Helping Your 'Not-Thin' Kids

What parents should (and shouldn't) do

From the WebMD Archives

Fit kids come in all shapes and sizes, just as fit adults do. And many experts say we should keep this foremost in mind when it comes to children who aren't thin, but who eat healthfully, have lots of energy, and exercise almost every day.

It's crucial, they say, that in concern for their overweight or obese child, parents first do no harm.

"Frankly, I am frightened by all the media attention regarding a child obesity epidemic," says Kathy Kater, LICSW, a national expert on healthy body image. "If you limit the food needed to satiate hunger completely, it will backfire, triggering preoccupation with food and, ultimately, an overeating or compulsive eating response."

If you ask Ellyn Satter MS, RD, LCSW, today's crisis is not one simply of overweight children, but also of parenting and feeding.

"Jobs, money, and social advancement compete in importance with raising children, and parents aren't encouraged to keep their priorities straight," says Satter, author of Your Child's Weight: Helping Without Harming. "As a result, a high proportion of today's children are anxious and depressed. As a society, we are abominable about feeding ourselves, only marginally better about feeding our children, and obsessed with weight."

Some say our society's obsession with dieting and weight has hurt more than it has helped. One recent study from the University of California-Berkeley showed that frequent dieting may lead to weight gain. Of the 149 obese women studied (with an average age of 46), those who had dieted before age 14 were more than twice as likely to have dieted 20 times or more, and to have the highest BMIs (body mass indexes).

Even worse, this obsession appears to have extended to our children. Studies show that 5- to 9-year-olds who get the message that they're overweight feel flawed in every way -- that they're not smart, not physically capable, and not worthy, says Satter. At the same time, she says, equally heavy children who haven't gotten that message feel fine.

"Overweight diagnoses create the very problems they are intended to address when parents restrict food and then the food-deprived -- and therefore food-preoccupied -- child overeats and gains too much weight," says Satter.


Eating Disorders on the Rise

Anorexia has risen steadily since the 1950s, while the rate of bulimia among 10- to 39-year-olds tripled between 1988 and 1993, according to Diane Mickley, MD, director of the Wilkins Center (which specializes in eating disorders, self-esteem, and weight issues).

What are the ages when children are most vulnerable to developing eating disorders? "For anorexia it's … in the 12- to 13-year ballpark, around physical puberty, and also later, in the 17-year range, around the approach of separation for college," says Mickley. "Bulimia has a peak onset during the college-aged years."

Research shows these illnesses may be hereditary (as much so as schizophrenia). But environment is also important.

"For anorexia, the vulnerable temperament is anxious, harm-avoidant, perfectionistic, disciplined, restrained, responsible, people-pleasing," says Mickley, "while for bulimia, being more impulsive, stimulus-seeking, and [changeable] seems to put people more at risk."

In a vulnerable person, experts say, an intentional -- even appropriate -- weight loss "diet" can generate a series of events that help set an eating disorder in motion.

So what should a concerned parent do when a child is overweight or obese? And -- just as important -- what should parents not do? Here are some tips from the experts:


What Parents Should Do:

  • Have regular family meals and structured snacks. This gives children a sense of security, Satter says. "Teens who have regular meals do better in all ways -- nutritionally, socially, emotionally, academically," says Satter.
  • Trust your child to eat what, and as much, as he or she needs from what you serve. Based on decades of experience working with children, Satter says that preteens and teens (along with younger children) do best when parents take the lead of the "what" "when" and "where" of feeding, but trust children to manage "how much" and "whether" they eat.
  • Find realistic ways to increase activity and decrease sedentary time, recommends the American Dietetic Association. Do this as a family; finding ways to exercise will help make everyone healthy and strong.
  • Be a good role model in your eating and exercise habits. Avoid fad diets and obsessing about body size or weight.
  • Increase the fiber in your family's food choices. Fiber comes with a laundry list of health benefits -- from lowering cholesterol and potentially reducing the risk of some cancers, to helping us feel full faster. Serve more whole grains, higher-fiber breakfast cereals, beans, fruits, and vegetables.
  • Offer fewer beverages (and foods) sweetened with high-fructose corn syrup, and more low- or no-calorie beverages (like water, unsweetened hot or cold tea, and low-fat milk). Some experts say part of the rise in obesity in the U.S. is due to rising consumption of high-fructose corn syrup, which is used in many soft drinks, fruit juices, sports drinks, and packaged baked goods. One study found that rats fed a high-fructose diet were more likely to develop features of metabolic syndrome, says researcher Richard J. Johnson, MD, of the University of Florida College of Medicine. Metabolic syndrome is a group of symptoms linked to a high risk of diabetes and heart disease.
  • Serve a balanced breakfast. Kids who eat healthy breakfasts tend to score better on school tests, and to be less overweight than children who skip the morning meal. A balanced breakfast contains protein (from grains, low-fat dairy, lean meats, or egg whites); fiber; and a little fat, too.
  • Focus on fitness -- rather than thinness -- for the whole family. "We have shown here at the Cooper Institute [in Dallas] that men and women who achieve a high level of fitness, regardless of weight, live longer and develop fewer chronic illnesses than thin people who aren't fit," says Steven Blair, chief executive officer.
  • Call a family meeting, and ask each person to share what his or her favorite foods/dishes are. The family can then incorporate them (or more healthful versions of them) into a balanced week or month of meals.
  • Limit television and computer time. Not only do TV and computers decrease time available for physical activity, but TV viewing has been linked to greater consumption of soda, fried foods, and snacks. The American Academy of Pediatrics suggests that parents limit their child's use of TV, movies, and video and computer games to no more than two hours per day.
  • Encourage the whole family to eat slowly. When you eat slowly, you're more likely to enjoy what you are eating and to be in touch with your physical hunger and fullness physical signals.
  • Seek professional help for children who seem excessively anxious, depressed, or negative about their bodies; who diet excessively or inappropriately; or become preoccupied with weight and body size. Mickley urges parents to get help for their child at the first hint of a possible eating disorder.
  • Help your child think critically about media messages that encourage unrealistic, unhealthy body images and attitudes.


What Parents Shouldn't Do:

  • Don't resort to "diets" -- they don't even work for adults. "Only 5%-10% of dieting adults maintain their significant weight loss over time," says obesity researcher John Foreyt, PhD, from the Baylor College of Medicine.
  • Avoid labeling the child as "too fat," says Satter. If a child is overweight, don't focus on the child, but work on moving the whole family toward a healthier lifestyle.
  • Don't comment on people's weight and/or bodies -- strangers', friends', your own, and especially your child's, urges Mickley. Stress to your children that a person's worth comes from his or her character, personality, and good works -- not appearance.
  • Don't use food as a bribe, reward, or punishment. This encourages children to think of food as something other than nourishment.
  • Don't serve large portions to the whole family. The bigger the serving, the more children and adults will tend to eat, according to a Cornell University study by researcher David Levitsky, PhD.
  • Avoid the two eating rules that make children fail. According to Satter, these are "don't eat junk food" and "don't eat so much." She points out that children tend to eat junk foods in moderation when these foods are available regularly at home; and that restricting food intake may make children preoccupied with food and prone to overeat when they get the chance.
WebMD Weight Loss Clinic-Feature Reviewed by Louise Chang, MD on January 20, 2006


SOURCES: Journal of the American Dietetic Association, June 2004; January 2005. Obesity Research, 2005, 13:1422-1430. International Journal of Obesity, 2005, 29:6: 557-64. News release, Dec. 6, 2005, University of Florida. Kathy Kater, LICSW, psychotherapist in private practice. Ellyn Satter MS, RD, LCSW, president, Ellyn Satter Associates. John Foreyt, PhD, director, Behavioral Medicine Research Center, Baylor College of Medicine, Houston. Steven Blair, PED, chief executive officer, Cooper Institute, Dallas. Diane Mickley, MD, director, Wilkins Center, Greenwich, Conn. Richard J. Johnson, MD, chief of nephrology, hypertension, and transplantation, University of Florida College of Medicine, Gainesville, Fla.


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