Below are a series of questions and answers about the Kids in Action program.

How long is an average visit?

Each visit lasts approximately 60 minutes.

Who attends each visit?

At each visit a health professional, one parent and the child are all present.

What is in average session like?

Each visit is designed to teach both the child and parent a new component of nutrition, implement new healthy behaviors, and to manage medical complications. Below is a sample outline of what is covered in the first visit.

Visit 1 Topics
• Program Introduction
• Health Evaluation (Nutrition, Activity, Family History, Medical Complications)
• Explanation of blood pressure, metabolic syndrome, weight and cholesterol (dependent on lab results)
• Kids in Action Workbook
• Work for following meeting
o Nutrition Diary
o Activity Diary
o Parent Behavior
• Activity: How to read food labels

Why is a parent required to attend each meeting?

Parents are a major influence on the food choices of their children. They make decisions about which foods are available at home, and where and when foods can be eaten in the house.

One of the most important roles of a parent is to be a positive role model. Parents are a child's first and most influential role model for making food choices, developing eating patterns, and formulating attitudes, values, and beliefs about food and eating. For example, if a parent believes that eating a wholesome breakfast is important and does so every day, it is likely that the children in the house will automatically think so too.

Parents also are providers. They purchase foods for the family and buy the toys and sports equipment that encourage physical activity. Parents provide both wholesome, nutritious foods and occasional treats. They also provide an environment that is consistent and supportive, and fosters a lifestyle that embraces healthy eating for the entire family.

The parent as enforcer "enforces" positive influences on a child's food and eating behavior. For example, parents help a child learn to listen and respond to internal signals of hunger and fullness. These actions of enforcement help children learn to eat only when truly hungry and not out of boredom. The overall goal of the enforcer is not to become the "family food cop" but to ensure that food choices and eating patterns support the overall health and well-being of all members of the family.

Will I be exercising during each visit?

The Kids in Action program does not have any exercise facilities at it's clinics. Instead the program seeks for the patient to:

• Develop awareness of current physical activity, and parenting behavior.
• Identify the problem behaviors such as barriers to participating in physical activity or sedentary activity.
• Modify current behaviors and situations by starting with a few small, doable and gradual changes and then adding further plans when previous changes are in place. 
• Increase activity level and decrease sedentary time.

Why are serving sizes important?

Studies have found that children eat more when they are served larger portions. Most children, as well as adults, eat the amount of food that is placed in front of them rather than stopping when they are full. With larger portions comes the risk of eating more calories than the body needs. 
Increased portion size in soft drinks is particularly noticeable, with a soft drink serving measuring 16 to 20 ounces, depending on bottle size, compared to 6 to 8 ounces 30 years ago.4 Soft drinks have been linked with weight gain because researchers have found that total calories go up when soft drinks in the diet go up. More importantly, reversing the trend can make a difference. A study in the U.K. found that those children who simply cut back on soft drinks lost weight over the course of a year, while the children who did not cut back gained weight.

What is screen time and why is it important? 

Screen time is the amount of time spent in front of the TV, computer, and video game console. Limiting screen time is a key strategy to reduce the amount of time spent in sedentary behavior and encourage the child to find something more active to do. The American Academy of Pediatrics (AAP) recommends limiting screen time for children older than two years of age to a maximum of two hours per day and suggests no screen time for children under the age of two. 
The number of hours of daily television watching has been linked to weight gain. Furthermore, children who have a television in their bedroom are more likely to develop weight issues.
The effects of childhood television watching may carry into the adult years. One study found that adults who watched the most television as children weighed more, had higher blood cholesterol and were less fit than those adults who watched less television as children.

My child is a picky eater and will not eat vegetables. What can I do? 

Virtually all young children have the potential to become "picky eaters." This is because they are naturally afraid of new things, including foods. The way that parents introduce new foods can help lessen food this dislike. For example, research has found that it may take up to 10 "exposures" to a new food for a child to feel brave enough to try it. A useful strategy for parents is to keep serving the same food day after day, but without calling undue attention to it. In time, and without prodding, many children will try the new food. Seeing parents eating a new food also takes away some of the fear factor for the young child.

How much weight can I expect to lose?

Weight-loss recommendations for children are different from those for adults. Unlike adults, children need calories for growth and development, in addition to the calories that their body requires for daily metabolism and physical activity. Children who eat too little may not have enough calories to grow in height. For this reason, a child's calories should not be cut too much and weight loss recommendations for children are quite modest. 
Current recommendations for weight loss in children have two goals. The first is to ensure that the child grows and develops normally and the second is to help the child reach a healthy weight. 

Maintaining weight allows children to "grow into" a healthy weight as they get taller. Children who are encouraged to develop healthy eating and activity patterns without "dieting" can stop excess weight gain and maintain their weight while growing taller. Compared to adults, children are more successful at using healthy eating and regular activity to keep weight in the healthy range long term.
Weight maintenance strategies can be used with children as young as three years of age.2 One approach suggests limiting weight gain in overweight young children to less than 2 pounds for every inch of growth. As children get older, over 4 years of age, the recommended strategy might be to maintain weight as the child grows and until the child's Body Mass Index (BMI) drops down into the normal range, that is, below the 85th percentile. The recommendations are similar for children older than 7 years of age -- children who are "at risk of overweight" should maintain and grow into their weight.

Weight loss is rarely recommended for children under 7 years of age. It may be appropriate only if the child's BMI falls in the overweight range and the child has a weight-related medical condition like high blood pressure or high blood cholesterol. Adult-based weight loss programs are not appropriate for most children. 
In most instances, a child's weight loss should be limited to an average of 1 pound per month. This allows the child to continue growing taller and building muscle. Children can be successful at losing weight gradually, a goal that rewards parents and children with a sense of accomplishment.