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Helping Your 'Not-Thin' Kids

What parents should (and shouldn't) do

Reviewed by Louise Chang, MD on January 20, 2006

Fit kids come in all shapes and sizes, just as fit adults do. And manyexperts say we should keep this foremost in mind when it comes to children whoaren't thin, but who eat healthfully, have lots of energy, and exercise almostevery 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 childobesity epidemic," says Kathy Kater, LICSW, a national expert on healthybody image. "If you limit the food needed to satiate hunger completely, itwill backfire, triggering preoccupation with food and, ultimately, anovereating or compulsive eating response."

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

"Jobs, money, and social advancement compete in importance with raisingchildren, 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 anddepressed. As a society, we are abominable about feeding ourselves, onlymarginally better about feeding our children, and obsessed withweight."

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

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

"Overweight diagnoses create the very problems they are intended toaddress when parents restrict food and then the food-deprived -- and thereforefood-preoccupied -- child overeats and gains too much weight," saysSatter.

Eating Disorders on the Rise

Anorexia has risen steadily since the 1950s, while the rate of bulimia among10- 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 eatingdisorders? "For anorexia it's … in the 12- to 13-year ballpark, aroundphysical puberty, and also later, in the 17-year range, around the approach ofseparation for college," says Mickley. "Bulimia has a peak onset duringthe college-aged years."

Research shows these illnesses may be hereditary (as much so asschizophrenia). 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 aneating 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 sometips from the experts:

What Parents Should Do:

  • Have regular family meals and structured snacks. This gives children asense of security, Satter says. "Teens who have regular meals do better inall ways -- nutritionally, socially, emotionally, academically," saysSatter.
  • Trust your child to eat what, and as much, as he or she needs from what youserve. Based on decades of experience working with children, Satter says thatpreteens and teens (along with younger children) do best when parents take thelead of the "what" "when" and "where" of feeding, buttrust children to manage "how much" and "whether" theyeat.
  • Find realistic ways to increase activity and decrease sedentary time,recommends the American Dietetic Association. Do this as a family; finding waysto exercise will help make everyone healthy and strong.
  • Be a good role model in your eating and exercise habits. Avoid fad dietsand obsessing about body size or weight.
  • Increase the fiber in your family's food choices. Fiber comes with alaundry list of health benefits -- from lowering cholesterol and potentiallyreducing the risk of some cancers, to helping us feel full faster. Serve morewhole grains, higher-fiber breakfast cereals, beans, fruits, andvegetables.
  • 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. isdue to rising consumption of high-fructose corn syrup, which is used in manysoft drinks, fruit juices, sports drinks, and packaged baked goods. One studyfound that rats fed a high-fructose diet were more likely to develop featuresof metabolic syndrome, says researcher Richard J. Johnson, MD, of theUniversity of Florida College of Medicine. Metabolic syndrome is a group ofsymptoms linked to a high risk of diabetes and heart disease.
  • Serve a balanced breakfast. Kids who eat healthy breakfasts tend to scorebetter on school tests, and to be less overweight than children who skip themorning meal. A balanced breakfast contains protein (from grains, low-fatdairy, lean meats, or egg whites); fiber; and a little fat, too.
  • Focus on fitness -- rather than thinness -- for the whole family. "Wehave shown here at the Cooper Institute [in Dallas] that men and women whoachieve a high level of fitness, regardless of weight, live longer and developfewer chronic illnesses than thin people who aren't fit," says StevenBlair, chief executive officer.
  • Call a family meeting, and ask each person to share what his or herfavorite foods/dishes are. The family can then incorporate them (or morehealthful versions of them) into a balanced week or month of meals.
  • Limit television and computer time. Not only do TV and computers decreasetime available for physical activity, but TV viewing has been linked to greaterconsumption of soda, fried foods, and snacks. The American Academy ofPediatrics suggests that parents limit their child's use of TV, movies, andvideo and computer games to no more than two hours per day.
  • Encourage the whole family to eat slowly. When you eat slowly, you're morelikely to enjoy what you are eating and to be in touch with your physicalhunger and fullness physical signals.
  • Seek professional help for children who seem excessively anxious,depressed, or negative about their bodies; who diet excessively orinappropriately; or become preoccupied with weight and body size. Mickley urgesparents to get help for their child at the first hint of a possible eatingdisorder.
  • Help your child think critically about media messages that encourageunrealistic, 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 overtime," says obesity researcher John Foreyt, PhD, from the Baylor College ofMedicine.
  • Avoid labeling the child as "too fat," says Satter. If a child isoverweight, don't focus on the child, but work on moving the whole familytoward 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 childrenthat a person's worth comes from his or her character, personality, and goodworks -- not appearance.
  • Don't use food as a bribe, reward, or punishment. This encourages childrento think of food as something other than nourishment.
  • Don't serve large portions to the whole family. The bigger the serving, themore children and adults will tend to eat, according to a Cornell Universitystudy 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." Shepoints out that children tend to eat junk foods in moderation when these foodsare available regularly at home; and that restricting food intake may makechildren preoccupied with food and prone to overeat when they get thechance.

Show Sources

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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