “What is it?” Offer one new fruit, vegetable, grain or other healthy food per week for your family to try. Eliminate one fast-food meal per week and prepare a simple, veggie-based meal at home instead; collect the money you save toward a family trip.

Cut back juice consumption to no more than one six-ounce glass a day and nix soft drinks. Sugary fluids don’t satisfy hunger, so kids are more likely to overeat. Offer chilled water instead.

Replace a half hour of TV or computer screen time daily with a half-hour family walk or other activity. One fun idea is to set up “circuit training” in your house: You and your kids do ten push-ups in the living room, ten sit-ups in the dining room, 20 jumping jacks in the kitchen and so on.

Assign your child chores: unloading the dishwasher, getting the mail, raking leaves, walking the dog—anything that helps her to be active, feel needed and learn that homes run best when everyone helps.

Ask for a doggie bag when eating out and put a third to half of your entrée in it before you start eating. Teach your kids to do the same. They’ll learn proper portion sizes and have a fun lunch of leftovers the next day.

Maintain a regular schedule of meals and snacks so your child isn’t tempted to graze all day.

Declare the kitchen closed after 8:00 p.m. “Kids who eat after dinner, often while watching TV, typically take in an extra six hundred to eight hundred calories a day,” says Dr. Mirza.

Set an appropriate bedtime for your kids and enforce it. In one new study of 785 third and sixth graders, children who slept fewer than nine hours per night were more likely to be overweight by the time they got to sixth grade than those who slept more. Whether we’re intentionally teaching or not, our children learn eating and exercise habits primarily from us. So it makes sense that improving them should be a family affair. By joining your overweight child in these goals and making sure you serve healthful meals and curb the amount of junk food you keep in the house, you’ll help her avoid feeling deprived or stigmatized—and you won’t feel like a food cop. Instead, she’ll have a good chance of looking and feeling better, and the rest of your family will, too.    For additional information and support: the American Academy of Pediatrics (aap.org/obesity), the American Heart Association (americanheart.org), the National Library of Medicine (nlm.nih.gov/medlineplus/obesityinchildren.html).