Management of Childhood Obesity – a dietitian’s perspective.

Obesity in children is a global epidemic, and the situation locally is particularly grave. In the most recent ‘Health Behaviour in School-aged Children’ study by the World Health Organisation (2020), it was reported that Maltese children aged 11, 13 and 15 had the highest rates of obesity among all the countries surveyed (45 in total). Lifestyle was an obvious culprit and in fact Maltese children were found to have low consumption of vegetables, high consumption of sweets, and high rates of problematic social media use. The approach taken to tackle obesity in a child will vary according to age group.

Infants and Preschool Children

While it is difficult to overfeed a breastfed infant, a bottle-fed infant can indeed be persuaded to drink greater volumes than they require. It is therefore important for the parent of a bottle-fed infant to not always assume that crying signals hunger. The infant can simply be bored, tired, or uncomfortable. It is also essential that formula is made up exactly as per manufacturer’s directions, and that volumes provided are appropriate for age. Infants should be introduced to a cup from about 7 to 8 months of age and bottles should omitted completely by 1 year of age as there is a tendency to consume larger quantities of milk when feeding from a bottle.

Children under 5 who can walk on their own should partake in at least 3 hours of physical activity per day. This includes both light activity such as moving around and playing, and more energetic activity such as running and jumping.

Primary School Children

For primary school children, ownership of the issue needs to be taken by the parents/carers. The parents are the gatekeepers of the child’s food and it is up to them to ensure that the appropriate quality and quantity is being provided. The intervention will have the highest odds of success if the whole family adopts healthy eating patterns, and parents should strive to be role models for the child. The main changes recommend are for the family to reduce the intake of foods high in fat and sugar, replacing them with healthier options such as fruits and vegetables, and ensuring that age-appropriate portions are being consumed.

Goals should be set with the child and rewards for achieving these goals can be motivating. Rewards should be inexpensive non-food items such as a book or a family excursion.

It is also helpful to remove temptations that encourage unhealthy behaviours and provide more opportunities for the child to engage in the desired behaviour. Examples would include not having sugary drinks around the house, going for family walks on the weekends, and always having fruit available as a quick snack.

It is important however to avoid extreme dietary restriction or unbalanced diets, since this could impair the child’s growth and development. It should go without saying that weight-loss supplements are not appropriate in children.


Adolescents are a challenging group and the intervention will only be successful if the teenager himself/herself acknowledges the need for change and is ready to commit to it. Parents should ‘only’ play a supporting role. The main issue at this age is peer pressure for the consumption of fast foods and high calorie snack foods. Strategies used in this age group will involve negotiating acceptable food swaps, portion control, and an increase in physical activity.

Children and young people aged 5 to 18 years should aim for at least 1 hour of moderate-intensity physical activity each day, such as fast walking, playground activities, cycling, and organised sports.

Screen Time

Screen time (watching television, using computers or mobile phones) has become an increasingly insidious problem, and for a lot of children (and their parents) reducing screen time can be the most challenging change to make. According to WHO recommendations (2019), screen time should be avoided in children under 1, while children between 2 to 4 years should be allowed not more than 1 hour of screen time per day. It is recommended that parents designate media-free times for all the family (e.g. meal times) as well as media-free locations at home, such as bedrooms.

Authored by Manuel Attard, M.Sc RD – registered dietitian and nutritionist. This article was first published in the Times of Malta Child Magazine on November 20th, 2021.

Published by Manuel Attard

Manuel Attard Registered Dietitian & Nutritionist

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