July 20, 2000 -- Stories on childhood obesity these days are almost as plentiful as the peas left on many a child's dinner plate. But in the spirit of the topic, here's a command: you're not getting up until you've read every last word in this story! At least if you're a parent with concerns about your child's weight.
Childhood obesity has risen dramatically since the 1960s, according to government statistics, with as many as 30% of children meeting the definition of obese. Recent studies even show that parents underestimate their child's own weight problems, especially low-income parents.
That adds to the problem, but the usual suspects rarely change: foods are too high in fat, lives are too lacking in exercise, partly because of the constant lure of television and video games. Most are guilty as charged, but ...
"We don't know what is responsible for the epidemic," says Jennifer Buechner, RD, CSP. "We do know all these factors are contributors. Certainly kids do not move as much as kids used to. Eating is much different these days, frequently a very hectic affair." Buechner is involved in a program for obese kids called FitKids at Children's Healthcare of Atlanta.
Experts agree it's a given kids are too fat because of high-fat foods, and they don't exercise enough. But Ellyn Satter, MS, RD, points out that children are normally active, and children normally don't overeat "out of thin air." Instead, they normally eat as much as they're hungry for. "So what's going on with today's children that is interfering with their natural ability to regulate their energy balance and grow in a way that is right for them?" Satter asks. "That's the real question." Satter is the author of three books, including Child of Mine: Feeding with Love and Good Sense.
It's a question that has a different answer for every overweight child, and every family of an overweight child. But you should know, if you're thinking of changing your child's diet in order to reduce his or her weight, you should first consult your pediatrician, who can also tell you what your child's ideal weight should be. If the weight problem isn't medical and your child is 20 pounds or less over his ideal weight, you may be able to manage his weight problems with some behavioral and nutritional changes.
In talking with experts, some common themes for helping children with unhealthy eating habits that could lead to weight problems rise to the top.
Here's what a few nutritionists recommend:
- Eat meals together as a family so you can control how much and what your kids eat, and don't allow kids to eat food between meals or snack times.
- Focus on fitness as a family to make it more of a habit and to make it more enjoyable.
- Shop wisely; if you don't want your child to eat it, don't bring it in the house.
- Teach children to eat slowly, savor the food, and listen to the body's hunger and fullness cues.
- Plan regular meals. If children get too hungry, they may overeat.
- Don't force a child to clean his plate.
For all the suggestions, though, one theme dominates: parental involvement. "People often blame [obesity] on externals instead of looking at what's going on in the family. Why is that kid allowed to watch so much TV or play on the computer so much? Why is the food so important, why does this kid have such a drive to overeat?" asks Diana Koenning, MPH, RD, a wellness nutritionist at Healthworks in Raleigh, N.C.
Koenning works with a program called Shapedown that was developed years ago at the University of California School of Medicine in San Francisco by a team of physicians, exercise and mental health specialists, and dieticians. The program is designed to help obese kids, but it puts just as much focus on the kids' parents.
Family structure can be "all-important, depending upon the age of the child," Koenning tells WebMD. "Kids focus on immediate gratification, mid to older teens can tackle the problem fairly successfully if they have good motivation. Younger than that -- without the parents making changes, it's very difficult to impossible for things to change for the child."
Debbie Beasley of Raleigh, N.C., agrees. Her son, Chris, is 12 years old. He's 5'4" and used to weight 245 pounds. Though not uncommon, his case is more extreme than many kids. Beasley describes her son as "one of those kids who likes to sit in front of a TV with a video game controller in his hand." His size impeded his activity, she says, and Chris would sometimes get picked on by kids on the school bus. Upon the advice of a pediatrician, Chris and his family enrolled in the Shapedown program, which works with families to regulate eating habits depending upon the severity of the weight problem.
After 12 weeks, Beasley says she's pleased with the results. Chris has lost about 18 pounds, he's more active, and he's "learned an awful lot of about nutrition, things to look for on the labels, how important it is to drink water vs. all the Cokes he was putting away." Beasley, who's struggled with her weight, also has modified her eating habits, such as eating until satisfied instead of stuffed.
Koenning says it's important that obese people listen to their body's own cues. "Responding to cues of hunger and fullness to stop and start eating, that's a big area of disconnect for kids, and I'd say people in general, with a problem of obesity. They have lost the sensory gauging ... to body signals," Koenning tells WebMD.
Buechner's program also puts a strong emphasis on parenting skills while stressing exercise. The program "focuses on developing fitness habits in children and not focusing on weight change. Our goal, first of all, is to help parents partner with their children in family fitness behaviors," Buechner tells WebMD.
This is about exercising for health, though, not exercising to achieve some advertising ideal. Satter emphasizes the need for parents to let children find their natural body weight, which can vary as they grow. And don't overreact if your child gains a few pounds, because some kids naturally gain a little weight, for instance, right before the onset of puberty or a growth spurt. Koenning says respect the child's "developmental stages. To help prevent excessive weight gain and obesity before it develops, keep exercise enjoyable.
Buechner tells WebMD that her program also places an emphasis on proper nutrition, but within a healthy eating environment. "We don't focus so much as on what to eat, but on how to eat well as a family ... we strongly emphasize family meals in our program," Buechner tells WebMD.
Satter couldn't agree more; family meals are central to her philosophy. "If you're going to optimize your child's nutrition, if you're going to give him the very greatest chance that he possibly can of growing up to get the body that is right for him or her, that absolutely mandates family meals; that's the bottom line," Satter tells WebMD.
An important part of structured meals and snack times, according to both Buechner and Satter, is they teach kids to regulate their own eating habits. Part of that comes down to limits and responsibility, Satter tells WebMD.
Allowing kids to eat between scheduled meals and snacks can sabotage the process, both Buechner and Satter say.
Some formal, regimented diets "do not teach them the skills of 'normal' eating," Koenning tells WebMD. "When you're directed as to what you should eat instead of finding how to balance your choices of health and pleasure, you're not developing the skills you need to maintain it."
So, if a child is overweight, is it always the parent's fault? Though parents are always willing to take the blame, says Satter, that's too simple. Cultural changes also apply pressure, say experts, such as a business world that places productivity over nurturing, kids spending too much time alone, and even communities designing subdivisions without sidewalks.
"In my experience, parents do the best they can," says Satter. Buechner agrees, saying "in terms of obesity at any age, the causes are multifactorial."
But that doesn't let the parent off the hook. Yes, it's a team effort, but the parent remains the coach. "Child obesity can be prevented from birth on by optimizing the child's nutritional and physical environment. That's really key," says Satter.
From a parent to parents, Beasley has this advice: "[You] have to be willing to commit yourself to helping your child and I don't know any parent that's not willing to do that, and that's all this is."
For more information from WebMD, visit our Diseases and Conditions Weight Control page.