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Advice for Parents and Children
I think in the beginning, if you’re not used to thinking about preparing food and thinking about food choices in the way that we’re recommending, then it probably does seem like it costs more and requires more time to cook and eat healthily. You do have to be more thoughtful when you’re shopping and look at the labels for sugars and carbohydrates. But eating vegetables doesn’t mean that you have to do anything fancy; you can use frozen vegetables, and that doesn’t take very much time. As far as the cost goes, yes, fresh vegetables are a little more expensive, but not any more expensive than a meal at a fast food restaurant, so you have to put it all into perspective. And I think if you look at healthy food as medicine, then it’s not really expensive at all. If your child got diabetes, you’d never think of not giving them the medicine that they needed to get better. If your child is overweight, it’s the same thing: you need to give him the food that’s going to make him better, and eating healthy is what that is. Colleen Kochman, RN, MSN, PNP
I think it is sometimes hard for parents when these children have siblings. Frequently, the siblings are not overweight, and they are sometimes even underweight. Parents can have a difficult time trying to determine which foods to keep in the house. They often explain to me that they do not want to “punish” the sibling who seems to be doing okay weight-wise. However, we also do not want parents pointedly making all types of contradictions by giving the siblings tons of ice cream and other snacks that they are not allowing the other child to have. I have noticed that it becomes very tricky within the family to try to be consistent but not be overly restrictive with siblings. In addition, a lot of the time, parents are accustomed to having junk food in the house and to eating in a certain way. Unfortunately, in these cases parents may be trying to get their child to change his or her eating habits, but the parents themselves still want to be able to eat their same unhealthy and fattening foods in front of their child. In that sense, I think parents can inadvertently send their children mixed and confusing messages. Nicole Eldridge Marcus, PhD, Behavioral Therapist
In talking to families about their expectations, I tend to describe weight loss not as a linear progression. There are up and downs and I think that this is one of the reasons we really try to stay away from just focusing on the numbers, meaning the child’s weight in pounds. I think that just focusing on pounds lost can actually sometimes be a real mistake. You can see this when a child comes in [to the OWL clinic], having gained two pounds but having tried very hard to make some positive changes, and you can see how disappointed that child is. Disappointment— I have found— can sometimes be a real obstacle to motivating a child. I think it is important to warn children and their parents that there are going to be ups and downs. For example, at holiday seasons like Thanksgiving and Christmas or Hanukkah, families get together and frequently celebrate with elaborate family meals. . As clinicians, we want our patients to make healthy food choices, but we also want them to be able to enjoy the holidays, and we help them recognize that this time of year might be a bit of a difficult period. Luckily, January will come and we will be able to refocus, but we do want them to enjoy themselves and their time with their extended families. I think it is like anything; it’s allowing families to know that every visit they come in for will not necessarily have the child moving in a positive direction. The hope is that children and their families are creating and developing a mindset in which they want the change to happen. Nicole Eldridge Marcus, PhD, Behavioral Therapist
I think it sometimes can be helpful for a child to be able to talk to a parent [about weight issues]. We once had a father who came in with his son, and the father was very proud that he himself had changed the way that he was living. He had increased his activity level, he had lost some weight, and he really wanted to serve as a role model for his son. This dad also wanted to make sure that his son was aware of the fact that the father had been very heavy previously and had been able to change his entire lifestyle. I feel that children can really learn from their parents. When they see that their parents are perhaps also struggling with weight issues, I think it often actually helps them. Then they know, “It's not just me; I’m not alone in this. This is something that has been an issue in my family: my grandfather struggled with this, my dad is struggling with this, and now I am too. And hopefully, I am going to be able to overcome it.” Nicole Eldridge Marcus, PhD, Behavioral Therapist
It is no more expensive to eat a healthy diet. Possibly, it requires more time, but there are basic things that can be changed that are very simple to implement. Avoiding sugary drinks and fast foods and increasing intake of salad, vegetables, and fruits are the basic steps we recommend to the family of an overweight child. Diego Botero, MD, Pediatric Endocrinologist
The best approach for families to take is to view this as a slow, kind approach that occurs over time. Let me just qualify: slow, meaning at the pace of the patient. Kind, meaning it feels kind to the patient. And time: encouraging the patient to view this as a process, or to give him or her the gift of time, so that he or she feels comfortable in the process and doesn’t focus on just one long term goal or weight. Jan Hangen, Clinical Nutritionist
Parents need to model the behavior. That is the most important predictor, I believe, of the children doing well. Jan Hangen, Clinical Nutritionist
Setbacks and disappointments happen. I think group support is important, because children need to know that setbacks and slow progress, or lack of progress, are common themes in this population of kids trying to lose weight or manage weight. One important thing is to let children know that they’re not alone. This might be by done by establishing contact between their family another family, so that they can be in contact with other children. Or it could be done by having them be part of a group, even a special exercise group. The other really important thing to remember in dealing with setbacks is that certainly a long-term goal is being in an ideal body weight range, but leading up to that goal there should be numerous small goals. Meeting small goals should be rewarded, and there are many types of rewards that don’t need to cost money. For example, a reward can be verbal praise. I used to photocopy children’s hands and then have them put the photocopies on the wall and high-five themselves when they had a great day. I also encourage parents and guardians to give verbal praise. I often encourage parents not necessarily to keep a food journal, but to keep a praise journal to celebrate short-term goals. At the end of the day, they sit down and write two things in the journal that the child thought went very well. Then parents can look at those two things and ask the child if he or she thinks that one of those two positive things could be improved a bit. The idea is to focus on praise and not on foods, but to make the foods a part of the praise. Also, we’re building on the positives; we’re not saying, “How did you mess up today?” In fact, that may come out in the conversation at the end of the day, but in general I like to keep a very positive chain of events going. Focus on the positive, and build on the positive. Jan Hangen, Clinical Nutritionist
A family history of weight issues often comes up in the course of a child’s medical evaluation. But even if it doesn’t, I always bring the subject up, because it goes back to the bottom line for me in treatment, which is that these issues of overweight occur within the context of a family. There may be a genetic predisposition, but there are also numerous environmental concerns. Some of those environmental concerns are certainly related to school and society, but the bottom line is that children come home at night. So I try to use kindness and humor to bring out the fact that a family needs to do this together. I have gone so far as to suggest that a family weigh in together— that each family member get a weight, and that the families come back to the clinic together. These families, believe it or not, do beautifully. So one of the things I have been doing is having families keep a lifestyle journal, including everything they’ve done to change their lives. For example, how did they clean out the kitchen and make the kitchen cupboard and fridge conducive to healthful family eating? How did they rearrange their house and their schedule so that they could increase activity? We’ll take pictures of where they were each month— how they looked each month. We’ll also include their weights, and food, if they want to talk about food. I have families who will glue food labels into their journals, old ones next to new ones. It’s a journal of actually getting back to the root meaning of the word “nutrition,” which comes from a Greek word meaning “to cherish.” It’s a journal of how these families cherish themselves Jan Hangen, Clinical Nutritionist
Show empathy while still being matter-of-fact. We want to make it clear that their goal is good health. Parents want their children to have a healthful life and a long life. They need to view this as a process: they’re at Point A, where they’re not as healthy, and their lifestyle is not as healthful, and they want to get to Point B, where they are in a healthful ideal body weight range, and where they have better health indices (blood pressure, cholesterol, weight etc). They can travel from Point A to Point B in a fairly straight line or they can take a very jagged, long journey. But always put it back in perspective: “The concern is that I want you to have a good life and I want you to be happy, but I also don’t want you to take forever. Because from my perspective, I see people taking forever, and I don’t want you to go through the trials and tribulations that happen when someone takes a long time to do this.” Another very supportive and empathic thing to do is to model the behavior, so that you serve as 1) an intellectual resource who has the knowledge; and 2) an emotional resource who can say “I know what it feels like to eat breakfast when you don’t want to. I know what it feels like to eat a half-plate of vegetables when you don’t necessarily like vegetables. I don’t go off and sneak treats, where you can’t see, because I don’t want you to do that.” So I think we really have to model behavior, so we know what it feels like. Not only as parents, but also as providers— it’s imperative that providers model the behavior. For me to be effective at my job, I have to come in here and feel like I can provide some inspiration and help them become re-committed to their vision as a healthful person. Jan Hangen, Clinical Nutritionist
Change is very difficult, and it’s daunting to most people. One interesting thing that I’ve found from treating adults and children is that it’s less daunting for children than it is for adults. I think a lot of times we’ll place our own perceptions of change on our children, but it might be harder for us than it is for them; it goes back to the idea of teaching an old dog new tricks. I think we need both to be open minded about change and to model the behavior. Change should also occur slowly, because new foods are almost like new people. It takes a lot of time to develop trust in new foods and new activities. For a child for whom food is like comfort, and especially for a child for whom there hasn’t been a lot of food variety at a young age, trying to increase variety at the same time that you are introducing weight plans can couple things in an unfavorable way. Model the behavior; show that you’re willing to do this. And encourage slow changes- changes that the child likes. For example, if your kid is not a sports person, don’t put him on a team. Jan Hangen, Clinical Nutritionist
There are a lot of consumer traps directed towards those who are overweight. And there are a lot of “miracle cures.” The bottom line is: eat less, exercise more. That would not make a best-selling book, but it’s what we all have to do. There are no miracle cures, period. There are many foods with claims that are not accurate. Remember that diet books have been around since the time of Abraham Lincoln, so this is not new. People have been trying to lose weight since the birth of our nation. It’s gotten more press recently, because there are more people who are overweight today, but it all goes back to eating less and exercising more. Jan Hangen, Clinical Nutritionist
I tell parents that a child won’t be successful at weight loss if the entire family doesn’t decide to change their eating habits. It can’t be something that just the child does, or just the child and one parent does; families are most successful are when everybody in the family agrees to do this together because they know it will be healthy for everyone. Then they all do it together and face the challenges together. We advocate a low glycemic index diet because we feel that is the best way to help someone lose weight. Different things work for different people, but if you don’t have family support, no matter what approach you take, it’s not going to work. Kelly Sinclair, Clinical Nutritionist
I’ve had a couple of sixteen or seventeen year-old patients who clearly voiced to me that they didn’t want to be [at the clinic] and that they didn’t want to do this. Sometimes this was because they had other issues in their lives that were taking up their attention, and sometimes it was just because they didn’t see their weight as an issue. In these cases, you can really see the pain in the parents’ faces, because their child losing weight was so important to them, there were obviously health concerns around it, and frequently the parent had tried not buying certain foods for them and nothing was working. We try to explain to the parent, “It’s not really your responsibility to get them to eat healthily. You can want that for them, but you can’t do it unless the child or teenager wants to do it.” So in that case, I suggested, “There is no point in going through all the motions if it’s not something the child wants.” It really comes back to giving them the control, because so frequently a parent is taking the control away from the child around food and trying to police all of their decisions. If you finally just give the child or teenager that control and say, “Okay, it is your decision,” they end up finally realizing that this is something they want to do, because there is no power struggle there; there is no reason for them to rebel anymore. So I tried in that session to say, “If you don’t want to talk about this anymore, we don’t have to. We can stop right here.” I’ve had a couple of kids who have decided they don’t want to talk anymore, and I don’t think they came back to the clinic. They said that they wanted to end [the program], and I said, “Please come back and see us if you are ever interested in doing this again; you’re more than welcome to.” But there was really no point in continuing right then, because they’ll just be going through the motions and not actually doing it. Changing your eating takes work, and if you don’t want to do it, it’s not going to happen. And other times, when I’ve suggested to kids, “We can stop right here if you like,” they’ve been shocked that they have that control and then said, “No, no— it’s okay. Let’s keep going.” So giving that control back can make a difference. Kelly Sinclair, Clinical Nutritionist
I start each session by saying, “Why are you here? I know your parent brought you, but what motivated you to be here? Why do you want to lose weight?” For girls, it’s typically because they want to be able to wear some particular style of clothing, or they want to fit into a different size. For boys, it’s usually that they tire easily when hanging out with their friends or playing a sport. So we try to link food choices back to that specific motivation: “Eating this is what is going to help you to be healthier, lose a little bit of weight, run faster, catch that football, or make that lay up. Things are just going to be easier.” So we try to link the goals we’re setting with their particular motivations. Definitely, sports tend to be more of a motivator for the boys, and appearance and peer opinions more of a motivator for the girls. Kelly Sinclair, Clinical Nutritionist
Parents play an important role in helping a child to lose weight, because parents are the ultimate role models for their children. If you want your child to eat more fruits and vegetables, you need to eat healthier. You can’t tell them, “I want you to eat more of these foods,” and then sit there eating a bag of potato chips, because that sends a mixed message. Parents frequently think that they’re not as major a role model as they actually are when it comes to food choices. In fact, they are the most important role models that their child has. Kelly Sinclair, Clinical Nutritionist
A lot of times the media creates this environment where there is a “quick fix;” where you can find some fad diet that says it will help you lose weight quickly. There are lots of ads about pills and lots of food labels talking about the latest no-carb or fat-free diet. I have had some people come in with bottles of weight loss pills that they’ve seen at the pharmacy or seen advertised, wanting to know my opinion. I recently told a patient, “Don’t you think that if this really worked— if there was a pill out there that was healthy and that would really help you lose weight— don’t you think that I would give it to you? I don’t want to keep that from you! If it really worked, I’d give it to you. But it doesn’t work, and that’s why you come here to see me— so I can teach you what does work to help you be healthier.” I think sometimes the media can create this idea that there is a quick fix, and there isn’t. I think it goes back to the kids who see success and then go back to their old habits again. They feel like, “I got to where I need to be, and now I can revert back to all of these foods that I get bombarded with.” The one thing I’m really disappointed about is the constant advertising of food to children. It just seems to be everywhere, all the time— relentless advertising. That’s why I try to discourage kids and families from eating in front of the television— meals in particular, but also snacks. Because when you turn on the television, even if you weren’t hungry to start with, there’s going to be a commercial about food that sparks, “Hey, I should go get something to eat before I sit down.” Also, if you’re always eating in front of the television, turning on the TV becomes a cue for eating; your brain just starts to link those two things together. So try to break that link and keep the two separate. Eating is in the kitchen, sitting at the table; watching television is a completely separate activity. Also, in the media children see images about what their body should be like, and certainly the people on TV are at a low weight. There is this idea that some kids would like to achieve these ideals that just aren’t realistic for their bodies. That’s why I try to stress that they just maintain weight. Especially if they’re still going to grow, I just want them to grow into the weight, rather than pushing weight loss. With older kids who have stopped growing, I want to try to help them lose weight, but also to set a realistic body image of where you’re going to get to, rather than this extremely thin image that the media is always advocating. Kelly Sinclair, Clinical Nutritionist
You want to avoid labeling a child at all costs. You don’t want to be calling them any sort of names; they get enough of that at school. I think parents should show kids their family history of diseases and say, “Our family is at greater risk of getting type 2 diabetes, heart disease, and high blood pressure—“ maybe not necessarily using those terms but using terms that they feel their child would be able to understand. And just say, “Because of this, it’s really important that we work a little bit harder at following a healthy diet.” And show them what you mean by a healthy diet; model those foods that you want them to eat, and model physical activity. Those are all key things that parents can do, as opposed to saying, “You must do this. You must do that. If you do this, you’ll get ill-” those are just scare tactics that don’t usually work. In some cases, families think, “Our family has type 2 diabetes; my father had diabetes, my grandfather had diabetes, and I’m going to get diabetes.” But parents need to point out to kids that it’s not written in the stars; it’s not definitely going to happen to you. It’s not fate; you have control over whether or not you get those diseases that are associated with obesity. You can change what you’re eating, increase your physical activity, and really choose a healthy weight. Kelly Sinclair, Clinical Nutritionist
Sometimes when you see a patient or family not coming to appointments very regularly, or not showing progress over a period of time, I think you need to present to them the questions that you’re considering, like, “Is this a good time to try and make these changes?” I think it is especially hard when you are talking about a child’s health; maybe the child is motivated to make changes and show up and they want to do this, but they may be lacking parent support and family support. So there isn’t any really specific time period after which we say, “Okay they have been here a year and they’re not showing signs of success, so we are going to suggest that they go elsewhere.” It’s not like that; it’s much more on a case-by-case basis. We have to look at a lot of factors, like where they started, what changes they have been able to make, and what kinds of support that particular family has. I think what we do is think carefully as a team about whether we need to ask the family if they are willing to do some of the small things to try and keep on the path towards a healthy weight. That is usually our biggest factor in determining whether their time here needs to be stopped. Some families will say, “You know what? No, we are not ready to do this anymore. We just can’t do it.” Then maybe we need to refer them to other things that they need to do. We invite them back too, though. I think one thing that we always do is to say, “You can come back when you feel more ready.” Allison Lauretti, PhD, Staff Psychologist
Because our clinic works with three to thirteen year-olds, we see kids who are still growing taller, so sometimes they may actually gain weight. What we focus on is their BMI not moving. If their BMI stays the same or maybe goes down, but they grow taller and gain some weight, that’s fine. What I tell families all the time is that we’re working on stopping the rapid weight gain. If you never lose weight with our program, but you stay the same, you’ve met your goal. That takes some of the pressure off. Also, I am very careful about the way I use the word “diet.” I don’t use it to mean “going on a diet,” but everyone has a diet, and I provide people with some education on that. There are some kids who just get down on themselves, and who really feel awful if they’ve gained weight. Then for other kids, it’s not on their radar, and they’re not thinking about it; they’re worried about, “Oh, I really want to play outside and this lady won’t stop talking to me!” So a lot of it depends on the child. If the child has gained a couple of pounds, that’s okay; they are working on figuring this out. The other thing that I tell parents and kids all the time is that if you’re eleven, it took you eleven years to get to where you are now. You learned all of this behavior in eleven years, and it’s only been three months that you have been unlearning some of that behavior. So give it some time. If it took eleven years to learn this, it might take three, four, five, or maybe eleven to unlearn it. We’re hoping to shorten that, but it could be that long; we don’t know. Jennifer Rein, MSW
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Copyright © 2005, Children's
Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. July 10, 2005 |
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