# Course:KIN366/ConceptLibrary/Healthy Weight

Movement Experiences for Children
KIN 366
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Instructor: Shannon S.D Bredin
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Healthy weight is defined as the body composition of an individual, which contributes to their overall health, wellbeing, and quality of life in a positive way (Serrano & Branstand, 2009). It is an important concept which effects the movement and health of a child. Healthy weight for a child is not a static range; each child develops and matures differently from one another. There are a number of factors which influence healthy weight for each child, such as, height, sex and age (Dhir & Ryan, 2010).

## Calculation of Healthy Weight

In order to calculate and assess whether or not a child has a healthy weight, a measure of body mass index (BMI) can be taken. It is calculated by dividing a child’s weight (in kilograms) by the square of their height (in metres) (Dhir & Ryan, 2010). BMI is a measurement and indicator of body fat, which takes into account the height and weight of a child. A growth chart, which is age and sex specific, can then be used to plot a child’s calculated BMI and give you a number called a percentile (Dhir & Ryan, 2010). A percentile informs us if the child falls within a healthy range and shows us how their BMI value compares with the BMI of others of the same age and sex. Interpretations can then be made just by viewing the chart, giving us a visual understanding of where the child sits on the chart.

• Underweight = Less than the 5th percentile
• Healthy weight = 5th to 84th percentile
• At risk of overweight = 85 to 95th percentile
• Overweight = greater than or equal to 95th percentile

(Dietz & Robinson, 2005).

Although BMI is the recommended practical assessment and indicator of overweight children in a population, it needs to be taken with proper consideration as it is not a direct indicator of adiposity (Dhir & Ryan, 2010).

## Overweight

A BMI value which falls in the age and sex specific 95th percentile is considered obese. BMI values between the 85th and 95th percentiles are considered overweight and an area of concern because at this specific level there are increased risks of health implications as well as becoming obese (Dietz & Robinson, 2005).

### Causes of Overweight Children

There are many determinants which can cause children to fall above the healthy weight for their age and sex, such as, genetics, environment, fatty and non-nutritious diet, and lack of physical activity (Dhir & Ryan, 2010). According to Dhir & Ryan (2010) a child with an obese parent is prone to become obese as well compared to a child with parents who have a healthy weight. A child’s dietary and activity habits are dependent on their environment (Dhir & Ryan, 2010). For example, if a child and their family have a deficiency in their socio economic status and/or a child is raised by only one parent then the chances of the child becoming obese according to Dhir & Ryan (2010) increases. Times today have changed from the past as both men and women are out in the work force earning an income. This makes it very difficult for parents to cook fresh home cooked meals (Dhir & Ryan, 2010). Soda cans, juice boxes, processed food, and fast food chains are high in fat and calories. Although these foods are unhealthy families today consume them because it is quick and requires no effort (Dhir & Ryan, 2010). The amount of television and electronics that children use nowadays causes a decrease in physical activity causing children to not only be inactive but unconsciously snack, as a result falling above the healthy weight (Dhir & Ryan, 2010).

### Health Implications in Overweight Children

Children who are overweight can be affected by physical, mental and emotional health implications (Dhir & Ryan, 2010). The excess weight a child carries adds extra stress onto the body especially on the bones and joints of the lower limbs. This causes an overweight child to feel pain and exhaustion faster when participating in physical activity and sports compared to a child who has a healthy weight.

Health Implications which arise from children who are overweight can arise in the short run such as asthma, sleep apnea, and arthritis (Dietz & Robinson, 2005). Asthma can arise when a child is overweight as it is more difficult to breathe, especially when moving, even a movement as simple as walking can cause increase and difficulty in respiration. Arthritis can also arise at a young age from the amount of pressure the joints must hold. Sleep Apnea can be described as momentary involuntary breathing pauses which occur frequently and can disturb a child while they are sleeping. These short run implications make it difficult for a child to live a good quality of life and if action is not taken these implications can develop into more serious health implications (Dietz & Robinson, 2005).

Type II Diabetes, high blood pressure and high cholesterol are some of the serious health implications which may arise in the long-run (Dhir & Ryan, 2010). High cholesterol means that the child’s blood lipid levels are abnormal. High blood pressure means that the child’s heart has to pump harder which means that the aorta has to be able to carry the blood coming from the heart at a great amount of pressure. Type II Diabetes emerging in overweight children means that the insulin is not as effective at transporting glucose in the cells because of the excess body fat the child has. More insulin is needed in order to keep normal blood sugar levels (Dietz & Robinson, 2005).

As a child becomes older and continues to be overweight cardiovascular disease can start to develop and the chances of developing cancer or having a stoke increases (Dhir & Ryan, 2010). These health implications, which are caused by the long run health implications above, can possibly lead to death (Dietz & Robinson, 2005).

### Stats and Trends

• The percentage of overweight children ages 6 to 11 has tripled over the past 3 decades, and overweight adolescents ages 12 and 19 have had a comparable increase (Kirk et al., 2005).
• Between 1995 and 2006, prevalence of obesity among boys aged 2-15 years increased from 11% to 17% and in girls from 12% to 15% (Dhir & Ryan, 2010)
• According to National Child Measurement Programme, of children measured in 2007 to 2008 almost 1 in 4 (age 4-5) was either overweight or obese. Age 10-122 this was nearly 1 in 3 (Dhir & Ryan, 2010)
• The risk for overweight is increased among persons with high birth weight (4000 g or more) and parental obesity (Dietz & Robinson, 2005).
• More than 60 percent of overweight children 5 to 10 years of age have at least one risk factor for cardiovascular disease, such as elevated blood pressure or serum insulin levels or dyslipidemia, and 25 percent had two or more risk factors (Dietz & Robinson, 2005).
• Type 2-diabetes now accounts for up to 45 percent of all newly diagnosed diabetes in pediatric patients (Dietz & Robinson, 2005).

## Underweight

A BMI value which falls below the age and sex specific 5th percentile is considered underweight. The issue of children who are underweight isn’t as focused upon and doesn’t have as many reviews and research compared to overweight and obesity (Mak & Tan, 2012)

### Causes of Underweight Children

There are a number of determinants as to why children are under the healthy weight for their age and sex, such as, under nutrition, socioeconomic status, geographical location, underlying sickness, and body image to name a few (Mak & Tan 2012). Deprivation of nutrients needed in a child’s growing body is more likely to occur in families with a low socio-economic status or from rural, undeveloped countries compared to those who come from wealthy or urban, developed countries (Bharati et al., 2010). This means that a child is more likely to be underweight in low socio-economic, rural and non-developed countries because of lack of accessibility or poverty (Bharati et al., 2010). Children in elementary school nowadays, especially girls, thanks to the media, tend to have a low body image of themselves which can cause them thrive to become underweight

### Health Implications in Underweight Children

Children who are affected by a very low body weight have many health implications such as harmful effects on immune function, organ development, hormonal function and brain development (Mak & Tan 2012). If a child is underweight it can become difficult for them to move as they do not have enough energy and stamina to participate in physical activity. A child with a weight less than the healthy range is more prone to infections as their immune system becomes weak, making physical activity difficult to participate in when you are not well. Malnutrition can cause organ failure and harmful effects to the brain. Osteoporosis can be a health implication found even in those who are young, especially women, making the bones weak and brittle so they are not able to handle pressure, like the force which comes from running for example (Mak & Tan 2012)

### Stats and Trends

• In 2012, an estimated 17%, or 97 million children under five years of age in developing countries were underweight (Mak & Tan, 2012)
• Most underweight children live in Southern Asia (30%) (Mak & Tan, 2012)
• In South Korea, a prevalence of underweight of 12.1% was recorded in girls in 2002 and 28.2% in 2008 (Mak & Tan, 2012)
• In Hong Kong, the prevalence of Grade I underweight and Grades II/III underweight in 2006–2007 were 11.3% and 5.4% in boys, and 16.4% and 5.9% in girls, respectively (Mak & Tan, 2012)
• A higher prevalence of underweight in girls than boys is observed within the East Asian countries compared to a higher prevalence of underweight boys than girls within most of the South and West Asian countries (Mak & Tan, 2012)

## BC programs that Address Healthy Weight

Many programmes have been developed around BC to try and inspire families to alter and improve their nutrition and activity aspects of their life. These programs must be serious and ongoing in order to maintain life style change not just a temporary change.

### Childhood Obesity Foundation

In 2004 the Childhood Obesity Foundation was created by a pediatrician and lawyer from the province of BC who wanted to diminish the occurrence of childhood obesity in Canada (Our Story & Mission, 2006). Together they started to gather experts in the field of childhood obesity and collectedly they formed the Childhood Obesity Foundation (COF). The COF Board of Directors held a Childhood Obesity Forum in March 2005 with the help of BC Ministry of Health and the Provincial Health Services Authority (Our Story & Mission, 2006). The charitable status of COF was granted in 2006. To get their foundation started The BC Ministry of Health provided assistance and funding (Our Story & Mission, 2006). This Foundation is a Canadian registered charity which leads power on issues related to childhood obesity. The foundation is devoted and has a mission to reduce the prevalence of childhood obesity by identifying, evaluating and promoting the best possible practices in healthy nutrition and physical activity (Our Story & Mission, 2006). Having the youth and children of Canada free from chronic disease that arise from obesity is the ultimate vision of the Childhood Obesity Foundation (Our Story & Mission, 2006). Some of the principles which they abide by in order to fulfil their mission statement and vision are, collaboration and cooperation, accountability, integrity, transparency, and principle-based fundraising (Our Story & Mission, 2006). The Foundation has been working on a number of initiatives, since the forum in 2005, such as, SCOPE, Screen smart, Sip smart, Childhood Healthy Weights Intervention Initiative and many more (Our Story & Mission, 2006).

### Shapedown Program

Shape down BC is a free behavioural weight program for children, teens and their families (ShapedownBC, 2006). This program assists individuals and their families to create and set SMART goals as well as identify and overcome specific barriers in order to make the journey to a healthier lifestyle easier. Additionally, it aids individuals and their families lead a healthy lifestyle through active living and healthy eating, through a no-diet, all-inclusive approach (ShapedownBC, 2006). BC health authorities, YMCAs and recreation centers help deliver this program (ShapedownBC, 2006). In order to join and be considered for the Shapedown Program a physician referral is required. To be eligible for the program the child/adolescent should be between the ages of 6-17, have a BMI value greater than 97%, be regular in attendance and adaptable to changes, and at least one parent who attends the program should be proficient in English (ShapedownBC, 2006). Those children with a BMI between 85-97% will be considered only if certain medical conditions are present. Individuals who are eligible are booked for 2 appointments with the team; the first is a 4 hour ‘comprehensive medical, psycho-social and lifestyle assessment’ and the second appointment is a 1 hour feedback session to review the results of the assessment (ShapedownBC, 2006). The capacity for success in the group program for the child is discussed and determined in the feedback session (ShapedownBC, 2006). In the group program, groups are split up into ages 6-8, 9-11, 12-13, 14-17 and have 2 sessions per week, for 10 weeks. There is also a 2 hour evening session at BC Children’s Hospital and a one hour family fun activity session on the weekend at the YMCA or Rec Center (ShapedownBC, 2006). Families are offered free access for 6 months to YMCA and recreation facilities, including the registered dietitian and mental health professional for support, as soon as they start the program (ShapedownBC, 2006). Currently Shapedown is offered in 5 different locations: Vancouver (specifically BC Children’s Hospital), Nanaimo, Kamloops, Prince George and Surrey (ShapedownBC, 2006).

### MEND Program

MEND is an abbreviation for Mind, Exercise, Nutrition, Do it! The MEND program is created for children who are working toward a healthy lifestyle and weight. These children have BMI values which fall above the 85th percentile for their age and sex and have no medical limitations when it comes to participating in physical activity or group sessions (MEND, 2006). There are 2 MEND programs; both programs are free, fun, interactive, supportive and empowering children and their families to become more fit and healthy. The first MEND 5-7 program is for children ages 5-7 and their families, whereas the second MEND 7-13 program is for children 7-13 years old and their families (MEND, 2006). This 10 week long MEND program occurs twice a week, allowing parents to sit with their child and learn about small changes which can be made, in food choices and physical activity choices, that make a big difference overall. Practical games and fun physical activities are done in order to learn about healthy food (MEND, 2006). MEND is not a weight loss program or diet it is all about having a fun, and promoting healthy lifestyle and decisions. This program is offered in 15 locations: Abbotsford, Campbell River, Chilliwack, Kamloops, Kelowna, Langley/Surrey, Nanaimo, Nelson, New Westminster, Prince George, Quesnel, Saanich, Terrace, Vancouver, and Victoria (MEND, 2006).

## Practical Application- Tips and Recommendations to Maintain Healthy Weight

When it comes to being over or under the healthy weight, early detection is crucial in order to prevent the health implications that will occur otherwise. The main two things that tend to be altered when a child is not within the healthy weight range for their sex and age are physical activity and diet. This is because a child who is overweight is usually overweight because the calories they take in and consume are greater than the calories they expend and burn. Likewise, a child who is under weight is usually underweight because the calories they take in and consume are less than the calories they expend and burn.

### Parents

Parents should pack their child’s lunches with fresh foods and healthy choices instead of giving them money to buy whatever sugary foods they would like to eat. Parents should give children small portions of healthy food such as fruits and vegetables. Instead of giving them juice boxes which are full of sugar give them water to keep them hydrated at all times. Instead of providing three large meals provide children with six small snacks. Children should not be eating processed food, sugary food, fats which are solid at room temperature and refined grains; instead they should be eating, fruits, vegetables, whole grains, lean meats and milk products (Dietz & Robinson, 2005). Parents should be a positive role model for their child as children tend to mimic their parents behaviours. Children should be spending at least 60 minutes a day doing physical activity. Enrolling children on sport teams is one way parents can encourage physical activity. In order to increase physical activity parents should limit the amount of time spent watching television and being on the computer. If all these life style changes do not seem to help alternatively parents should put their child on a weight-control program. If your child is overweight a 1 pound (450g) decrease per month is safe way to lose weight while allowing normal growth and development (Dietz & Robinson, 2005).

### School System

Schools should get rid of vending machines which provide sugary beverages and junk food and instead have a water fountain and healthy snacks selling at reasonable prices (Dietz & Robinson, 2005). School systems should provide a playground and a huge field to allow safe outdoor play (Dietz & Robinson, 2005). School based randomized trials have shown that reduction in the television and computer time a child spends should be replaced with increased in frequency and intensity of activity during gym classes in order to prevent normal weigh children becoming overweight or children at risk of becoming overweight (Dietz & Robinson, 2005).Schools should make it mandatory that each child must participate in at least one sport or physical activity program to graduate, that way children are required to participate in some sort of physical activity and remain active (Troiano & Flegal, 1998). Every child who attends school should receive physical education, not just team sports (Troiano & Flegal, 1998). Schools should educate children about the importance of healthy lifestyle, physical activity and proper nutrition (Mansfield, 2005).

## References

Bharati, S., Chakrabarty, S., Som, S., Pal, M., & Bharati, P. (2010). Socio–economic determinants of underweight children in West Bengal, India. Asian Pacific Journal of Tropical Medicine, 3(4), 322-327.

Dietz, W.H., & Robinson, T.N. (2005). Overweight Children And Adolescents. New England Journal of Medicine, 353(10), 1070-1071.

Dhir, S., & Ryan, F. (2010). Child overweight and obesity: measurement, causes, and management of overweight and obesity in children. Community Practitioner: The Journal of the Community Practitioners' & Health Visitors' Association, 83(1), 32-34.

Kirk, S., Zeller, M., Claytor, R., Santangelo, M., Khoury, P. R., & Daniels, S. R. (2005). The Relationship of Health Outcomes to Improvement in BMI in Children and Adolescents. Obesity, 13(5), 876-882.

Mak, K., & Tan, S. H. (2012). Underweight problems in Asian children and adolescents. European Journal of Pediatrics, 171(5), 779-785.

Mansfield, B. (2005). Achieving healthy weights in children and adolescents. Kansas Nurse, 80(10), 3-5.

Mind, Exercise, Nutrition, Do It! (MEND). (2006). Childhood Obesity Foundation. Retrieved Feburary 23, 2014, from http://www.childhoodobesityfoundation.ca/MEND

Our Story & Mission . (2006). Childhood Obesity Foundation. Retrieved February, 23, 2014, from http://www.childhoodobesityfoundation.ca/

Serrano, E., & Branstand, K. (2009). Healthy Weight for Healthy Kids: What Should I Do if My Child Is Overweight?. Virginia Cooperative Extension, 1, 1-2

ShapedownBC. (2006). Childhood Obesity Foundation . Retrieved February 23, 2014, from http://www.childhoodobesityfoundation.ca/shapedownbc

Troiano, R. P., & Flegal, K. M. (1998). Overweight Children and Adolescents: Description, Epidemiology, and Demographics. Journal of the American Academy of Pediatrics, 101(1), 497-504.