Parenting Your Overweight Child

With more than 60% of Americans Being overweight or obese,  most of us have relatives, friends, and other loved ones who are overweight, unfit, and unhealthy. Perhaps some of us even have a chubby son who loves television or a daughter who is slightly pudgy.
And herein, the question lies: What's a parent to do to help their child?
 Here are 12 easy tips to follow as you work with your child toward a healthy lifestyle:

1. Modeling healthy choices and engaging in regular physical activity yourself is one of the better things you can do for your child. Children learn by watching you and copying behaviors, both good and bad.

2. Limit Fast foods- hamburgers, French fries, and the like-that contributes to weight gain and is bad for the heart! Healthy eating doesn't mean Children can never eat at fast food places. When you do eat out, select foods in which no more than 30 % of the calories come from fat. Some fast food restaurants post the nutritive content of their foods. Try backed potatoes, salads (with nonfat or low-fat dressing), chicken or turkey breast deli sandwiches, vegetables and rice, fruit salads, or toasted bagels (hold the cream cheese or butter).

3. Do not put your overweight child on a diet. Dietary restrictions cause more problems than they solve. For example, children often overcompensate and don't stop when they're full (binging). Your child may also resort to "last chance eating" and eat more or may begin to sneak food.

4. Provide your child with healthy, nourishing options at home, as well as some healthy snack foods. (Otherwise children will go out and get them on their own.) Encourage breakfast and plan structured meals and snacks. Keep easy-to-grab fruits and vegetables within easy reach of hungry families on the run. Many children like apples, bananas, blueberries, carrots, grapes, oranges, sliced red peppers, peaches, raisins, and strawberries. A few even enjoy broccoli florets and celery sticks. Serve more fresh fruit and 100% fruit juices in place of soft drinks.  For those few times you serve soft drinks (should you decide to do so), keep the portions small. My Pyramid for kids gives tips on nutrition and exercise. (teamutrition.usda.gov/resources/mpk_tips.pdf)

5. Limit sedentary activities such as television watching, computer use, and video games and substitute enjoyable family activities. Simple activities you can all enjoy such as bike riding or walking after dinner, can make a big difference.

6. Restrict the use of refined Carbohydrates such as chips, white bread, pastries, and sugary breakfast cereals. Offer healthy whole-grain breads and cereals sweetened with bananas, raisins, and applesauce instead. Half the grains you serve should be whole grains.

7. Remember that many children grow out before they grow up (i.e., put on a little body fat before they gain inches in height). Instead of putting a child on a diet, which can damage self-esteem, get your child involved in sports and other activities.

8. If your child freely expresses discontent with his or her body, and wants to learn how to eat better, arrange for a consult with a dietician who specializes in pediatric weight control.

9.  Check yourself. If you're feeling uncomfortable about your child's weight, get some professional advice from your pediatrician to determine if the problem is real. Some parents do have reason for concern, while others simply have anxiety about having an "imperfect" child. Your child might not be as thin as you were as a child, but still be within the normal weight. You can monitor your child's weight on charts available through the CDC (www.cdc.gov/growthcarts).

10.   Be sure to love your child for who they are and be careful not to judge him or her from the outside in. Even little comments such as" that dress is pretty, but would look better if you could lose just a few pounds" gets interpreted by the child as "I'm not good enough." Self-esteem falls and can lead to anorexic thinking where the child begins to believe that "thinner is better."

11. Become an advocate for your community. Make your voice heard about the need for safe sidewalks, health clubs that welcome overweight children (and adults) to wear shorts and tee shirts rather than bathing suits.

12. Remember that your job is to determine where, when, and what your child is eating your child's job is to determine how much and whether to eat. In other words, don't force your child to eat spinach and don’t keep them from second helpings. Interfering with a child's natural ability to regulate food can cause a lifetime of struggling.

Adapted from: Nancy Clark, RD,FACSM. American and Wellsource, Inc.  College of Sports Medicine Fit Society Page. Fall 2005

Who Are You Calling Fat?; For Fear of Parents' Reactions -- and Other Reasons -- Many Pediatricians Ignore the Biggest Problem That Weighs On Young Patients
Sandra G. Boodman, Washington Post Staff Writer

Some doctors call it "the other f-word" -- a problem they see on a daily basis but many are reluctant to address: kids who are too fat.   The issue is not new, but experts say it has acquired greater urgency as obesity has ballooned in the past 25 years, accompanied by sharp increases in diabetes, hypertension and high cholesterol, conditions that used to be largely the province of those middle-aged or older. In 1980, according to the federal Centers for Disease Control and Prevention (CDC), 7 percent of children and 5 percent of teenagers were overweight; today the figures hover around 19 percent and 17 percent, respectively.

Doctors at Children's National Medical Center in Washington, where 38 percent of patients are obese, say that in recent years they have treated a 9-year-old who suffered a heart attack, a child with a body mass index of 52 (a 5-foot-6 adult with a BMI of 52 would weigh 322 pounds) and several others so dangerously fat that they underwent gastric bypass surgery.

So why are many doctors reluctant to mention an obvious problem?  The reasons are many, experts say: fear of alienating a family or hurting a child; uncertainty about what weight loss approaches have the best outcomes -- or work at all; accelerating time pressures coupled with the requirement that doctors cover an increasing number of topics in a visit; and an insurance system that often does not reimburse doctors for follow-up visits to treat obesity alone. Many pediatricians also say they have no place to refer children who need more intensive help managing their weight.

Locally, that will change in September when Children's is scheduled to open a multidisciplinary pediatric obesity clinic for children between 2 and 18. The clinic, which will feature individual and group treatments for children and their families, will include a nutritionist, a cardiologist, an endocrinologist and a personal trainer. "We're hoping to create a home for overweight and obese children," said Nazrat Mirza, the Children's obesity specialist who will direct the clinic.

"Many doctors don't feel comfortable or competent talking about obesity," Mirza said. Because pediatricians typically schedule patients every 10 to 15 minutes and are expected to cover a multitude of topics including immunizations and safety issues, "they think, 'Do I want to open that Pandora's box' " by mentioning a child's weight?

Often, she said, the decision is no -- particularly if a parent is overweight, as is often the case. Some who have broached the subject, Mirza said, have complained that "it doesn't seem to make a difference, kids just keep gaining weight, so why are we wasting our time?" And many doctors are unsure about which approaches are likely to work best with kids.

To help physicians address the problem, Children's has held classes designed to help doctors and nurses communicate with parents, advising them to open the discussion by showing them where a child falls on the growth charts and calculating the child's BMI.  Even the terminology used to describe children's weight problems is prompting debate, as doctors draw up new guidelines for the diagnosis and treatment of obesity under the aegis of the American Medical Association and the American Academy of Pediatrics (AAP).

For several years the CDC has recommended that clinicians classify children who are overweight -- above the 85th percentile on growth charts that track height, weight and age -- as at "risk of overweight."  Those above the 95th percentile are called overweight -- rather than obese -- to avoid stigmatizing them.  Reginald Washington, a pediatric cardiologist in Denver who is co-chairman of the AAP's task force on obesity, said the CDC's "warm and fuzzy" labels obscure the health crisis personified by the children who are routinely referred to him for treatment of high blood pressure and high cholesterol.  "I think until people realize they have to change, they won't," Washington said, adding that one reason childhood obesity "is so out of control is that no one wants to talk about it."

Washington said he has been accused by parents of callousness or an inability to understand the problem when he tells them their children need to lose weight -- criticisms he rejects. Many parents, he added, are too fat themselves and are unwilling to make changes to help their children lose weight.  "There's a lot of denial," Washington said, adding that parents have told him they can't buy healthier foods because their children refuse to eat them, or they don't want to remove the TV set from a child's bedroom because he or she will get into trouble doing other things.  

But other experts say that labeling kids overweight and obese may prove more harmful by making them feel there is little they can change. It is easy, they warn, to oversimplify a complex problem that may involve cultural differences, poverty and psychological factors.  "The issue is not as simple as telling people to eat more fresh fruits and vegetables and move more," said adolescent medicine specialist Adekemi Oguntala, who co-directs an obesity treatment program at Children's Hospital and Research Center in Oakland, Calif., that is grappling with problems similar to its District counterpart. In some cases, she said, families don't have access to fresh produce, are resistant to making changes that involve the entire family, or eat cheap, high-calorie foods because they are accessible or affordable.  And, Oguntala said, even someone who is highly motivated and has struggled with weight knows how difficult the problem can be.

In some cases, cultural differences in attitudes toward overweight can play an important role, said Children's Mirza. "The majority of parents don't know their child is overweight, and some parents get very upset" if they are told their child is too heavy.  "They say, 'I was big as a kid,' or that their child has a hormonal problem," she said. In some cultures, Mirza added, chubbiness is seen as a sign of health and people talk about "that poor skinny thing."

A recent study of 194 Latina mothers in California, presented at the Pediatric Academic Societies annual meeting, found that 44 percent had children who were overweight by age 3, but three-quarters thought their children were of normal weight.  Sometimes ignorance is a factor.  "Most people are not that knowledgeable," said Kelly Sinclair, a clinical nutritionist at Children's. "They think their diet is healthy -- that low-fat Pop Tarts are healthy or Goldfish crackers are because they're not potato chips. Some people count candy in the shape of fruit as a fruit."

Nathaniel Beers, medical director of Children's general pediatric clinic, said he takes a straightforward approach with families whose children are overweight or obese. First he calculates a child's BMI, then he asks parents and the child if "this is something they want to work on."   "Most people are willing to think about it," he said. Even those who haven't been successful controlling their own weight are often eager to help their child "because they don't want him or her going through what they've been through." It's important not to alienate parents by blaming them, he added.  "As pediatricians, we try to help get a dialogue going and to leave the door open," Beers said. Although he counts a few successes among his patients, Beers added, "it's a huge uphill battle."*