The staff of the Pediatric Weight Control Program: Clockwise from top, left: Richard Strauss, MD, director; pediatric nutritionist Michele Colin, MS, RD, CSP; pediatric psychologist Gail Burack, PhD; and pediatric nutritionist Daria Rozdilsky, RD, CDE.

Dieting is never an option for very young children because it may interfere with normal growth patterns. "For this age group, we encourage weight maintenance, not weight loss," explains Strauss. "By developing healthier eating habits and getting more exercise, the child may still gain weight, but less rapidly."

Parents of young children are advised not to obsess over a weight problem. "Overanxious parents need encouragement not to pressure the child," says Burack. "It's important to remember that not every overweight child turns into an overweight adult."

Management of obese teenagers is a bit more complex. Adolescents must be motivated to lose weight and willing to make the necessary changes in eating and exercise habits. Since they have more freedom than young children, parents have less control over what they eat. So the impetus to lose weight must come from them, not their parents.

Equally important is getting this age group to become more active. "Some kids are so self-conscious about their weight that they won't do anything physical," says Burack. "They lack the confidence to try a sport. They don't even walk. They are more comfortable sitting inside," says Burack. "We try to get them out of that 'couch potato' mentality."

These children frequently encounter problems developing socially as well. Fearful of being teased or shunned, they lack the self-confidence to make friends. Instead, they stay home and soothe themselves with food.

When Dieting is Appropriate
Once a teen has demonstrated willingness to change eating and activity patterns, dieting is an option. The program uses a protein-sparing, modified fast diet that is tailored to each individual. Patients on the diet eat foods which are high in protein, including lean meats, fish, poultry, eggs, nuts and cheese. Fat intake is moderate while high-carbohydrate foods are avoided.

The principle behind the diet is fairly simple, explains Rozdilsky. The diet is called "protein-sparing" because the high protein intake allows the body to maintain muscle mass. By restricting carbohydrate intake, the body burns fat for energy, producing ketones as a by-product. Ketones are chemicals that have a suppressive effect on the appetite. The diet is highly structured, with daily meal plans. Though patients have many choices, sample menus are provided, making it easy for teenagers to follow.

Teens on the diet consume about 1,000 calories a day. Vitamin and mineral supplements are taken daily. Within about a week, many kids report that their appetites are decreasing. At first, they lose weight rapidly -up to 8 pounds a week in the first few weeks. However, much of this initial loss is from fluids.

Patients are encouraged to drink at least six to eight glasses of water a day to replace lost fluids. Weight loss gradually tapers off to about three to six pounds a week.

Patients stay on the diet for 3 to 6 months; then carbohydrates are slowly added back to the diet. Patients who are motivated to lose weight stay in the program for about one year, on average. While not everybody attains their ideal weight, a loss of even 10 percent results in significant improvement in cholesterol, blood pressure, blood glucose, and overall health, says Strauss. Patients who drop out of the program without losing weight frequently return later on, when they are more motivated.

Rozdilsky says, "For kids, losing weight can be one of the hardest things they ever have to do. But the results are definitely worth it." She recounts the story of one patient, a moderately obese 15-year-old boy who was initially somewhat resistant to weight loss and spent most of his time at home alone watching TV. Once in the program, he went on the protein-sparing, modified fast diet. Over time, he lost 25 pounds and began Rollerblading. He now enjoys Rollerblading daily and found a group of friends to skate with.

"Success is not just about losing weight," says Rozdilsky. "It's also about changing behaviors, getting out of the house, developing friendships and feeling better about yourself."