Dear Dr. Garner,
My daughter-in-law is constantly pushing food at my four-year-old grandchild. She weighs 45 pounds and is 40 inches tall. If you need a picture in your mind, she looks markedly obese. She watches TV all the time and seems to be constantly having snacks and soda.
I am concerned that she will always be overweight. Every time I try to talk to my daughter-in- law, she tells me that this is baby fat that will be outgrown, and that I should mind my own business. Could you please talk about this, as I know she reads The Tablet and hope she will listen to what you have to say. Thank you very much.
Brooklyn Grandma Upset About a Weighty Issue in Williamsburg

Dear Brooklyn Grandma,
First, I would like you to know that unfortunately your situation is not unique. One in five children age four and younger in the United States is obese. It is most prevalent among Native Americans and children of color, with the rates reaching one in three for these groups.
Childhood obesity is a serious medical condition. It predisposes children to develop diseases that we had formerly only seen in adults, such as adult-onset diabetes, high blood pressure and heart disease.
While a few cases of obesity are caused by genetic and hormonal matters, most excess weight is simply caused by children eating too much and exercising too little.
There are many factors that increase a child’s risk of being overweight:
• Diet – Regular consumption of high-calorie foods, such as fast foods, and vending machine snacks contribute to weight gain.
• Inactivity – Sedentary kids are more likely to gain weight because they don’t burn calories through physical activity.
• Genetics – If a child comes from a family of overweight people, he or she may be genetically predisposed to obesity.
• Psychological factors – Some children overeat to cope with problems or to deal with stress or boredom. Interestingly, in these groups, the parents often exhibit the same tendencies.
• Socioeconomic factors – Children from low-income backgrounds are at greater risk to become obese. Poverty and obesity often go hand in hand because low-income parents may lack the time and resources to make healthy eating and exercise a family priority.
The first step is to have your granddaughter visit her doctor to verify that she is obese. There are specific measurements and formulas using height and weight to determine if a child is truly obese. Normally, it is quite obvious and measurements are not necessary.
It is important to treat this problem early as it can lead to serious lifelong health problems, such as:
• Type 2 diabetes
• High blood pressure
• Asthma
• Sleep disorders
• Liver diseases
• Eating disorders
• Arthritis
• Many types of cancer (breast being the most common).
Being overweight can also lead to low self-esteem and bullying by other children. Many children become depressed. In addition, behavioral and learning problems are increased in obese children.
There are certain things a parent can do to help ensure that a child does not become obese.
• Common sense – Keep healthy food and snacks in the house. A child will learn to eat whatever types of food the parents have available. Never use food as a reward or punishment.
• Eat at least five fruits and vegetables per day.
• Limit television time to two hours. Never allow a child to eat while watching TV as this can lead to eating more food than one realizes.
• Get together for healthful family meals. Make it an event – a time to share stories.
• Limit the number of times the family eats out, particularly at fast-food restaurants. Studies actually show that obesity in a neighborhood is related to the number of local fast-food restaurants.
• Exercise – One hour per day is necessary. This does not have to be formal exercise, as in going to a gym, but can include walking up and down the stairs, helping with household chores and perhaps a family walk. Free-play activities, such as hide and seek, tag, or jumping rope, can be great for burning calories and improving fitness. Find activities your child enjoys. Remember, if you want an active child, be an active parent.
• Give up sugary sodas and juices. A can of Coke contains about 300 calories and the equivalent of 10 teaspoons of sugar. Many people believe that switching from soda to water can eliminate many cases of childhood obesity.
If it is obvious that a child’s weight problem cannot be corrected with the simple measures above, then a trip to the pediatrician is in order. There are treatments available, based on a child’s age and if he or she has other medical conditions.
Treatment usually includes changes in your child’s diet and level of physical activity. In certain circumstances, it also may include medications or weight-loss surgery.
I hope your daughter-in-law reads this column as this issue is very important to your granddaughter’s current and future health.
If action is taken now, the problems I noted above can be avoided.

*Reprinted with permission of The Tablet