Childhood Obesity | Diagnosis & Treatments

How is obesity in children diagnosed?

To determine if a child is obese, a doctor will use the child's body mass index (BMI) to obtain a percentile ranking. BMI is a measure of weight in relation to height and it indicates the amount of body fat your child has.

BMI is a measure of weight in relation to height and indicates the amount of body fat your child has. If your child’s BMI falls at or above the 95th percentile, he is considered obese. In this case, your child’s doctor might do a full physical exam and screen for the following:

  • diabetes
  • high blood pressure
  • abnormal blood lipids (high cholesterol, high triglycerides, and low levels of good, HDL cholesterol)
  • fatty liver
  • menstrual problems in girls
  • psychological problems

Your child is considered overweight and at risk for obesity if his BMI falls between the 85th and 95th percentiles. In this case, your doctor might screen for the following:

  • family history of cardiovascular disease, elevated total cholesterol, diabetes, parental obesity
  • large increases in BMI assessments from year to year
  • person concerns about weight (emotional or psychological)
  • concerns related to weight and perception of self as overweight
  • blood pressure

How we treat childhood obesity

Whether your child has genes causing weight gain or he is obese simply from eating too much unhealthful food, lifestyle changes are key factors in long-term weight loss. This includes dietary improvements and increased physical activity.

But weight loss is not always the goal when treating excessive weight in childhood. In some cases, especially with young children, a child can “grow into” his weight by maintaining his weight as he grows taller. In older teenagers with a higher body mass index (BMI), weight loss might become a treatment goal, as the rate of growth slows.

Whatever the case, it's important that your child's goals are realistic. This might include a modest reduction in portion sizes, small but consistent improvements in the types of foods he eats, and adopting a more active lifestyle.

Depending on your child's needs, a multi-specialty team consisting of a physician, a registered dietitian, a mental health professional, and an exercise specialist may be helpful to develop a specific treatment plan that can include:

  • nutrition counseling and modification of diet quality and caloric content
  • increased physical activity
  • behavior modification to address self-esteem and attitudes about food
  • individual or group therapy focused on changing behaviors and confronting feelings related to weight and normal developmental issues
  • family counseling to help support changes in the home


The low-glycemic diet

Traditionally, overweight individuals have trouble following low-fat and low-calorie diets, and those who do lose weight typically have a difficult time keeping it off long-term. This is usually because they feel deprived by the limited amounts and types of foods they can eat.

The Optimal Wellness for Life (OWL) program uses an approach known as a low-glycemic diet. This diet: 

  • combines slowly digested carbohydrates — like vegetables, fruits, beans, and minimally processed grains — with protein and healthy fats like nuts, avocado and olive oil, all of which help us stay full longer after eating
  • is based on whole foods that digest slowly, helping blood sugar and hormones stay at a steady level for many hours after eating

How do I follow a low-glycemic diet?

Following a low-glycemic diet is easier than it may sound. You don't have to memorize the glycemic index or count grams of carbohydrates in foods. Instead, you can:

  • eat fiber-rich, natural carbohydrates such as non-starchy vegetables, fruits, and beans along with protein and healthy fat (like nuts, avocado, or olive oil)
  • eat grain products in their least-processed state possible (for example, stone ground whole grain bread rather than white bread)
  • have a sugary treat, but do so only in moderation and after a balanced meal
  • limit fruit juice to 1 cup a day, avoid sugary soda, and drink mostly water

Research has shown that the low-glycemic diet has many benefits, including:

  • lowering risk for diabetes, heart disease, and fatty liver
  • lowering blood sugar and cholesterol levels in people with diabetes, both type 1 and type 2
  • controlling appetite, which supports healthy weight in both kids and adults

However, to be as healthy as possible, children should eat a healthy diet and obtain daily physical activity.

Physical activity

Eating right is half the equation for optimal weight and fitness. Regular physical activity is the other half.

What is the best form of physical activity for an obese child?

If your child hasn't been active in the past, start slowly. Intense physical activity and competitive sports may, at first, be intimidating and even dangerous for an obese child who is not physically fit. But just 20 minutes of daily walking can get things moving in the right direction for a child who has been previously sedentary.

It's also an important move toward long-term weight management. To keep your child active, focus on making physical activity fun but also appropriate to her developmental level and ability. This can raise her self-confidence and motivate her to continue.

Experts suggest at least 60 minutes of moderate physical activity daily for most children. Running, bicycling, jumping rope, dancing, and playing basketball or soccer are good ways for them to be active.

Preventing childhood obesity

Researchers continue to search for ways to treat obesity. At this point, prevention is the best way! This means eating a healthful diet based on vegetables, fruits, legumes, whole (instead of refined) grains, protein, and healthy fats. Also, maintain an active lifestyle by aiming to getting an hour of physical activity a day.

You can also help your child to maintain a healthy weight by:

  • protecting the home environment: stocking your home with only healthful foods so that your child is not tempted to snack on unhealthful ones
  • role modeling: parents who eat a healthful diet and maintain an active lifestyle will set a positive example for their child
  • serving water instead of sugar-sweetened drinks
  • offering age-appropriate portion sizes and keeping serving platters and bowls off the table to avoid overeating
  • limiting screen time to two hours a day (TV, computer, and video games)
  • not using food as a reward for good behavior, academic achievement, or eating a healthful food

If my child has been diagnosed with an obesity-related condition such as type 2 diabetes, is it too late to make changes that will help him?

It's never too late to improve health. Many problems such as high cholesterol and high blood pressure, elevated insulin, fatty liver, and even type 2 diabetes can be reversed. With careful monitoring of changes in height and weight, many weight-related problems can be identified early enough to prevent the progression to more serious and chronic health problems.

Coping and support

Boston Children's offers three programs that provide medical, nutritional, and behavioral supports:

  • The Optimal Weight for Life (OWL) Program treats overweight and obese children between 2 and 20.
  • The One Step Ahead program treats children between 3 and 13, with a focus on prevention.
  • STEP treats patients between 13 and 25 and focuses more on teens and young adults, although encourages family involvement as well.

All of these programs are family based to some extent; that is, they encourage an approach that includes all family members and not just the overweight child.

Community partnerships

Boston Children's has initiated several community programs and partnerships to help further address overweight and obesity in local Boston communities:

  • Fitness in the City (FIC) program: Boston Children's works with 11 Boston community health centers to offer culturally sensitive obesity prevention and management programs. Boston Children's is working with the centers to track long-term results of diet and lifestyle changes.
  • Healthy Kids, Healthy Communities: a partnership between Boston Children's, the Boston Red Sox, and Northeastern University. This is an obesity prevention program targeting preschool-age children. The program partners with Action for Boston Community Development, Head Start, and the Boston Centers for Youth and Families to provide nutrition workshops and exercise programs for families in the community.
  • OWL on the Road is an obesity treatment program serving financially disadvantaged children in Boston. The program is provided through the OWL clinic and funded from a grant from the New Balance Foundation. Each week, a team consisting of a physician, nurse practitioner, dietitian, and psychologist visits neighborhood health centers to provide services free of charge.