How do we talk to our kids about weight?

It's a conversation parents dread -- one fraught with guilt and, even worse, destructive consequences

Elena McHugh and her sons (from left) Max, Matt, and Mike. For the whole family she emphasizes ‘‘healthy choices.’’ Elena McHugh and her sons (from left) Max, Matt, and Mike. For the whole family she emphasizes ‘‘healthy choices.’’ (Jonathan Wiggs/Globe staff)
By Beth Teitell
Globe Staff / August 18, 2011

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For all the national conversations about eliminating childhood obesity - and it’s a favorite subject for luminaries as varied as first lady Michelle Obama, TV doctor Mehmet Oz, and rapper 50 Cent - there’s still one place where the discussion doesn’t flow so easily: at home.

“I always wanted to say something to my daughter, but I held back,’’ said Agnes Mastropietro, 46, a medical biller at Dana Farber Cancer Institute. When her child started gaining weight in high school, Mastropietro was torn between telling Michelle to put down the chips and keeping quiet for fear of hurting her or triggering an eating disorder.

“The pain I felt for her - it would kill me,’’ said the Wilmington mother, who struggles with her own weight and with guilt for passing along bad eating habits. “What have I done to my kids?’’ she often asks herself.

As childhood obesity rises - the condition now affects 17 percent of all children and adolescents in the United States, triple the rate a generation ago, according to the Centers for Disease Control - so too does the need to guide children about healthy eating.

But fighting to ban cupcakes from the school celebrations or railing against fast food is one thing. Sitting down with your own vulnerable child, whether he’s obese or only the slightest bit overweight, and suggesting - delicately - that he forgo cookies, is quite another.

“This gets very emotional very quickly,’’ said Carleton Kendrick, a Millis-based family therapist, and author of “Take Out Your Nose Ring, Honey, We’re Going to Grandma’s.’’

“Many women have told me that they struggle so much with weight themselves, and have for so long, that [when they consider discussing it with their children], they click back to when their moms told them they were too fat and to not eat as much,’’ he said.

“They’re haunted. The mother may be dealing with her own eating disorder, and her daughter doesn’t know a darn thing about it.’’

Some of his patients also face another challenge: “These women know they have openly showed their frustration with their own weight - sucking in their stomaches when they try on a bathing suit, or cursing when their jeans are tight - so when they bring it up their daughters say, “Really, Mom?’’

In her case, Mastropietro said that when she did suggest that her daughter stop eating high-calorie food, her teenager played “the sensitive card’’ and started crying. “She’d say, ‘You’re supposed to love me the way I am.’ ’’

Responses like that - and the fear of them - leave many parents baffled about the right course of action, said Deirdre Pizzoferrato, a Connecticut nutritionist who works as the Nutrition Nanny. The subject is so touchy, she said, that parents often ask their children to leave the room so they can discuss it privately.

“Almost every single parent has the best intentions, but it is such a tricky subject. You don’t want to hurt them and you don’t want them to be hurt by their peers.’’

That’s the quandary Elena McHugh, 40, of Braintree, says she faces. Her older son, Michael, an athletic 12-year-old, is on the stockier side, and sometimes his younger brothers call him “fat.’’

While McHugh sometimes suggests Michael wait to see if he’s truly hungry before he takes seconds, she’s afraid of being too restrictive. “I don’t want to give him a complex,’’ she said, lowering her voice as her three boys shopped with her at Target in Watertown.

Rather than single him out, she said, she makes a point to talk about “healthy choices’’ for the whole family. “I don’t say, ‘You don’t need those chips.’ ’’

The advice from most experts boils down to this: Work to create a healthy lifestyle for the entire family and don’t focus on the heavier child and calories; don’t label foods as “bad,’’ as that can make them more appealing or lead to eating issues later in life; don’t privately or publicly shame a child by yelling at him to stop eating cake at a party; build exercise into the family’s routine.

It all sounds so straightforward, but in practice it can be anything but, said Amelia Winslow, a Los Angeles-based nutritionist, and founder of the Eating Made Easy website.

“Because weight issues affect kids’ self-image they have to be approached very gently to make sure you are not doing long-term emotional damage,’’ she said.

She recommends parents start by establishing healthy habits for the entire family without even mentioning weight concerns. “That may sound deceptive, but as a parent you have a lot of control over what your child eats, so changing your home food environment can make a big difference. When everyone at home is practicing similar eating or activity habits, it will help prevent your overweight child from feeling singled out or attacked, and can lead to improved health for the whole family.’’

Not everyone agrees with the sensitive approach. Why pussy-foot around, asks John Mayer, a clinical psychologist in Chicago, and author of “Family Fit: Find Your Balance.’’ “Would you be ‘delicate’ to insist that your child needs to take chemotherapy for a suspected cancer??’’ he wrote in an e-mail. “NO, as a responsible parent you would say: ‘This is what you are doing to save your life.’ Why do we treat obesity and weight control differently when so many more kids suffer from this illness than they do cancer?? Let’s stop the rhetoric and take action as parents.’’

He also disputes the idea that being honest about a child’s weight problem might lead to body-image issues. “Am I going to give you a complex, or are you going to have confidence that good nutrition and healthy eating are a good parenting decision? Parents should stop being so delicate and insist on what’s right and what’s wrong.’’

But Colleen Tedesco, 56, a mother in Franklin, feared that being blunt with her teenage daughter, a dancer, about a recent weight gain might indeed lead to an eating disorder.

“My husband would say, ‘Why don’t you say something?’ ’’ she said, “but we know people who are bulimic, and I didn’t want her putting her finger down her mouth [to make herself purge].’’

“We had to be real careful - we had to wait for her. But it was hard, because I knew she was suffering physically.’’

Eventually Tedesco’s daughter came to her, concerned that her weight gain was making it hard to dance. She put herself on a diet, and has slimmed back down to a healthy weight. “She handled it perfectly,’’ Tedesco said, “but I was flying by the seat of my pants.’’

As for what it feels like to be on the other side of the conversation, that’s not easy, either.

“It was hard for me to hear,’’ said Agnes Mastropietro’s daughter, Michelle Mastropietro, 25, a referral specialist at Dana Farber Cancer Institute. She had gastric bypass a few years ago and lost 140 pounds, but says weight remains a sensitive topic.

“I don’t know if there is an appropriate way to approach it with another person,’’ she said. “I wouldn’t know how to say to my mom, ‘You just lost 110 pounds, what are you doing eating that piece of cake?’ ’’

Beth Teitell can be reached at Follow her on twitter @bethteitell.