Last update: July 2016 - Please read disclaimer before proceeding

 

The problem; an overview

At present over 20 per cent of children in Australia are either overweight or obese. This is twice the incidence of ten years ago! The maximum incidence in girls is just prior to puberty. In boys, however, the incidence continues to increase throughout adolescence, with about one third of sixteen to eighteen year old boys being affected. This presents a major problem as many obese children will go on to become obese adults. The likelihood of childhood obesity persisting into adult life increases with:

It is an unfortunate fact that only 15% of adults who seriously attempt weight loss succeed in the long term. Thus, preventing or successfully treating obesity in children is the best method of preventing obesity in adults. Treatment is hampered however by the fact that in 50 per cent of cases, the parents do not perceive their child as being overweight or obese.

Obese children suffer from mental illness and are at increased risk from numerous illnesses later in life, including heart disease and diabetes. They also tend to take the poor eating and exercise habits that they have learned in childhood into adult life.

Defining obesity
At present there is no universally accepted classification of childhood obesity. Most classifications are based on an interpretation of the child’s body mass index (BMI).

Body Mass Index   = Weight (in kilograms) divided by the height (in metres )squared  
                                

The method most commonly adopted in Australia is to use percentile charts that relate a child’s BMI to their age. Those above the 85th percentile are classified as overweight. Those above the 95th percentile are classified as obese.
Calculation of a child's BMI percentile can be done from the internet site below.

http://kidshealth.org/en/parents/bmi-charts.html

 

Using BMI percentile results

In adults, the healthy BMI range (20 to 25) is the same irrespective of age and sex. Examination of the BMI charts for boys and girls shows that healthy BMI levels vary for boys and girls and are also age dependent. This occurs because there are rapid changes in BMI values as growth occurs during childhood and because girls and boys have ‘growth spurts’ at different ages.

 

When interpreting BMI results, it is important to note two things; the actual BMI percentile and any change that occurs in percentiles that occurs over time.

 

(i) Actual readings: The percentage lines that appear on these charts are a way of comparing children with respect to their body mass index. For example, being on the 75th percentile line means that 25% of a normal population of children has a higher BMI and 75% has a lower BMI.

Children are defined as:

  • overweight if they are above the 85th percentile
  • obese if they are above the 95th percentile
  • underweight if they are at or below the 5th percentile

Unfortunately Australia does not have a ‘normal child population’ with regard to BMI and at present about 25% are over the 85th percentile. (For this reason it is often not helpful to compare a child's weight with that of his peers. It may cause parents to 'miss' their child's obesity problem.)

Remember that these readings do vary with growth spurts and it is important not to be alarmed by a single high or low reading; unless it is very high or very low.

Interpreting an initial first BMI percentile reading

  • BMI percentile above the 85th or below the 5th percentile – See a doctor for advice.
  • BMI close to the 5th or 85th percentiles  - Repeat again in a couple of months. (It may be that a rapid change in growth led to a borderline reading.)
  • BMI between 15th and 80th percentiles – Repeat at six monthly intervals.

(ii) It is important to monitor change in percentiles over time: BMI readings should be taken regularly as this allows the change in percentile that occurs over time to be monitored.  (Twice a year is generally adequate and it is not healthy or helpful for the child to be continually monitoring their weight.)

Most children tend to track along the same percentile line (with a few growth spurt bumps along the way). A gradual change in percentile over time (either up or down) means that something is happening regarding eating / exercise habits or that other health problems might be present and such changes should be discussed with a doctor. For example, there would be concern regarding developing obesity in a child who moves from the 75th percentile to the 86th over several readings and a visit to a GP would be worthwhile.

 

Assessment using waist measurement

As in adults, childhood waist measurement is generally a better indicator of detrimental health outcomes that occur because of obesity than BMI measurement. Like BMI charts, waist circumference can be expressed in the form of percentiles. See chart below. Being over the 90th percentile is cause for concern.

Waist circumference (cm) for age percentiles for boys and girls aged 2 years to 18 years
 

Percentile for boys

Percentile for girls
 
10th
25th
50th
75th
90th
10th
25th
50th
75th
90th
Age (yrs)
2
43.2
45.0
47.1
48.8
50.8
43.8
45.0
47.1
49.5
52.2
3
44.9
46.9
49.1
51.3
54.2
45.4
46.7
49.1
51.9
55.3
4
46.6
48.7
51.1
53.9
57.6
46.9
48.4
51.1
54.3
58.3
5
48.4
50.6
53.2
56.4
61.0
48.5
50.1
53.0
56.7
61.4
6
50.1
52.4
55.2
59.0
64.4
50.1
51.8
55.0
59.1
64.4
7
51.8
54.3
57.2
61.5
67.8
51.6
53.5
56.9
61.5
67.5
8
53.5
56.1
59.3
64.1
71.2
53.2
55.2
58.9
63.9
70.5
9
55.3
58.0
61.3
66.6
74.6
54.8
56.9
60.8
66.3
73.6
10
57.0
59.8
63.3
69.2
78.0
56.3
58.6
62.8
68.7
76.6
11
58.7
61.7
65.4
71.7
81.4
57.9
60.3
64.8
71.1
79.7
12
60.5
63.5
67.4
74.3
84.8
59.5
62.0
66.7
73.5
82.7
13
62.2
65.4
69.5
76.8
88.2
61.0
63.7
68.7
75.9
85.8
14
63.9
67.2
71.5
79.4
91.6
62.6
65.4
70.6
78.3
88.8
15
65.6
69.1
73.5
81.9
95.0
64.2
67.1
72.6
80.7
91.9
16
67.4
70.9
75.6
84.5
98.4
65.7
68.8
74.6
83.1
94.9
17
69.1
72.8
77.6
87.0
101.8
67.3
70.5
76.5
85.5
98.0
18
70.8
74.6
79.6
89.6
105.2
68.9
72.2
78.5
87.9
101.0
 

 

Problems caused by obesity in children.

(i) Psychological problems

Psychological problems are also more prevalent in obese children. These include poor body image and decreased self-worth, mainly as a result of being ignored, teased or bullied by peers, which may in turn lead to anxiety and depression. Thirty per cent of very obese girls have an underlying eating disorder, although preoccupation with weight is a problem with both normal weight and obese young women. Obesity in adolescence may reflect family discord, boredom or depression.

(ii) Maintaining obesity into adult life

About 40% of overweight 4-year-olds and 60% of children over the age of six who are overweight become overweight adults. This is a huge problem as only about 10%  to 15% of adults who seriously try to lose weight are successful in the long term. Thus, most of these children are likely to suffer from the complications of adult obesity, which include an increase in the incidence of:

 

Causes of Childhood Obesity

Reduced physical activity:

An increasingly sedentary lifestyle that includes several hours a day spent watching television or in front of the computer is a major cause of the increase in childhood obesity. Studies show that childhood obesity levels are directly related to the amount of television watched.

Changed eating patterns:

Also of significance are changes in eating patterns. The increasing consumption of soft drinks, fatty foods and take-away / fast foods and the overall increase in food portion sizes has resulted in a large increase in the energy intake in children. Between 1985 and 1995, energy intake in 10 to 15 year old children increased by close to 10 per cent (1400kJ per day for boys and 900kJ for girls); a huge amount. About one third of food expenditure in Australia is on foods not produced or consumed in the home and these foods are likely to be higher in energy content (kilojoules) than home prepared foods. Parental preferences significantly influence child food preferences, so try to set a good example.

Parental influences:

Parental obesity more than doubles the risk of adult obesity among both obese and non-obese children, mainly because:

Children adopt parent behaviours that cause obesity: The physical activity level of parents is a critical factor influencing the risk of developing childhood obesity. Families with two active parents are six times more likely to have active children than families with inactive parents. Similarly, children often adopt obesity-causing eating habits, including eating food containing high amounts of energy (i.e. calories) such as take-away foods, snacking, large portion sizes etc.

Genetic influences: Some children have a genetic predisposition to becoming obese. However, obesity only develops in an environment conducive to weight gain (i.e. low exercise and poor diet).

Failure to recognise childhood obesity: Many parents fail to recognise that their child’s obesity is an issue of concern. Many parents (up to 50 per cent) see their child’s obesity as being ‘normal’.

Other illnesses:

Childhood obesity is only very occasionally due to a specific medical cause. Short stature for age, developmental delay, and the early onset of obesity are warning signs that there may be an underlying medical cause and these symptoms need to be investigated by a medical practitioner. Any parent who is worried that his or her child may have a medical cause for their obesity needs to consult their general practitioner.

Influences in later adolescence:

Older teenagers are at a significantly increased risk of developing obesity for three reasons.

 

Childhood obesity – a family problem, not a problem with the child.

In dealing with childhood obesity, adopting a family approach is likely to lead to greater success. As is the case with most aspects of life, parents can often help their children most by being good role models.

“Children have never been very good at listening to their elders, but they have never failed to imitate them.”
                                                                                                                                         James Baldwin (1924-1987), US writer.

And including all the family in healthy weight-reduction initiatives such as consuming heallthy meals and partaking in family-orieted physical activities benefits everyone, whether they are overweight or not.

Making childhood obesity a family problem rather than a problem with the child also prevents the child from being ‘singled out’ as different from other family members and reduces the risk of the child developing feelings of guilt regarding their size. Such guilt can initiate body-image problems that can lead to more serious problems, such as anorexia, in adolescents and young adults.

It is important to concentrate on long-term changes in behaviour rather than on a particular weight goal. Again, this will help avoid guilt. As with any change in behaviour, do not try to take on too much at once. Just try to gradually introduce small changes that can be maintained in the long term. (For example, an extra walk each week or reducing TV viewing by a couple of hours per week.)

Often all that is needed to overcome a exess-weight problem is to aim to maintain the child’s present weight and, as the child grows taller, the obesity problem will gradually disappear. (In cases where the the child is consideably overweight, actual weight loss will be required to ensure the child remains healthy.)

There are four main ways a parent can intervene to treat or prevent childhood obesity.

1.   Helpful parental (carer) attitudes
2.   Better control of the child’s eating environment
3.   Increasing the child’s physical activity levels
4.   Decreasing time spent doing sedentary activities (TV & computer!!)

These are now discussed in more detail.

Five important interventions that help children maintain a healthy weight

  • Ensure every member of the family eats breakfast every day
  • Reduce recreational TV / computer time to less than two hours per day (or less if possible)
  • Eat at least one meal together as a family at the table (with NO TV) each day and encourage all family members to always to sit at the table when eating a meal
  • Ensure children are active outside for at least 60 minutes each day
  • Choose water as the child's main drink

 

1. Helpful parental (carer) attitudes

 

2. Controlling the child’s eating environment

Parents need to assist change in their children’s eating behaviour through control of their environment. Here are some suggestions.

Serving sizes are smaller for young children (pre-schoolers)

Vegetables and fruit: One serve is equal to their age in tablespoons

Meat: One serve is about the size of the palm of child’s hand

Bread / cereals: One serve is about the size of the child’s clenched fist

Choosing foods with a low energy content

For most people, only a certain volume of food can be eaten at any one sitting before they feel full and wish to stop eating. One good way of reducing the amount of energy that is consumed is to try to mostly consume foods with a low energy density. This means choosing foods with relatively few kilojoules per gram of food. Most foods available for purchase in Australia are required to have the energy density on the packaging; it is expressed (and displayed) as the number of kJ in 100g of the product. The table below displays the APPROXIMATE energy density of many foods commonly consumed in Australia and there are a few things that are worthwhile pointing out regarding this table.

  • Most vegetables and fresh fruit have low energy densities and filling children’s meals with these is a good way of reducing energy consumption. There are some exceptions to this 'rule', including dried fruits such as sultanas and prunes, hot chips, and avocado, which has a high fat content. Also, baking vegetables in oil or adding butter obviously significantly increases their energy content, as does adding oil-based dressings or mayonnaise to salads. An appropriate intake of fruit and vegetables for children is :
    • Vegetables: 4 to 5 servings per day
    • Fruit: 2 to 3 servings per day
  • All oils and spreads have very high energy densities due to their very high fat content and should be used sparingly.
  • Many take away foods have a energy density due to their high fat / sugar content and are better avoided or consumed very sparingly. Luckily, many of these tasty foods can be made at home with a reduced energy content by using little oil / sugar. Good examples are home made pasta sauces, pizzas and hamburgers.
  • Fruit juices (without added sugar) have a similar energy to soft drinks. They should be consumed in moderation and in general it is better to consume fruit fresh 'whole', not as juice. (As stated previously,  those with added sugar should be avoided altogether in overweight people.)
  • The fat content and thus the energy density of meat can be reduced significantly by using lean cuts, removing all visible fat, and taking the skin off chicken.
  • Alcohol (Alcohol is mentioned here and in the table below for the benefit of parents!! Children should obviously not be comsuming any alcohol.) Alcohol also has a high energy density and regular consumption will help stack on the kilos; as well as cause other health problems.

A high energy density does not necessarily mean a food is unhealthy. There are numerous healthy foods with high relatively energy densities that are good for us, such as meat, olive oil and avocado; people should just not eat too much of them. Also, some foods with a high energy density are less important for most people because they usually only consume a small quantity of them. Crispbreads, which are usually very light in weight, are an example

Table showing the energy density of foods appears at the end of this topic.

Some nutritious snacks for children

Snacks, when needed, should occur at specific times during the day and be low in fat, especially saturated fat. Here are a few ideas.

  • Bread based snacks such as sandwiches, fruit loaf, fruit buns.
  • Breakfast cereals
  • Fruit; fresh, dried or canned (unsweetened). Try an assortment of fruit, fruit skewers, or serve fruit with yoghurt dips.
  • Vegetables
  • Dairy products; milk, yoghurt, cheese, fruit smoothies.
  • Home made popcorn

Many ‘museli-type’ bars have a high energy content and contain chocolate etc. They should really be considered as confectionary food items and thus used only as occasional treats.

Appropriate daily energy intakes for children.

Appropriate energy intakes for children will vary greatly according to their age, sex and activity levels. Energy charts for children are provided at the end of this section.

Using these charts together with ‘energy content of foods’ tables to determine design an appropriate dietary plan for a child is a difficult process and one that is best attempted with the help of a dietician.

For parents, a better approach to dietary change is to attempt to reduce the consumption of problem foods, such as soft drinks or confectionary and to ensure other high energy foods (see table above) are consumed in moderation.

 

3. Increasing physical activity

Exercise is important for all children and, as Australian children are becoming more sedentary, all children should be encouraged to achieve adequate levels of physically active. Those that do so are very likely to enjoy this most important health benefit thoughout their lives. The two most imprtant factors in promoting physically active children are:

1. Children should do exercise they enjoy: The main message regarding encouraging physical activity in children is to ensure they are doing physical activities (both structured and unstructured) they enjoy. The best way to determine what structured activities (i.e. sports, dance etc) they enjoy is to provide a range of opportunities when they are young. When they find something they like, encourage it further by providing extra coaching, joining in as a parent, and finding teams / organisations they can join where they can associate with children who enjoy the same activities.

2. Parents being physically active themselves. This is perhaps the most important thing a parent can do to help bring up physically active children. Families with two active parents are six times more likely to have active children than families with inactive parents.

What types of physical activity are appropriate for children?

Physical activity for children can be divided into six categories. A variety of activities should be scheduled at suitable times during the day, especially taking advantage of free daylight hours such as after school and during school holidays.

  1. Unstructured activity: Play that kids just do; running, bike riding, skate boarding, throwing a ball or frissbee etc
  2. Structured activities: Activity classes such as sporting / dance lessons, swimming, little athletics, gym classes for older teenagers. Boy scout and girl guide groups are also a good option.
  3. Sport / activities done in association with organisations / clubs:
    • Participating in a sport / activity as part of an organised team should be encouraged as it promotes socialisation and leadership as well as activity. Sporting / activity clubs are one thing Australia is not short of and there are many choices; football, ballet / dancing, tennis, little athletics, netball, hockey, cricket, basketball, swimming, saling, badminton etc etc.
    • Older children can be encouraged to coach / referree.
  4. Active transport: Increasing walking as part of getting to places is a good way to schedule extra activity into the day. Examples include; walking to school or shops, choosing stairs rather than lifts / escalators, parking the car further away from a station or getting off a bus or train a stop early.
  5. Part-time work for older children that involves physical activity
  6. Active family / home activities:
    • Family outings such as picnics, walks, bike riding, bushwalking. (Doing such activities with friends who have children of similar ages makes such activities more enjoyable for children.)
    • Household duties that require physical activity. It is reasonable for children to help with their fair share of the household chores. Try giving them one specific responsibility, such as sweeping the paths or vacuuming the floors or walking the dog.)Involve children in active household chores, such as vacuuming, walking the dog, sweeping the yard / driveway etc

How much physical activity should children do?

The recommended physical activity levels for children are listed in the box below. Parents who are unsure how much exercise their children are doing can make a good assessment by keeping a diary for a typical week. If the recommended level is not being achieved, then they can schedule some extra specific activities into their child's week. (Such a diary is also helpful for monitoring TV / computer use.)

Physical activity levels and recreational ‘screen time’ levels for children

Child age group

Appropriate activity level

Recreational screen (TV/ computer) time

 

 

 

Preschoolers

Children age 3 to 5 years - Several hours a day – Mostly of supervised unstructured play.

Children under 2 years of age – None

Children aged 2 to 5 years – Up to one hour per day

Primary-school children (Age 6 to 11 years)

Moderate to vigorous exercise for a minumum of 60 minutes per day (and up to several hours per day)

No more than 2 hours per day

High-school children (Age 12 to 18 years)

A minimum of 20 minutes vigorous exercise and 40 minutes moderate exercise per day.

No more than 2 hours per day

Parental encouragement - Parents can encourage their child's participation in the above acitivites by:

Activity at school

Adolescents and physical activity

Most older children prefer participating in team sports and they are very important for socialisation as well as physical activity. However, many children cease team sports when they leave school and it is therefore important to encourage sports and other physical activities that will be easy to continue throughout adult life. Such activities include walking, cycling, golf, tennis or swimming. However, the golden rule is that the activity should be enjoyed and any sport or activity the child is interested in should be encouraged!

4. Decrease sedentary activity – TV and computers

In order to increase time for physical activity, time spent doing sedentary activities, such as watching TV and playing computer games, needs to be restricted. Childhood obesity intervention programs that reduce such sedentary behaviours have been shown to be as effective at inducing weight loss as those that aim solely at increasing physical activity. The best option is to replace 'screen recreation time' with physical activity.

Watching less TV also reduces the consumption of snack foods and reduces exposure to advertisements for poor quality foods, which in turn helps to improve food preferences. Such advertisements are very commonly shown in child viewing times.

It is worthwhile remembering that computers are now also DVD players and successfully restricting TV/ DVD viewing requires monitoring what children are doing on the computer, especially if they have access to a laptop.

Restricting 'screen recreational time' will be best achieved if the whole family becomes involved in the process. Children will learn good TV viewing habits from parents who practice them and parents will find it difficult to justify restricting child TV viewing time if they spend all night in front of the TV.

Here are some practical suggestions / recommendations to help encourage healthy 'recreational screen time' habits.

Sorting out fussy eaters

Getting children to eat a wide range of healthy foods is difficult for parents and can cause many family disagreements. This is a pity as eating is part of who we are and meal times are important family-together times. Thus, while it is important to ensure children learn to eat 'well', it is also important to try to achieve this with as little angst as possible. (There will be plenty of other issues to disagree over.) Parents have many years to achieve good eating habits in their children and learning good habits is usually a gradual process. Here are some suggestions that might help in this process.

  • Try not to make too much of a fuss about children refusing to eat. Just take away the food that is not eaten. Do not then produce dessert. A food often needs to be tried many times before it is accepted. (Try up to 10 times before giving up.)
  • Don’t create a meal that only includes things children do not like or have not tried before. Make sure there is something that they will eat but not so much of it so that they can fill up on that food item alone and not try something new.
  • Try putting the food on several serving dishes rather than on plates. All family members can then help themselves. If the child chooses nothing or very little, the child will go hungry. The parent needs to put out just enough of each food item so that each member gets a normal serving. This will prevent the child just stacking his or her plate with one item of food that they particularly like.
  • If a child eats little of his or her meal and is thus still hungry, provide healthy snacks (such as a piece of fruit) in between meals so that the child gets sufficient to eat. Not too much though as the child needs to be hungry for the next meal. And make sure that such snacks do not include treat-foods as this will just reinforce the 'poor' behaviours.
  • Try not to eat too late when children are tired.
  • Allow the use of fingers if that helps. Sometimes making food ‘fingers friendly’ helps acceptance.
  • Present vegetables attractively. Be creative. Try making faces out of them.
  • Do not bribe children with treats (high-fat, high-energy foods) for eating good foods.
  • Remember that treats are only treats if they occur occasionally; not every day. Try not to have stores of unhealthy snack foods, such as biscuits, cakes, muffins, ice blocks and chocolates, in the house. Rather, buy one-off items for consumption on that day. When making biscuits etc, don’t make too many at a time and ration them out.
  • Watch the drinks. Drinking lots of fluids between eating times will make them less hungry at dinner. In between main meals and afternoon and morning tea, use water as the drink of choice. Healthy drinks such as milk and unsweetened juice can be kept to designated eating times. Other poorer drink choices, especially cordials, sweetened fruit juices and soft drinks, are best avoided altogether. It is especially important not to let toddlers roam around for extended periods with bottles of any drink but especially sweetened drinks such as fruit juices and cordials. It adds too many calories and is very bad for their teeth.
  • Do not watch TV while eating meals.
  • For infants:
    • Breastfeeding for the first six months
    • Once solids are commenced, usually at about six months, try to make sure they have some texture and flavour. Home mashed / pureed foods are best and try to avoid purchased sloppy foods.
    • Allow young children to feed themselves when they are able. This will avoid parental overfeeding.

 

Obtaining professional help

A weight control program can be a difficult and frustrating task for both parents and children. Thus, it is often beneficial to enlist the help of a dietitian or the family’s GP. They can also help recognize any underlying medical cause.

Helping overweight pre-adolescents: When the overweight person is younger (pre-adolescence), most of the advice needs to be given to the parent and it is appropriate for the parent to have consultations without their child being present after an initial assessment is completed. (Repeated visits by younger children can cause feelings of guilt about body shape, resulting in body-image problems in adolescence.)

Helping overweight dolescents: When the overweight person is an adolescent, he or she needs to be part of each consultation and separate consultations for parents and the adolescent are often appropriate. The 'outsider’s point of view' that the health professional provides can be invaluable in initiating change in adolescent behaviour. (In addition, more serious eating disorders, such as bulimia, are a problem in this age group and health professionals will be needed to help with treatment.)

As a team, the family and health professional can assess the family’s dietary problems, initiate an appropriate weight-loss strategy for all members of the family, and help with monitoring the family’s progress through regular follow-up visits.

 

Childhood fat consumption

The fat content of children’s diets should gradually decrease from a relatively high content in the first year of life to about 25 per cent of total dietary energy intake by the onset of adolescence*. Recent recommendations have decreased the age at which total dietary fat intake can be lowered and the current recommendations are listed below.

Full-fat dairy products are still an important part of child diets in the early years. They can be gradually replaced by low-fat dairy alternatives once a more varied diet that contains a variety of healthy fat-containing foods is being consumed. This usually occurs in the 3 to 4 year age group.

The first year of life

  • Breast feeding is the best source of nutrients, including fats, for babies and where possible should continue for at least 6 months.
  • Preterm infants (babies born early) can be at risk from low omega-3 fatty acid consumption. All preterm formulas available in Australia contain supplements of DHA (a type of omega-3 fatty acid) to overcome this problem.

Toddlers (1 to 2 year olds)

  • These children need a higher fat content in their diet to ensure they receive enough energy to provide adequately for this rapid growth phase. Fats should provide about 30 to 35 per cent of their daily energy needs.
  • It is important that a wide variety of fats, including polyunsaturated fats, is included and this means encouraging a wide variety of foods. Whole nuts should be avoided as they can cause choking.
  • Full fat milk is recommended in this group as it is their major source of fat.
  • There is no evidence that altering childhood fat intake from foods in any way will alter the incidence of attention deficit hyperactivity disorder. Similarly, there is little evidence to support supplementing children’s diets with omega-3 fats to reduce the incidence or prevent the occurrence of asthma.

Preschoolers (3 to 4 year olds)

  • Both appetite and the amount of food being eaten increase in this age group and it is therefore reasonable to reduce the fat content of the diet. A lower fat diet that contributes about 30 per cent of dietary energy needs is appropriate.
  • Full-fat milk can be replaced by low-fat alternatives in this age group as the diet becomes more varied.
  • Sources of saturated fats should be reduced, especially takeaway foods, chips, chocolates, cake, pastries, biscuits etc.
  • Whole nuts should be avoided as they can cause choking. (Try using nuts that have been well-groundin ‘meals’.)

Primary School Children

  • This is a period where children are at risk of developing obesity and excessive fat intake is a factor that contributes to this problem. (Excessive fat is an important source of excess energy in child diets.)
  • Fat should contribute a maximum of 30 per cent of dietary energy intake.
  • Saturated fat in the diet should represent no more than a third of total fat intake. (See notes above.)
  • Minimising the use of spreads will help reduce overall fat intake. (Butter should be used sparingly as it is an important source of saturated fats.)

Adolescence (and adults)

  • Once a child has reached adolescence they should be consuming a normal adult low-fat diet.
  • Dietary energy intake from fat should be about 25 to 30 per cent of total energy intake.
  • A healthy mixture of fats is needed. In Australian diets this usually means reducing saturated fats and increasing Omega-3 fats.

*Dietary fat intake is usually expressed as a percentage of total dietary energy intake. For example, when a diet is said to contain 30 per cent fat, it means that the energy supplied by the fat consumed in the diet makes up 30 per cent of energy supplied by all the foods in the diet.

 

 

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Approximate 'energy density' of common foods

(Please note that serving sizes often vary greatly and more be considerably more or less than 100g)

Food

 

Energy density

Fat content

Food

 

Energy density

Fat content

kJ per

100g of food

g of fat  per 100g of food

kJ per

100g of food

g of fat  per 100g of food

Fruit (fresh)

Vegetables (Steamed or boiled unless stated)

Apple

180

0.1

Avocado

879

22.6

Banana

360

0.1

Beans (long green)

87

0.2

Grapes

260

0.1

Broccoli

24

0.3

Mango

236

0.2

Capsicum

75 to 100

1.6

Pear

200

 

Carrot

103

0.8

Rockmelon

90

0.1

Lettuce

27

0.1

Pineapple (fresh)

160

0.1

Peas

250

0.4

Pawpaw

120

0.1

Potato (boiled)

260

0.1

Plum

150

0.1

Potato chips (hot)

1030

14.0

Peach

132

0.1

Pumpkin (boiled)

200

0.7

Prunes

780

0.4

Sweet potato (boiled)

270

0.1

Raisins / Saltanas

1200 to 1300

0.5 to 0.9

Tomato

56

0.1

 

 

 

Zucchini

60

0.3

 

 

 

Canned beans (drained)

308 to 360

0.6

 

Drinks

kJ per 100mL

g per 100g

Dairy

kJ per 100g

g per 100g

Soft drinks,  lemonade, cola

175

0.0

Cheese

1200 to 1700

22.0 to 37.0

Apple juice

176

0.0

Cheese spread / dip

1200 to 1440

25.0 to 33.0

Orange juice

150

0.0

Yoghurt, natural 

360 (normal)

250 (low fat)

4.4 (normal)

0.2 (low fat)

Pineapple juice

160

0.1

Yoghurt, fruit

370 (normal)

315 (low fat)

2.1 (normal)

0.2 (low fat)

Water

0

0.0

Ice cream

830

11.2

Beer

145

 

Milk (regular)

270

3.8

Beer (Low alcohol)

100

0.0

Milk (reduced fat)

225

1.8

Wine (red or while)

280

0.0

Milk (skimmed)

145

0.1

Fruit drinks (tropical, apple, orange etc)

160

0.0

Custard

390

3.0

Milk (See dairy)

 

 

Milk, sweetened condensed

1370

9.2

 

Meat

kJ per 100g

g per 100g

Spreads / oils

kJ per 100g

g per 100g

Blade steak (grilled)

740 to 860

6.8 to 10.6

Butter

3000

81.4

Rump steak (grilled)

800 to 1140

6.7 to 16.8

Margarine

3000

83.5

Mince

900 to 1200

12.0 to 22.0

Margarine, reduced fat

1500

40.0

Leg of lamb (baked)

740 to 940

5.6 to 11.9

Cream

1400

35.6

Fillet steak (grilled)

860 to 970

9.6 to 13.2

Olive oil

3700

100.0

Lamb chop (loin)

740 to 1530

7.2 to 31.4

Peanut butter

2640

54.4

Chicken breast (baked)

660 (no skin)

910  (with skin)

4.8 (no skin)

12.7 (with skin)

Honey

1400

0.0

Beef sausage (grilled)

1070

18.2

Vegetable oil

3400

92.0

Ham, leg

450 to 585

3.6 to 7.6

Jams

1100

0.0

Salami

1800

36.0

 

 

 

Egg (Poaged boiled, scrambled)

630 to 680

11.0 to 13.5

 

 

 

Egg (fried)

1070

21.3

 

 

 

 

Treats / takeaway food

Carbohydrate foods

Apple pie

960 to 1300

13.4 to 20.0

Pasta (boiled weight)

500 to 550

0.4 to 0.8

Danish pastry

1290

15.5

Rice (boiled weight)

520 to 630

0.2 to 1.0

Pizza

1000 to 1100

9.0 to 10.6

Bread (white)

970 to 1250

2.0 to 3.0

Garlic bread

1700

17.4

Bread (wholemeal)

940 to 1130

2.6 to 3.8

Cake

1200 to 1600

7.0 to 19.0

Other biscuits

1700 to 2200

3.8 to 30.0

Doughnut (iced)

1780

24.1

Cracker biscuits / crispbreads

1340 to 2000

2.5 to 24.0

Ice cream

830

11.2

Breakfast cereals

1100 to 1700

1.0 to 16.6

Chocolate

2150

28.0

Pizza

1000 to 1100

9.0 to 10.6

Sweet biscuits

1700 to 2200

3.8 to 30.0

Garlic bread

1700

17.4

Hot chips

1100

8.0 to 14.0

Pancake / picklet

1200

15.0

Potato crisps

2250

35.0

 

 

 

Cheese cake

1420

22.2

 

 

 

 

Notes:

  • Foods marked in pink have either a high energy density or high fat content and consideration should be given to restricting their consumption.
  • The energy contents mentioned in the table relate to 100g (or 100mL) of the food. Often the actual serving will be considerably more or considerably less. For example, the average serving of fruit juice would be 200mL to 250mL, while the average serving of peanut butter would be more like 5g.
  • The values for energy density and fat content for meats depend on how much fat is removed. The lowest levels are where all visible fat has been removed.
  • Many take away foods have a energy density due to their high fat / sugar content and are better avoided or consumed very sparingly. Luckily, many of these tasty foods can be made at home with a reduced energy content by using little oil / sugar. Good examples are home made pasta, pizzas and hamburgers

 

Further information on health in children

The Sydney Children's Hospitals Network (includes The Children’s Hospital at Westmead.)

This hospital network's web site (https://www.schn.health.nsw.gov.au) is a great source of information on children’s health topics. It provides fact sheets about many child health issues that are free and downloadable and lists books on most child health topics that have been assessed by members of the medical staff at the hospital. These books are available for purchase from the Kids Health Bookshop at The Children’s Hospital at Westmead (Phone 02 – 9845 3585) or they can be purchased via the ‘e-shop’ on the web site. Any profits go into supporting the work of the hospital.

Some suggested books on parenting children

Every parent. A positive approach to children’s behaviour  by  Matthew R Sanders, PhD.

More Secrets Of Happy Children  by Steve Biddulph

Raising Kids- A parent’s survival guide by Charles Watson, Dr Susan Clarke and Linda Walton.

Bully Busting by Evelyn M. Field

Raising Boys  by Steve Biddulph

Your Child's Self Esteem  by  Dorothy Corkhille Briggs

(All these books and many more appear in the ‘self esteem, behaviour and family life’ section of the books section in parents section of the Children’s Hospital at Westmead web site. https://kidshealth.schn.health.nsw.gov.au/bookshop-and-products) There is information about each book on the web site; just click over the title.) Better still, for parents able to visit the hospital, most of the books are available to view and there will be someone there to help with book selection.)

Some suggested books on parenting adolescents

What to do when your children turn into teenagers  by Dr D. Bennett and Dr Leanne Rowe (This is a wonderful book that is unfortunately now out of print. Second hand copies may still be available.)

You can't make me  by Dr D. Bennett and Dr Leanne Rowe

I just want you to be happy. Preventing and tackling teenage depression. by Professors Leanne Rowe, David Bennett and Bruce Tonge. Published by Allen and Uwin, 2009.

Puberty boy  by  Geoff Price

Puberty girl  by  Shushann Movsessian

The puberty book  by  Wendy Darvill and Kelsey Powell

Teen esteem by Dr P. Palmer and M. Froehner

Most children suffer anxieties at some time and another book (not on the above list) that is very useful for parents is - Helping your anxious child. A step by step guide for parents. by Rapee, R., Spence, S., Cobham, V. and Wignall, A.New Harbinger, 2000.

 

The Resilience Doughnut parenting program to help build child resilience
The Resilience Doughnut Program is outlined in a book published by Lyn Worsley, which can be purchased through her website: www.lynworsley.com.au  (The cost is about $30)

Triple P Positive Parenting Program
www.triplep.net.

Child and Youth Health
Parenting and child and youth health; links to research updates; telephone helps lines for parents and youth.
www.cyh.com

 

Further information on sexual health

Sexual health information
www.shinesa.org.au

Family Planning NSW
https://www.fpnsw.org.au

The Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp

 

Further reading regarding teenager sexual health

Sexwise by Dr Janet Hall. Published by Random House Australia.
(What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)

Unzipped by Bronwyn Donaghy. Published by Harper Collins 
(A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)

Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)

 

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