Pearly Ruiz, a health education assistant in Oakland, was shocked to find her own daughter at risk for high blood pressure and diabetes. At 12, her daughter weighed 200 pounds, but Ruiz didn't worry until "I read an article saying that if your child is overweight and has a dark ring around her neck, that could be a sign of diabetes." Her daughter's doctor confirmed that "if she doesn't control her nutritional habits, she will end up with diabetes."

Like Ruiz's daughter, one in five American children are struggling with obesity—and the number of obese children in the United States has doubled in the past thirty years. Why? Dr. Dennis Styne of the UC Davis Medical Center's Childhood Obesity Clinic blames two trends.

• Children are eating more junk food. Junk food ads in the media and school contracts with soda and fast-food vendors contribute to this trend.
  
  
• Children are less active. There are fewer safe places to play and not enough affordable after-school programs, so kids spend more time sitting and watching TV.

Many of these problems are worse for children in low-income families, says Joel Cohen, who presented his California Research Bureau report at a recent legislative hearing on childhood obesity. Low-income parents can't afford the fees for sports programs and may not be able to drive children to practices, says Cohen. And high-calorie fast food is a convenient and cheap alternative for low-income working parents.

Children, however, pay a heavy price for extra pounds. Overweight children are at greater risk for diabetes, high blood pressure, gall bladder disease, heart disease, and other health problems.

So now Ruiz and her daughter work with a nutritionist and attend classes on nutrition and exercise. Ruiz helps her daughter keep a "food diary" and decide "what to add in and what to substitute out." And, Ruiz says, "I try to foster an attitude of good self-esteem."

That's extremely important, says Dr. Styne. Pressuring kids too much can harm their self-esteem and lead to depression or anorexia. But parents and caregivers can avoid this by focusing on positive encouragement for active lifestyles and healthful eating habits.

Model good eating habits—don't keep high-calorie snack foods on hand

Joanne Ikeda, professor of Nutritional Education at UC Berkeley, says, "Snack foods like ice cream, potato chips, soda, and cupcakes tempt children to overeat. Better to avoid this by not bringing a lot of these foods into the home. On the other hand, don't go to the extreme of making these foods 'forbidden fruits' or they will become very desirable to your child."

Plan daily exercise for the family

Family bike trips, active games, or weekend hikes make exercise fun. "Kids need to see their parents leading an active life and enjoying it," says Tara Hembrooke, graduate student in nutrition and exercise science at UC Davis.

Encourage children to be physically active at home

"Have toys that encourage active play, such as balls, bats, and roller skates," says Ikeda. "For children who live in an apartment or are afraid to go outside, there's jumping rope, dancing—anything besides watching TV!" says Karen Hood, social worker at the UC Davis Childhood Obesity Clinic. "If they do watch TV, tell them to run around during the commercials to get their heart rate up!"

Tackle TV

Parents can discourage passive sitting by limiting TV viewing to two hours or less per day. And have children eat at the table with the television off, so eating while watching TV or playing on the computer does not become a habit. (See Children's Advocate tips on limiting TV, Taming the TV )

Educate children about what they're eating

Use the U.S. Department of Agriculture food pyramid to teach kids about the nutritional value of different foods and how much of each type they should eat.

Build self-esteem and support positive self-image

Obsessions with body image often lead to eating disorders, psychological stress, or preoccupation with food. Karen Hood recommends teaching children to realize and remind themselves about their positive qualities.

Avoid harsh restrictions on a child's eating

Withholding food can cause children to become preoccupied with food and overeat more, says Ikeda. She suggests telling children, "We are going to help you eat and exercise so you will be healthy and get the body that is right for you. We're going to have regular meals and snacks for the whole family. At meals and snacks, you can eat as much as you want. I'd like you to trust your body to tell you when you are hungry and when you are full.… I also want you to know that we're not going to put you on a diet because you are growing and it could hurt your body by stunting your growth."

Identify emotional triggers

Your child may be overeating as a reaction to stress or depression. Try to find out what is bothering the child and figure out possible solutions.

For a healthier community:

• Advocate for schools to provide healthful meal choices and eliminate junk foods. A current bill in the California legislature, SB 19 (Escutia), would set dietary standards for food served in California public schools, including food from outside vendors. Contact your state legislator.
  
  
• Advocate for safe places in your community for children to be active. Many neighborhood groups advocate for safe sidewalks, crosswalks, playgrounds, bicycle paths, trails, parks, and community facilities. Get involved.
  
  
• Advocate for more funding for free or low-cost after-school activities After-school programs can provide an alternative to TV-watching and encourage kids to be more active.
  
  
• Ask your school district to provide quality, daily physical education to all students. Trained P.E. teachers can design fun activities that encourage kids to be active during nonschool hours too.

Resources for a healthy lifestyle

• UC Davis Medical Center Childhood Obesity Clinic, 916-734-7098. For interpreting service, 916-734-2321
  
  
• U.S. Department of Agriculture nutrition education, including materials for kids and a food guide pyramid, www.usda.gov/
  
  
• If My Child Is Overweight, What Should I Do?, pamphlet by Joanne Ikeda, $3, 800-994-8849

Extra resources from the Children’s Advocate bulletin (updated 4-06)

• Childhood Obesity, from the Future of Children Journal, discusses ways to prevent childhood obesity by making changes to neighborhoods, media, schools, child care, and homes. Recommends obesity-prevention programs, improved school nutrition and physical activity, and less junk food marketing to children. Online at http://futureofchildren.org/futureofchildren/
  publications/journals/journal_details/index.xml?journalid=36
  
• Childhood Obesity: Health in the Balance, from the Institute of Medicine discusses causes and effects of childhood obesity and offers recommendations for families, schools, industry, communities, and government. Online at http://www.iom.edu/
  
  
• Healthy Food, Healthy Communities, from PolicyLink, discusses the health and economic benefits of making affordable, healthy foods available in low-income neighborhoods. Includes case studies and policy recommendations. Online at http://www.policylink.org/Research/HealthyFood
  
  
• Preventing Child Obesity in California, from the California Endowment, is a policy brief on child obesity, contributing factors, and policy goals for schools, child care, neighborhoods, health care, and marketing.

Strategic Alliance for Healthy Food and Activity Environments offers resources:

• ENACT is a tool to help child care, schools, neighborhoods, health care, and government improve nutrition and physical activity policies. Online at http://www.preventioninstitute.org/sa/enact/enact/index.htm
  
  
• Resources compiles links to tools, data, programs, and policy issues. Online at http://www.preventioninstitute.org/sa/resources.html#childtools

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