Online Health Chat with Sara Lappé, MD

July 25, 2013


Over the past three decades, childhood obesity rates in the U.S. have tripled. Today, nearly one in three children is considered overweight. The amount of time that children exercise has changed over the last 30 years—partly due to the introduction of video games, computer and other screen media. Excess screen time has been associated with increased risk of obesity in children. Only one-third of children get the recommended levels of physical activity. Without changing current habits, experts estimate that most of these overweight children will suffer from diabetes at some point in their lives. Others could face chronic obesity-related health problems, such as heart disease, high blood pressure, sleep problems, depression and asthma.

To curb this national trend, many pediatricians, nutritionists and other experts are involved in helping children stay active, achieve physical fitness, maintain an optimal weight and achieve nutritional balance. Unlike adult diets, children need special attention to their nutrition in order to support healthy growth and development. Additionally, changes in physical activity need to account for the unique needs of kids. Particularly, children have different cardiovascular systems, temperature control and limitations to strength training and impact sports. Therefore, proper changes to diet and exercise are crucial.

With the national focus on nutrition and fitness, this generation of children can be at their best physical health.

About the Speaker

Sara Lappé, MD is a staff pediatrician in the Department of General Pediatrics at Cleveland Clinic Children’s. She is the director of the Be Well Kids Clinic that is aimed at helping families reverse obesity and its health consequences. She also provides comprehensive primary care for infants, children and adolescents, and helps parents understand the value of proper activity levels and nutrition on a daily basis.

Dr. Lappé is a board-eligible physician in general pediatrics. She completed her pediatrics residency at Duke University Medical Center. She is a medical school graduate from Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

Let’s chat about what is 'Weighing on Your Mind—Talking to Your Kids about Exercise and Nutrition’

Weight from Infancy Through Adolescence

Bernie: Should I be concerned when my baby is chubby that he will continue down that road into adolescence? I am wondering if chubby babies and kids can outgrow being overweight?

Sara_Lappé,_MD_: Studies have shown that overweight infants are at risk of becoming overweight adolescents and adults. It is never to late to make changes that can help your child reach a healthy weight. Make sure to offer your child healthy eating options as you introduce solid foods and create healthy eating habits. Encourage your child to be active and model healthy behaviors yourself to make sure your child maintains a healthy weight.

Growth Percentiles and BMI

Patsy: The doctor brought up the fact that my 10-year-old daughter is chubby. She is in the 95th percentile for both weight and height. I thought since she was tall and has parents that are both tall it equaled itself out. Can you comment?

Sara_Lappé,_MD_: It depends on where her BMI falls. That is the more important number to discuss with your pediatrician. Within the 95th percentile of both height and weight there is a range of numbers. If your daughter falls on the low end of the 95th percentile for height and the high end of the 95th percentile for weight, she may fall into the overweight category. Sometimes it helps to look at where your daughter falls on the growth curves. You can ask your pediatrician to show you.

Health Problems Associated with Excess Weight in Children

Cheyenne: Are there signs I should watch for if I think my child is becoming overweight besides looking at height and weight?

Sara_Lappé,_MD_: Keeping an eye out for these signs that extra pounds may be harming your child’s health is important. Here are five signs that you can watch for:

  1. Difficulty keeping up with other kids while playing. Asthma is a big problem for kids with obesity. Exercise often triggers asthma, a condition that makes breathing difficult. Adding excess weight to these breathing difficulties—and running and playing hard can be a challenge.
  2. Aches and pains while moving. Excess weight can actually cause pain and deformity in children’s joints. Kids may get to the point where they don’t know how to move their body, have limited flexibility, and develop other bone and joint problems.
  3. Snoring at night. Sleep apnea causes snoring, disturbed sleep and pauses in breathing while asleep. Most kids who are heavy have sleep problems, whether it is sleep apnea or insomnia.
  4. Acting nervous, sad or moody. Children who are overweight often suffer from anxiety, depression and body image concerns. They are often bullied at school.
  5. Darkening of skin around the neck. This darkening, called acanthosis nigricans, and being overweight are outward signs that a child is at risk for type 2 diabetes. You can see darkening around the neck, under the arms or in the groin. A lot of parents mistake this for dirt and try to scrub it off.

Prevention is the best approach. Obese kids create more fat cells than healthy-weight kids as they grow — up until early adolescence. Because of this, they have more difficulty losing weight when they are older.

basket2: What health problems are caused by childhood obesity?

Sara_Lappé,_MD_: Childhood obesity is being seen linked to the following health problems: type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, fatty liver disease (which can lead to cirrhosis) and polycystic ovarian syndrome (PCOS, or irregular periods in overweight adolescent girls.) Our Children's Health Essentials Kids Clinic webpage is another good resource for understanding the links between obesity and other conditions.

AKV: My son, who is 17, is about six foot and one inch tall and 400 lbs. I am very concerned about his health. Are their signs or symptoms of health conditions that I should be looking out for because of his size? How do I know if he needs intervention besides just observing him physically?

Sara_Lappé,_MD_: Your son's weight puts him at risk of multiple medical problems. Some of the health problems have outward signs and others need to be investigated by your son's doctor. You can look for heavy breathing or snoring, which may be a sign of obstructive sleep apnea. Darkening of the skin around his neck (acanthosis nigricans) may be a sign of diabetes. Also, difficulty breathing and chest pain can all be signs of serious problems. You should make sure that your son has had his yearly physical, so that his doctor can discuss his weight with him and screen him for health problems such as hypertension, diabetes and elevated cholesterol.

Food Choices for Infants

waddawadda: Does starting a baby too early on cereals with formula mean that he might grow up with a weight problem?

Sara_Lappé,_MD_: There is data that introducing solid foods too early is linked with risk of obesity later in life. I would not recommend putting cereals into formula unless specifically directed by a physician.

Paula: I have infant twins who have just moved into solid foods. How do you suggest I begin making sure their meals are well-rounded and that they don’t become picky eaters? Any tricks to ensuring that they will eat their vegetables?

Sara_Lappé,_MD_: Make sure that your children eat three regular meals, sitting with your family at the table. Continue offering a variety of foods to expose your children to varied flavors. It may take multiple tries before your child will like a new food. Avoid offering sweetened foods. Show your child that you like vegetables, too!

Promoting Healthy Food Choices

twinter2: My question is more about applying healthy eating than talking to my kids about it. They are two and three years old. I make healthy meals and offer healthy snacks, but they decline to eat them. I've tried stating ‘You are not getting out of your high chair until you eat some of your food.’ We do a moderately good job of keeping junk food out of the house, so they can't demand to eat that instead of the healthy meal that I made. Do you have any other suggestions on how to get my kids to eat the healthy option in front of them? My boys are very physically active. They play outside for hours each day, so weight isn't a concern for me at this time. This is more about making sure they are getting the required nutrients and developing healthy eating habits now, so they don't become overweight as older children and adults when their physical activity slows down.

Sara_Lappé,_MD_: It sounds like you are doing a great job encouraging your children to eat healthy and be active. Studies have shown that it can take offering a food up to 15 times before a child will eat it. Also, encourage your child to try, it but don't force them to eat the entire serving. The first time you serve something new, offer a small portion. Continue to model good eating behaviors for your child and it will help them continue to eat well.

Ryans_mom: My toddler has gotten into a bad habit of only wanting the type of food they feed her at daycare, like spaghetti and chicken nuggets. Are their alternatives to these items, and how do you suggest introducing new foods into her diet?

Sara_Lappé,_MD_: Ask your daycare if you can have input on the foods they serve, and see if you can get them to offer healthier choices. This may encourage more variety in your toddler's diet. In addition, you don't have to offer those foods at home. If you don't have them at home, then they can't be an option for dinner. Continue to offer new foods and include your toddler in helping to pick out some of those healthy foods. Take your child to the produce department and let her pick out something new to try. You might be surprised!

Liberte: My daughter gets breakfast and lunch provided to her at school. I don’t think that they are the healthiest of lunches. Do you have any suggestions on how I can balance out her meals on a small budget?

Sara_Lappé,_MD_: Some schools allow children choices for their meals and provide a school menu. Look at the menu ahead of time and help your daughter pick out the healthy options. She may be more likely to eat the healthier option if she made the decision already. Encourage her to have plain milk or water to drink (avoid juice or sweetened milks, like chocolate or strawberry).

At home, offer healthy snacks. Buy fruits and vegetables in season and when they are on sale. Frozen or canned vegetables can also be a cheaper healthy alternative.

TrojanMom: My 11-year-old son, who is thin, plays multiple sports (football, baseball and basketball). When he is not at a game or practice, he is sedentary (with lots of ‘screen’ time). His nutrition is the pits! We've tried appealing to him with the logic that regular exercise and good nutrition will make him play better in sports, but that has not worked in getting him to eat better or get moving. What suggestions do you have?

Sara_Lappé,_MD_: One of the best ways to get your kids to have healthier habits is to model. If you want him to be active, try to encourage him to go outside with you and play. Some parents find that involving their children in grocery shopping and having them pick out some healthy options that they would like to try can help. Take your son with you to a farmer's market, and try to get him engaged in the food. Also, see if you can get him to help cook.

akcfoster: Do you have any advice on how to explain to friends, grandparents, aunts and uncles that the junk food they give my kids when they're visiting isn't O.K.? I often run into this issue. Adults seem to think it's O.K. to keep cookies, candy and unhealthy food in the house for the kids, even though they themselves say they don't eat it regularly because it's not healthy or will make them gain weight. I always run into excuses like, ‘The kids will run it off’ or ‘But she's skinny.’

Sara_Lappé,_MD_: Many parents have this same concern. Try to talk to the adults that are watching your kids ahead of time. Let them know that you do not want your child to have treats unless you approve it. Remind them that treats are for special occasions, not every day.

Srit: My whole family has a ‘pop’ (soft drink) problem. Unfortunately, my pre-teen daughters have picked up on it. Besides too much sugar, what could be the ramifications of taking in large quantities of pop?

Sara_Lappé,_MD_: Soda pop has multiple negative health effects. The acid in carbonated drinks can damage the enamel on your teeth and dark beverages can stain them. Caffeinated sodas are not appropriate for children. The extra calories from the sweetened beverages can lead to extra pounds.

Discussing Food Choices and Weight

kldevaney: I want to help my 10-year-old daughter make good choices regarding foods. I also don't want her to be too focused on her body image. I tell her she needs to make healthy choices so her body will be strong and healthy, but it doesn't seem to help. I have avoided saying too much junk food will make her overweight. Is that O.K. to say?

Sara_Lappé,_MD_: I agree. When talking with your daughter, avoid emphasizing weight or body image. Focus on the positive aspects of healthy lifestyle choices. You could say that junk foods will make you unhealthy.

LizCat: How do you talk to someone that is in denial about their weight? My cousin is very heavy and has been for a majority of his life. Whenever someone broaches the topic of getting help, he just denies that he needs it and skirts the topic. Our family is beginning to fear that there is no hope and is concerned for his livelihood. Any insight you can provide would be most helpful.

Sara_Lappé,_MD_: Try to talk to your cousin one-on-one. If you are discussing weight in a group setting, it can feel like an attack. The first step is to find out whether your cousin is concerned about his weight or his health. You can tell your cousin that you are concerned about his health and that he might have problems down the road. Encourage your cousin to find something that would motivate or inspire him to make healthy changes.

Encourage your cousin that he can make small changes in his daily life that can help him be healthier. Often people see getting healthier as having to change everything that they do. Encourage him to start small, and the changes will pay off.

Portion Control

Bleuzy: My husband cooks the meals for our family every night and he loads up each plate with about the same portions for everyone. How do I know how much my 11- and 13-year-old sons should be eating in comparison to their father and me?

Sara_Lappé,_MD_: Half of each plate should be fruits/vegetables and one quarter protein and one quarter grains. Many people use large plates and this leads to overeating. Don't fill the plate up all of the way. You can use this website to guide appropriate portion sizes for different foods. also has a nice calculator based upon age that tells you how much you should be eating.

heather9812: I make healthy meals and provide healthy snacks for my five-year-old daughter. In the past year, my daughter has been gaining weight. It seems like no matter what she eats or how physically active she is, I cannot get her back on track. She is very active. She takes dance lessons, gymnastics, and runs around playing outside every chance she gets. I limit television, games, etc. to 20 minutes a day and always make sure she has plenty of fun activities to choose from. Do you have any advice on how I can get her to lose her extra weight?

Sara_Lappé,_MD_: Often people are making overall healthy choices, but are eating too large of a portion of food. Other pitfalls include drinking sweetened beverages, which have lots of extra calories and frequent snacking. You can use this a guide to try to help your daughter stay healthy:

Encouraging Exercise

EmmaMollieMom: My daughter is nine years old and I've noticed that she has put on some excess weight in the past 12 months. Family members on her father's side are larger in size and have battled weight issues. How can I talk to my daughter about her weight and not damage her self esteem? Any tips on encouraging physical activity without coming across as forcing her to do it? She has tried multiple team sports, but doesn't seem interested enough to stick with it.

Sara_Lappé,_MD_: Encourage physical activity by trying to find out what she is interested in doing. Not all kids enjoy team sports. She can be physically active by playing outside, riding a bike, hula hooping, dancing or doing just about anything that get her heart rate up. When talking with your daughter, try not to emphasize her weight or how she looks. Talk more about what it means to be healthy, and model good behaviors to help her stay healthy.

Dakkota: My son loves video games, and I was finding that he was spending too much time with the remote, so I encouraged him to start playing with the Wii® and Wii Fit®. I figured that might get him a little active. Do you think that’s a good idea? How do you suggest I try to transition him into more physical activity away from the TV?

Sara_Lappé,_MD_: The American Academy of Pediatrics recommends less than two hours of screen time per day. If your child can be active during that time with an interactive video game, that is even better. If he is going to be watching TV encourage him to get up and move during commercial breaks. Jumping jacks, jogging in place or dancing can be fun. Get active with your child. Make it a family event—have everyone turn off the TV and do fun activities together.

Marti: My son is 11 years old, and has exercise-induced asthma. Before being diagnosed a year ago, he was very active, now he’s nervous about running around with friends or playing sports. I feel like it’s contributing to weight gain, too. How can I convince him to be more active and get in more exercise?

Sara_Lappé,_MD_: The goal of asthma treatment is to let kids be kids, and for him to not have breathing problems while being active. You should reassure him that he can still play sports like other kids. This website may help you explain asthma to your son: If your child is still having breathing problems after starting therapy prescribed by your doctor, you should go back for another visit.

There is also a short video that explains asthma to kids.

Post-exercise Nutrition

PharmD1995: Is it safe for a 15-year-old boy to drink 25 grams of protein following a high intensity cardiovascular workout lasting at least 30 minutes?

Sara_Lappé,_MD_: I would not recommend that amount of protein intake in a beverage—that is almost half of his recommended dietary allowance (RDA) for protein. The Centers for Disease Control has a good reference page on RDA for protein:


Moderator: I'm sorry to say that our time is now over. Thank you again, Dr. Lappé, for taking the time to answer our questions today about talking to your kids about exercise and nutrition.

Sara_Lappé,_MD_: A lot of families believe being overweight and obesity is an insurmountable problem. They feel overwhelmed by everything they need to change. But small changes really add up. Every parent can make these changes to get their kids— and the whole family—healthier.

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To make an appointment with Sara Lappe, MD, the Be Well Kids Clinic, or other Cleveland Clinic Children’s services, please call 216.444.KIDS (5437) or call toll-free at 800.223.2273, ext 45437. You can also visit us at to learn more.

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Reviewed: 08/13