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More time is spent in relatively minor activity than in strenuous physical activity, so policies that increase energy expenditure in activity must include reductions in sedentary 'activities.' People, not only children, tend to eat more when they are inactive

Table 3 Management of childhood obesity: dietary measures

Purpose of action

Policy

Action

Organize eating

Be aware of the nutrient content of meals

Reduce the energy content of the food intake

Reduce energy content of drinks

Increase satiety

Control number of eating events

Eat meals, as a family whenever possible, at table rather than in front of the television

Meals prepared at home

Precooked/ready to eat meals

Portion sizes

Change the form of food used to low-energy density versions

Avoid added fats and sugars

Fruit juices, etc.

Tea, coffee, etc.

Increase intake of foods that require chewing, that take time to eat, or that increase satiety

Take more time over meals

Restrict eating to recognized meal and snack periods with perhaps two snacks only for children and three snacks for adolescents Where possible, eat meals prepared at home and served on a plate rather than ready-to-eat, microwaved individual meals Where possible, prepare meals at home so that the cook at least is aware of the nutritional makeup of the meal Read the nutritional information given on the packet and observe not only the content/100 g but also the weight (and thus nutrient content) of the food bought and fed to each member of the family Portion sizes can be reduced—using smaller plates may make this less obvious; avoid second helpings Use 'low-calorie' margarines, spreads, mayonnaise, yoghurts, soups, baked beans, etc. Use semi-skimmed milk, sugar-free fruit squashes, etc. Grill and bake and boil without added fat rather than frying foods Do not add fats to vegetables when preparing them for table Avoid (or reduce) added sugar to stewed fruit dishes; sweeteners dissolved in boiled water can be used instead if necessary Eat whole fruit rather than fruit juices (which are usually many fruits compressed and often with added sugar) Use 'low-calorie' fruit squashes Preferably drink water Avoid added sugar Try to avoid sweeteners so as to accustom child to less sweet tastes Increase vegetable, salad, and fruit intake Increase whole-meal cereal intake Encourage 'jacket' potatoes, boiled potatoes rather than chips, crisps, and mashed potatoes Eat as a family when possible to allow social interaction during eating, slower eating, and thus greater sense of satiety after the meal

Table 4 Management of childhood obesity: increasing energy expenditure

Purpose

Type of action

Reduce sedentariness

Increase activity in everyday life

Increase family activity

Encourage and support child to participate in physical activity at school

Increase energy expenditure as heat

Reduce time spent watching television

Develop interests/hobbies that give children things to occupy them at home and that may give them activities outside the home

Encourage children to participate in family life by helping parents around homes, doing simple domestic tasks, running up- and downstairs to fetch for other members of family, etc.

Walk or cycle rather than go by car whenever possible

Use public transport rather than car so at least have to walk to bus stop

Use stairs rather than elevators and escalators when practical

Walk up escalators

Do short walking errands for family as much as possible

Send child out into garden for activity when he or she comes home from school before doing homework, etc.

Make a habit of going for walks, taking part in physical activity in garden or parks, etc. in leisure time

Plan activities during holidays and weekends

Obese children may be very successful at swimming (but may be too self-conscious to wear bathing suit)

Dancing and aerobics may be more acceptable than contact sports, especially for girls

Reduce home heating a few degrees to increase need for energy to keep warm in cold weather

Encourage family to become accustomed to relatively cool environments and relaxing rather than when they are occupied and active. Keeping children from being bored or from spending their leisure time watching television, when food can be consumed almost unnoticed, should reduce eating opportunities. Overweight children should be encouraged to take up hobbies in order to keep their minds off eating. Table 4 outlines how their physical activity can be increased without necessarily subjecting them to the often perceived misery of sports and gym (although these should also be encouraged). Embarrassment and fear of ridicule as well as the high energy expenditure required for activity on the sports field are exacerbated by mechanical difficulties associated with gross weight.

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