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Implementing a Weight Loss Program for Overweight Children and Their Parents

Physicians should encourage parents to follow these steps with their overweight child:

1. Diet liquids
2. Drink water before meals/decrease portions
3. Healthier cooking
4. Exercise
5. Positive reinforcement

Step 1: Diet liquids

Switch to diet beverages such as:

• Waters (Fruit2O, Propel)
• Sodas (Coke, Pepsi, Dr. Pepper, Sprite)
• Juices (V8 Splash)
• Other drinks (Crystal Light, Snapple)

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Step 2: Drink water before meals/decrease portions

Drinking 8 to 16 ounces of water just before eating each meal tricks the stomach. By partially filling the stomach with zero calories before the meal even starts, drinking water helps decrease or eliminate feeling hungry, especially when cutting back on meal size. Remember to eat immediately after drinking. This allows the food to absorb the water and helps you feel full for a longer time.

Decrease meal size 15 percent across the board.

• All meals should have 15 percent less food on the plate.
• Eyes say patient will be hungry—stomach says patient is full. Encourage patient to learn to listen to his or her stomach.
• If patient is still hungry, he or she can have more but must leave table for 20 minutes first.

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Step 3: Healthier cooking Cook all meats in a way that fat can drip away.

• Broiling or grilling has the least number of calories. It preserves taste but with lower calorie and fat intake.
• Baking melts fat into other foods and frying adds calories.
• Take all skin off chicken and turkey.

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Step 4: Exercise Start a gentle exercise program to instill confidence and build a habit.

Start with two to three minutes a day, seven days a week. Each week, increase time 30 seconds until reaching 20 minutes per day. Also, make sure work out is aerobic (dance to fast music, Tae Bo tapes, exercise equipment).

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Step 5: Positive reinforcementReward daily for completing the above steps. This is the most important step!

• Give a prize (no food and can’t break the bank) for doing the program daily (ex. allowing child to stay up 15 minutes later at bedtime).
• Caution about negative reinforcement (no attention to an undesired behavior, no arguments).
• Parents get rewarded for doing the program too.

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Physicians then should follow up with their patients.

Initial follow-up visit

• Ask patient to return in about four weeks to check on progress.
• Initial weight loss goal for those with secondary medical problems: ½ - 1 pound every two weeks.
• Reinforce the general principles of the weight loss program:
  
  • If weight loss occurs, give lots of praise. If weight gain occurs, investigate the cause.

Intervention at second follow-up

Tip: Encourage patients to leave a small, visible amount of food on the plate to throw away each meal. This visually reminds them that they don’t have to finish everything on the plate and helps battle the “I see it therefore I must eat it” mentality most of us have.

• Reduce meal size another 5 percent across the board.
• Cut visits to restaurants or carry-out in half.
• If having a snack each day, limit to 100 calories.
• Discuss stressful eating and minimize its impact.
• Continue to reinforce diet liquids and daily exercise program.
• Follow-up in another four weeks.

Intervention at third and fourth follow-ups

• Address concerns from last visit.
• Reinforce the initial principles of weight loss program.
• Reduce meal size another 5 percent each visit.
• Continue to increase the exercise program up 30 seconds per week toward 20 minutes per day.
• Give lots of praise for what patients is doing right with the program.
• Be creative to help find solutions for difficult portions of the program for the patient.
• Have follow-up in four to six weeks.

Follow patient's progress

• If patient continues to do well, then space out visits to three-month and then six-month intervals.
• Continue to follow and refine the program ito fit patient's life style.
• If weight loss stops, start focusing on healthier, lower-calorie food choices and on calorie restrictions. May also have one or two more 5 percent reductions in portion size over time, if necessary.

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Source:

Ronald Williams, MD
Associate Professor of Pediatrics
Associate Professor of Internal Medicine
Director, Combined Internal Medicine/Pediatrics Residency
Penn State Hershey Medical Center Children's Hospital