In the previous chapter we discussed general changes in lifestyle which might facilitate the weight control process for overweight and obese children. This chapter deals with creating sustainable changes in energy intakes.

Overweight and obese children do not necessarily have higher energy intakes than the normal weight. Nevertheless overweight/obesity must reflect energy intakes which have been in excess of energy needs for affected individuals. If we are to help these children we need to provide advice on lowering energy intakes which is implementable and sustainable. This involves knowing the ‘normal’ eating habits of affected children and their families.

How do we find out what overweight/obese children are eating?

Table 9.1 lists methods that can be used to determine energy intakes in individuals under a variety of circumstances and for a variety of purposes. Diet diaries, asking the children or their parents to document on consumption all food and drink taken over a certain period (one day, one week) can be used but, in our experience, compliance is often too poor to be helpful. Retrospective 24-hour recall is the most useful way of making some sort of dietary assessment in the clinic. Details of foods, their preparation, the frequency of consumption and the pattern of meals, snacks, incidental eating and drinking, create understanding of what, where, when and why the subject eats. The aim is to develop a description of foods eaten and the quantities eaten but not a precise, or even estimated, energy intake.