Healthy Weight Toolkit

Going through changes

The pre-adolescence years are when kids go through many physical and emotional changes. This period is when kids are often vulnerable to weight gain and obesity. Parents need to help their children get regular exercise and adequate sleep and ensure they continue to follow healthy eating habits.

PILLAR ONE: Physical Activity

Science continues to show that increased physical activity in pre-adolescent children (ages 10 to 14) can improve their cardiovascular and muscular fitness, and lead to higher bone mass and strength. The effect on bone health, in particular, is most significant around puberty and can benefit both boys and girls.

Besides helping to lower the risk of obesity and maintain a healthy weight, regular bouts of activity can enhance children’s mental and emotional skills, such as cognition, memory, attention, and social and motor skills. Active children also tend to have higher academic performance, self-esteem, and quality of life.

Guidelines suggest this age group get 60 minutes or more per day of moderate-to-vigorous intensity activity. They also should spend at least three days per week doing specific muscle- and bone-strengthening exercises and more vigorous activity.

Here are some examples:


  • Moderate-to-vigorous (You breathe hard, but can still maintain a conversation)
    • Brisk walking
    • Bicycle riding
    • Active recreation, such as kayaking, hiking, and swimming
    • House and yard work, such as sweeping or pushing a lawnmower
    • Video games that include continuous movement


  • Vigorous (You can only say a few words before taking another breath)
    • Running
    • Bicycle riding
    • Active games that involve running and chasing like tag and flag football
    • Jumping rope
    • Cross-country skiing
    • Organized sports, such as soccer, basketball, swimming, and tennis
    • Martial arts
    • Dancing


  • Muscle-Strengthening (Anything that makes muscles work harder)
    • Playground games like tug of war
    • Resistance exercises using body weight or bands (push-ups, squats, pull-ups, etc.)
    • Rope or tree climbing
    • Some forms of yoga


  • Bone-Strengthening (High impact, dynamic, short-duration, and other weight-bearing activities)
    • Jumping rope
    • Running
    • Sports that involve a rapid change in direction, such as flag football, soccer, basketball, and martial arts


Physical activity strategies

As with other age groups, pre-adolescent children are more likely to do activities they enjoy. If they need inspiration, work with them to find something they may like to try. Always be mindful that any movement is better than nothing, and 10 to 30 minutes of activity at first is okay. Here are some other strategies parents should adopt to encourage more daily activity:

  • Limit TV watching and computer and phone time to two hours per day. Sedentary time is associated with poorer health outcomes and a higher risk of weight gain.
  • Include more low-cost or free activities, like playing at parks and recreation centers, and joining community sports leagues and after-school programs. Not only do these outings save you money, but they also can expose your child to new friends and experiences.
  • Children are more motivated to exercise when they see their parents doing the same. Organize more family activities; for example, lead neighborhood walks and trips to the park and bike together to school or the store instead of driving.
  • Enlist your child’s help with household chores, such as walking the dog, helping to wash the car, and assisting with yard work.

Wellness tip

Time for endurance and resistance

Physical endurance improves during the pre-adolescence years, which allows children to participate in longer and more sustained activities like organized sports. This age group also can begin light resistance training using exercise bands and dumbbells, depending on their skill and maturity level. Children should learn and understand proper form, technique, and body position to ensure they perform exercises correctly and avoid injury.


PILLAR TWO: Nutrition

The most common nutrition-related causes of obesity in pre-adolescence children are similar to other age groups: eating processed and fast foods, drinking sugar-sweetened beverages, consuming large portion sizes, and excessive snacking.

Pre-adolescents should eat three healthy meals and one-to-two snacks a day at structured times. Parents should focus on age-appropriate portion sizes and cut out or limit sugar-sweetened beverages, like soda and juice drinks. In terms of fruit juice, the American Academy of Pediatrics suggests no more than 8 ounces per day.

Here is a breakdown of the recommended daily intake and suggested meal portion sizes for pre-adolescence children:


  • 9 ounces protein
  • 3 cups dairy
  • 3 cups non-starchy vegetables
  • 2 cups fruit
  • No more than 2 cups whole grains

Portion Sizes

Proteins - 2 ounces

Fruit - ½ cup

Vegetable - ½ to 1 cup

Dairy - 1 cup

Grains - ½ cup

Wellness Tips

Talk about healthy food choices

Since this age group eats more meals on their own—breakfast and lunch at school and snacks when they get home—encourage parents to speak with their children about how to make healthier choices. For example:

  • Discuss the health risks of consuming sugar-sweetened beverages and foods with added sugar. The American Heart Association recommends children younger than age18 consume no more than 25 grams of added sugar per day. Refer to the "Rethink Your Drink” handout for more information.
  • Explain the benefits of consuming more whole fruits and vegetables and encourage them to try new ones and revisit foods they avoided in the past.
  • Pre-adolescents sometimes can be swayed by food and diet trends and celebrity endorsements. Parents should teach their children how to identify trustworthy sources for nutrition information. Encourage children not to bow to peer pressure when eating with friends and instead make healthier selections, such as:
    • Drink water instead of soda or milkshakes
    • Watch portion sizes like large and “super” sizes
    • Choose grilled foods instead of fried or other breaded options
    • Avoid sauces packed with extra calories, salt, sugar, and fat


Healthy eating strategies

Here are some ways to help your children and the entire family eat healthier:

  • Meals and snacks should include healthy proteins with whole vegetables and fruits with less emphasis on grains.
  • Choose low glycemic index foods, such as oats, quinoa, 100 percent whole-wheat pasta, and low-fat dairy foods. Low glycemic index foods can help control blood sugar levels and manage cravings.
  • Make healthy foods easily accessible. Keep the kitchen well stocked with their favorite fruits and vegetables and healthy snacks. See the handout “25 Healthy Snacks” for suggestions.
  • Serve desserts only on a special occasion and not with every dinner.
  • Review food labels to look for hidden added sugar and other additives. See the “Nutrition Facts Label” handout for more information.
  • Limit the number of fast-food meals.
  • Whenever possible, eat structured meals as a family. Avoid TV viewing and keep phones and other electronic devices away from the table.

PILLAR THREE: Behavioral Health

Approximately 3 percent of children ages 3 to 17 have diagnosed depression, according to the Centers for Disease Control and Prevention. However, the condition is more likely to occur between the ages of 12 and 17.

As children enter pre-adolescence, it is essential to watch for early warning signs of depression to make appropriate treatment recommendations.

All children experience sadness at some point, especially after a significant stressor like the unexpected death of a pet or family member. It also can occur as a result of problems at school, like bullying and poor academic performance.

Depression may be an issue if sadness persists for an extended period, and there are behavioral changes, such as tearfulness, lack of interest in activities, low self-esteem, social withdrawal, and problems sleeping.

These symptoms of depression often can alter children’s eating patterns, so they eat larger portions or engage in more frequent emotional eating, like eating to cope with negative feelings, which can lead to weight gain and increase their risk of obesity. However, it is important to note that children with depressive symptoms also may begin to eat significantly less, which is a risk factor for future disordered eating and health problems.

Providers should encourage parents to take their child to a therapist and/or psychiatrist if there is any concern for depression. Cognitive-behavioral therapy and interpersonal therapy are the recommended evidence-based treatments for childhood depression.

Watch for eating pattern changes

It is common for depression or prolonged sadness to affect eating behavior and body image. For children without mental health concerns, disordered eating can often emerge during pre-adolescence. Therefore, you want to be mindful of the following warning signs and symptoms:

  • Preoccupation with weight, food, and calories
  • Refusal to eat certain foods (the child may begin with specific foods and then restrict whole categories, like no carbs, no sugar, and no dairy)
  • Appears uncomfortable eating around others
  • Frequent dieting
  • Skipping meals or eating smaller than usual portions
  • Difficulty controlling portions
  • Hiding or sneaking extra food, like eating in the bedroom or when others are not around
  • Compensatory behaviors, such as excessive exercise, purging food, restrictive eating, and taking laxatives or diet pills
  • Shame and guilt associated with eating “too much” or eating unhealthy or undesirable foods
  • Withdrawal from friends and activities
  • A concern with body size and shape
  • Frequently comparing their body to others


Help your child during low times

Children often need support and encouragement during rough patches. Here are some ways you can help them process their emotions and improve their mood.

  • Encourage children to talk about their feelings and provide age-appropriate support and comfort (for instance, “I miss Grandma, too. It’s okay to miss her”).
  • Let them talk when you are alone together. Children may feel embarrassed to discuss their feelings when others are around.
  • Teach them how to express emotions by labeling and discussing your feelings of sadness. For instance, “I’m feeling sad right now because this didn’t work out how I planned it.”
  • Suggest that your child write about his or her feelings in a journal or draw pictures about what makes them feel sad.
  • Schedule a daily fun activity. It can be something simple, like listening to music, doing arts and crafts, or playing a board game. You also could take them somewhere like the park, pool, or museum. Let your child choose the activity.
  • Build your child’s confidence. Give them a chore or task and then offer praise when it is completed, like "Thank you for putting your clothes away. That was a big help!"
  • Let your child be a mentor. Pair him or her with younger or less-experienced children on a game or activity. This interaction gives your child a chance to lead and teach, which can improve self-esteem.
  • Get active with your child. Take him or her for a walk or play an outdoor game. Regular exercise can help improve your child’s mood.
  • Consult with teachers and school administrators if your child’s sadness appears to be because of bullying or other school problems.


As with the other age groups, adequate sleep is essential to reduce the risk of obesity for pre-adolescence children ages 10 to 14. The National Sleep Foundation recommends they get nine to 11 hours of sleep nightly.

This group can encounter the same sleep disturbances as when they were younger, especially obstructive sleep apnea, but also may have sleep difficulties from excessive screen time from TVs, phones, laptops, and tablets. Here is how both can interfere with their sleep.

Screen time. Overexposure to screen time is a constant issue with all school-age children; however, it is more relevant among pre-adolescents as they become tech-savvy and more interested in social media. One study found that 89 percent of adolescents have at least one electronic device in their bedroom, and most use it close to bedtime.

Much research has shown that too much screen time during the day, especially before sleep, can affect sleep duration and quality. Two possible reasons are psychological stimulation from social media and the Internet, and exposure to blue (short wavelength) light emission from screens, which can disrupt the body’s natural circadian rhythm and suppress the sleep hormone melatonin. Parents can address these problems by monitoring their children’s daily screen time and blocking all electronic devices at least two hours before bedtime.

Obstructive Sleep Apnea (OSA). OSA is a disorder in which a sleeping person experiences either partial upper airway obstruction for prolonged periods or complete upper airway obstruction intermittently.

Children with OSA frequently snore with periodic pauses or gasps in their breathing. Snoring can disrupt their sleep and cause problems with attention, concentration, and daytime sleepiness.

Overweight or obese children are at higher risk for OSA, yet symptoms often improve when children maintain a healthier weight.

Always screen children for snoring during wellness checks. Refer any child who snores three or more nights per week, and has any OSA symptoms, to a sleep medicine physician/sleep lab, or a pediatric ear, nose, and throat physician. A polysomnography—a test used to diagnose sleep disorders—can diagnose OSA.

Some children with OSA may need to use a Continuous Positive Airway Pressure (CPAP) machine at night. However, this is a second-line option for children who are not surgical candidates as it is often poorly tolerated.

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