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Barbara F. Meltz writes the Globe's Child Caring column. She is author of "Put Yourself in Their Shoes, Understanding How Your Children See the World," and a frequent speaker to parent groups. Join her chat on the first and third Monday of the month at noon.
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Monday, October 1, 2007

If your child's overweight...


Good news for parents of over-weight children: Small changes matter.

A study published today in Pediatrics, the journal of the American Academy of Pediatrics, shows that by altering just a few things in your child's life, you can reduce weight gain. By simple, they mean simple: a routine family walk every night after dinner; using no-cal sweetner on morning cereal instead of sugar; interupting homework to take a jumping jack break or to run around the perimeter of the house three times.

The idea that simple changes can make a difference is not new; it's what pediatricians and nutritionists have suspected for a long time. Now, though, there is clinical evidence to prove it. The study was conducted by Dr. James O. Hill, professor at the University of Colorado at Denver. Hill is co-founder of America On the Move Foundation, a national nonprofit. Funding came from the National Institutes of Health and from McNeil Nutritionals which does, by the way, manufacture SPLENDA..

What struck me is that the study also validates the importance of a family's involvement in a child's weight gain or loss. It's always seemed to me to be a no-brainer that mom and dad can't expect their 12-year-old to exercise and eat carefully when they are couch potatoes themselves and they eat ice cream while they're on that couch. Hello? Anyway, America on the Move, makes two recommendations for families:

Increase physical activity by 2,000 steps a day. That's about a mile, which may sound like a llot, but not if you take a family walk each day; walk to school when/where possible; intersperse physical activity into ordinary daily routines.

Eliminate 100 calories per day. Again, not as difficult as you may think if you scale down serving sizes, make dessert a weekly or twice-weekly treat instead of a twice-daily activity. You get the idea.

With 1/3 of all US school children either overweight or close to becoming so, the America On the Move campaign is also trying to attract children, not just parents, with challenges specifically targeting kids.

Meanwhile, here's a Child Caring column from 2002 about how families can help their over-weight child:


Joey was 9 when he began to gain weight. His parents didn't say much to him, but Joey knows they talked to each other about it. Once, he overheard his mom say to his dad, "I'm worried about Joey's weight." His dad said, "Me, too. What should we do?"

This did not make Joey eat less. His parents recently had gone through a
nasty divorce. To hear them agree about anything was music to his ears. He
gained 35 pounds in a year.

Weight-loss specialist Caroline Cederquist of Naples, Fla., uses this
anecdote to make the point that children overeat for psychological reasons,
just like adults. "Kids don't just eat because they're hungry," she says.
"They eat because something tastes good even when they aren't hungry, or
because the food is there and everyone else is eating it, and yes, they
definitely eat for comfort."

Childhood obesity is a serious problem in this country. According to
the Centers for Disease Control, the number of 6- to 11-year-old children
who are overweight or obese has doubled in the last 20 years, and the
number of overweight 12- to 19-year-olds has tripled. That translates to
roughly 13 to 14 percent of all American children.

Pediatrician Walter Murphy of Plymouth sees the increase reflected in
his practice. "I'm spending far more time on overweight children than I
ever used to," he says.

Jane Franks, coordinator of school health services for Lexington, calls
it an epidemic that puts children at serious risk. Her town is looking for
creative ways to head off the problem: This year, a middle school and
elementary school launched successful Breakfast Clubs, and Hasting
Elementary is looking for parent volunteers to lead jump-rope and walking
clubs at recess as part of a proposed fitness program .

Medically, risks for overweight children can surface even in 5- to
10-year-olds, with elevated blood pressure, high cholesterol, and nighttime
breathing problems. Toronto pediatrician and obesity researcher Miriam
Kaufman sees an increase in joint problems among overweight teenagers. By
far, however, the most dramatic medical problem is that childhood obesity
tends to progress into adult obesity, which translates to heart disease,
Type 2 diabetes, and high blood pressure.

"Bottom line, we're talking about a shortened life span," says Murphy.

Then there are the social and emotional issues. Social stigmas continue
to surround those overweight. In one study cited by pediatrician David
Ludwig, director of the Obesity Program at Children's Hospital, young
children were shown photographs of lean people and heavy people and asked
to describe them. The words for the overweight people were strikingly
negative, says Ludwig: lazy, dirty, unhealthy, not smart. "To say that
overweight kids can be teased pretty badly is an understatement," says
Kaufman, co-author of "The Overweight Child" (Firefly).

Parents often are unsure how to cope with any of this.

For starters, deciding your young child is overweight is not always
easy. Children are constantly growing; weight gain is normal, indeed
necessary, to fuel a growth spurt. Parents are not necessarily wrong to
assume that a child, especially a prepubescent one, will outgrow today's
pudginess when pounds redistribute over a newly taller frame. On the other
hand, there is no magic line children cross that says, "Now you're

If you're worried, Murphy recommends asking a pediatrician to chart your
child's growth. "If I've been tracking a child and he's been in the 75th
percentile all along and now he's suddenly in the 90th, that's a red flag,"
he says. To be in the 75th percentile means that a child's weight is
greater than 75 percent of the population; to be in the 90th means she
weighs more than 90 percent of the population. Overweight is somewhere in
between, and the determination is somewhat subjective, influenced by
genetics and body frame as well as attitude. "Parents and children have
different tolerance levels about this," says Kaufman. What is aesthetically
overweight to some may not be to others.

Equally tricky is when and what to say to your child. "If you push too
hard for her to be thin, [it can] lead to an eating disorder. If you're too
lax about weight gain, it likely will continue," says psychologist Kelly
Brownell, director of the Yale Center for Eating and Weight Disorders.

It's a mistake, however, to not say anything. "An overweight child knows
he is different from other children," says Ludwig. Parents who say nothing
hoping to spare a child pain may, instead, be depriving her of support.

Then there's the other extreme. Kaufman says she is stunned by the
teasing some overweight children experience at home from parents and
siblings. Family members may think they are doing the child a favor by
hoping to shame or guilt him into eating less, but it doesn't work that

"A child can say, `I don't like being fat, pass the doughnuts,' all in
the same breath," says Cederquist. "Under age 11, they don't have the
cognitive ability to understand cause and effect."

This is why the current thinking in helping overweight children targets
the family, not the child.

"Kids should be eating what the family eats - no special diets. The
parents do the work by making healthy food choices," says Cederquist.

This takes a major commitment by parents to set limits on food choice
and portion size; to limit television and computer time (Cederquist and
others recommend no more than an hour a day); create exercise opportunities
(30 minutes a day beyond physical education); and limit fast-food intake.

"You can't bring junk food into the house and say, `You can't eat this,'
" says Murphy. "If you want cookies for yourself, put them in the trunk of
your car and keep them there!" He isn't joking.

Some parents are too quick to recognize a child's weight problem, others
too slow. Not surprisingly, it tends to correlate to their own issues with
weight. "Parents often feel they're to blame, but the environment is a big
part of the reason we're seeing so much childhood obesity," says Brownell.
He and others say television, videos, and computer games are a huge problem
not only because they take time away from physical play, but also because
TV exposes the typical child to 10,000 food ads a year, 95 percent of them
for unhealthy food items, such as sugared cereal.

Another culprit is schools that have soda and snack food vending
machines. Brownell urges parents to lobby for their replacement with
machines that offer water, milk, and healthy snacks. To school
administrators who say they need the revenue, he says team up with sports
equipment manufacturers instead.

"It's a whole lot healthier," he says.


1 Children who are breast-fed are at lower risk for childhood obesity.

2 Avoid making your child feel deprived. It's not that you can never buy ice cream, but buy a pint that gets consumed at one meal, not a half-gallon that stays in the freezer. It's not that he can eat only the banana while his thin sibling gets the banana split; both can have the banana split, just not very often.

3 Two - to 4-year-olds who are picky eaters are at risk for becoming overweight by 6 or 7 because parents tend to cater to their tastes and push food on them even when they aren't hungry. When their appetite kicks in at 6 or 7, they don't have healthy eating habits to rely on.

4 Tell an overweight child, "Even though we want you to eat healthy so your body is healthier, you don't have to lose weight for me to love you."

5 A healthy portion size for most foods is the size of a deck of cards.

6 Get a child into the habit of eating when he's hungry, not because
something tastes good. When any child wants more, ask: "Are you still
hungry?" Many times he'll say no. If an overweight child wants more of
something that's high in fat, tell him, "You've had your serving of meat.
You can have more vegetable or salad." If that's not what he wants, hold
firm. "Children need to understand what it feels like to be hungry or full
in order to have a healthy relationship with food," says weight-loss
specialist Caroline Cederquist, author of "Helping Your Overweight Child"
(Advance Medical Press;, which offers recipes and
guidance for good food choices.

7 Avoid using food as a reward.

8 Put fat in food where children appreciate it - for instance, on the
icing instead of in the cake. (Substitute applesauce or pineapple juice for

9 Find ways to make exercise part of your child's life (walking to
school). Exercise together (take a family evening walk, a Saturday hike).
Adding exercise by signing her up for a class tends to backfire; an
overweight child is often too embarrassed to wear shorts or a bathing suit.

10 If you sign her up for a sport, go for one high in activity (not
baseball). When possible, ask a coach: "If you're looking at my kid and
thinking, `He's too big to be fast, I'm not going to play him,' can you
tell me beforehand, so this won't be a bad experience?"

11 Avoid connecting food to self-esteem, for yourself or your child.
Not, "You're so bad, you ate two pieces," but, "That was a bad choice,

12 The Centers for Disease Control is piloting a new approach to
childhood weight gain prevention. Called motivational interviewing, it
encourages practitioners to ask parents, "Do you think your child has a
weight problem?" rather than tell them he does, and then to find out what
they feel capable of doing about it rather than dictate remedies. "The goal
is to prevent parents from feeling blamed and therefore guilty and
reluctant to return for help when they haven't followed a particular
regime," says CDC's William Dietz.

Posted by Barbara Meltz at 02:38 PM
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