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INTERVIEW to their long-term health, wellness and productivity. We also know that many of the long-term health risks as adults are largely determined by the age of 20, so promoting health and wellness in the early years is going to translate to a healthier adult. At what point should parents seek help for their children? It depends on the age. Before the child is 2 years of age, there are no body mass index standards, so we use height vs. weight. If they’re at the 95th percentile or quickly jumping up percentiles in terms of weight, that would be a red flag. You need to be looking at what the child is eating or drinking — usually it’s sugared drinks or juices that are the biggest culprits. After age 2, we have the BMI standard: If you’re between the 85th and 94th percentile you’re considered overweight, and at the 95th percentile or above you’re considered obese. When I am talking with a parent of a young child in that situation, I explain that we need to be mindful of what might be going on and what we can work on to make a difference. We do what’s called 1 in 3 children U.S. is obese or overweight in the Preventive Measures : What can you do at home? Active Playtime More Sleep Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car or walk around the mall. Establish a regular bedtime and wake-up time. Healthy Meals and Snacks Replace sugary drinks with healthy natural bevarages, such as juice and water. Avoid eating processed food and prepare more fresh meals. motivational interviewing, which explores the family’s confidence about what they can do to change, and ask them to make choices within the context of their lives. It is a family centered approach to behavior change. The family has to not only care about making changes, but has to embrace them. What are some of the front-line strategies for addressing the problem, or preventing a problem from occurring? One of the tenets of a healthy lifestyle is having routines. That includes eating three meals a day and snacks, so that you’re not going to be so hungry that you overeat. It means incorporating physical activity in your daily life, ideally totaling at least an hour a day. Among the most important from a dietary perspective is avoiding sugary drinks. You want it to be difficult to access unhealthy foods, so that healthy foods are the default. We also believe that being mindful of what you eat and when you eat is important. Family meals in the evening may be healthier than eating out. Be Supportive Children know if they are overweight and don’t need to be reminded or singled out. Don’t use food as a reward or punishment. Children should not be placed on restrictive diets unless done so by a doctor. What is the basis for your program’s approach? We have a psychologist, a dietitian and myself seeing children and families monthly, and it’s very individualized. We spend time addressing not just the mental health of the patient but the mental health and well-being of the family, particularly the parents. If they’re not on board and not taking care of themselves, the children will have a harder time addressing their own nutritional and psychological needs. As far as diet, we are very specific about what needs to be changed and we work on small, incremental steps. To view a video about childhood obesity, go to: childhoodobesity Wendy Slusser, MD Vital Signs Winter 2014 Vol. 61 9