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Obesity and Weight Management

Dietary and Exercise Recommendations for Children and Adolescents for Healthy Living

Obesity in children has increased so quickly over the past 30 years that it is now thought of as an epidemic. More than 23 million, or 2 out of 3 children and teenagers are either overweight or obese.  And rates continue to rise.

Experts agree that diet and exercise play very important roles in your child’s risk for building up unhealthy weight. The American Academy of Pediatrics suggests the following diet and exercise guidelines for children and adolescents.  These guidelines are based on evidence from studies that show that they help improve the health of youth.

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

pregnant womanIf you are pregnant, your diet is very important to both you and your growing baby.  Your diet directly affects your baby’s health in both the short- and long-term.  We now know that too many or too few calories during pregnancy can increase your baby's risk for several health problems later in life, including:

So during pregnancy, it is important to:

Use the chart below to find out how much weight you should gain based on your 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

tummy time

Fighting obesity must start early. Building up too much baby fat can increase the risk of your child becoming fat later in life.

During the first year of life, the focus should be on the unique nutritional needs of each specific growth period. Your child's health care provider should closely monitor your child for appropriate growth and weight gain. Introduce family mealtime once your child begins to eat table foods at 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 free movement and development, such as providing tummy time for an infant, are important at this stage. 

Following safe sleeping guidelines is also important during this period of a baby’s life.  Risk of SIDS (Sudden Infant Death Syndrome) is highest during the first 12 months after birth.  To reduce this risk:

 

Nutrition Recommendations from Birth to 11 Months Old:

young mother breastfeeding infantHuman milk is superior. Try to rely mainly on breastfeeding or pumping to supply your baby with bottles filled with breast milk.  Feed anytime your baby is hungry.  Try to continue breastfeeding for 12 months. 

If you must use formula, however, follow these guidelines:

On average, a baby should drink 2.5 ounces of formula for each pound they weigh every day. For example, a 10-pound baby should drink 25 ounces of formula each day. 

Start other sources of nutrition:

Introduce healthy foods like:

Continue to offer these foods even if your baby initially refuses them.

Wait until your baby is at least 6 months of age before offering 100% juice.  Limit juice to no more than 4-6 ounces per day, and offer it only with a meal or snack.

 

 Nutrition Recommendations from 12 to 23 Months Old

When your baby is 12 months old, you may give him or her whole cow’s milk.  At that time, limit the amount of milk your babsippy cupy drinks to 32 ounces each day.

Continue to introduce healthy foods like:

  • vegetables 
  • fruits
  • protein such as:
    • meat 
    • poultry
    • tofu
    • egg yolk.

Offer these foods even if your baby initially refuses them. Do not introduce foods without any nutritional value simply to provide extra calories. Limit salt/sodium intake to less than 1500 mg per day.

Give juice in a cup only – not a bottle. Make eating a social event for the family by establishing regularly scheduled meals together.  Do not overfeed or force your child to finish meals if he or she is not hungry.

If you are concerned about your baby becoming obese, discuss this with your baby’s doctor. Do NOT put a baby younger than 2 years old on a diet or restrict their calories and dietary fat intake.

 

Recommended Overall Dietary Intake for a One Year Old

900 calories each day (no differences between boys and girls)

  • 300-350 from fat (almost half)!
  • 550-600 from protein and carbohydrates  

    Must include:

  • whole milk or 2% milk - 16 ounces
  • meats/proteins - 1½ ounces
  • fruits - 1 cup
  • vegetables - ¾ cup
  • grains - at least 2 ounces*
  • fiber - 19 grams

 Additional calories should be used as carbohydrates.

*For example, one piece of whole grain bread = 1 ounce

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 Exercise Recommendations from Birth to 23 Months Old:Exercise

Provide a safe, nurturing, minimally structured play environment for your child to participate in daily.

Allow infants/toddlers to explore the outdoors with supervision so they can develop an enjoyment of the outdoors. Activities include:

 


Age 2-3 Years Old

Healthy nutrition for toddlers should focus on eliminating excessive snacking as well as providing healthy snack choices that do not include too many calories. Junk food often has extra calories.

You might notice that your toddler’s appetite has dropped.  This is usually okay since growth rates have slowed.  Your toddler might not need as much food as he or she did as a baby.  Parental modeling of appropriate eating behavior is also important at this age during family meal times.

Focus exercise to allow for your child’s continued development and safe exploration outdoors.

 

 Nutrition Recommendations for 2-3 Years Old:

Eat regularly scheduled family meals together, and make them social events for the family.  This will promote social interaction and give you a chance to role model positive food-behavior.

Provide meals with a variety of choices of fruits and vegetables instead of ice cream, salty snacks, fried foods, and cookies.

Avoid or limit sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 4-6 ounces each day, if given.  Also try to avoid these beverages as snacks.

 

Recommended Overall Calorie Intake for 2-3 Years Old

1000 calories each day (no differences between boys and girls)

  • 300-350 calories from fat
  • 650-700 calories from protein and carbohydrates    

Must include:

  • Fat-free or low-fat milk - 16 ounces Meats/proteins - 2 ounces
  • Fruits - 1 cup
  • Vegetables - 1 cup
  • Grains - at least 3 ounces 
  • Fiber - 19 grams

Additional calories should be used as carbohydrates.

*For example, one piece of whole grain bread = 1 ounce.

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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.

Children younger than 2 years old should not watch any TV.

Toddlers should be allowed to explore the outdoors with supervision to help them develop an enjoyment for the outdoors. Activities include:

 


Age 4-8 Years Old

During young school ages, family meal times continue to be important, especially with regard to parental modeling. Additionally, following through with reduced snacking and healthy food choices remain key ways to encourage proper nutrition.

Organized play and participation in simple sports or dance activities become new ways to incorporate exercise. If it is not possible for our child to be in organized activities, consistent organized play should be enforced so that your child begins to learn the habit of regular exercise.  Free play each day is also important, however, and should be added into your child’s daily schedule.

 

Nutrition Recommendations for 4-8 Years Old:

Eat regularly scheduled family meals together, and make them social events for the family.  This will promote forced eatingsocial interaction and give you a chance to role model positive food-behavior.

Continue to offer a variety of healthy foods even if your child is a picky eater.

Avoid or limit sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of:

Also try to avoid these beverages as snacks.

 

Recommended Overall Calorie Intake for 4-8 Years Old

1400 calories each day for boys 1200 calories each day for girls
  • 350-500 calories from fat
  • 900-1050 calories from protein and carbohydrates

 

Must include:

  • Fat-free or low-fat milk - 16 ounces
  • Meats/proteins - 4 ounces
  • Fruits - 1½ cups
  • Vegetables - 1½ cups
  • Grains - At least 5 ounces* 
  • Fiber - 25 grams

Additional calories should be used as carbohydrates.

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  • 300-450 calories from fat
  • 750-900 calories from protein and carbohydrates

 

Must include:

  • Fat-free or low-fat milk - 16 ounces
  • Meats/proteins - 3 ounces
  • Fruits - 1½ cups
  • Vegetables - 1½ cups
  • Grains - At least 4 ounces* 
  • Fiber - 25 grams

Additional calories should be used as carbohydrates.

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Exercise Recommendations for 4-6 Years Old:

Encourage at least 60 minutes per day of free play with an emphasis on:

Co-ed activities that include both girls and boys are suitable, since there is little difference between the sexes in weight, height, endurance, and motor skills. Appropriate activities include:

Ensure proper safety and adult supervision.

Encourage your child to participate in 30 minutes of adult-led activity per day. Expect a pre-school aged child to walk reasonable distances with family members.

Limit to less than 2 hours per day:

 

Exercise Recommendations for 6-8 Years Old:

BBPhysical activity should occur a minimum of 60 minutes per day, 7 days each week and should include:

Co-ed activities that include both girls and boys are suitable since there is little difference between the sexes in weight, height, endurance, and motor skills.

Competitive organized sports – such as soccer, baseball – may be introduced at this time but with the following conditions:

Encourage free play that involves learning new physical skills with proper safety and adult supervision. TV time should be limited to 2 hours or less per day. Encourage:

 


Age 9-13 Years Old

With the onset of puberty during middle school years, nutritional requirements start to differ between boys and girls.  Your job as a parent is to monitor what your child eats; your child’s job is to determine how much to eat.  Having healthy snacks and meals available at home when your child is hungry will help them learn how to make healthy choices. Having them assist with the shopping and preparation of meals and snacks is another way to encourage good decisions about foods.

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 9-13 Years Old:Breakfast

Eat regularly scheduled family meals together, and make them social events for the family.  This will promote social interaction and give you a chance to role model positive food-behavior.

Provide meals with a variety of choices of fruits and vegetables instead of ice cream, salty snacks, fried foods, and cookies.

Avoid or limit sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 8-12 ounces each day.

 

Recommended Overall Calorie Intake for 9-13 Years Old:

1800 calories each day for boys

1600 calories each day for girls

  • 450-650 calories from fat
  • 1150-1350 calories from protein and carbohydrates

 

Must include:

  • Fat-free or low-fat milk - 24 ounces
  • Meats/proteins - 5 ounces
  • Fruits - 1½ cups
  • Vegetables - 2½ cups
  • Grains - at least 6 ounces*
  • Fiber -31 grams

Additional calories should be used as carbohydrates.

*For example, one piece of whole grain bread = 1 ounce.

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  • 400-550 calories from fat
  • 1050-1200 calories from protein and carbohydrates

 

Must include:

  • Fat-free or low-fat milk - 24 ounces
  • Meats/proteins - 5 ounces
  • Fruits - 1½ cups
  • Vegetables - 2 cups
  • Grains - at least 5 ounces* 
  • Fiber - 26 grams

Additional calories should be used as carbohydrates.

*For example, one piece of whole grain bread = 1 ounce.

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Exercise Recommendations for 9-13 Years Old:runner

Encourage activities that focus on physical skill development and understanding of sports tactics. These activities should occur a minimum of 60 minutes every day, 7 days each week.

 


Age 14-18 Years Old

 Nutritional requirements differ between boys and girls during adolescence due to pubertpopcorny differences.  Your job as a parent is to monitor what your child eats; your child’s job is to determine how much to eat.  Having healthy snacks and meals available at home when your child is hungry, or having them assist with the shopping and preparation, will help them learn how to make healthy choices. This 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.

 

Nutrition Recommendations for 14-18 Years Old:

Eat regularly scheduled family meals together, and make them social events for the family.  This will promote social interaction and give you a chance to role model positive food-behavior.

Provide meals with a variety of choices of fruits and vegetables instead of ice cream, salty snacks, fried foods, and cookies.

Avoid or limit intake of sweet/sweetened beverages such as soda, juice, sports drinks to a maximum of 8-12 ounces each day.

 

Recommended Overall Calorie Intake for 14-18 Years Old

2200 calories each day for boys 1800 calories each day for girls
  • 550-750 calories from fat
  • 1450-1650 calories from protein and carbohydrates

 Must include:

  • Fat-free or low fat milk - 24 ounces
  • Meats/proteins - 6 ounces
  • Fruits - 2 cups
  • Vegetables - 3 cups
  • Grains - at least 7 ounces*
  • Fiber -38 grams

Additional calories should be used as carbohydrates.

 

*For example, one piece of whole grain bread = 1 ounce.

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  • 450-650 calories from fat
  • 1150-1350 calories from protein and carbohydrates

 Must include:

  • Fat-free or low fat milk  - 24 ounces
  • Meats/proteins - 5 ounces
  • Fruits - 1½ cups
  • Vegetables - 2½ cups
  • Grains - at least 6 ounces*
  • Fiber - 29 grams 

Additional calories should be used as carbohydrates.

 

*For example, one piece of whole grain bread = 1 ounce

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Exercise Recommendations for 14-18 Years Old:

Encourage activities that focus on your teen's individual idea of fun and on his/her enjoyment with friends. Activities should occur a minimum of 60 minutes every day, 7 days each week and can include the following:weight

Aerobic activity should occur daily, including vigorous-intensity activities such as:

Weight training:


 

Points to Remember:

  • Preventing childhood obesity must start early, even before your child is born.
  • Make eating a social event for the family by establishing regularly scheduled meals together. 
  • Do not overfeed or force your child to finish meals if he or she is not hungry.
  • Eliminate excessive snacking.
  • Avoid or limit intake of sweet/sweetened beverages such as soda, juice, sports drinks.
  • Provide meals with a variety of choices of fruits and vegetables instead of ice cream, salty snacks, fried foods, and cookies.
  • Have healthy snacks and meals available at home.
  • Provide a safe and nurturing play environment for your child.
  • Encourage age-appropriate exercise every day.

 

 

 

 

 

 

 

 

 

 

References

American Academy of Pediatrics: healthychildren.org.  Accessed: http://www.healthychildren.org/English/agesstages/gradeschool/nutrition/pages/Cooking-With-Your-Children.aspx

American Heart Association.  Gidding et al. 2006 Dietary Recommendations for Children and Adolescents:  A Guide for Practitioners.  Pediatrics.  Feb; 117(2): 544-559.  Accessed: http://pediatrics.aappublications.org/content/117/2/544.full.pdf+html?sid=3bbf2e40-be42-4056-b18c-d70e7e089ebb

Barker DJP, Osmond C. 1986 Infant mortality, childhood nutrition, and ischemic heart disease in England and Wales. Lancet: 1: 1077-1081.

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.

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.

Institute of Medicine. Nutrition During Pregnancy. Washington DC: National Academy of Sciences; 1990.

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.

US Department of Agriculture & US Department of Health and  Human Services. 2010 Dietary Guidelines for Americans. Accessed: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf

US Department of Health and Human Services.  2008 Physical Activity Guidelines for Americans: Chapter 3: Active Children and Adolescents.  Accessed: http://www.health.gov/paguidelines/guidelines/chapter3.aspx

 

This article was originally written by Dr. Jennifer Dyer, MD. 

 Dr. Jennifer Dyer, MD

 

Ashley Lucas, PhD, Dietetic Intern, The Ohio State University, assisted in the current review of this content.

 

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Last Reviewed: Jun 15, 2013

Carolyn  Gunther, PhD Carolyn Gunther, PhD
Assistant Professor of Human Nutrition
College of Education and Human Ecology
The Ohio State University