As a childhood and adolescent psychiatrist, I see young people each day who are struggling with being overweight. It's a problem more common than many parents might think, with obesity now affecting about one in five children and teens in the United States, according to the Centers for Disease Control and Prevention.

For most young people, carrying too many extra pounds is a sensitive topic and one they're not eager to talk about. And that's understandable. Many kids who are overweight or obese suffer from low self-esteem and anxiety surrounding their body image. Some endure insensitive comments from classmates every day and even outright bullying. While it might be tempting to let it go and hope that your child will grow out of the problem, it's best not to ignore your child's weight issues given the associated risks to kids' health. These include increased risk for high blood pressure, high cholesterol and type 2 diabetes; breathing problems such as asthma and sleep apnea; joint problems and fatty liver disease.

I advise all parents to take a family approach to a teen's weight challenges. The idea is to work together to eat healthier and get more exercise, rather than focusing on losing pounds, counting calories or "going on a diet." The latter strategies can actually be counterproductive and lead to unhealthy behaviors. I've seen young people become so calorie-conscious that they develop an eating disorder. And some overweight kids get so discouraged when the scale doesn't move that that they give up in frustration - and wind up eating unhealthy food as consolation, making the problem even worse.

Start by having a family meeting and talking together about concrete steps you all can take to pursue a healthier lifestyle. It's very important for your child who is overweight to be invested in this discussion, so be sure to encourage him or her to make some suggestions that are realistic and actionable. Perhaps your family could agree to give up sugary beverages (such as soda and juice) in favor of seltzer flavored with real fruit. Maybe you all decide that you've been eating too much fast food, so you pledge to cut back to once a week (or less). If high-calorie snacks are a particular challenge, then make a family pact to keep cookies or ice cream out of the house. Don't take on too many changes at once; instead, adopt one change at a time - and be sure to celebrate when you hit a milestone, such as your family going two months without soda. Remember that the idea is to adopt changes that will ultimately be long term, so be careful not to sign on to anything too onerous that your family won't be able to sustain.

I've found that it can be also very effective to involve your teen in meal planning, grocery shopping and meal prep. Farmers' markets offer healthy fruits and vegetables in every color of the rainbow, so think about taking your child with you to shop. If your yard allows, plant a small garden and enlist your teen in tending it and harvesting the produce. The more involved your kids are in planning and preparing the food they eat, the better the chance that they'll eat it and/or try something new - which increases your odds of getting the thumbs up on spaghetti squash in place of regular pasta, for example, or roasted kale chips in lieu of potato chips.

Getting regular exercise is also very important, and that's an area where you may well get push-back when your kids are overweight. I advise tackling this as a family issue as well. Rather than buying a gym membership for the child who needs to lose weight, plan family outings around fun activities that will get everyone moving: walks in the woods, touch football in the backyard, ultimate Frisbee at the park. Being active shouldn't be something to endure; otherwise, your teen won't adopt a more active lifestyle for the long haul.

I also advise parents to avoid focusing on physical appearance - of you, your kids or other people - and instead focus on behaviors. Instead of admiring your best friend's svelte figure, for example, comment on how great it is that she manages to stay true to her daily run through rain, sleet and snow. Avoid negative self-talk about your own body ("I look so horrible in this dress because of my big thighs!"), because your kids will pick up on that and be more apt to be critical of their own appearance. That even goes for seemingly positive comments about your child's weight loss. Avoid saying things like, "You definitely look like you've lost weight," or "You're looking thinner these days," and instead focus on progress in healthy behaviors: "I'm really proud that you've started making salads a regular part of your diet!"

It's worth noting that teens, by their very nature, can be moody and difficult to communicate with, so sometimes it's helpful to bring in an outside expert your child will trust to help with healthier eating. Some families find it helpful to schedule a visit or two with a nutritionist, who can work with your child to explain the science behind food and talk through healthy eating strategies.

There will undoubtedly be days when you and your teen get discouraged, but don't give up. And keep your eye on the big picture. Children who have obesity are more likely to become adults with obesity, and their health risks in adulthood will be more severe. So it's vital to take steps now to adopt healthier eating and activity strategies that your child can stick with for a lifetime.

For more information about steps you can take to help your teen achieve and maintain a healthy weight, visit the Centers for Disease Control and Prevention's website: cdc.gov/obesity/childhood/causes.html.


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Allison Tweedie, MD is a board-certified child and adolescent psychiatrist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Burke Medical Center.