 |
    |
Frequently Asked Questions
I’m a nurse practitioner, so I’m considered part of the medical team. When a patient comes in for their initial visit to the clinic, they generally see a medical provider first. What we do is to take the patient’s history and talk to them about what we do here at the OWL clinic. Then I do a physical exam on the patient to rule out any underlying medical issues that may be a cause of their obesity, although that’s very rare, and also to diagnose any medical complications. One thing about being a nurse practitioner in this clinic, as well as in general, is that we’re educated to teach prevention, and we’re also focused on teaching holistic patient care. Those are roles that I get to do very well here. Colleen Kochman, RN, MSN, PNP
I am a behavioral medicine clinician. I usually explain to families that I am here to help with issues of motivation and trying to figure out what programs at the OWL clinic are working and what aspects of our program are not working as well. Some children come in to our clinic and are doing really well with the strategies that we have suggested for home, but when it comes to school or camp they are having a harder time following the various suggestions from our OWL Clinic. My role is to help understand where the strengths and weaknesses are for both the child and the entire family and determine how we can best target areas for change. Nicole Eldridge Marcus, PhD, Behavioral Therapist
One of the things that tends to come up a lot is that often parents feel that when they have their child in their own home they really are able to be on board with all of these nutrition suggestions. Parents can prepare and give great snacks and all kinds of ideal meals. The problem comes when the children go out. I spoke to a family today that told me they went to the beach yesterday with about ten other children, and everyone was pulling out bags filled with chips and cookies. Parents ask me, and ask others on our team, “What do we do in those situations, when I’m trying to give my son fruit salad and all of his friends are being handed chips and cookies? He is very tempted.” That’s a hard question to answer; I think that I am still trying to figure out what the best approach is. One suggestion is to make sure that healthy foods are on hand. One patient of mine told me that he really liked bringing soy chips, because those are healthier than the chips the other children were eating but still let him feel like a kid, as opposed to whipping out a salad or some other item while the other children are munching along. Another thing this child told me that he did was to distract himself and remove himself from situations where there were unhealthy foods, so that he would not be faced with too much temptation. I think children taking themselves out of an unhealthy context can be important to their staying on track. Or some children whom I work with eat something healthy before they get put in those situations, so that they do not feel overwhelmingly hungry when faced with friends eating fast foods. These are some of the things that perhaps children and their families can try to do. But that is a hard question, and one that has definitely come up repeatedly. Nicole Eldridge Marcus, PhD, Behavioral Therapist
The most common question is, “Is this simply a genetic predisposition? Is there something genetically not right with my child that makes him this way?” The way I answer that is to say that certainly genetics play a part, but that the environment, or what you do, given your genetics, is the most important part of this. Jan Hangen, Clinical Nutritionist
In terms of nutrition, there are three main questions I get: “How do I get my child to eat vegetables?” “Breakfasts are tough; my child doesn’t want to eat breakfast,” and “What do I do about snacks, when the only snack foods available are ones you’re telling us not to eat?” When people ask me about getting a child to eat vegetables, I say to encourage variety slowly. So first work on the total amount of vegetables; if there’s a vegetable that they love, let them have a half plate of that vegetable, and let them have it repeatedly, until they initiate a request for more variety. The second thing I tell them is to cook the vegetables plain, because everyone’s taste is very individual. I encourage them to put on the table what I call a “vegetable condiment tray,” and for that tray to let the children help choose all of the condiments, such as low-sugar ketchup, or even regular ketchup (but use just a bit), mustard, seasonings, herbs, low fat salad dressings, and grated low fat cheese. The reason for this condiment tray is so the child can eat his or her vegetables the way that he or she likes to eat them. Taste is so individual, and we can’t force our taste preferences on our children. In terms of breakfast, I just encourage a lot of what I call “grab-and-go breakfasts.” The other thing to do about breakfast is to assess whether the kid is what I call a “sweet kid,” or a “savory kid.” Sweet kids prefer sweets, and savory kids might like something like a cheese sandwich for breakfast. I have kids who eat a grilled cheese sandwich for breakfast, or a tuna sandwich, or leftover chicken. As for snacks, the child must learn to view a snack as a small meal, rather than eating “snack-y” foods. For example, a sandwich could be a snack, or leftovers could be a snack. Jan Hangen, Clinical Nutritionist
It’s important to meet with someone at the school, particularly if a child is in grade school. Meet with their teachers, because of the issue of school parties. They often have quite a number of days in a row when they have cupcakes for birthdays, end of the year parties, or holiday parties. Encourage teachers to present alternative snacks that are healthful, or even non-food-related rewards. But some schools will reward kids with food, so I think it’s important to establish that you have some goals for your child that are health-related and that include weight management, and that you would like the school to help you accomplish them. A byproduct of this approach is that the other children in the class can achieve better health too. Jan Hangen, Clinical Nutritionist
Frequently people ask how much weight they’re going to lose during the course of the program. I never come up with a set goal weight for my patients. I basically want them not to focus so much on weight; I want them to focus on changing eating behaviors, and focus on choosing healthy foods. Normally, by doing that, things just start to fall in line. So many of the kids I see have a lot of growing left to do that it’s really a matter of maintaining the weight that they’re currently at and growing into it, because they are going to have gains in height over a period of time. People are also frequently looking for specific food ideas, and we’re constantly trying to give them new snack ideas, dinner ideas, and ways to incorporate the basic concepts we teach in the program into daily life. We give them lots of recipes, and also when they come back I try to make it more hands-on and to provide them with specific ideas Kelly Sinclair, Clinical Nutritionist |
 |
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 |
 |