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Exercise over diet

  Sunday, 29 l 05 l 2011  Source: The Sunday Times   

Increasing physical activity is a healthier option to help a child to shed weight than diet restrictions 

diet-over-exerciseParents should not restrict their overweight toddlers’ diet because this might affect their growth, Singapore doctors say. Instead, they should get their children to exercise to shed the excess weight. So they should not follow the example of Hong Kong actor Nicholas Tse and his wife, actress Cecilia Cheung. On the advice of their child’s doctor, they put their second son, Quintus, on a special diet to restrict his food intake, reported Hong Kong newspaper Ming Pao Daily last month. The boy is not even 12 months old and already weighs 14kg, more than 3kg of the maximum ideal weight for a one-year-old child, according to paediatricians the Hong Kong newspaper quoted.

If Quintus were in Singapore, his parents would have been advised differently. Associate Professor Lee Yung Seng, senior consultant at the University Children’s Medical Institute in the National University Hospital, advises parents against putting an overweight child on a diet aimed at weight loss. This “may deprive the child of essential nutrients” or put him at risk of developing an eating disorder. Instead, parents should get the child to eat healthily and be more physically active to “slow down the rate of weight gain”, rather than aim for “outright weight loss”, he adds.

Slowing or stopping weight gain will allow the child to “grow into his or her body weight gradually over time”, says Dr Veronica Tay, deputy director of the Health Promotion Board’s student health centre. In addition, she advises that the entire family have to change their diet and lifestyle, rather than singling out the child. Junk food should be avoided, says Dr Lieu Ping Phun, a paediatrician at an Upper Bukit Timah clinic. They include sweetened food and drinks such as cakes, candies and soft drinks, as well as fatty food such as fried chicken wings and french fries. Parents should encourage their children to eat more fruits, vegetables and wholegrains such as wholemeal bread, wholegrain cereal or brown rice, says Ms Letty Shiu, a nutritionist at the board’s youth health division.

Complex carbohydrates such as wholegrains release sugars more gradually, help the child feel full longer and makes him less likely to snack between meals, says Dr Lee. But excessive intake of wholegrains can also lead to excessive weight gain, he cautions. Children should engage in at least 60 minutes of moderate-intensity physical activities such as cycling, swimming and brisk walking on five or more days a week, advises Ms Shiu.

Parents should encourage their children by doing these activities and playing outdoor games with them, she adds. They should also get their children to be more active in daily life by walking and taking the stairs, she says. An overweight child is at higher risk of developing chronic diseases in adulthood, such as diabetes and heart disease. The Yearbook of Statistics Singapore 2010 reported that 12.1 per cent of Primary 1 boys here were obese in 2009 – slightly down from 13.1 per cent in 2006. Similarly, fewer Primary 1 girls were obese in 2009 – 10.8 per cent in 2009, down from 12.3 per cent in 2006.

A seven-year-old boy here is considered severely overweight or obese when his body mass index (BMI) – a measure of weight relative to height – exceeds 23kg/m2. A girl here of the same age is obese when her BMI exceeds 22kg/m2. This is based on body mass index for-age charts to compare a child’s weight relative to his height and also to other children of the same age and gender. The charts were introduced by the Health Promotion Board last July. Nurse Tracy Dong’s six-year-old son became severely overweight two years ago, after he initially lost his appetite and she gave him diet supplements. He also transferred to another childcare centre that organised fewer outdoor activities than his previous centre.

She now plans family outdoor activities such as basketball, cycling and swimming on Sundays, and stops him from eating his favourite chicken skin. But it has been an uphill task. Ms Dong, 35, says: “He eats more after the exercises. My family members are also not co-operative and give in to his huge appetite.”  

Help at your fingertips

children-bmiCalculate a child’s body mass index (BMI) by dividing the weight in kilograms by the square of the height in metres. Refer to the BMI-for-age charts to see if he is underweight, overweight or of normal weight. The information is available for those up to 18 years old.

The charts for children aged six to 18 are available on the Health Promotion Board website ( Those for children aged up to six years old are available in its section on educational materials for pregnancy and parenting (

Alternatively, you can log on to another of the board’s websites to work out the maths ( Although the formula for the BMI of an adult and that of a child is the same, the result for a child is interpreted differently. This is because the amount of body fat in children changes at different stages of their development and growth, says the board. For example, during puberty, a child may experience accelerated growth and increased muscle mass, which could affect the BMI, it says.

Tips on planning healthy meals for toddlers are also available under the educational materials for pregnancy and parenting section on the board’s website.

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