When I advise my 3 year old patients to wear helmets on their tricycles, then I end up with 10 year old patients who wear their helmets. It’s near impossible to convince my 10 year olds to START wearing a helmet.

Why do you think so many ED doctors end up advocating for car seat safety? They see the results of horrible car accidents that could have been prevented.

That’s how I feel about obesity prevention. Far and away, poor diet and a sedentary lifestyle wreak havoc on the mental and physical health of my patients – from young to old – those with poor lifestyle choices have a decreased quality of life. They come to see me with more illnesses, more headaches and most certainly more abdominal pain.

When I start talking to my families about diet, I try to give anticipatory guidance about offering fruits and vegetables and limiting processed foods. Toddlers and young children do two things really well – they don’t eat when they are not hungry and they stop eating when they are full.

We as parents, and grandparents, mess up their satiety cues by trying to get them to eat when they are not hungry and trying to get them to keep eating when they are full. Allowing children to control the amount of food they eat leads to a long term healthy relationship with food. Parents have control over what is offered but should not try to control how much is eaten.

Along those same lines, children are naturally conditioned to be outside and to be active. We as parents mess that up by keeping them inside in front of an iPad or video game. We have control over their media time.

I think focusing on healthy behaviors rather than BMI is a positive way to talk to parents. Most parents are doing 1 or more things right in the 5-2-1-0 recommendations. Kids are motivated to follow these recommendations, but they need their parents to create an environment at home that allows them to do so. This goes along with the thinking of the Blue Zones.

I do think there is value for using BMI as a tool. I usually show growth charts to families as an objective measurement of what is happening and then we turn to talking about healthy behaviors. But I do see a flattening of BMI with improved diet/activity choices. It is also not uncommon for me to see an increase in BMI and ask what has changed, and families are usually able to say – oh yeah, he quit playing soccer, or he doesn’t have PE this year….etc.

When you look at guidelines for treatment of obesity, the first thing you must have is motivation for change. If that is not there, you really can’t go forward. What if we don’t have to motivate people to change because they have been feeding their children correctly from the beginning?

But Aaron’s latest role is that of a young man whose weight has become such an issue, weighing in at 550 pounds, he was recently asked to leave a plane because he took up two seats.

“As I saw the seats, I’m literally hoping that no one had to sit next to me because I knew it wasn’t going to work if they did,” Aaron told NBC News.

The Centers for Disease Control and Prevention (CDC) report that Aaron’s struggles with his weight aren’t as unusual as you might expect. The CDC says that more than one third of kids and adolescents in the U.S. are overweight or obese. In addition to facing isolation and embarrassment, potentially continuing into adulthood, these children are at increased risk for numerous health ailments. Endowed Chair of Cardiovascular Health and Risk Prevention at Cook Children’s Don Wilson, M.D., warns, “most children with risk factors for cardiovascular disease will have them as an adult; being overweight or obese often results in weight related to health risks such as diabetes, high blood pressure, injury to bones and joints, disturbed sleep, fatty liver disease, abnormal blood fats and isolation and depression.”

To help children avoid problems caused by obesity in their adult life, parents have a responsibility to address concerns early. According to Wilson, “it is important to determine what, if any, cardiovascular risk factors your child may have, and begin working with your health care team in finding safe and effective long term solutions. Small changes at a young age can make a big difference in making sure your child has a healthy future.”

Becoming overweight or obese can happen to anyone; some factors can be controlled, while others are inevitable. One can’t control being predisposed to developing high blood pressure, having abnormal blood fats or family members with diabetes, for example, but there are always opportunities to improve one’s health, make lifestyle changes and develop a plan of action to reach a healthy weight.

Since children’s bodies are still growing, it can be difficult to identify when weight gain reaches a level of concern. Dr. Wilson suggests the following guidelines: “Is often difficult to simply look at a child and tell they are developing an unhealthy weight. That's why it's important that you calculate your child’s body mass index (BMI); there are several calculators available on-line. A BMI above the 85th percentile for age/sex is considered overweight, above the 95^th percentile is considered obese and over the 99^th percentile is regarded as morbidly obese.” The first step is to identify patterns that may indicate a problem; regardless of BMI, be sure your child is not gaining excessive amounts of weight each week or month and alert your doctor to any sudden changes. Bring up concerns during your child's health checkup and ask for guidance.

A common misconception is that poor diet and exercise is the only culprit for childhood obesity. These factors indeed have an impact in many cases, but an overweight child should never be blamed or labeled as “lazy,” as there are many other elements that can contribute to unhealthy weight gain. Be sure to rule out health-related causes while you are developing an appropriate weight-loss plan. Just as with adults, encouraging and motivating kids to lose weight can be a touchy issue. Parents often have the biggest influence to help their children become better informed about healthier food choices and the benefits of daily exercise. Wilson says, “As a concerned parent, you can help set realistic goals for weight, food and activities, talk about your child's food in terms of preference, preparation and portion size, increase physical activities for the entire family, discourage smoking and avoid smoking yourself and make healthy living a family affair.  Perhaps the most important thing you can do is to be a good role model for your child.

Aaron is using the uncomfortable experience of being kicked off his flight as motivation to speed up his weight loss plans. Remember, if you child’s BMI rises above the 85^th percentile or their weight gain is excessive (i.e. crossing percentiles on the CDC’s growth chart) be sure to discuss any underlying causes with your doctor and work with your family to develop healthy lifestyle patterns early on. Your child’s future depends on it.

For more information and to determine your child’s BMI, try using the American Academy of Pediatrics’ and Centers for Disease Control and Protection’s BMI calculators.