Childhood Obesity: What To Do About It?

In earlier postings I have discussed various aspects of childhood obesity including demographics, health consequences, and causation. In the entry of 3/17/06, I  listed some general principles for treating the problem. Now it’s time to get down to specifics.

Children are not small adults

In some ways treating children who are overweight is easier and in other ways harder than treating adults. For children under about 10 years of age, the responsibility for success falls mainly on the parents (or whoever has primary responsibility for the child- e.g., grandparents, foster family). Parents can fully control access to food in young children; after age 10 or so, it is exceedingly difficult to do so. For young children to be successful with a healthy eating plan, all care-givers must understand the plan and be willing to support it. For example, the plan is doomed to failure if the parents do a great job supervising adherence to the plan when the child is with them yet the eating is completley uncontrolled when the child spends 3 days a week at grandma’s house. Obviously, grandma and whoever else the child spends time with on a regular basis must know what the plan is and agree to follow it. This includes the school: teachers, nurses, lunchroom personnel, etc., must know the game plan. For example, we often find that overweight children are having a breakfast extravaganza on schooldays; the child has breakfast at home and then a second breakfast at school! Parents are generally completely clueless about what really goes on at school with regard to what their child is eating.
One particularly difficult and not uncommon situation is where the parents are divorced and the child spends significant amounts of time with each parent. I find that typically the routines differ quite a bit in the two settings, and unless both parents are “on the same wave length,” things usually don’t work out very well. Sometimes, the divorced parents compete for the child’s affection and may use food in an effort to accomplish it.

If the primary care-giver is concerned that not everyone involved in the care of the child is “on the same team,” it may be very useful for the health-care provider to meet with all of the “team members” to explain what the plan is and answer any questions.

What I have learned from families with children who have the Prader-Willi syndrome

Prader-Willi syndrome is a genetic disorder that is strongly associated with obesity. Children with this disorder typically have virtually no control over their appetite and don’t know when to stop. The only way to keep these children from gaining and gaining is to limit their access to food, all day and every day. That is easier said than done, but many families have great success over many years if they are committed to the task.

I mention this special situation of children with the Prader-Willi syndrome only to illustrate that failure to achieve some measure of success long-term in young children with obesity is usually the result of either unwillingness or inability of the parents to control the child’s access to food. I don’t mean this in a mean-spirited way; it may be a daunting task, but it can be done.

What should you tell your child about the “healthy eating plan?”

One sometimes sticky subject is what to actually tell the child about why they need to see a doctor about their weight and why they need to stop going to McDonald’s 3 times a week for a quarter pounder with cheese, large fries, and a sugar-containing megasoda. In general, my advice is to keep explanations as simple as possible and focus on developing a healthy eating plan for the entire family. The younger the child, the less specific one needs to be; in a 4 or 5 year old it does not do much good to make a “big deal” out of the new approach to eating. It is important not to make the child feel like he or she is being singled out and that they are “bad” for being overweight (even if a parent doesn’t mean to imply that the overweight child is to blame for their health problem, the child may get the message anyway).

In older children (10 years+), it is important that the child know what the problem is (it’s overweight that may lead to health problems later), and to make them true partners in any management plan; a plan that is imposed on a child old enough to understant what’s what, will fail miserably and create tension at home unless the child is willing to pursue the proposed treatment plan- I’ll get to the details on how to do this in an upcoming posting (I hope the suspense won’t be too great a stress for you to handle).

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