He Said, She Said: Obesity Awareness Month

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He Said

The concept of National Childhood Obesity Awareness Month is flawed in several ways, many of which Joanne covers in her She Said passage. The most glaring issue, in my opinion, is that by promoting the use of weight as a proxy for health, the government is paradoxically distracting from matters of actual health.

Human beings can be healthy at a variety of weights, which is why we cannot draw accurate conclusions about someone’s health or behaviors based solely on their size. Thin folks can have plenty of medical woes. A couple of years ago, I wrote about a slender friend of mine who was diabetic, suffered a heart attack, and ultimately died of cancer. Someone might be thin due to food insecurity, a medical condition, psychological disturbances, eating disorders or disordered eating, or overexercise, just to name a few of the health-threatening issues that might lead to lowered body weight.

With a focus on obesity, not only do we miss an opportunity to identify and assist people at risk for or suffering from these problems, but we actually push them in the direction of trouble. For example, I have recently seen an increase in pediatric patients, including males, with eating disorders or disordered eating that reportedly stemmed from a fear of getting fat brought on by discussions at school or the doctor’s office.

One of my teenage patients recently told me how his pediatrician praised him for having lost weight from one annual checkup to the next after having chastised him the year before, but what his doctor did not know was that my patient had overexercised and restricted his food intake leading up to the appointment for fear that his doctor would again be mad at him if he had not lost weight. My patient’s behaviors brought him further away from health, not towards it, and the poor communication between him and his doctor puts him at risk for improper care in the future. Furthermore, food restriction elevates his risk for binge eating disorder and, ironically, ultimate weight gain.

Trust me, children who are obese already know it. They hear about it on the playground, in gym class, on television, online, maybe in the pediatrician’s office, and from other sources that tell them something is wrong with their bodies and it is their fault. National Childhood Obesity Awareness Month calls even more attention to them and their bodies, thereby exacerbating stigmatization and bullying.

The concept of National Childhood Obesity Awareness Month may be well intentioned, but its fallout is the exact opposite of the desired effect. If we want to improve the actual health of our children, better to promote size diversity and the importance of healthy behaviors, such as fun and appropriate physical activity, for everybody.

 

She Said

According to the U.S. Department of Health and Human Services (HHS), September is National Childhood Obesity Awareness Month. Per the HHS website, “one in 3 children in the United States are overweight and obese,” putting kids at risk for developing health problems such as type 2 diabetes, hypertension, and heart disease. The website goes on to say that childhood obesity is preventable, as “communities, health professionals, and families can work together to create opportunities for kids to eat healthier and get more active.” Some of the strategies that the HHS recommends are nutrition based, such as “keeping fresh fruit within reach” and providing healthier food options at school, and other strategies are focused on activity levels, such as encouraging families to go on an after-dinner walk and incorporating daily physical activity at school.

While I actually applaud the strategies put forth by the HHS to improve kids’ health, I am saddened to see the focus be on body size. Thanks to Michelle Obama, childhood obesity is at the forefront of the American consciousness. Kids are being weighed and measured at school and then later sent home with a health report card telling them whether they are at a “healthy” body mass index (BMI) or are in the “overweight” or “obese” categories. Even though the medical community as a whole willingly acknowledges that the BMI is woefully flawed as an indicator of health status, it still condones its use in determining the health of our kids. Time and time again, studies have shown that behaviors rather than weight are a better determinant of health, but unfortunately, this is not being reflected in current policy.

My greatest concern is the effect that focusing on childhood obesity could be setting up kids to develop eating disorders (EDs). I cannot tell you how many preteens who have stepped into my office had been sent home with their BMI report card and then developed either extremely disordered eating or an actual diagnosable ED. What often happens is that the parents become alarmed at their child’s negative BMI report and will start to impose harsh diet restrictions and exercise ultimatums. I had one patient whose father promised her and her sister iPads if they both lost weight. Not only would he limit their access to “junk” food, he would make them run laps around their neighborhood after dinner every night. As a result of this, the patient developed a very disordered relationship with food and her body. This story is not unique, unfortunately. I have heard it too many times to count.

So, I have a few issues with the HHS’s focus on obesity. First of all, I don’t believe that we should have schools be weighing and measuring kids and sending them home with a BMI report card. Instead, the child’s pediatrician and parents should be the gatekeepers of the child’s health. Every child has their own unique growth charts – some trend on the higher end of weight for height, while others trend on the lower end of the chart. In other words, some kids are just meant to be in bigger bodies, while others are meant to be in smaller bodies. These body sizes do not tell us anything about the child’s health unless there are major changes in either direction. For instance, one would expect a child trending on the 85th percentile to stay at that percentile. If there was a sharp drop to the 50th percentile, that would be cause for concern. Similarly, if a child was trending on the 50th percentile and then jumped up to the 90th percentile, that should also be looked at. One body type is not inherently healthier than the other – every body is unique.

In addition, I think it is so important to not speak negatively about a child’s weight. Kids are like sponges, and they pick up on everything. Talking with one’s child about how their body works and teaching them how to take care of it is one thing, but telling a child that they are too big and need to lose weight is extremely damaging and can set the child up for years of negative body image and a life of disordered eating. Many EDs start when a well-meaning parent tries to teach their child to diet and use exercise to burn calories. In fact, there are a number of studies that show that when children are put on restricted diets, they will often end up being heavier adults.

Also, I think that if a parent has concerns about his or her child’s weight, they should talk with their child’s pediatrician separately (i.e., not with the child in the room). Instead of telling the parent that their child simply needs to lose weight, it would be wonderful if pediatricians did not just make an assumption based solely on the child’s weight that the child is engaging in unhealthy behaviors. If it is determined that the child is in fact not practicing healthy lifestyle behaviors, it would be best if the doctor just focused on helping the child develop these healthy habits (perhaps by referring them to a registered dietitian or other health care provider) and measure the child’s progress by their weight.

Given that, I don’t think that National Childhood Obesity Awareness Month is helpful at all in helping our kids lead healthier lives. By teaching them that weight is synonymous with health, we are doing them a major disservice. Perhaps September could instead be called National Healthy Habits Awareness Month? Just a thought.

“How do I get my children to not only eat, but also to eat foods that are good for them?”

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“How do I get my children to not only eat, but also to eat foods that are good for them?  Where is the line of encouraging children to eat without creating food issues down the line?” – JB

My first counseling position as a dietitian was at a pediatric practice and I continue to see many children here at Soolman Nutrition and Wellness LLC.  JB is not alone in her concerns, as many parents share the same questions stated above.  While every child and family dynamic is different, I do find that the following ideas tend to help.

Allow your child to help with food selection.  Take your child to the grocery store and let him pick out a new fruit or vegetable that he is curious about or finds interesting.  I remember not being a huge fan of carrots as a kid, but then one day I saw carrots in the supermarket with the green stems still attached, which made me think of one of my favorite cartoon characters, Bugs Bunny.  Suddenly, I wanted carrots!  If bringing your child to the supermarket is not appealing because of the potential for conflict over foods you do not want to buy, consider going to a farmers’ market instead where the non-produce temptations are less.  Having a garden that your child helps to maintain can be a great way to get him interested in vegetables.  Even an indoor planting system, such as the AeroGarden, can have a similar effect.

Involve your child in food preparation.  Your child can participate by performing tasks that range from pulling grapes off their stem, to slicing a pepper, to making a side dish, to preparing an entire meal, depending on his abilities and level of interest.

Give one alternative and that’s it.  If your child is a picky eater and does not want to eat what the rest of the family is having for dinner, offer one standby alternative, something that is easy for you to make and is relatively healthy, such as a turkey or peanut butter and jelly sandwich.  It is understandable that parents want to give their child what he wants, and the fear that he will not eat anything can also be stressful, but being a short-order cook usually leads to more stress and conflict in the long run.  Create an environment where the only options are Choice A or Choice B and your child will likely adapt.

Set ground rules ahead of time for trying new foods.  Children often fear trying new foods not because of the foods themselves, but because of what might happen if they say they like or dislike a new food.   Their rationale is often, “If I say I like this broccoli, are they going to make me eat more of it?  I don’t want more of it, so I had better say I don’t like it.”  Negotiate ground rules with your child ahead of time regarding how he will try new foods.  For example, how often will he be expected to try something new, how much must he sample, and what happens if he dislikes the food?  What if he likes it?  Just this week, I brokered a deal between a mom and her son that established the ground rules under which he will try new fruits, and they both walked out of here happy and excited.  Be nonchalant about the process and roll with whatever reaction your child has.  Remind your child that tastes do change over time and encourage him to keep an open mind to the possibility of retrying a disliked food again down the road.

Tap into your child’s motivation.  Many children have trouble appreciating that what they eat affects their health down the road, so instead draw a link between what your child eats and what currently motivates him.  If he wants to be a better soccer player, for example, talk about how eating can help him play better.  I find that nearly every child perks up if I ask him if he would like more energy.  That gets my foot in the door to talk about basic nutrition concepts.  The child does not care that what I am teaching him can reduce his risk of chronic disease decades in the future, but he is engaged and pays attention because what I am talking about will help him with what feels important to him right now.

Set a positive example.  In my experience, the families in which the parents eat one way while expecting their children to eat another way also tend to be the families with the most conflicts around food, and I do not believe this to be a coincidence.  Role modeling the eating behavior you desire for your child can have a very positive effect on his own eating.

Talk about balance and being mindful, not weight or dieting.  Eating disorders, disordered eating, exercise obsession, poor body image, low self-esteem, and associated issues often (but certainly not always) start with messages that children pick up at a young age.  How you behave and treat yourself rubs off, so be wary of going on diets, talking about diets, disparaging yourself, or discussing weight in front of your children.  Similarly, overly restricting children can lead to secret binges, as was the case with a recent patient of mine who snuck a bunch of 100-calorie snack packs and soda when his mom was not looking.  Labeling foods as “bad” can also be detrimental.  Children need to learn how to find balance while incorporating all sorts of foods.  Otherwise, think about what can happen when that child grows up and has the freedom to access previously-forbidden “bad” foods whenever he wishes.  Instead of all that, a much more positive message is to talk about listening to what makes our bodies feel good, honoring our preferences, and loving and accepting ourselves no matter what we look like.  Help your child to build a foundation of balanced eating that gives him the best shot at having a healthy relationship with food for the rest of his life.

Note: For the sake of brevity, I referred to a child as “he,” as opposed to “he or she,” but in no way was that to imply that these suggestions are specific only to boys.  On the contrary, I find that these ideas work well for both boys and girls.