Parenting an overweight child

Dealing with an overweight child can be a tricky business for parents. Should you monitor weight or calories or put your child on a strict diet? Some tips to help make the process easier and more successful.

I wasn't sure what to make of this: I saw an obese boy about 11 years old, wearing a T-shirt that said in big letters "Insert Candy Here", with an arrow point up at his mouth. Sadly someone was not taking his situation seriously.

The childhood obesity epidemic is serious. It can seem like an abstract concept, a lot of statistics and anxiety on the part of health experts. When it hits close to home, it's not abstract at all. It's your child. What do you do? Well for one thing, don't buy that T-shirt. The causes of this epidemic, and your child's problem, are many. An article in the journal Family Relations: sums it up nicely: the family system is the main driver of obesity. Parenting styles and feeding practices contribute, as does our sedentary lifestyle. Genes may play some role, but don't blame them entirely. And there are certainly other unrecognized issues at work.

It's popular to blame certain foods, and you might conclude that sugar is the culprit based on the results of one new study. Toddlers from low-income families were fed lunch and then offered a tray with sweets like cookies, and salty snacks like chips. The kids were all allowed to eat as much of these extra foods as they wanted. Some kids went for the sweets; some preferred the salty snacks. Some kept right on eating, and got upset when the trays were taken away. The researchers noted this behavior.

A gradual increase in body fat by 33 months of age was linked to preference for the sugary foods, and to being more upset when the trays were taken away. The kids who preferred the salty snacks did not show that body fat increase. The researchers concluded that a tendency to eat well past hunger was a risk factor for kids.

This isn't too surprising. Too many calories + too little physical activity = accumulation of body fat. There's no way around that fact of human metabolism. But it's interesting that the behaviors that set someone up for obesity can be observed so early in life. Conclusion: while overeating sugary foods is certainly a bad idea, the overeating behavior itself is more concerning.

What's a parent to do?

Whether it's strictly controlling access to sweets or access to unlimited food, parents need to seize control of the situation that's contributing to their child's weight. No one else is going to solve the problem for you. It's nice if the school schedules more recess or removes soft drinks from vending machines or bans cupcakes at birthday parties. It's nice that TV ads encourage kids to play for 60 minutes. It's nice that food companies are busy cutting calories from all manner of food products. It's nice that fast food kids' meals have apple slices. But those pieces of the puzzle won't help unless you have a strategy to be involved and stay involved with the process. The good news is that if you can stick to a reasonable plan, you'll end up creating a New Normal for your whole family, a normal that values health and well-being as part of family life.

How many calories does your child need?

Kids need calories for energy and growth, so they need proportionately more per pound of body weight than an adult. But they're smaller than adults, so their total intake may not seem that large. Baylor College of Medicine has a calculator to estimate needs, depending on your child's general activity level. This can give you a very general idea of your child's average daily needs. But actual daily intake may vary greatly from one week to another depending on activity and growth spurts.

Should you restrict your child's calories?

Children are growing. Restricting calories the way you would for an adult on a weight loss diet is not a good idea. It sets the child up to feel deprived and stigmatized. Not to mention hungry and unhappy.

A better plan is to make sure your family's food choices are focused primarily on healthy options and that physical activity is an inherent part of daily life. The toddler study also suggests keeping sugary foods at a minimum, to avoid setting kids of up later problems.

Should you weigh your child?

Short answer: no. Don't make a young overweight child any more self-conscious about his or her body. Don't discuss the child's weight in front of the child or with siblings. And don't tolerate teasing from siblings, other family members or friends.

Here are some strategies I've advised clients, friends and family to use. You don't need to use all of them. Pick the 2-3 tips that will be easiest to implement right away. Start slowly. Expecting your family to accept a sudden and massive change in food choices, meal schedule and lifestyle isn't realistic for most people. Then make more changes as time goes on and your efforts pay off.

1. Don't make food the focus of family activities and don't use food as a reward or a bribe.
2. Don't nag about eating behavior. Criticizing an 8 year old for eating too many French fries, or worse, saying "you can't have a donut because you need to lose weight" is going to backfire. If you don't keep tempting treats or junk food in the pantry, you won't have any reason to nag about these choices. As the study showed, kids will just keep on eating as long as tempting foods are available, so make them less available, or better yet unavailable.
3. Establish strict rules about snacking, both for allowed foods and portion sizes. In the case of young children, keep snack foods under your control only, out of reach, and out of sight. This is true even for healthier options. Calories add up no matter what foods you overeat, whether yogurt or granola bars or chips or cookies. And don't allow kids to eat out of food containers. This just invites overeating. Use plates, preferably small plates for snacks.
4. Keep desserts to a minimum, preferably only on special occasions.
5. Set a good example by establishing family time that involves physical activity that's fun. Visits to a playground, walks, bike rides, jump rope, sledding, skating, swimming and the like are all great. Your child may enjoy organized sports, or prefer pick-up games of basketball, baseball or soccer. Dance is another great physical activity. The point is: there are plenty of activities that are fun that kids like. Organized sports are nice, but they aren't necessary to encourage activity and physical fitness.
6. Don't let kids spend hours a day sitting in front of a screen.

Children are growing, so rather than trying to encourage weight loss, facilitate healthy growth and weight stability. That means your child's weight would gradually shift to the normal range as he or she grows taller. This process isn't fast, but it's healthier than some quick weight loss scheme, which would be inappropriate for a child.

Take Away Message:

Dealing with an overweight or obese child can be a tricky business, part psychology, part food management, part lifestyle logistics. The best overall plan is to make this an opportunity for the whole family to be involved in healthier lifestyle choices.

Weight Loss->Family & Friends