Dear Dr. Garner,
My daughter-in-law is constantly pushing food at my four-year-old grandchild. He weighs 45 pounds and is 40 inches tall. He looks obese. He watches TV all the time and seems to be constantly snacking. Every time I try to talk to my daughter-in-law, she tells me that this is baby fat and that my grandson will outgrow it. Is she right or is my concern justified?
Grandma Upset About a Weight Issue in Williamsburg

Dear Grandma,
First, I would like you to know that unfortunately your situation is not unique. Childhood obesity is a serious medical condition. It predisposes children to develop diseases that we had formerly only seen in adults, such as adult-onset diabetes, high blood pressure and heart disease.
While a few cases of obesity are caused by genetic and hormonal matters, most excess weight is simply caused by children eating too much and exercising too little.
Some factors that increase a child’s risk of being overweight:
• Diet – Regular consumption of high-calorie foods, such as fast foods and vending machine snacks, contribute to weight gain.
• Inactivity – Sedentary kids are more likely to gain weight because they don’t burn calories through physical activity.
• Genetics – If a child comes from a family of overweight people, he or she may be genetically predisposed to obesity.
• Psychological factors – Some children overeat to cope with problems or to deal with stress or boredom. Interestingly, parents often exhibit the same tendencies.
• Socioeconomic factors – Poverty and obesity often go hand in hand because low-income families may lack the time and resources to make healthy eating and exercise a family priority.
The first step is to have your grandson visit the doctor. There are specific measurements and formulas using height and weight to determine if a child is truly obese. Normally, it is quite obvious.
It is important to treat this problem early as it can lead to serious lifelong health problems, such as Type 2 diabetes, asthma, high blood pressure, sleep disorders, liver diseaeses, eating disorders, arthritis and cancer.
Being overweight can also lead to low self-esteem and bullying by other children. Many children become depressed. In addition, behavioral and learning problems are increased in obese children.
Parents play a key role in helping to ensure that a child does not become obese by taking these action steps:
• Keep healthy food and snacks in the house and put them in your child’s lunchbox. Never use food as a reward or punishment.
• Offer your child at least five fruits and vegetables per day.
• Limit television time and never allow a child to eat while watching TV as this can lead to eating more food than one realizes.
• Get together for healthy family meals. Prepare and share the meals together.
• Limit the number of times the family eats out. Studies show that obesity in a neighborhood is related to the number of local fast-food restaurants.
• Provide opportunities for exercise. This does not have to be formal exercise but can include walking up and down stairs, doing household chores or taking a family walk. Free-play activities, such as hide and seek, tag or jumping rope, can be great for burning calories and improving fitness.
• Limit household consumption of sugary sodas and juices. Many people believe that switching from soda to water can eliminate many cases of childhood obesity. For school-age children, try implementing these changes as part of a new family routine for the upcoming school year.
If action is taken now, future health problems can be avoided.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.