An updated report from the Institute of Medicine (IOM) confirms what many parents and pediatricians already know: Childhood obesity is only getting worse.

An estimated one-third of American children and adolescents are now obese or at risk of becoming obese, according to the report. Yet efforts to control obesity in kids remain "fragmented and small-scale," according to a panel of experts convened by the IOM, a nonprofit that often conducts research for the government. The panel also noted that commitment and resources for fighting childhood obesity pale in comparison to other public health efforts, including control of infectious disease outbreaks and prevention of bioterrorism.

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"When it comes to promoting nutrition and physical activity to our kids, we're not only stuck in neutral, we're asleep at the wheel," said Sen. Tom Harkin (D-Iowa) in response to the report. "It's time that we get serious and truly focus . . . on addressing this problem with a comprehensive approach. The federal government, our schools, employers, parents and communities all have a role to play in fighting and preventing obesity."

Until that happens, it's up to you and your family to take care of yourselves. What can you do to help your kids either lose weight or keep them from piling on unwanted pounds? Experts say that there's no single answer. But a number of helpful strategies are emerging from research and pilot programs throughout the country. Among them:

Start early . How early? Infancy. Breast-feeding infants exclusively for the first four to six months of life -- a practice recommended by the IOM -- significantly cuts the risk of childhood obesity.

Limit your child's screen time. The more hours spent sitting in front of the television or computer, the more likely kids are to be overweight or obese. The surprise: Research suggests that sedentary kids are most motivated to get active when television (in limited quantities, of course) is offered as a reward for healthy activity. One tool that may help: TV Allowance, a $99 timer that plugs into either the television or the computer. Parents and children receive a code that must be keyed into the timer to turn on the television or computer. When the time is up, the device turns off.

Or take a tip from the Academy of the Sierras, a boarding school for overweight children in California, where television watching is limited to the gym. Students must walk on a treadmill, climb a stair machine or work out in some other way to view the tube.

Know the score . Turns out that some parents of overweight kids have trouble identifying their children as super-sized. So a number of states, including Maryland, are considering providing body mass index (BMI) report cards for kids to take home to Mom and Dad.

The IOM urges parents to regularly check their children's BMI. You can do that at the Web site of the Centers for Disease Control and Prevention (find an easy link at http://www.leanplateclub.com/ ). Or talk to your child's doctor.

Unlike in adults, BMI in children and teens is expressed in percentiles to account for age, growth and body fat differences between boys and girls.

Break bread together . Cornell University researchers showed that teens who eat frequently with their families also eat more fruit and vegetables, whole grains and other essential nutrients than those who don't regularly eat family meals. The kids who have family meals also drink fewer sweetened soft drinks and eat less fat.

While you're at it, get your kids to help with meal preparation, too. Studies suggest that's another habit that helps foster more-nutritious eating.

Wear pedometers. They're standard issue at the Academy of the Sierras. The goal: 10,000 steps per day. Track those steps in a low-tech way by simply encouraging each family member to mark their initials and step numbers on the kitchen calendar. "It's very low-tech," says Daniel Kirschenbaum, professor of psychiatry and behavior sciences at Northwestern University and clinical director of Health Living, which runs both the Wellspring Summer Camps and the Academy of the Sierras.

Walk the walk yourself. If you want your children to eat smart and move more, you have do it, too, "without any crapola excuses," says Kirschenbaum, who was overweight as a child. "You have to show them this isn't torture. . . . You need to embrace this lifestyle, not just do it grudgingly." ?