Approximately 70 million Americans are obese. More than one in three of all adults and one in five of all children are overweight. Research suggests the best opportunity to address problems of overweight and obesity is before childhood. Change becomes more difficult as the child reaches adolescence. Some adults may not be well suited to speak to a child about their obesity. Their personal biases or struggles about weight issues may negatively affect their ability to talk with a child in a supportive, non-judgmental way. Consider other individuals who may be more helpful or effective in connecting with the child. Choose a private place to speak with the child; somewhere you can focus on the discussion. Pick a time when both you and the child do not have to be rushed. Avoid addressing issues when emotions are high. Begin the discussion by expressing you acceptance and approval the child. The child's weight should not be associated with their approval or acceptance. Look at the positive aspects of the child. Allow the child to express their concerns and experiences. Listen and empathize. Try to understand the child's perceptions of the issues. Discuss feelings, concerns for their health, social implications. Understand, the child may have a positive esteem and body image despite being overweight. This is to be encouraged. However, if the child expressed poor body image, be sensitive and acknowledge their pain. Overweight kids may have feeling of depression from being teased or not being popular, particular when they are developing interest in the opposite sex. Negative body image may decrease self-esteem. They can develop negative feelings of school and other social settings. They often become discouraged and drop out of sports or other physical activities when they are unable perform at the level of their peers. Many overweight kids do not know what to do or where to turn for help. Invite them to share their concerns with you anytime. Express your willingness to support appropriate health and wellness goals. Do not focus on weight loss as a criteria for success, but instead emphasize healthier habits, improved fitness, increased energy, etc. Older children must make the decision to start the weight management program. They should not be made to do anything against their will. A program initiated without the child's true consent will be short lived. Certainly, a younger child's eating habits and daily activities must be shaped by proper parenting skills and modeling. A child's or teenagers's motivation to lose weight may come from a variety of factors including health, social aspirations, sports or performance goals, desire to fit in clothes, inspiration from peers, siblings, fitness models, or sports figures. The family should seek the assistance from a variety of experienced professionals. The family should be educated about the complications of obesity. Ongoing support for the family will help maintain their new behaviors. A healthcare provider should be consult before placing a child on a weight-reduction diet. The family and all caregivers should be involved in the treatment program. The family must be ready for change. If the family is not prepared to change their diet or activity, or feels obesity is inevitable, the program should either be deferred or the family should be referred to a qualified therapist. Treatment should involve permanent changes, not short term diets or exercise regimens aimed at rapid weight loss. Small, gradual, and targeted changes in activity and diet should be implemented. A flexible and a balanced approach to eating and exercise should be encouraged. A program for overweight children should reduce the rate of body weight gain while allowing growth and development. An adolescent's increasingly independent eating and activity behaviors should be recognized and respected. Allow the child to regulate how much they eat. Attempting to control what or how much a youth can eat may back fire. Controlled feedings can initially lead to anger, control battles, secret eating behaviors, preoccupation with food, fears of disapproval, and may increase the likelihood of developing eating disorders. The family should learn to monitor eating and activity. The following tips can be offered to the parents. Stock up and maintain a variety of healthy foods at home. Consider removing all foods from the home that are off limits such as soft drinks, chips, and other high calorie snack foods or learn how to eat these foods in limited quantities. Minimize juice consumption. Intakes of carbonated beverages and other sweetened beverages are related to higher body fat, where as consumption of calcium rich foods such as milk and milk products are correlated with lower body fat. Eat at restaurants that have healthy food choices. Encourage portion control, particularly for higher calorie foods. Teach your child to cook healthy meals at home; keep it fun. Eat breakfast and other meals as a family. Pack healthy school lunches. Allow your child to assist in the planning of meals and snacks. If the food is not appealing, kids will eat elsewhere. Do not reward with food, instead use praise, stickers, time for favorite activities, etc. Don't make kids exercise. Instead use language like, "Let's play." or "Let's go...". Kids often prefer the term "physical activity" or "play" over "exercise". Kids often view exercise as something they have to do where as physical activity or play is something they just do. Find what kids enjoy. Kids will do what is fun and encouraging. At least 60 minutes of physical activity on most, preferably all, days of the week is recommended for children and adolescents. Decrease television viewing and excessive computer time to a total of 2 hours a day or less. Decrease television viewing leads to improved body mass index (BMI) in children. Alternatively, exchange screen time for outdoor play time or other physical activity. For example, one hour play time allows them one hour screen time. Parents, caregivers, coaches, teachers, and health practitioners should encourage kids with their program goals without pressure. Let them know they should not get discouraged if they drop out of their program. Encourage them to keep trying. Do not preach but be involved. Criticism, lecturing, or reprimanding should be avoided; encouragement and empathy should be practiced. Avoid shaming comments such as "I'll give you $500 if you..." or "do you really need that extra serving?". In addition, do not use moralistic or blaming positions such as "you know you should not be eating junk food," or "it just takes will power". These type of statements only perpetuate shame and guilt. Shaming can negatively effect self-esteem, social interactions, relationships, and their willingness to try new challenges. Promote a healthy self-esteem and self-acceptance. Avoid talking negatively about your own body. Let the child know it is ok no matter what they weigh. Help the child identify interests, activities, or talents to pursue. This develops areas of competency and promotes self-esteem. Nurture the child with encouragement and compliments for qualities, abilities, and accomplishments. Stick up for your child. Be an advocate by calling parents of bullies and combating weight prejudices. Intervention should begin early. If you are seeking to be understood, seek first to understand. Parenting skills are the foundation for successful intervention. Teach by example and implement ongoing positive reinforcement. Practice and model healthy lifestyle choices. Healthy family oriented meals and activities are many times more effective than diets and lectures in long term weight management. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendation, Pediatrics. 1998; 103, 3. Pieper K, Barlow SE, et. al. Obesity and Kansas City Kids (2003 Conference), Reardon Convention Center, Kansas City, Kansas. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999 Oct 27; 282(16):1561-7. Skinner JD, Bounds W, Carruth BR, Ziegler P. Longitudinal calcium intake is negatively related to children's body fat indexes. J Am Diet Assoc. 2003 Dec;103(12):1626-31. USDA (2005) Dietary Guidelines for Americans, vii-viii.