Adolescents (10-19 years)- strategies to reduce weight

Adolescents transgress through many physical changes like in growth, weight, height, and other bodily changes throughout their life. These changes can be traced back to their parents and their lifestyles. Therefore, parents affect the mental, emotional as well as physical growth of the child.
Parents can prevent their children from being overweight by developing healthy eating habits, creating a calorie-deficit diet. Also, them being physically active, by reducing their screen timing and also by getting adequate sleep.

What is Adolescents obesity?

Adolescent obesity is a condition in which a child is significantly overweight for his or her age and height.

Who are at risk?

Those children are at greater risk of being obese who have:

• poor physical activity/exercise,

• poor eating habits

• been in front of the screen continuously.

These are all factors contributing to the epidemic.

How to calculate BMI for your adolescents?

BMI helps in estimating how much body fat your child have which is usually based on height and weight. But for children, height and weight alone aren’t as accurate as they are for adults. So, you must be thinking why is that? It is because their BMIs vary due to their regular growth and development, body fat percentages change.

The formula which is used for calculating the BMI:

BMI = Weight (kg)/[height (m)]2 

After the child’s BMI is calculated with the help of the above formula then it is expressed as a percentile. This percentile is obtained from a graph provided by the Indian Pediatric Academy (IAP).

BMI percentiles are grouped into eight categories:

Weight Status Category	Percentile Range
Underweight	Less than the 5th percentile
Healthy Weight	5th percentile to less than the 85th percentile
Overweight	85th to less than the 95th percentile
Obesity	Equal to or greater than the 95th percentile

Let’s see some hypothetical examples for BMI percentiles:

Firstly, let’s take an example for a 17-year girl of average height 156 cm who weighs 68.5 kg will have a BMI of 28.2 kg/m2. This will also place the girl in the 90th percentile for BMI. And she will also be considered to fall into the overweight category according to the reference table above provided by WHO.

Now, this percentile is plotted on the BMI-for-age percentile chart. The green dot on the graph represents the BMI percentile for the girl which is in the 90th percentile – the overweight region.

Chart 1: The chart for a 17-year-old girl showing BMI percentile

Similarly, let’s take another example for a 16-year-old boy of average height 160 cm who weighs 65.5 kg will have a BMI of 25.5 kg/m2. This will also place this boy in the 78.33 percentile (between 75th and 85th). He will also be considered to fall into the normal category according to the reference table above provided by WHO.

This percentile now is plotted on the BMI-for-age percentile chart. The green dot on the graph represents the BMI percentile for the boy which is in the 78th percentile – the normal region.

Chart 2: The chart for a 16-year-old boy showing BMI percentile

How accurate is BMI for all children?

The BMI is a good measure of body fat. But this can be misleading in the case of some children like athletes and sportsperson who can fall into the overweight or obese category. This happens due to their bulky muscles and also lean body mass.

How adolescent obesity can be treated?

Adolescent obesity can be treated with the focus on developing healthy eating and exercise habits as well.

Thereby, reducing calorie intake and burning calories are two ways to meet these goals.

Firstly, calorie intake is reduced by planning a customized well-balanced diet of healthy foods. And by making permanent changes in their eating habits. Secondly, calorie-burning can be increased by increasing their physical activity.

TIP: In addition, also do not use any weight-reducing drugs for adolescents as there may be concerns about their safety.

Dietary guidelines for adolescents:

These dietary guidelines are the basis for designing healthy eating patterns that link nutrients to food intake and also ensure overall dietary quality for the health of your child.

• First thing to remember is to give your child a variety of foods from all the five food groups   (for example – cereals, pulses, milk, meat, fruits and vegetables, fats and sugar). It is to ensure a balanced diet. But how much food adolescents need depends on their body size and also their activity levels.
• Secondly, add plenty of green leafy vegetables, seasonal vegetables and fruits in their diet. Diet rich in vegetables and fruits will also provide them various nutrients like vitamin C, vitamin A, vitamin E, iron, etc.
• Thirdly, include milk and milk products in skimmed form. They should be consumed in moderate amounts as this is the best source of calcium for them and low in saturated fat as well.
• Also, use moderate amount of edible oils and animal foods and use a minimum of ghee/butter/vanaspati.
• Furthermore, ensure an adequate amount of water intake (8-10 glass/day) for them.
• Most importantly, avoid soft drinks, fruit juices, flavoured milk and water, sports drinks, energy drinks, tea as well as coffee as they are only empty calories without any nutrients.
• Additionally, children under 18 years shouldn’t drink alcohol.
• Avoid overeating to prevent overweight and obesity and also divide their meals into 5-6 meals a day.
• Exercise regularly and also be physically active to maintain ideal body weight.
• Restrict salt intake to a minimum for them.
• Ensure the use of safe and clean foods.
• Minimize the use of processed foods rich in salt, sugar and fats.   

A sample menu including all the food groups and a balanced diet

Mealtime	Menu	Household amount
Breakfast	Skimmed milk Multigrain spinach cheela (wheat + jowar) Green chutney	1 glass 2 pieces 1 tsp
Mid-morning	Fruit smoothie Soaked almonds	1 glass 3-4
Lunch	Paneer vegetable roti wrap Mint buttermilk (chaas)	2 1 glass
Evening snack	Makhana bhel with vegetables in it	1 bowl
Dinner	Chapati Rice Rajmah curry Salad	1 1 Katori 1 Katori ½ plate
Post dinner	Fruit rabri/Fruit custard	1 Katori

Parent’s role in managing their child’s healthy eating habits and serving healthy food options to the Adolescents:

Parents or Guardians play a very big part in shaping children’s eating patterns as well as lifestyle habits.

1. Have regular family meals – Family meals are a chance for parents to introduce their child to new foods and to be role models for healthy eating. This can also help them grow as a healthy and happy family.
2. Keep your meal-time calm and friendly, therefore no lectures or arguing should be included on the dining table which may cause your child to lose appetite.
3. Likewise, make it easy for your child to choose healthy snacks by keeping fruits and vegetables on hand and ready to eat too. Also, other good snacks include low-fat yogurt and celery, or whole-grain crackers and cheese.
4. Also, involve your child in what to make for dinner. In addition, talk to them about making healthy choices and planning a balanced meal. Some might even want to help shop for ingredients and prepare the meal also.
5. Moreover, make healthy food fun. If your children won’t eat vegetables, you can also experiment with condiments and dips.
6. You can get furthermore creative with meals. The more creative the meal is, the greater the variety of foods your children eat.

The healthy recipes that children of age group 10-19 enjoy:

Non-Vegetarian	Vegetarian	Dessert/Drinks
Chicken-spinach pasta	Grilled sandwich	Oats-apple phirni
Chicken biryani	Multigrain bread burger	Makhana dry fruit kheer
Chicken rolls/wraps	Sweet potato tikki/sweet potato chaat	Apple-banana oats pudding
Bread omelet with ketchup/green chutney	Soya cutlet/oats-moong Dal Tikki	Fruit rabri/fruit custard
Steamed rice with fish curry/chicken curry	Tomato-spinach savory pancakes	sweet rose lassi
Chicken biryani with curd	Oats-tofu pancakes
Hummus wrap	Stuffed paneer moonglet
Egg tomato curry	Sprouts parantha
Egg fried rice with vegetables in it	Besan cheela/sooji  cheela/jowar cheela (with vegetables)

Exercise and Physical activity in Adolescents:

Exercise and physical activity are important parts of keeping your children healthy especially in today’s scenario. Especially when everyone is sitting behind their computers with little physical activity. This is only leading your children into depression, mood swings, anxiety, and other health comorbidities also.

I myself believe that lifestyles that are learned in childhood from your family and friends are more likely to stay with you till the end. That’s why learning a healthy lifestyle at an early age can benefit you in so many ways.

Not to forget, that there are so many health benefits of exercise and physical activity like controlling body weight as well as its composition. Also reduces the risk of chronic diseases and builds strong muscles, bones, and joints too. It also improves flexibility, wards off depression, and improves mood, sense of well-being, and self-esteem too.

Children with comorbidities like heart disease, hypertension, diabetes, asthma, osteoporosis, and obesity should consult a physician before taking up any exercise program.

Children need at least 60 minutes of exercise every day which can be low intensity, moderate intensity, and vigorous intensity levels as well.

The low to moderate intensity activities include the following:

• Pleasure walking
• Climbing stairs
• Dancing
• Yoga

The vigorous-intensity activities include the following:

• Brisk walking
• Running
• Swimming
• Cycling
• Roller skating
• Jumping rope
• Playing on the playground
• Jumba
• Gymnastics
• Hiking
• Soccer

Lifestyle modifications in Adolescents:

By definition, lifestyle modification is altering long-term habits typically of eating or physical activity, and also about maintaining the new behavior for months or years.

• Children should exercise regularly for at least 60 minutes a day.
• They should also eat a healthy balanced diet coupled with changes in meal size, meal times, or frequency of meals.
• They should also maintain a healthy weight in their teen years as children and teenagers with obesity are more likely to have obesity as an adult.
• Also, they should get enough sleep (at least 8-10 hours a day) as sleep patterns are irregular in teen children.
• A habit of brushing and flossing teeth twice a day should be encouraged which can help teens to prevent tooth and gum problems in adulthood too.
• Lastly, a good balance between school, work, and social life to avoid stress in life.

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