Expert Q&A: Helping Your Child With Weight Loss

An interview with David S. Ludwig, MD.

From the WebMD Archives

Concerned that your child might be overweight or obese? As a parent, it can be hard to know what to do. Can you just hope your child will grow out of it? Can you encourage healthy habits without nagging? Is there some way to get your child to try a bite of vegetables without turning dinner into a pitched battle every night?

WebMD got some answers from David S. Ludwig, MD. He's a pediatrician at Children's Hospital, Boston and founding director of its Optimal Weight for Life (OWL) program, a clinic for overweight kids. Ludwig is also the author of Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World.

How do I know if my child's weight is unhealthy?

Well, you can look for signs of being overweight. Is your kid having trouble keeping up with other kids in sports? Is he outgrowing standard clothing sizes? But the best way is to look at the growth charts, which your pediatrician should be doing regularly. You can find out how your child's BMI (body mass index) compares with those of other kids.

If your child is overweight or obese, you need to take action. Some parents of obese kids want to write off the issue. They say, "Oh, he'll grow out of it." But all we have to do is look around us. It's very obvious that many, many children are not growing out of it.

What are the potential health effects of being overweight or obese as a child?

We know that obesity in childhood increases the risk of becoming an obese adult and developing all the complications that can go with adult obesity -- diabetes, heart disease, cancer, and other chronic conditions.

But the risks of childhood obesity aren't all in the future. It causes immediate problems, too. Excessive weight affects virtually all of the organ systems in a child's body. It can exacerbate asthma and trigger sleep apnea. It causes a range of heart disease risk factors and problems with the GI tract, liver, bones, muscles, and joints. We've seen high blood pressure in kids as young as 5 years old.

Having excess weight in childhood is serious, because it's a pivotal moment in development. The organs are still forming. Excess weight can affect how a child grows and develops, and that can have long-term repercussions. Unless you do something now, these changes will be very hard to deal with later.


What are some things I can do to help my kid lose weight?

At our clinic, we try to address this on multiple levels. It's important to realize that obesity isn't caused by one thing. It's the result of a combination of factors: the foods we eat, our physical activity level, emotional issues, stress levels, family dynamics, finances, and societal influences.

Of course, physical activity and diet are crucial. Contrary to what a lot of popular diets suggest, we don't recommend cutting out specific macronutrients -- like fat or carbs. Those approaches are counterproductive, because they're too hard to follow in the long term. Instead, we concentrate on the quality of the foods. We also use what's called the low-glycemic eating plan, which helps stabilize the surge in blood sugar that occurs after a meal. It helps people feel fuller and makes them less likely to overeat.

You may need to change some of your own behaviors. You need to model healthy eating and physical activity. You may also have to adjust how you deal with your kids. Nagging, criticism, and excessive restrictions on food don't work. We see many families that put so much energy into fighting over body weight and nutrition that there's actually very little energy left over to make any healthy changes.

How can I encourage my child to exercise?

It depends on the age. Obviously, young kids aren't designed to spend 20 minutes on a treadmill, either psychologically or physically. You have to make physical activity fun for them.

Sometimes it's simple. Just putting a young child outdoors with some toys or other children encourages them to be active. With older kids, you might need a little more structure. They could take part in competitive or noncompetitive sports.

You should also involve the whole family. Take fun outings to a park, or the beach, or the mountains. Start going on a family walk after dinner instead of collapsing in front of the television. Walking is a good way of burning calories and improving cardiovascular health.

How can I get my kid to stop eating junk food?

As a parent, you have control over what foods are in the kitchen. So if a food doesn't support health, don't bring it into the house. By doing that, you'll improve the quality of nutrition for the whole family. But it's got to apply across the board. The dad can't have his personal stash of ice cream bars in the freezer and expect the kids to leave them alone.


This doesn't mean that your kids can't have treats or sweets. If you want a splurge, go ahead -- just have it outside the home. Go out for a cup of ice cream once in a while and make it a celebration.

Now when you have teenagers, it gets trickier. Trying to prevent your teenager from going to fast-food restaurants with friends is going to be a losing battle. You should focus your energies on the areas where you do have control.

Are there other changes I should make to our home environment?

You have to de-emphasize television. TV is probably the worst influence -- worse than video games -- because not only are kids inactive when they watch it, but they're also likely to be snacking and getting exposed to junk food commercials. It's a triple whammy. So you definitely need to get the TVs out of your child's bedroom, the kitchen, and preferably the living room. Make watching TV less convenient and attractive.

Instead, create an active play area -- it could be a playroom, but it could also be a corner of your living room. Set up a sound system so your kids can put on music and dance around. You can also get some activity equipment for outside -- or just put up a basketball hoop in the driveway.

How can I get my child to eat healthier foods?

First of all, don't force him to eat a food. That's terribly counterproductive. We need to feel relaxed to enjoy a food. But if a child feels forced or pressured, his body will release stress hormones. He'll start to pair the food with the unpleasant feeling, and that's a great way to create food aversions that can last a whole lifetime.

So you want to encourage gently. At dinner, you could give your child a reasonable serving of an entree he likes to eat along with a serving of vegetables. Ask him to take a bite of the vegetables. If he doesn't want to finish it, that's fine. But don't give him a second helping of the entree to compensate. Hunger can be a good motivator. If he's still hungry, he'll go back to the vegetables.

You can also try some stealth nutrition -- sneaking vegetables into your child's diet in forms that he doesn't recognize. So he could get some of his vegetables through pasta sauce, or through a puree that you put into other foods. I don't like to push this approach too far though. Kids can get wise and feel manipulated.


Are there other mistakes parents make at the dinner table?

Yes. Another typical mistake is to say, "You can't have your dessert until you eat your vegetables." Maybe that will work a few times. But what you're doing is making dessert a reward and vegetables a punishment. That will have unfortunate long-term consequences.

Instead, just say, "First we eat our vegetables, and then we eat dessert." It's a subtle but important difference. You're just showing your child the proper order of things without placing relative value on either food.

How can I help my child deal with bullying related to his or her weight?

This can be really painful, both for the kids and for their parents. But you do have to be careful not to overreact. You don't want to make the situation worse than it actually is.

The first thing to do is really listen to what your son or daughter has to say. Then, depending on the child's personality, you can walk your kid through a few different responses. Some kids can handle teasing with humor, a witty comeback. Other kids can learn to ignore it -- they pretend that they're surrounded by a force field and the negative comments just bounce off.

There's no simple answer. In some situations where there's very abusive behavior, you may need to speak to the teacher and file a complaint. But in most cases, kids can handle it on their own, especially with some support from their parents, a sense of humor, and a little creativity.

Parents with overweight kids sometimes feel discouraged. Trying to push back against societal pressures can feel overwhelming. What do you have to say to them??

It is important to recognize what we're up against. We live in a society that, unfortunately, undermines our efforts to stay healthy. But parents shouldn't get discouraged. Once you have the family working together and making behavior changes, improving the health of your kids really can be easier than you think.

After they make some progress in the home, I do think it's important that parents turn their energy outward into the community. You could start lobbying to have the junk food taken out of the vending machines at your child's school and insisting on better quality school lunches. Fight to maintain open spaces for recreation and don't let them get bulldozed for developments.

It's really in our long-term interest as a country to deal with the problem of childhood obesity -- even from an economic perspective. Because if we raise a generation of kids who are obese, who have diabetes and heart disease at an early age, it will have an economic impact that will dwarf the financial crisis we're facing today. Our most precious resources are our human resources. Without the health of our children, we've got nothing.

WebMD Feature Reviewed by Louise Chang, MD on March 19, 2010



David S. Ludwig, MD, pediatrician; endocrinologist; founding director, Optimal Weight for Life (OWL) program, Children's Hospital, Boston; associate professor in pediatrics, Harvard Medical School; author, Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World.

© 2008 WebMD, LLC. All rights reserved.


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