Your child's pediatrician is an important ally in getting him on the track to good health. She can help you pinpoint the lifestyle factors (in rarer cases, the health or hormone problem) that are behind your child's weight issue and can also help you determine whether weight maintenance or weight loss is appropriate for your child. She can also screen for the existence of any weight-related health complications.

According to the U.S. Centers for Disease Control and Prevention (CDC), weight maintenance rather than weight loss is always the goal for children under two years of age. This approach allows them to “grow into” their weight and diminishes the possibility of caloric restriction depriving them of important nutrients needed for brain development and growth. The same strategy of weight maintenance goes for at-risk kids (those in danger of becoming overweight) and for those aged two to seven who are considered overweight but who aren't experiencing any weight-related complications (such as hypertension or high cholesterol).

Children who are candidates for gradual weight loss (of approximately one pound per month) include those with the following characteristics:

• Between the ages of two and seven, with a BMI in the 95th percentile or higher and the presence of weight-related complications

• Seven or older, with a BMI between the 85th and 94th percentile and the presence of weight-related complications

• Seven or older, with a BMI in the 95th percentile or above, regardless of the presence of complications

Potential health complications of childhood overweight issues are discussed in more detail in Chapter 1. In summary, however, these include hyperlipidemia (high cholesterol), hypertension (high blood pressure), glucose intolerance (prediabetes), insulin resistance, hepatic steatosis (fatty liver), cholecystitis (inflammation of the gallbladder), sleep apnea, and early puberty.