Obesity now affects an alarming 20 percent of U.S. children ages 6 to 11, but well-meaning parents, healthcare providers and advocates find themselves pitted against a food industry that has become skilled at enticing kids to overeat and to crave junk food. In a bold countermove, the San Francisco Board of Supervisors recently passed legislation that prohibits the city’s fast-food restaurants from including toys and games with meals that don’t meet basic nutritional requirements.

It’s an effort to get to the problem’s root. “Major influences have caused this obesity epidemic over the last 30 years,” says Thomas Robinson, M.D., MPH, director of the Center for Healthy Weight at Lucile Packard Children's Hospital, whose research team was awarded a $12.7 million NIH grant to design a pediatric weight-control program that could be used across the country. “We spend billions of dollars to get kids to want foods that are no good for them, we’ve set up policies that have reduced the cost of sugary, fatty foods, and we’ve built systems that have engineered physical activity out of our lives.”

The result? Doctors are seeing weight-induced health problems in their younger patients that used to be rare in kids, including high cholesterol, hypertension, type 2 diabetes, and even liver and kidney problems.

But experts say that parents have more power than they might think. “Kids learn most of their behaviors from their parents, so it’s important to eat the foods you want your kids to eat and also model physical activity for your kids,” says Dr. Robinson. If a child is overweight or obese, adds Grace Moore, APRN-BC, of Brown & Toland’s Care Management Department, “it’s an opportunity for the entire family to make changes that have a positive impact on everyone’s life and health.”

Educating the Palate

It’s no surprise that kids prefer cookies over broccoli. Still, the more often kids are exposed to healthful foods, the more they’ll favor those flavors. “Put fresh fruits and vegetables in places that kids can get to easily — on counters, in the refrigerator — and keep unhealthy snacks out of the house,” Dr. Robinson says. At meals, serve kid-size portions. Urging kids to wait 20 minutes before having seconds lets satiety kick in and discourages overeating — the strategy works best when the whole family follows suit.

As for beverages, opt for water over soda and fruit juice, even organic or natural fruit juice. “Kids don’t drink enough water, and they substitute it with lots of sugary beverages,” says Payal Bhandari, M.D., a Brown & Toland physician. “Juices have a lot of empty calories, so they’re really just a lesser evil.”

Also, don’t let your kids start their day on an empty stomach. “Breakfast gets their metabolism working,” explains Dr. Bhandari. “If kids wait until their hunger signal goes off to eat, they’ll pick what’s quick and make unhealthy choices.”

Finally, be aware of the messages you’re sending about food. “It’s important not to use food — especially sweets — as a bribe,” Dr. Robinson says. “It just makes kids like the foods that you’re rewarding them with even more.”

Along the same vein, resist the urge to make every celebration center around high-calorie goodies. “In our studies, we conducted after-school programs, and when a girl or boy had a birthday, we’d have them invent a new dance,” Dr. Robinson says. “We didn’t let the parents bring in cupcakes or cookies, and the kids were happy with it. They just want to have fun.”

Burning Off Fuel

Today’s kids love tech diversions (video games, remote controls, texting), which can make life easier — and less physically active. A good fix? First Lady Michelle Obama’s Let’s Move campaign, joined by the American Academy of Pediatrics and other groups, recommends limiting screen time to two hours daily. There’s an added benefit: “Our studies show that kids, on average, consume one-quarter to one-third of their daily calories in front of a screen,” Dr. Robinson says. “When you’re eating in front of a screen, you’re distracted, so you eat more.”

The Let’s Move campaign also recommends incorporating at least one hour of movement into your child’s day. By getting kids to walk to school together, for example, “our studies demonstrate you can increase the amount of moderate to vigorous physical activity by 30 minutes a day, on average,” says Dr. Robinson.

Slow and steady is the best approach, though, when helping kids make lifestyle changes. “Pick one goal and work on that, and then keep moving forward,” says Dr. Bhandari. If your child has been diagnosed as obese, you may consider enrolling him or her in a special weight loss program. (See “For More Info.”)

Despite the health problems associated with obesity, there is good news. “I’ve seen many kids who, after losing weight, have reversed the metabolic complications,” Dr. Robinson says. “Their cholesterol, insulin and glucose levels, and blood pressure come back to normal, so these effects are clearly reversible.”