70 million Americans are obese. More than one in three of all
adults and one in five of all children are overweight. Research
suggests the best opportunity to address problems of overweight
and obesity is before childhood. Change becomes more difficult
as the child reaches adolescence.
Some adults may not be well suited to speak to a child about
their obesity. Their personal biases or struggles about weight
issues may negatively affect their ability to talk with a child
in a supportive, non-judgmental way. Consider other individuals
who may be more helpful or effective in connecting with the child.
Choose a private place to speak with the child; somewhere
you can focus on the discussion. Pick a time when both you and
the child do not have to be rushed. Avoid addressing issues when
emotions are high.
Begin the discussion by expressing you acceptance and approval
the child. The child's weight should not be associated with their
approval or acceptance. Look at the positive aspects of the child.
Allow the child to express their concerns and experiences.
Listen and empathize. Try to understand the child's perceptions
of the issues. Discuss feelings, concerns for their health, social
implications. Understand, the child may have a positive esteem
and body image despite being overweight. This is to be encouraged.
However, if the child expressed poor body image, be sensitive
and acknowledge their pain.
Overweight kids may have feeling of depression from being
teased or not being popular, particular when they are developing
interest in the opposite sex. Negative body image may decrease
self-esteem. They can develop negative feelings of school and
other social settings. They often become discouraged and drop
out of sports or other physical activities when they are unable
perform at the level of their peers.
overweight kids do not know what to do or where to turn for help.
Invite them to share their concerns with you anytime. Express
your willingness to support appropriate health and wellness goals.
Do not focus on weight loss as a criteria for success, but instead
emphasize healthier habits, improved fitness, increased energy,
Older children must make the decision to start the weight
management program. They should not be made to do anything against
their will. A program initiated without the child's true consent
will be short lived. Certainly, a younger child's eating habits
and daily activities must be shaped by proper parenting skills
and modeling. A child's or teenagers's motivation to lose weight
may come from a variety of factors including health, social aspirations,
sports or performance goals, desire to fit in clothes, inspiration
from peers, siblings, fitness models, or sports figures.
The family should seek the assistance from a variety of experienced
professionals. The family should be educated about the complications
of obesity. Ongoing support for the family will help maintain
their new behaviors. A healthcare provider should be consult
before placing a child on a weight-reduction diet.
The family and all caregivers should be involved in the treatment
program. The family must be ready for change. If the family is
not prepared to change their diet or activity, or feels obesity
is inevitable, the program should either be deferred or the family
should be referred to a qualified therapist.
Treatment should involve permanent changes, not short term
diets or exercise regimens aimed at rapid weight loss. Small,
gradual, and targeted changes in activity and diet should be
implemented. A flexible and a balanced approach to eating and
exercise should be encouraged. A program for overweight children
should reduce the rate of body weight gain while allowing growth
adolescent's increasingly independent eating and activity behaviors
should be recognized and respected. Allow the child to regulate
how much they eat. Attempting to control what or how much a youth
can eat may back fire. Controlled feedings can initially lead
to anger, control battles, secret eating behaviors, preoccupation
with food, fears of disapproval, and may increase the likelihood
of developing eating disorders.
The family should learn to monitor eating and activity. The
following tips can be offered to the parents. Stock up and maintain
a variety of healthy foods at home. Consider removing all foods
from the home that are off limits such as soft drinks, chips,
and other high calorie snack foods or learn how to eat these
foods in limited quantities. Minimize juice consumption. Intakes
of carbonated beverages and other sweetened beverages are related
to higher body fat, where as consumption of calcium rich foods
such as milk and milk products are correlated with lower body
fat. Eat at restaurants that have healthy food choices. Encourage
portion control, particularly for higher calorie foods. Teach
your child to cook healthy meals at home; keep it fun. Eat breakfast
and other meals as a family. Pack healthy school lunches. Allow
your child to assist in the planning of meals and snacks. If
the food is not appealing, kids will eat elsewhere. Do not reward
with food, instead use praise, stickers, time for favorite activities,
Don't make kids exercise. Instead use language like,
"Let's play." or "Let's go...". Kids often
prefer the term "physical activity" or "play"
over "exercise". Kids often view exercise as something
they have to do where as physical activity or play is something
they just do. Find what kids enjoy. Kids will do what is fun
and encouraging. At least 60 minutes of physical activity on
most, preferably all, days of the week is recommended for children
Decrease television viewing and excessive computer time to
a total of 2 hours a day or less. Decrease television viewing
leads to improved body mass index (BMI) in children. Alternatively,
exchange screen time for outdoor play time or other physical
activity. For example, one hour play time allows them one hour
Parents, caregivers, coaches, teachers, and health practitioners
should encourage kids with their program goals without pressure.
Let them know they should not get discouraged if they drop out
of their program. Encourage them to keep trying. Do not preach
but be involved.
lecturing, or reprimanding should be avoided; encouragement and
empathy should be practiced. Avoid shaming comments such as "I'll
give you $500 if you..." or "do you really need that
extra serving?". In addition, do not use moralistic or blaming
positions such as "you know you should not be eating junk
food," or "it just takes will power". These type
of statements only perpetuate shame and guilt. Shaming can negatively
effect self-esteem, social interactions, relationships, and their
willingness to try new challenges.
Promote a healthy self-esteem and self-acceptance. Avoid talking
negatively about your own body. Let the child know it is ok no
matter what they weigh. Help the child identify interests, activities,
or talents to pursue. This develops areas of competency and promotes
self-esteem. Nurture the child with encouragement and compliments
for qualities, abilities, and accomplishments. Stick up for your
child. Be an advocate by calling parents of bullies and combating
Intervention should begin early. If you are seeking to be
understood, seek first to understand. Parenting skills are the
foundation for successful intervention. Teach by example and
implement ongoing positive reinforcement. Practice and model
healthy lifestyle choices. Healthy family oriented meals and
activities are many times more effective than diets and lectures
in long term weight management.
Barlow SE, Dietz WH. Obesity evaluation and treatment:
expert committee recommendation, Pediatrics. 1998; 103, 3.
Pieper K, Barlow SE, et. al. Obesity and Kansas City Kids
(2003 Conference), Reardon Convention Center, Kansas City, Kansas.
Robinson TN. Reducing children's television viewing to
prevent obesity: a randomized controlled trial. JAMA. 1999 Oct
Skinner JD, Bounds W, Carruth BR, Ziegler P. Longitudinal
calcium intake is negatively related to children's body fat indexes.
J Am Diet Assoc. 2003 Dec;103(12):1626-31.
USDA (2005) Dietary Guidelines for Americans, vii-viii.