This may sound like a blunt assessment, and it is, but we must face the unfortunate truth that many of us are overweight. Among youth, overweight is a particularly pressing concern.

The development of overweight during childhood and adolescence has important health and social implications. In the years since 1980, there has been a significant statistical increase in the number of heavy youths in the United States and Israel. Today roughly one out of every five boys and girls aged twelve to eighteen is obese. This includes our own yeshivah youths.

At first glance, this trend may not seem alarming, since children and teens have fewer weight-related health problems than adults. Why create a problem if none exists? However, overweight children are statistically at high risk of becoming overweight adolescents and adults, making it vital to recognize the problem and address it in its early stages.

Why has there been such a dramatic increase in the body weight of children and adolescents? Most health professionals are quick to point the finger at poor dietary habits, and there is no question that eating habits share in the blame. But it is possible that the lack of physical activity by our youth is a stronger contributory factor to overweight.

Numerous factors account for these lower levels of physical activity among children and adolescents. Youths should participate in physical activity three to four times a week, but the average teen does so two times a week or less. On the whole, yeshivah students lead an especially sedentary lifestyle. Some kids partake in no physical activity beyond walking to and from school and shul. As for organized activities, many schools have virtually eliminated physical education classes, and very few yeshivos have a regular gym class.

Here in Israel, the considerable increase in television viewing among the general population during the last several years (especially with the availability of cable programming) has contributed to inactivity. Sedentary activity estimates are further increased if we also include playing video and computer games. Drs. William H. Dietz and Steven L. Gortmaker at Tufts University have linked TV viewing and obesity. Their research has shown that obesity in twelve-through-seventeen-year-olds increases by two percent for each additional hour of TV viewed.

Yeshivah students, both boys and girls, spend a greater part of their day at a desk than their public school counterparts, thereby compounding the problem. Many yeshivah boys have a predetermined schedule from seven a.m. till after ten p.m., with little room for exercise built in. And often boys are given the impression that ball-playing or exercise is bitul z'man, a waste of time that should be spent learning Torah. Cognizance is not taken of the fact that an unhealthy body eventually leads to more sick time and perhaps a shorter life span.

To address the rising rates of overweight, health care professionals stress the importance of a more active everyday lifestyle in preference to participating in a structured program, such as joining a health club. The reason is that most individuals are unlikely to go to a gym or health club regularly. The structured approach to exercise has been ineffective in achieving physical activity; it is also somewhat constrained by socioeconomic status.

The access for youths to such facilities is even more limited. We know, however, that exercise, especially for those kids who are mildly to moderately overweight, is the key ingredient for facilitating weight loss. How can we encourage an overweight child to increase activity? We start by focusing on gradual lifestyle changes rather than a radical shift. For inactive youths, increasing their everyday activities can achieve this health standard. Such activities may include riding a bicycle, walking rather than driving to and from yeshivah, and taking the stairs instead of the elevator. The activities should be fun and motivating, and should allow children to begin developing behavioral skills that will lead to long-term changes in physical activity.

The objective is to encourage the sedentary child to become moderately active and the moderately active child to become vigorously active. We should motivate children to move gradually from one level of physical activity to the next. Unlike many adults, children have the time and energy for physical activity, and they will engage in such activity if they see a reason for it.

Along with promoting increased physical activity, we need to emphasize healthy eating patterns for all children. Most children should increase the amount of nutritious food they eat; at the same time, they need to reduce excess fat and calories. A useful strategy is to replace high-calorie, high-fat foods with nutritious, high-carbohydrate, lower-fat foods. (See chart.) Specific recommendations regarding weight loss and caloric needs are best determined by your health professional, who is equipped to consider your child's individual level of growth, development, and sexual maturity. Keep in mind that young children should not be placed on a severely restricted energy diet, since this may compromise their growth.

Many overweight children can reach their ideal weight by making gradual changes in food intake and exercise as they grow. But children who are moderately or severely obese may need a medically supervised weight-control program.

The following are several considerations for parents with an overweight child:
• Encourage and support recommendations made by a health professional.
• Don't single out a heavy child by serving "special" foods or imposing restrictions. Include the whole family in making healthier food choices.
• Never give food as a reward or withhold it as punishment.
• Encourage your child to eat slowly and to enjoy what he/she eats.
• Involve your child in food shopping, meal planning, and preparation.
• Don't tell your child that he/she is "on a diet" and that certain foods are "good" and others are "bad."
• Never discuss your child's weight in front of others.
• If siblings or friends are teasing an obese child, address the issue with your health professional.
• Have family members participate in lifestyle activities with your overweight child (go for a walk/jog, play soccer, walk to school, etc.).
• For the entire family, discourage eating meals and snacks while watching television.

Healthy Food Alternatives
Food Potato chips Ice cream Whole milk French fries Brownie Muffin	Alternative Pretzels Low-fat frozen yogurt 3%, 1%, or skim milk Oven-heated fries or baked potato Low-fat chocolate pudding Bagel
The changes to your child's diet should be subtle, and should be compatible with the food preferences and eating style of the child. For instance, a child may be prepared to substitute a similar type of food that is lower in calories and fat for potato chips (e.g., pretzels) rather than switching to a food he does not perceive as a snack (e.g., carrot sticks).

Dr. Reuven Bruner is a health, fitness, and nutrition consultant in private practice in Jerusalem. He can be reached at 972-2-566-2921, or by e-mail at dr/bruner@hotmail.com.