By Christine L. Williams, MD, MPH

Dietary guidelines are basically the same for normal weight and overweight children, but for overweight children, the emphasis is on portion control and on trying to help them really meet the goals. This means mainly consuming fruits, vegetables, whole grains, low-fat dairy, and lean protein.

Here are helpful tips for a truly child-healthy diet:

1. Make sure your child’s diet includes enough of the following foods:

Fruit: Children should eat 2 or 3 pieces of fruits (either whole, chopped or diced) a day, and limit fruit juices to one small glass a day. The fruit provides more fiber than the juice.

Vegetables: Try to increase your child’s vegetable intake by trying a wide variety of ways.

This is often a challenge but here are 10 additional ways to try to achieve this healthful goal.

• Put out little plates of raw vegetables before dinner.
• Have your child help make the salad and choose the dressings. Kids are more likely to try something they have helped to “make.” Don’t forget to offer reduced-fat or reduced-calorie dressings, or instead enjoy small amounts of regular dressings.
• Make “veggie animals” for young children.
• Dip raw veggies in peanut butter for a snack.
• Try ”frozen peas” if your child likes crunchy foods.
• Pour a glass of vegetable juice, like V8® 100% vegetable juice, as a snack.
• Add a sprinkling of grated cheese or melted low-fat cheese to veggies to make them more appealing.
• Puree some veggies into a sauce for pasta or meat.
• Grind up veggies and add them to meatballs.
• Serve more vegetable and bean soups. Check out Campbell's® soups that provide at least a ½ cup serving of vegetables.

Whole Grains and High Fiber foods: Switch your child and family to whole grain breads, pasta, cereal, rolls and crackers.

• Encourage whole-grain crackers as a snack rather than cookies.
• Serve whole-grain pasta for favorite dishes.
• Make sandwiches with whole-grain bread

Low-Fat Dairy: Children who are 2 years and older should switch to reduced-fat milk, yogurt, cheese, and other dairy products since regular dairy has higher amounts of calories, total fat and saturated fat. One percent low-fat milk or yogurt is often satisfying for the whole family, and fat-free (skim) milk or yogurt is fine, too. The calcium content of low-fat milk is just as high as regular milk, so you will not short-change your kids if you make the switch. Flavored milks are higher in calories than plain milk, so when trying to cut calories, avoid chocolate milk. Eight ounces of yogurt has the same amount of calcium as a cup of milk, which makes them interchangeable. Yogurts vary a great deal in calorie content, depending on the added fruits and sugars, so choose those that are lower in calories.

Lean Protein: Choose lean protein foods rather than those with higher fat contents. The less fat in the foods or that is added during cooking, the lower the number of consumed calories. Also, protein seems to satisfy hunger better than carbohydrates or fat. When you select the protein to serve your family, be sure to:

• Trim the fat from the meat; take the skin off the chicken and turkey.
• Limit the amount of fat you add during cooking (olive oil, butter, cream), and spoon off or skim as much extra fat and oils as you can afterwards.
• Choose canned tuna fish packed in water and not in oil.
• Bake, broil, or steam foods, instead of frying or sautéing.
• Make sandwiches with lean-protein fillings instead of fatty ones. This might be turkey breast instead of bologna or salami; low-fat cheese instead of full-fat cheese, and so on.
• Serve beans (legumes), such as black beans, kidney beans, and garbanzo beans, more often for their high-fiber (low-fat) content.
• Add beans (legumes) to soups, chilis and stews.

Water: Encourage your child to get an adequate intake of milk for calcium but to drink water when thirsty.

2. Keep a close watch on the following, especially if your child is overweight:

Portion Sizes: Oversized portions are not necessary, nor are second helpings of foods and beverages. To learn about recommended portion sizes for foods, visit MyPyramid.gov to see pictures of servings sizes for the different food groups. You may find that the portions you are serving are much bigger than the recommendations. Other tips:

• Gain an understanding of the different portion sizes by using measuring cups for a little while to see how much food is actually in a cup.
• Try to reduce the size of most food portions by one-fourth, however serve bigger portions of vegetable dishes, broth-based soups, and fresh fruits.
• Try to limit the amount of foods purchased, cooked, and served at a meal so that everyone does not get into the habit of second helpings.
• Check out a handy portion guide for visual cues on different servings.

Food Labels: Compare food labels to determine lower calorie foods. There are foods that provide a lot of calories without providing much nutrition to match. Use the food label to help determine these foods. These are foods to eat moderately. Some examples:

• Full-fat yogurts with candy sprinkles. Try low-fat yogurts with a teaspoon each of chopped nuts and dried fruit for a lower calorie option.
• Regular soda, fruit drinks and regular ice tea made with sugar provide a lot of calories. Choose reduced sugar or diet varieties, or encourage milk or water consumption instead.

Food Preparation: To help lower calories, try these alternatives:

• Bake frozen French fries in the oven instead of deep-frying them.
• Choose lower-fat hotdogs (even those made from chicken or turkey) and reduced-fat cold cuts.
• Choose the leanest ground beef possible.
• When you cook, use oils sparingly. Moisten food with low-fat broth or water.
• Choose light, “low-fat” salad dressings and mayonnaise. Or, make your own salad dressing with olive oil and vinegar or lemon juice.
• Eat nuts and seeds in moderation (a handful).
• Modify favorite high-fat meals to be lower-fat versions (e.g., make macaroni and cheese with low-fat milk and half the amount of soft margarine instead of with whole milk and butter; make meatballs from ground turkey breast instead of beef; bake chicken pieces in the oven with a light bread coating).

Snacks: Try to follow a regular schedule of snacks, just as you do meals.
To do so:

Aim for 3 meals a day and 2 small, 150-calorie snacks a day for school-age children who are overweight. (Normal weight children, and those very active in sports and other physical activity, may need more calories from snacks).

For overweight preschool children (ages 2-5), a pattern of 3 meals and 3 small snacks (each about 100 calories) is a good pattern to follow.

Try to choose snacks that are calorie-controlled but take more time to eat. For instance, try tiny pretzels or mini rice cakes instead of “gummy fruits.”

Fast-Food, Take-Out, and Restaurant Meals: Try to reduce the number of times you, as a family, eat out or order in, since these meals generally involve bigger portions and can foster overeating. Plus, they often have high-fat and calorie counts. Once a week or less is a good compromise, especially if your family has been used to eating out or ordering in more often than this.

If you drive your child to after-school activities, bring along some healthful snacks: whole fruit, air-popped popcorn, granola, breakfast bars, whole-grain crackers, and bottled water. When you go on a family trip, pack snacks and a picnic lunch to bring along.

For information about making better choices about what to eat out at restaurants, visit Eating Out or Ordering In.

Christine L. Williams, MD, MPH is professor of Clinical Pediatrics, and director of the Children's Cardiovascular Health Center in the Department of Pediatrics and Institute of Human Nutrition at Columbia University, College of Physicians and Surgeons.