Living with a chronic illness is difficult enough, but when your child's condition or its associated treatment causes side effects like weight gain or restrictions in physical activity, her fitness level can deteriorate and leave her with an even more difficult battle ahead.

Is the Treatment the Trouble?

If your child is chronically ill and putting on too many pounds, the first step is determining what's behind the weight gain. Treatment of your child's illness may be the cause of the weight issue itself. For example, some children with Type 1 diabetes will initially gain weight when starting on insulin. They may shy away from exercise because of fears of low blood sugar (hypoglycemia) episodes, which could worsen the problem. Steroid treatments for asthma or lupus may cause fluid retention and subsequent weight gain. Other medications may promote weight gain through their pharmacological effects on appetite, hormones, and/or metabolism. For example, certain antidepressants can increase appetite, and the atypical antipsychotics used in the treatment of bipolar disorder are known culprits in weight gain.

Illness and Exercise

Chronic medical conditions may limit the type or amount of exercise your child gets, and this can also play a factor in weight problems. Kids who have musculoskeletal conditions like juvenile rheumatoid arthritis may find movement initially difficult, and since muscle burns more calories than fat, their low muscle tone may mean that they are burning less energy on a daily basis. Even a broken leg can be a trigger for weight gain if it sidelines your child from sufficient activity for long enough.

Appropriately treating the illness or medical condition is the first priority. That doesn't mean your child is stuck with the problem. Sometimes weight gain is just temporary. In other instances, medications or treatment regimens can be adjusted to slow or stop the mechanism behind the gain. If your child appears to be gaining weight due to a medical condition, discuss the situation with his doctor. Find out if there's a specific reason for it and if treatment adjustments are in order.

A Vicious Circle

Excess weight has been linked to many health conditions, including heart disease, high blood pressure, asthma, and joint problems (as described in Chapter 1). If your child has developed any of these conditions, weight loss may actually improve the health problems that are holding him back. It's easy to feel as if your child is stuck in a Catch-22 situation when he can't exercise due to pain or lack of stamina from a weight-related health problem, yet not exercising is contributing to his condition. In these cases it's absolutely imperative that your child have a medically guided weight-loss and fitness program supervised by his primary health-care provider. A team of pediatric health-care professionals, including an exercise physiologist or physical therapist and a registered dietitian, can put him on a safe program that can control both his weight and his health problems.