DEFINITION OF ACTIVITIES SUITABLE FOR THE OBESE CHILD

Most, but not all, physical activities if properly dosed and of appropriate intensity may be performed
safely and successfully by obese children. However, several factors inhibit obese children during
physical activity, including awkwardness around normal-weight peers and limited speed and agility
resulting from carrying excess fat weight. Therefore, it is important to consider the following factors
when prescribing exercise to obese children. First, obese children are often inhibited when expected
to exercise together with normal-weight peers. In contrast, when their peers are all (or mostly)
obese, overweight children play and exercise with little or no inhibition. In settings in which exercise
apparel is revealing, such as swimming activities, this is especially evident. Second, obese children
are taller than their peers (especially during pre-, early-, and midpubertal years), and although this
gives them some advantage in sports where height and arm span are important (e.g., basketball,
volleyball, shot put, discus, defensive or offensive line in football), their relative slowness and
clumsiness limit their ability to excel in these competitive settings. However, in many cases they
can still be useful to their team. Third, another type of activity in which the obese child can perform
well is strength training. This may be a result of advanced muscle development and bone age.
However, many strength exercises require the body to assume positions in which overall body
weight is supported. In this case, obese children’s performance will be equal, if not superior, to
normal-weight peers. Finally, obese children have two advantages for water-based activities: they
are more buoyant and better thermally insulated. The buoyancy gives them a definite advantage in
moving or floating in water, which may boost their success in swimming and water games — a
major contradistinction to land-based activities. In addition, the better subcutaneous insulation is
a definite advantage when the water is cool. In this environment, lean children will lose heat (and
feel the cold) much faster than those with more fat [48].
Several steps can be followed to motivate the obese child to be physically active. Chapter 14
examines various motivational theories and models; however, there are specific physical factors
that can be addressed as well. Both parents and health professionals can help make physical activity
enjoyable for the obese child. They can help identify local facilities for physical activity, including
parks, swimming pools, and community walking groups. Health professionals should teach the
children how to listen to their bodies and exercise at their own pace [49]. Pacing skills may not be
inherent. Therefore, instruction should include methods to help children identify moderate versus
vigorous activity and the resulting heat rate and breathing responses (see Chapter 20).
Weight-bearing activities should be limited at the start of a weight-loss program for obese
children [8,50]. Deforche et al. [51] reported that obese youth have poorer performances during
weight-bearing tasks compared with the nonobese children [51]. Swimming is an ideal, non-weight
bearing activity for obese children [8]. Swimming is ideal for obese children not only because of
their higher buoyancy and thermal comfort but also because their bodies are completely submerged,
therefore avoiding exposure to their nonobese peers.