Twenty-five percent of U.S. children are overweight or at risk for becoming overweight, and that number is increasing rapidly, according to The National Institutes of Health. The city of Birmingham, Alabama serves as a microcosm: In Birmingham, 23 percent of African-American girls and 10 percent of Anglo girls are obese by age 5, and 13 percent of African-American boys and 6 percent of Anglo boys are obese at this same age, reports Reinaldo Figueroa-Colon, M.D. while studying increased blood pressure in elementary school-aged children. And kids often aren't losing their excess weight by adolescence.

"Teenage obesity is complex in that both the potential physical and psychosocial consequences of obesity at this age need to be taken into account," says Dianne Neumark-Sztainer, Chair of the Public Health Nutrition Program, School of Public Health, University of Minnesota.

It also hurts parents, such as New York City mom Laura Vik, to see their teens in physical or emotional distress. "My 17-year-old son is 6 feet tall and weights around 300 pounds," Vik says. "He's always tired and complaining about his bad knee hurting when he walks." Vik's overweight daughter, Kari, faced name-calling from teenaged peers. But more than just ridicule, teenage obesity can lead to increased risk for cardiovascular disease, diabetes and other serious health disorders.

How did this overweight epidemic start and how can parents fight it? Experts blame the rise in obesity on unhealthy food choices and increasingly sedentary lifestyles. A recent study published in the American Journal of Health Promotion found that students decreased their consumption of breakfast, fruits, vegetables and milk as they moved from elementary to junior high and middle school. Between the third to the eighth grades, fruit consumption fell by 41 percent and vegetable consumption dropped by 25 percent. Soft drink consumption tripled, often at the expense of healthier alternatives, such as milk and fruit juice.

School Interventions
Neumark-Sztainer champions the need for effective weight control programs aimed at the prevention of obesity in children. She recently divided teens into several focus groups, asking hard questions such as: If you were designing a weight control program aimed at healthy weight control, healthy eating and increased exercise, what would you do? What activities? When? Where? She also asked if programs should include all kids or only overweight kids.

Teens across the board wanted fun, interactive activities -- such as in-line skating, aerobics and yoga -- within a supportive environment. They asked for physical fitness facilities and programs to be available both during and after school hours and requested appealing, healthy foods. The teenagers recommended focusing on a healthy lifestyle instead of specific weight issues and offering programs to all students, regardless of weight, to avoid stigmatizing those with a problem. But some students did express concern over differences in athletic ability and perceived embarrassment between overweight and normal-weight teens.

"The focus group data will help us in planning programs that meet the needs of teenagers with weight concerns," says Neumark-Sztainer. Indeed, many of the above suggestions were incorporated into the "New Moves" program, currently undergoing a pilot test in Minneapolis. "New Moves" aims to help overweight girls function in a society that values thinness, to avoid unhealthy weight control practices and to maintain healthy eating and exercise habits. Researchers have implemented the program for overweight girls only, and for girls of mixed weights to assess the advantages and disadvantages of both programs.

How can parents get local schools to start programs such as "New Moves"? "The program is now being studied," Neumark-Sztainer says. "We hope that in the future it will be available to all schools."

Margaret Roiniotis of Chicago wants to see a program such as "New Moves" available for her overweight 11-year-old daughter. A nutritionist spoke at Roiniotis' parent/teacher organization last year but she feels her daughter's school could do more to help. "I really think there could be programs developed for kids who have a difficult time with sports," she says. "Maybe yoga, or something where you don't have to be a major athlete to compete. My daughter has asthma and she used to like swimming, but she is too self-conscious about how she looks in a swimsuit to do it very often now."

Linda Morris battles negative reinforcement from her son's high school. "My oldest son, who is a 6-foot, 4-inch sophomore and weighs 250 pounds, was recently told by the football coach that he would like to see him reach 275 to 300 pounds by the time he becomes a senior in high school." As a nurse, Morris was appalled by the coach's suggestion.

Eat Smart, but How?
"The development of permanent lifestyle changes is the main goal of pediatric weight management programs, not necessarily weight loss," says Deborah Bonnell, clinical nutritionist at Children's Hospital in Birmingham, Ala. "Adult weight management programs may be inappropriate for children, given their need for growth and development."

Bonnell encourages parents to set a positive example by practicing healthy living through diet and exercise. "A parent cannot expect their child to adhere to a healthy lifestyle if they, themselves, do not practice a healthy lifestyle." She adds that it's important to combat obesity in children early; obese adolescents often become obese adults.

Bonnell recommends that families stick to three meals and two or three snacks per day with age-appropriate serving sizes of food. Meals should consist of three to four food servings and snacks should be smaller portions of one or two servings. "No food is out of the question; it depends on how often and how much you consume a high-fat, high-sugary food. Moderation is the key," she says.

Bonnell offers several suggestions for teen-friendly snacks:

• Non-starchy vegetables such as carrots, celery and broccoli dipped in fat-free salad dressings
• Sugar-free gelatin prepared with canned mixed fruit in its own juice
• Half of a bagel with fat-free or light cream cheese or jelly
• Baked chips with fat-free dip
• Bagel pizza made with reduced-fat shredded cheeses and turkey pepperoni

Bonnell's hospital offers two programs for overweight families: LESTER (Let's Eat Smart Then Exercise Right) for children ages 6 to 11 and THINK (Teaching Healthy habits and Improving Nutrition Knowledge) for parents and their children ages 12 to 18.

Fight For Fitness
Losing weight and choosing a healthy lifestyle are difficult for teens who may feel defeated by obesity so early in life. But 16-year-old Kari Vik battled her weight and won. Kari walked, rode her bike and cut down on junk food consumption to drop from a size 14 to a size 7. She offers advice for parents who want to help their overweight kids: "Walk and exercise with them. Try to help them eat right. Give the support they need and tell them daily [that] they are doing good." She says she wants schools to teach the risks of being overweight in health classes and offer teenagers more healthy foods. She'd also like longer gym periods and exercise classes such as aerobics.

There are several ways parents can help teens slim down. Crystel Riggs of Clemson, South Carolina has taught her overweight daughter about fat grams, calories and serving sizes, and she helps her daughter maintain a healthy diet. Roiniotis encourages her 11-year-old to exercise and eat healthy foods, resulting in weight loss by munching on carrots with low-calorie dressing, drinking peach iced-tea and participating in camp sports.

The changes shouldn't only happen in the home; parents can help fight childhood obesity by encouraging schools to offer a variety of physical activities, healthy food choices and weight intervention programs such as "New Moves." Experts suggest parents lobby the local Parent-Teacher Association or pick up the phone and ask what the school is doing to help overweight kids. Also, they say, check with local health care organizations to find healthy lifestyle programs tailored to children.