I think my child’s weight is affecting their health. How can I best support them?

Weight fluctuation and change in body composition with growth is a normal part of development. Apart from the first year of life, teenage years experience the most rapid increase in growth and development.

Your health-care provider will consider your child’s weight status as part of a holistic assessment considering age, sex, and stage of growth^[1].

Not all children with high weight will have health consequences^[2].

However, as children get older excess body fat may have health complications^[3] including sleep apnoea (where breathing stops and starts during sleep), bone or joint problems, liver disease, high blood pressure or cholesterol, or insulin resistance (pre-diabetes).

If you notice changes in your child or adolescent’s health – such as dark patches around the neck or under arms (which indicate insulin resistance^[4]), headaches, trouble sleeping or joint pain – speak with your GP.

What will your GP do?

Your GP can investigate if there is a health impact related to excess weight. They may check blood pressure, and do a blood test to check liver health, cholesterol levels and blood sugar levels.

High weight is often related to mental health issues such as depression, anxiety, or eating disorders. Your GP can help assess and manage these conditions.

A GP with experience in weight management^[5] can provide appropriate support and referrals to local support depending on your area. An accredited practising dietitian^[6] experienced in paediatric health, for example, can help develop healthy meal routines for the family.

Changes that involve the whole family

Initial treatments for weight-related health will depend on your child’s age. They usually involve a whole-of-family approach to improving health behaviours, such as^[7]:

• healthy dietary changes such as offering a variety of fruits and vegetables of different colours and types, and limiting^[8] sugary drinks and foods high in salt, fat and sugar

• limiting screen time (aiming for no more than two hours a day^[9] of non-education screen time for children aged five to 17)

• improving sleep habits (aiming for 9-11 hours a night^[10] for children aged six to 12, and 8-10 hours a night for teens)

• increasing physical activity (aiming for one hour^[11] of energetic play or vigorous activity a day).

Most children and adolescents will have improved physical^[12] and mental health and wellbeing after behaviour-changing interventions. This might include improved eating behaviours^[13], fewer symptoms of depression^[14], and better self-esteem and body image^[15].

Options for adolescents

Sometimes weight loss may be recommended for adolescents with significant excess weight and associated complications.

As children get older, they will be included in the treatment decision making-process^[17].

A range of prescriptive diets^[18] have been trialled with adolescents, including very low energy diets.

Our recent trial shows specific diets can stabilise weight and improve physical^[19] and mental^[20] health of adolescents. Our trial included 141 adolescents with obesity-associated complications and compared intermittent and continuous energy restriction.

We found improvements in weight, insulin resistance and liver function after one year for both groups. Symptoms of depression, eating disorders and binge eating reduced following four-weeks of a very low energy diet, followed by a transition to intermittent or continuous energy restriction, which was maintained for one year.

However, any prescribed diet should only be used under medical and dietary supervision.

New generation medications (such as Wegovy^[21]) are now available to adolescents with severe obesity to be used alongside behavioural therapy. These can help with weight loss and reduce risk of future health complications.

Bariatric surgery^[22] may be an option for older teens with significant health complications.

If you are thinking about using medications or having surgery, discuss the risks and benefits with your doctor.

Watch for signs of disordered eating

Children and adolescents with higher body weight may attempt^[23] to lose weight on their own. Unfortunately, most publicly available information is not tailored to the needs of growing children, can be unsustainable and may lead to disordered eating behaviours.

Social media is loaded with unhelpful weight loss^[24], diet^[25] and exercise^[26] messages, and often promotes unattainable body image^[27] ideals. Talk to you children about what they see on social media to help them recognise which social media content is beneficial.

If you notice your child^[28] is losing weight quickly, hiding food or eating in secret, binge eating (eating a lot of food and feeling they cannot stop), vomiting after eating, overexercising to burn off calories or skipping regular meals to try and lose weight, discuss this with your doctor. These could be signs of an eating disorder.

How you can support your child

Parents are important role models for children and have a key role in supporting the whole family to live a healthy lifestyle.

Start healthy habits^[29]. Make healthy eating and enjoyable exercise part of daily life.

Avoid making negative comments^[31] about your own or your child’s body – and ask others to do the same. If you hear a negative comment about your child’s weight, try to re-frame this into a positive message. For example, “growing bodies are strong bodies”.

Be aware of bullying. Some children with a higher weight experience teasing or bullying related to their body size^[32]. This can occur from peers at school, teachers, parents and even health professionals. Ask your child if they are teased or bullied about their body and take appropriate action.

Finally, keep in mind that different treatments may work differently for different people. If you find a treatment approach is not working for your child or your family, return to your health care provider to discuss other options.

Children and families with weight concerns should be treated with respect^[33] and dignity at all times. If you don’t feel your health provider is doing so, consider changing^[34].

References

1. ^{^} growth (www.schn.health.nsw.gov.au)
2. ^{^} health consequences (www.nature.com)
3. ^{^} complications (theconversation.com)
4. ^{^} insulin resistance (www.niddk.nih.gov)
5. ^{^} GP with experience in weight management (nacos.org.au)
6. ^{^} accredited practising dietitian (member.dietitiansaustralia.org.au)
7. ^{^} such as (publications.aap.org)
8. ^{^} limiting (www.eatforhealth.gov.au)
9. ^{^} two hours a day (aifs.gov.au)
10. ^{^} 9-11 hours a night (www.healthdirect.gov.au)
11. ^{^} one hour (www.health.gov.au)
12. ^{^} physical (pubmed.ncbi.nlm.nih.gov)
13. ^{^} improved eating behaviours (onlinelibrary.wiley.com)
14. ^{^} depression (jamanetwork.com)
15. ^{^} self-esteem and body image (onlinelibrary.wiley.com)
16. ^{^} Donamoth/Shutterstock (www.shutterstock.com)
17. ^{^} treatment decision making-process (theconversation.com)
18. ^{^} diets (academic.oup.com)
19. ^{^} physical (jamanetwork.com)
20. ^{^} mental (jamanetwork.com)
21. ^{^} Wegovy (theconversation.com)
22. ^{^} Bariatric surgery (theconversation.com)
23. ^{^} may attempt (dietitiansaustralia.org.au)
24. ^{^} weight loss (www.liebertpub.com)
25. ^{^} diet (onlinelibrary.wiley.com)
26. ^{^} exercise (theconversation.com)
27. ^{^} body image (theconversation.com)
28. ^{^} notice your child (dietitiansaustralia.org.au)
29. ^{^} healthy habits (pro.healthykids.nsw.gov.au)
30. ^{^} shurkin_son/Shutterstock (www.shutterstock.com)
31. ^{^} negative comments (link.springer.com)
32. ^{^} bullying related to their body size (butterfly.org.au)
33. ^{^} treated with respect (weightissuesnetwork.org)
34. ^{^} changing (nacos.org.au)