Maintain weight. A goal of weight maintenance versus weight loss depends on age, baseline BMI percentile, and whether the child has any medical complications because of obesity (such as hypertension and high cholesterol). Unless the child is severely obese, weight loss is not recommended for the overweight school-age child. Severe caloric restriction could compromise growth, delay the onset of maturity, and even enhance emotional overeating. The goal generally is to maintain weight or reduce the rate of gain. If weight is maintained while height increases, the percentage of body fat will decrease without compromising lean body mass and growth.

Eat healthfully. There are several constructive ways for parents to help their child slim down:

• Assess dietary intake. Monitor portion sizes.
• Modify food preparation if needed. Reduce the use of fats and sugars. Learn to modify recipes.
• Use the Food Guide Pyramid as a guide for healthful eating. Base meals and snacks on complex carbohydrates (breads, cereals, rice, pasta, grains).
• Wait a few minutes before giving additional servings. A break allows for you and your child to determine if hunger is the issue.
• Don't impose expectations about what or how much a child should eat.
• Encourage the child to listen to internal cues of satiety and hunger.

These changes may benefit all family members. Prudent diets have many health advantages, only one of which is weight control.

Encourage physical activity. Increased physical activity can decrease or at least slow the increase in fatty tissues in obese youth. Extended inactivity is not appropriate for normal, healthy children. In addition, inactivity in childhood has been linked to a sedentary adult lifestyle. Time, intensity and variety are three important concepts to enhance the impact of physical activity on health, as well as the child's interest in it.

• Time: Children should take part in at least 60 minutes of age- and developmentally-appropriate activities every day.
• Intensity: Activity periods should last 10 to 15 minutes or more and include a range of intensities (moderate to vigorous).
• Variety: Children should engage in a variety of physical activities of various levels of intensity.

For best success, all family members should participate in the increased activity. Physically active parents and siblings serve as role models. They also provide good company for bike rides, walks or swims. Physical activity should be fun and make children feel good, not a chore they must do to lose weight.

The Centers for Disease Control have recommended that schools establish policies that promote enjoyable, lifelong physical activity among young people. Their guidelines state, "Physical education should emphasize skills for lifetime physical activities (e.g., dance, strength training, jogging, swimming, bicycling, cross-country skiing, walking, and hiking) rather than those for competitive sports." These experts also recommend that fitness-enhancing physical activities become an integral part of the American family's lifestyle.

Be realistic. Be cautious that adults and children must have a realistic picture of the chances of weight-loss success. She stresses, "in weight reduction, there are very few Cinderella stories. Success in terms of weight loss may be limited, but success in terms of enhancing emotional well-being, nutritional status and physical capability may be considerable."