Boy Watching Television Surrounded by Junk Food
Pat Doyle  /  Corbis
Many youngsters have poor diet and exercise habits — often learned from their parents.
By contributor
updated 1/2/2006 2:01:16 PM ET 2006-01-02T19:01:16

Should you intervene when your child's friend is overweight and has bad eating habits? What should you do when a youngster has an imaginary friend? Growing Up Healthy answers your queries. Have a question about children's health and well-being? E-mail the author. We’ll post select answers in future columns.

Q: A very close friend of our family is a single father of a 5-year-old girl who is average height and weighs 90 pounds. Whenever she is at our home I try to encourage healthy snacks such as fruit and whole grains (because she always seems to want to eat). Yet, as often as not when they visit she brings a doughnut and some sugary drink. I am extremely concerned for her current and future welfare. Is it appropriate for me to broach this subject with my friend and, if so, how?

A: It’s certainly appropriate but how you do it could range from being direct and frank to simply setting a good example, says Amy Jamieson-Petonic, a registered dietitian at Cleveland’s Fairview Hospital and a spokesperson for the American Dietetic Association.

“What we do know is that we can’t really ignore children’s weight issues any longer,” she says. Jamieson-Petonic notes that because of obesity and the related health problems this is the first generation of children who might not outlive their parents.

“I’m seeing so many kids with so many problems related to weight — type 2 diabetes, high blood pressure, bone and joint disorders, reproductive disorders, high cholesterol, you name it," she says. "In children as young as 6 years old these days we’re seeing conditions indicative of coronary artery disease.”

She urges being direct with your friend, but only if you truly feel comfortable. If so, sit down and have a discussion without the child in the room. “Have a nice, calm environment and share your concerns with your friend about his daughter’s health,” recommends Jamieson-Petonic. Stick to discussing health issues, not weight and vanity. Almost all parents are concerned for their children’s health.

If your friend agrees there’s a problem, urge him to see his daughter’s pediatrician for an assessment and help with diet and exercise.

Also consider what you might do to offer support. If you’re a great cook, invite them over for a healthy dinner once a week (perhaps involve the father and daughter in the preparation even — it can be a learning experience for them). Or talk with him about good alternatives to some of the junk food items his daughter likes. Maybe your friend even needs help shopping or help with childcare so he can have time to grocery shop.

Don’t be surprised, however, if he’s not entirely receptive, warns Thomas M. Badger, director of the Arkansas Children’s Nutrition Center and a professor of physiology at the University of Arkansas for Medical Sciences in Little Rock. Last year Arkansas became the first state to measure the body mass index of school children and send the information home in the form of a “Child Health Report” letter to parents and guardians. (BMIs are assessments of body fat based on height and weight for a specific age; critics have charged, however, that they often don’t accurately assess whether a child is healthy or not.)

The Arkansas Child Health Report told parents their child’s BMI and whether, according to their standards, it meant the child was underweight, normal, at-risk for being overweight, or overweight. It also told them where their child ranked in terms of BMIs of other children across the state.

Even when parents were simply given statistical information, Badger says, not all parents took it well. Some of the parents were appreciative because they’d simply never recognized or admitted that their child had a weight problem. “But some parents were also outraged. People react quite differently to being told their children’s weight situation,” says Badger.

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Jamieson-Petonic, who has developed a program in her community called Shape Up, which involves getting the entire family to exercise and learn about nutrition, agrees. “In our program, we find the overweight kids basically model their parents’ exercise and eating habits.” She points out the obvious: if the 5-year-old is bringing doughnuts and soda to your house, her father is probably the one buying them. So what you’re really bringing up is that the family may need a health overhaul.

Both Jamieson-Petonic and Badger say, too, that there are ways to be proactive without a parent confrontation. If you have a feeling the father won’t react well to a discussion, focus your energy on setting a great example while the child is at your home. Ask her not to bring junk food and, instead, tell her you’d rather introduce her to some of the fruits, vegetables and healthy foods you like to eat. Get the little girl involved in preparing and eating nutritious foods together or taking walks, hiking, swimming, biking or doing any other fun, calorie-burning activity.

If she enjoys her time with you, there’s a very good chance she’ll want to be more like you. She may even ask her dad to do more biking and hiking and buy some of the foods you two enjoy together. These are all good steps toward achieving a healthier weight.

Q: Is it normal for a 3-year-old child to have an imaginary friend? My brother acts like there is someone there and won't let go of his hand. He even cries and says, "You sat on Carl!"

A: We know you don’t want to believe it, but, yes, your little brother is normal! “From ages 3 to about 7 or 8 imaginary friends are very common,” says Dr. Mark DeAntonio, professor of child and adolescent psychiatry at UCLA. “They’re usually in kids who are overall more anxious but it doesn’t necessarily mean they have an anxiety disorder.”

DeAntonio explains that children usually use imaginary friends to help them cope when they’re overwhelmed. “It doesn’t mean they’ve been abused or traumatized but maybe they have some social anxiety and this is a way to modulate it.”

Your parents may want to try to figure out if there’s been a change that’s caused some stress for your little brother. If he’s just started preschool, that could be it. It doesn’t mean he should be taken out but it may be helpful if your mother or father takes extra measures to make sure he feels secure. Perhaps they could spend a little extra time with him at the school in the morning or make a point to drop in or telephone during the school day.

Should your family, though, save a seat for "Carl" at dinner? Not really. But you also shouldn’t try to obliterate him.

“You should make the child aware that non-family members might not understand that he has this friend but then otherwise remain neutral,” recommends DeAntonio.

Some adults think it’s actually incredibly cute and creative to have an imaginary friend and may even encourage it. DeAntonio says, however, its best to remember that it’s first and foremost a coping mechanism, not reality.

“Encouraging it feels like not good reality testing for a child. Intuitively it feels wrong to me,” he says. On other hand, if you ban your brother from talking to his "friend" or tell him he’s embarrassing you, it’ll come off overly critical and probably send the message to him that he shouldn’t trust you.

So try your best not to sit on "Carl" and, otherwise, just bear with your little bro. DeAntonio says while imaginary friends seem bizarre they also generally make a very quiet exit and the whole family quickly forgets they were ever in residence.

Victoria Clayton is a freelance writer based in California and co-author of "Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom," published by Fair Winds Press.

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