| Contribution to weight gain | Examples of goals* | Counseling tips |
| Parent/caregiver role |
- Parent/caregiver is an important role model for healthy eating.
| - Family members have diet and activity goals that are similar to those expected of the child.
| - Be a good role model for healthy eating and exercise (regardless of your weight).
- Try to get all family members to do the same.
- Tell your child about your diet and activity goals; be honest if you don't meet them, and say that you will keep trying.
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- Parent/caregiver is often responsible for meal planning and influences the home environment[1].
| - Family plans and eats meals together.
- Aim to have a single meal prepared for the entire family, rather than making separate items for different members of the family.
| - Control the grocery list – It's easier to make healthy choices if almost all of the foods in the house are healthy.
- Prepare the same meal for all family members.
- Include at least 1 food that the child likes, and don't pressure the child to try every food.
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- Parent/caregiver can support the child's positive self-perception.
| - Support a healthy body image for the child.
- Model a healthy relationship with food.
| - Find positive things to say about the child that do not focus on their weight.
- Parents should use the same positive talk to themselves.
- Be positive about trying new foods.
- Model a healthy relationship with food – Focus on the importance of food for our bodies, and avoid negative comments about calories and eating.
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| Goals for specific food types |
| Sweetened beverages |
- High intake of sugar-sweetened beverages is linked to increased prevalence of obesity in children, but causality has not been established[2-5].
- Fruit juice should also be considered a sweetened beverage.
- Artificially sweetened beverages are safe and may help with weight control[6,7].
| - Avoid all sugar-sweetened beverages and juice. This can be facilitated by eliminating these beverages from the home environment.
| - Main beverages should be water or low-fat milk (unsweetened).
- "Diet" (artificially sweetened) beverages are OK but in moderation.
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| Fruits and vegetables |
- Eating fruits and vegetables may displace more energy-dense foods and increase satiety. There is some evidence that low consumption of these foods is associated with obesity[8-10].
| - Encourage at least 5 servings of vegetables and fruits daily (fresh, cooked, frozen, or canned).
- These should not be in the form of juice or candy-like "fruit snacks."
| - Plan a "field trip" to the grocery store or produce stand, allowing the child to pick out fruits and vegetables they want to try.
- Involve the child in meal planning, allowing them to choose fruits and vegetables for meals.
- Serve fruits and vegetables with meals, but don't pressure the child to eat or try them (which can cause negative reactions).
- Continue to offer new foods, even if child does not eat them initially. Offer them gently, but do not force the child to try them. Pair new foods with familiar ones.
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| Restaurants, fast food, and convenience foods |
- Meals eaten away from home increase portion size and total energy intake and are of poorer nutrient quality[11-13].
- Increased frequency of eating meals away from home is associated with increased BMI[14,15].
| - 1 or fewer take-out or fast food meals weekly.
- Plan meals for the week, including which meals will be at restaurants.
| - Practice more family meals; start with takeout that is brought home and put on plates to be eaten as a family.
- Make a family meal plan, including the child in planning.
- Schedule a day to grocery shop, and build the grocery list from the meal plan. Utilize meal planning websites for the family.
- Explore cooking and food preparation classes and websites; encourage the parent and child to participate together.
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| Energy-dense foods |
- An association between energy-dense foods and obesity has been established in adults but not yet in children[16].
| - Avoid serving fried foods at meals.
- Eliminate high-calorie snack foods from the house (eg, cookies, chips, ice cream).
- Offer only low-fat or skim milk, limit quantities of cheese, and choose cereals with relatively low sugar content.
| - Have snacks at home made from 2 food groups.
- Make homemade "snack packs" using small bags or containers.
- Schedule snack times instead of snacking when hungry and close to mealtimes.
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| Meal timing and planning |
| Breakfast |
- Skipping breakfast is associated with obesity in children despite perceived decrease in daily caloric intake[17-21] and has adverse effects on school performance[22-24].
| - Eat a moderate breakfast daily. Avoid breakfast foods with high sugar or energy density (eg, high-sugar cereals or pastries).
| - Let the child have non-breakfast food items in the morning if desired ("breakfast doesn't have to be breakfast foods").
- Prepare items ahead of time or wake up earlier to eat breakfast.
- If the child is reluctant to eat breakfast, let them have smaller breakfast meals to establish the habit of eating in the morning.
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| Other meals and snacks |
- Snacking tends to result in increased energy intake and poorer diet quality; a direct association between snacking and obesity in children has not been established.
| - Offer 3 meals daily on a regular schedule.
- 1 or 2 additional healthy snacks may be appropriate for some children.
| - Schedule a snack time.
- Establish "kitchen hours" to encourage the child to eat at mealtimes.
- Teach about hunger and fullness; if meals are offered at regular times, the child will get the needed nutrition.
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| Portion sizes |
- Larger portions lead to increased energy intake[25-26].
| - Goals depend on child's age, degree of obesity, and level of physical activity.
- Use a balanced plate approach to subtly decrease portion size.
| - Caution parents against focusing too much on portion sizes (to avoid excessive conflict over food).
- Encourage a balanced plate¶.
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