overweight 9 year old boy

Question
My son has been gaining weight steadily for the last 18 months.  He was always on the small side, a 6 pound baby, 20 pound 2 year old, 38 pound kindergartener, 48 pound 2nd grader...now he's in 4th grade and as of yesterday weighs 101 pounds at 4'6" tall.  I haven't done a BMI on him, but I'm guessing this puts him in the "obese" range since he weighs what a 5 foot tall kid should weigh. We've had him tested for diabetes and thyroid problems and all have come back negative.  Yes, he likes food.  BUT, he eats A LOT of vegetables and fruits.  He will pick a salad over cake ANY day.  He's home sick today (migraine) and I just noticed that he was eating cereal, although a healthy type, straight out of the box.  I realized that he doesn't have PORTION control!  I explained to him that if he eats from the container, cereal, chips, pasta, veggies, whatever...if it's not pre-packaged in a serving size he has NO IDEA how much he consumes.  Especially if he's reading or watching TV.  I've turned the TV off now during meal times and have drawn snacks to the kitchen table or outside only.  I am telling all my kids TODAY they must have all food approved by me or their dad before they eat it and we must dole out their portions.  It is also helpful not to have "junk food" in the house, but none of the rest of us have weight problems (I'm 5'4" 120 lbs, my husband is 5'10" 180 lbs).  All of us are active, and all of the kids are involved in organized sports and regular outdoor play.  That is one reason we have had the 9 year old tested for underlying illnesses.  My other 2 kids are both considered tall for their age(s), and this one is a little shorter than most of his peers.  My 7 year old daughter is the same height as my 9 year old son (4'6") and weighs 60 pounds (underweight maybe, but muscular and active) and my 2 year old is 3'6" (yes, he's 42 inches) and weighs 39 lbs.  SO, I still feel like there could be an underlying issue. Also, my son fails to see that he is overweight, although in the last 6 months he has gained 20 pounds and hasn't grown a bit, and he's getting cellulite and rolls on his chest and abdomen.  He was at the hospital yesterday and I had to help him put a dressing gown on and noticed he is getting what appears to be purple stretch marks just under the skin on the front of his upper thighs.  A LOT of kids in this area are overweight, and he thinks he's normal.  In fact, there are several kids in his class that are MUCH bigger than him.  But I am concerned not only about his physical health, but his emotional health.  I've tried to tell him that if he continues on the road he's on, that children will begin to tease him for being overweight and as he gets into middle and high school the girls will not be as eager to "date" him as other boys who are not overweight.  Of course, he doesn't understand that right now.    He thinks because he has plenty of friends right now he has no problems.  I've tried to explain to him the repercussions of a poor diet (as in consuming too much food) and being overweight...cholesterol problems, heart problems, diabetes, which could lead to kidney and vision problems, and the list goes on of what I've talked to him about, and he still seems to be either in denial or non-chalant.  I don't know what to do.  If he were any more active he'd never be inside.  If it's daylight he's riding a bike or playing baseball or basketball...and his choices of food aren't bad.  I do think it's portion control and still in the back of my mind I think there could be an underlying illness the doctors haven't checked for.  I have been open and honest with you and I'm very serious in seeking help for my child.  We live in a small town and there are no options open to us as far as seeking the help of a nutritionist or dietician and no organized exercise/diet programs for children.  So, I'm kind of out on my own here.  If nothing else, can you at least give me some guidelines about what and how much a child his age SHOULD be eating, and how we need to modify that to encourage some weight loss?  If you have any ideas about underlying causes, that would be great, too.  Thanks so much!

Answer
Dear Michelle, It sounds like your son has a sweet tooth. To eat cereal from the box means he is eating to taste the food, not because he is hungry. Normal portions sizes for kids are actually the ones found on the box. Average portion of cereal is usually 3/4 cup to 1 cup. Milk is one cup, three times per day. One cup juice per day and two whole fruits per day. Vegetables can be unlimited. He should have a protein food at lunch and at dinner and he should eat two to three slices of whole grain bread per day. Healthy fats should come from salad oil or nuts. Mac and cheese, pasta, rice, bagels, chips, crackers, and other carb foods should be limited while he is losing weight, or waiting for his next growth spurt. You have a hospital nearby, so you do have access to a dietician.
Food allergies can cause headaches and food eating problems, you might ask for a referral to see a specialist. Hope that helps, Laura Kraemer,Slimkids.com

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