Children can begin to associate fat with being shameful at a young age when they start watching TV and see images that build on a typical stereotype. Usually, the fat character is the butt of the joke, dumb, dirty, depressed or the evil villain in the cartoon or movie. Children may not be aware that they are in a larger body until they’re weighed and measured by their doctor or at the school health fair. The actual cause of a child being overweight is a whole other discussion without an easy answer, however, how we address a child’s weight can make a significant impact on that outcome.
New research shows that telling a child he or she is overweight or has a weight problem, causes more harm than good. A retrospective study in The Journal of Eating and Weight Disorders (June 2016), states that when parents comment negatively on a child’s weight, kids are more likely to grow to adulthood with negative body and weight dissatisfaction. A longitudinal study of girls aged 10 to 19 (JAMA 2014), found that “regardless of actual weight, adolescents who reported having been labeled ‘too fat’ by a family member or peer were more likely to become obese nearly a decade later.” Body dissatisfaction can lead to dieting, restrictive eating behavior, bulimia and other eating disorders in childhood and adolescents. How do we treat overweight children while preventing eating behaviors that can lead to eating disorders?
In my private practice, when I receive a referral for a child with a BMI > 95% (which is most often the diagnosis code) I usually request the parents meet with me alone without the child for our first visit or speak privately with them on the phone regarding our goals. I treat obesity in a child as a family concern and won’t single out a child as their weight being a problem. Most often it’s the parent’s approach to feeding that needs to be addressed. I believe strongly in Ellyn Satter’s Division of Responsibility; it’s the parents who purchase the food, make the meals and it’s up to the child to decide how much and of what foods to eat. When parents start limiting and restricting food, it only causes one to not trust their own hunger cues, leading to sneaking food and overeating when given the chance. Parents can help their overweight child by offering healthy meals and snacks, sticking to a meal and snack schedule, allowing them to eat by listening to their own hunger cues, being a healthy role model themselves, promoting positive body image and being active with their child on a regular basis. Research shows that 95% of diets don’t work and most who lost weight by reducing calories will regain their weight, (plus some), in 1 to 5 years. (Source: Statistics on Weight Discrimination: A Waste of Talent, The Council on Size and Weight Discrimination, Retrieved July 18, 2011). The actual weight cycling is what is correlated with being unhealthy, not the weight itself, (Int J Exerc Sci. 2009; 2(3), Lissner, et al., 1991; Diaz, et al., 2005). It’s important for a parent to accept their child in a larger body and not put undue emphasis on their weight but rather work to improve cholesterol, lower triglycerides and most importantly, to help them find enjoyment in an activity that move the body. Some children are born in larger bodies and will have a high BMI all their lives. Health is attainable regardless of weight. Having body confidence and supportive parents will make a huge difference for these kids in the long run.
AAP’s Evidence Based Guidelines
I was pleased to see these evidence based management strategies released by the AAP last year, (August 2016) to help treat obesity and prevent eating disorders. These management strategies are a great start to improving children’s body confidence and I encourage you to ask your pediatrician to implement these guidelines if not already.
- Discourage dieting: Encourage and support the implementation of healthy eating and physical activity behaviors that can be maintained on an ongoing basis. The focus should be on healthy living and healthy habits rather than on weight.
- Promote a positive body image among adolescents.
- Encourage more frequent family meals.
- Encourage families to refrain from talking about weight but rather talk about healthy eating and being active to stay healthy.
- Inquire about any history of mistreatment or bullying in overweight and obese teenagers and address this issue with patients and their families.
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