Obesity and Weight Management
Dietary and Exercise Recommendations for Children and Adolescents for Healthy Living
Childhood obesity has increased over the past 30 years by such an alarming rate that it is now termed as epidemic. Recent estimates show that almost 40% of all children are either overweight or obese, and rates are continuing to rise. Experts have looked closely at many contributing factors and feel that the strongest and most common causes of obesity are due to both decreased exercise and increased calories over the past 30 years.
The American Academy of Pediatrics recommends the following dietary exercise guidelines for children and adolescents. These recommendations are based on current knowledge about the benefits of healthy nutrition early in life as well as current knowledge on preventing heart disease when children become adults. Recommendations are divided by age as follows:
Prior to birth
Age birth to 23 months old
Age 2-3 years old
Age 4-8 years old
Age 9-13 years old
Age 14-18 years old
Prior to Birth:
The environment of the womb during pregnancy is very important to how the baby develops, 
especially with regards to nutrition. The nutrition that the mother eats is the same nutrition that the baby eats. Experts now agree that both too few of calories during pregnancy and too high of calories during pregnancy can increase the baby's risk of developing obesity, diabetes, and heart disease later in life because of how the baby's systems try to adapt to the mother's nutrition.
So during your pregnancy, it is important to:
- seek regular prenatal care and screening for any diabetes development during pregnancy.
- exercise as your doctor recommends.
- obtain a healthy weight gain (not too much and not too little).
The chart below gives recommendations based on the mother's pre-pregnancy weight body mass index (BMI).
Calculate your BMI
| Pre-pregnancy BMI |
Recommended total pregnancy weight gain |
| Underweight (pre-pregnancy BMI less than 19.8) |
28-40 pounds |
| Normal weight (pre-pregnancy BMI 19.8-26.0) |
25-35 pounds |
| Overweight (pre-pregnancy BMI 26.0-29.0) |
15-25 pounds |
| Obese (pre-pregnancy BMI greater than 29.0) |
15 pounds at most |
Institute of Medicine. Nutrition During Pregnancy. Washington DC: National Academy of Sciences; 1990.
Age Birth to 23 months old:
Combating obesity needs to start from early infancy. Too much baby fat can increase the risk of your child becoming fat later in life. During the first year of life, nutritional focus should be centered on the unique nutritional needs of each specific month. Appropriate growth and weight gain should be closely monitored by your child's health care provider. The family meal time should be introduced once your child begins to eat table foods around 6-9 months of age. Children who eat meals with the family are less likely to be obese. Exercise should generally be focused on unstructured, safe play environments. Activities that promote development, such as providing tummy time for an infant, are important at this stage.
Nutrition Recommendations from birth to 23 months old:
- Human milk is superior. Breastfeed only and feed anytime baby is hungry. (Try to maintain for 12 months.)
Delay the introduction of 100% juice until at least 6 months of age and limit to no more than 4-6 ounces per day. - Do not feed juice in bottle; use cup only.
- Start other sources of nutrition (rice, pureed baby foods) between 4-6 months.
- Introduce healthy foods and continue to offer if initially refused.
- Do not introduce foods without any nutritional value simply to provide extra calories.
- Limit salt/sodium intake to less than 1500 mg per day.
- Make eating a social event for the family by establishing regularly scheduled meals together.
- Do not overfeed or force children to finish meals if not hungry.
- Have your doctor check for rapid weight gain between 4-6 months and discuss plans with the doctor for limiting overall calorie intake if weight gain is too rapid. Care must be taken in calorie reduction at a time when the infant still needs calories for normal growth and development.
Recommended Overall Calorie Intake for birth to 23 months old:
|
900 calories per day (no differences between boys and girls)
- 300-350 of those calories from fat.
- 550-600 of those calories from protein and carbohydrates which
must include the following:
- 16 ounces of whole milk or 2% milk per day
- 1½ ounces of meats/proteins per day
- 1 cup of fruits per day
- ¾ cup of vegetables per day
- At least 2 ounces of grains per day (for example, one piece of whole grain bread = 1 ounce
- 19 grams of fiber per day
- Additional calories should be used as carbohydrates.
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Exercise Recommendations from birth to 23 months old:
- Parents should provide a safe, nurturing, minimally structured play environment for the child to participate in daily.
- Organized exercise programs or classes are not necessary.
- Children younger than 2 years old should not watch any TV.
- Infants/toddlers should be allowed to explore the outdoors with supervision so they can develop an enjoyment of the outdoors. Activities include: walking in the neighborhood, unorganized free play outdoors, and walking through a park or zoo.
Age 2-3 years old:
Healthy nutrition for toddlers should focus on eliminating excessive snacking as well as providing healthy snack choices that don't include excessive calories, such as the extra calories often found in junk food. Parental modeling is also important at this age during family meal times. Exercise focus should allow for continued development and safe exploration outdoors.
Nutrition Recommendations for 2-3 years old:
- Have regular family meals to promote social interaction and positive role model food-behavior.
- Parents, not children, should choose meal times.
- Provide meals with a variety of choices of fruits and vegetables instead of ice-cream, salty snacks, fried foods, and cookies.
- Use fat-free or low-fat dairy products.
- Encourage 2 servings of fish per week but avoid shark, swordfish, king mackerel, and tilefish.
- Limit salt/sodium intake to less than 1900 mg per day.
- Parents should not force children to eat when they are not hungry as this leads to overeating.
- Limit intake of sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 4-6 ounces per day if given. Restrict use of sweet/sweetened beverages such as soda, juice, and sports drinks as snacks.
- Limit snacking while watching TV, playing video games, and playing on the computer.
Recommended Overall Calorie Intake for 2-3 years old
|
1000 calories per day (no differences between boys and girls)
- 300-350 calories from fat.
- 650-700 calories from protein and carbohydrates which must include the following:
- 16 ounces of fat-free milk per day
- 2 ounces of meats/proteins per day
- 1 cup of fruits per day
- 1 cup of vegetables per day
- At least 3 ounces of grains per day (for example, one piece of
whole grain bread = 1 ounce)
- 19 grams of fiber per day
- Additional calories should be used as carbohydrates.
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Exercise Recommendations for 2-3 years old:
- Parents should provide a safe, nurturing, minimally structured play environment for the child to participate in daily.
- Organized exercise programs or classes are not necessary.
- Limit TV, video games, and computer times to 1-2 hours per day.
- Children younger than 2 years old should not watch any TV.
- Toddlers should be allowed to explore the outdoors with supervision in order to develop an enjoyment for the outdoors. Activities include: walking in the neighborhood, unorganized free play outdoors, and walking through a park or zoo.
Age 4-8 years old:
During young school ages, family meal times continue to be important, especially with regards to parental modeling. Additionally, enforcement of reduced snacking and healthy food choices remain key strategies for encouraging proper nutrition. Organized play and participation in simple sports or dance activities become a new way to incorporate exercise. If participation in organized activities is not possible, consistent organized play should be enforced so that your child begins to learn the habit of regular exercise.
Nutrition Recommendations for 4-8 years old:
- Have regular family meals to promote social interaction and positive role model food-behavior.
- Parents, not children, should choose meal times.
- Provide meals with a variety of choices of fruits and vegetables instead of ice-cream, salty snacks, fried foods, and cookies.
- Use fat-free or low-fat dairy products.
- Encourage 2 servings of fish per week but avoid shark, swordfish, king mackerel, and tilefish.
- Limit salt/sodium intake to less than 1900 mg per day.
- Parents should not force children to eat when they are not hungry as this leads to overeating.
- Limit intake of sweet/sweetened beverages such as soda, juice, sports drinks to maximum of 4-6 ounces per day if between 4-6 years old and to maximum of 8-12 ounces per day if between 6-8 years old.
- Restrict use of sweet/sweetened beverages such as soda, juice, sports drinks as snacks.
- Limit snacking during watching TV, playing video games, and playing on the computer.
Recommended Overall Calorie Intake for 4-8 years old:
| 1400 calories per day for boys |
1200 calories per day for girls |
- 350-500 calories from fat
- 900-1050 calories from protein and carbohydrates which must include the following:
- 16 ounces of fat-free milk per day
- 4 ounces of meats/proteins per day
- 1½ cup of fruits per day
- 1½ cup of vegetables per day
- At least 5 ounces of grains per day (for example, one piece of whole grain bread = 1 ounce)
- 25 grams of fiber per day
Additional calories should be used as carbohydrates.
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- 300-450 calories from fat
- 750-900 calories from protein and carbohydrates which must include the following:
- 16 ounces of fat-free milk per day
- 3 ounces of meats/proteins per day
- 1½ cup of fruits per day
- 1 cup of vegetables per day
- At least 4 ounces of grains per day (for example, one piece of whole grain bread = 1 ounce)
- 25 grams of fiber per day
Additional calories should be used as carbohydrates.
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Exercise Recommendations for 4-6 years old:
- Encourage free play with an emphasis on fun, playfulness, exploration, and experimentation with proper safety and adult supervision.
- Expect a pre-school aged child to walk tolerable distances with family members.
- Appropriate activities: throwing/catching, running, swimming, and tumbling.
- Co-ed activities are appropriate as there is little difference between the sexes in weight, height, endurance, and motor skills.
- Limit TV, video games, and computer times to less than 2 hours per day.
Above activities should occur a minimum of 30 minutes per day, 6 days per week
Exercise Recommendations for 6-8 years old:
- Encourage free play that involves learning new physical skills with proper safety and adult supervision.
- Encourage walking, dancing, jump rope, or miniature golf.
- Competitive organized sports (soccer, baseball) may be introduced at this time but with the following qualifiers: flexible rules, short instruction time, free time within practices, focus on enjoyment rather than competition, limited team strategy instruction.
- Co-ed activities are appropriate as there is little difference between the sexes in weight, height, endurance, and motor skills.
- TV time should be limited to 2 hours or less per day.
Above activities should occur a minimum of 30 minutes per day, 6 days per week
Age 9-13 years old:
With the onset of puberty during middle school years, nutritional requirements start to differ between the sexes. Family meal times and parental role modeling become less important as children begin to spend more of their meal times with their peer groups. The most important nutritional influence in the home is in regards to the availability of healthy snacks and meals for your child to choose. Options of regular exercise include involvement in more complex sports as well as supervised weight/strength training. An emphasis on enjoyment of regular exercise is important at this age.
Nutrition Recommendations for age 9-13 years old:
- Have regular family meals to promote social interaction and positive role model food-behavior.
- Encourage daily breakfast and one afternoon snack per day.
- Provide meals with a variety of choices of fruits and vegetables instead of ice-cream, salty snacks, fried foods, and cookies.
- Encourage 2 servings of fish per week but avoid shark, swordfish, king mackerel, and tilefish.
- Use fat-free or low-fat dairy products at home.
- Parents should not force children to eat when they are not hungry as this leads to overeating.
- Limit salt/sodium intake to less than 2200 mg per day.
- Limit intake of sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 8-12 ounces per day.
Recommended Overall Calorie Intake for 9-13 years old:
| 1800 calories per day for boys |
1600 calories per day for girls |
- 450-650 calories from fat
- 1150-1350 calories from protein and carbohydrates which must include the following:
- 24 ounces of fat-free milk per day
- 5 ounces of meats/proteins per day
- 1½ cup of fruits per day
- 2½ cup of vegetables per day
- At least 6 ounces of grains per day (for example, one piece of
whole grain bread = 1 ounce)
- 31 grams of fiber per day
Additional calories should be used as carbohydrates
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- 400-550 calories from fat
- 1050-1200 calories from protein and carbohydrates which must include the following:
- 24 ounces of fat-free milk per day
- 5 ounces of meats/proteins per day
- 1½ cup of fruits per day
- 2 cup of vegetables per day
- At least 5 ounces of grains per day (for example, one piece of
whole grain bread = 1 ounce)
- 26 grams of fiber per day
Additional calories should be used as carbohydrates
Portion Size Help |
Exercise Recommendations for 9-13 years old:
- Encourage activities that focus on physical skill development and understanding of sports tactics with an emphasis on enjoyment with family members and with friends.
- Activities can include the following complex sports: football, basketball, ice hockey, volleyball or individual sports: tennis, track & field, running, swimming, dance.
- Weight training may be initiated provided good supervision and teaching of proper techniques, using small free weights (15-20 pounds) with high repetitions.
- Avoid using heavy weights with short sets and avoid squat lift weights exercises.
Above activities should occur a minimum of 30 minutes per day, 6 days per week
Age 14-18 years old:
Nutritional requirements differ between the sexes during adolescence due to puberty differences. Family meal times and parental role modeling also continue to be less important as adolescents spend more of their meal times with their peer groups. The availability of healthy snacks and meals for your child to choose remains the most important nutritional influence in the home. Exercising options are similar to that of adults except for caution regarding heavy weight training in those adolescents who have not completed their growth. The consistency of exercise recommended is similar to adult requirements.
Nutrition Recommendations for 14-18 years old:
- Have regular family meals to promote social interaction and posit
ive role model food-behavior.
- Encourage daily breakfast and one afternoon snack per day.
- Provide meals with a variety of choices of fruits and vegetables instead of ice-cream, salty snacks, fried foods, and cookies.
- Use fat-free or low-fat dairy products at home.
- Encourage 2 servings of fish per week but avoid shark, swordfish, king mackerel, and tilefish.
- Parents should not force children to eat when they are not hungry as this leads to overeating.
- Limit salt/sodium intake to less than 2200 mg per day.
- Limit intake of sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 8-12 ounces per day.
Recommended Overall Calorie Intake for 14-18 years old:
| 2200 calories per day for boys |
1800 calories per day for girls |
- 550-750 calories from fat
- 1450-1650 calories from protein and carbohydrates which must include the following:
- 24 ounces of fat-free milk per day
- 6 ounces of meats/proteins per day
- 2 cup of fruits per day
- 3 cup of vegetables per day
- At least 7 ounces of grains per day (for example, one piece of
whole grain bread = 1 ounce)
- 38 grams of fiber per day
Additional calories should be used as carbohydrates
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- 450-650 calories from fat
- 1150-1350 calories from protein and carbohydrates which must include the following:
- 24 ounces of fat-free milk per day
- 5 ounces of meats/proteins per day
- 1½ cup of fruits per day
- 2½ cup of vegetables per day
- At least 6 ounces of grains per day (for example, one piece of
whole grain bread = 1 ounce
- 29 grams of fiber per day
Additional calories should be used as carbohydrates
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Exercise Recommendations for 14-18 years old:
- Encourage activities that focus on the teen's individual idea of fun and on his/her enjoyment with friends.
- Activities can include the following: yoga, dance, running, walking, cycling, household chores, and competitive or noncompetitive sports.
- Weight training may occur without restrictions provided completion of puberty.
- Weight training may be initiated in those who have not completed puberty provided good supervision and teaching of proper techniques using small free weights (15-20 pounds) with high repetitions.
- In children who have not completed puberty, avoid using heavy weights with short sets and avoid squat lift weights exercises.
Above activities should occur a minimum of 30 minutes per day, 6 days per week.
References
National Center for Health Statistics. Health, United States, 2006. www.cdc.gov/nchs/hus.htm; accessed December 2007.
The American Academy of Pediatrics Policy Statements.
Barker DJP, Osmond C. 1986 Infant mortality, childhood nutrition, and ischemic heart disease in England and Wales. Lancet: 1: 1077-1081.
Eriksson JG, Forsen TJ, Osmond C, Barker DJ. 2003 Pathways of infant and childhood growth that lead to type 2 diabetes. Diabetes Care 26 (11): 3006-3010.
Dyer JS, Rosenfeld CR, Rice J, Rice M, Hardin DS. 2007 Insulin resistance in Hispanic Large For Gestational Age neonates at birth. J Clin Endocrinol Metab. Oct; 92 (10): 3836-3843.
Institute of Medicine. Nutrition During Pregnancy. Washington DC: National Academy of Sciences; 1990.
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Last Reviewed: Apr 05, 2010
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