One in five American children is considered obese, according to data from the CDC, but weight loss in kids is a touchy subject. Just recently, WW (formerly known as Weight Watchers) came under attack after launching an app aimed at helping kids lose weight. Reaction on social media was fierce with many dietitians expressing outrage and concern that the tracking system could lead to an unhealthy fixation on food and body image, and ultimately an eating disorder, which can be life-threatening. Their concern isn’t totally misguided. An American Academy of Pediatrics (AAP) Clinical Report suggests that among children, dieting with the goal of losing weight is a risk factor for both obesity and eating disorders. One study found that girls who weren’t obese who dieted in the 9th grade were three times more likely to be overweight in 12th grade compared to girls who didn’t diet. The case against dieting among kids is so strong that the AAP says it’s counterproductive to managing weight.
Still, we can’t dismiss the fact that childhood obesity (which is clinically defined as a BMI at or above the 95th percentile) is a problem that can lead to serious health consequences — both in the short and long term. Those health problems include a higher risk of asthma and other breathing problems, joint pain, gastroesophageal reflux, fatty liver disease, high blood pressure and high cholesterol (which increase the risk of heart disease), and type 2 diabetes. Being overweight as a child can also have a powerful impact on emotional well-being, with an increased risk of bullying, low self-esteem, and serious mental health issues, such as anxiety and depression.
So what’s a parent to do? We checked in with some experts to help you discover the right way to help an overweight child lose weight.
How should you talk to your child about weight loss?
You shouldn’t! As a parent, your job is to model healthy behavior, and that means you should also avoid conversations centered on your own weight, size or body appearance. That goes for anyone else’s weight or body size, be it a celebrity or a stranger on the street. “This sends the message to the child that it’s weight that matters, rather than health,” says Michelle Cardel, Ph.D., RD, an obesity and nutrition scientist and assistant professor at University of Florida College of Medicine in the Department of Health Outcomes and Biomedical Informatics.
Though you may curtail weight talk inside the home, you can’t control what happens outside your house, where overweight kids may be subject to teasing and weight-based bullying. If your child seems distressed, ask, “What’s bothering you?” and don’t assume that it has anything to do with his or her weight. (There are a number of things that can affect a kid’s mood, like a fight with a friend or a bad grade.) Whatever it is, create a safe, loving and open space to have a conversation about it. If it turns out your child is the target of fat shaming, be sure he or she has tools to handle the situation. That might mean thinking through a curt comeback (like, “I don’t appreciate that” or “That’s not a cool thing to say”) or it might be telling a teacher or another grownup. But it usually doesn’t involve encouraging them to take the abuse. Instead, help your child develop resilience, show love and support and respect at home, and encourage friendships and activities where your child feels welcome.
How can parents help improve their children’s eating habits while encouraging a healthy relationship with food?
American Academy of Pediatrics Spokesperson Dr. Natalie Digate Muth, RDN, author of the forthcoming "Family Fit Plan: A 30-day Transformation" warns parents against making food rules or restrictions for one child that do not apply to the whole family. Instead, she says the focus should be on what the family can do together, such as limiting sugary drinks, switching up your snacks, or cooking and eating family meals together as often as possible.
Giving children a meaningful role in creating healthy meals will help them to feel more invested in sustaining behavior change around eating habits.
You can also get your kids involved in selecting healthful recipes, food shopping and cooking. “This helps children feel empowered and gets them excited about what they’re eating,” Cardel explains. Nicole Taylor, Associate Professor of Anthropology at Texas State University, and an expert in social issues related to childhood obesity and body image concerns, adds, “Giving children a meaningful role in creating healthy meals will help them to feel more invested in sustaining behavior change around eating habits.”
Don’t worry if your child shuns his or her new healthy meal at first. It’s totally normal for kids to turn their noses up at new foods. “Sometimes a child will need to see a new food at least 20 times before they’ll even try it, let alone like it,” says Cardel. Even if it sounds crazy, keep introducing it, and ultimately it may go over okay. “It’s the parent’s job to decide what foods to put in front of the child. It’s the child’s job to decide what to eat and how much to eat,” Cardel says. Accepting this dynamic will minimize mealtime battles and avoid food turning into a power struggle, she explains.
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What are some ideas for kids and teens to balance healthy eating and fun foods served at parties and social situations?
Between class parties, snacks at sporting events, and all of the other social situations where foods show up, it can be hard to navigate these settings healthfully. But part of having a healthy relationship with food is allowing for desserts and unhealthy foods that may taste good, says Muth. “That means enjoying them without any shame or guilt,” Cardel adds.
Rather than denying your kids these pleasures (which isn’t advised), focus on serving nutritious foods at home and teach your kids that these are fun foods. Taylor suggests reminding kids that while fun foods are a part of the celebration, there are other things to focus on as well. For example, there may be music and dancing or a chance to hang out and get silly with friends.
It’s also a good idea to plan for these occasions and brainstorm how to indulge without overdoing it, which can lead to stomach aches or lower energy levels. Taylor offers these strategies for starters: “Set an intention beforehand about how many treats and sugary drinks you plan to consume; prepare a small plate of treats and then walk away from the food table to socialize; tune into the full sensory experience of the occasion, including the sounds of music, laughter and conversation, the smells of delicious food, and the sight of friends smiling and having fun.” None of these are mandates, nor are they meant to be punitive. The idea is to enjoy the full experience and not just the food element of the social event.
Besides food, what else can families focus on to help encourage a healthier weight?
Weight is a complicated issue that involves more than just food. While that’s one piece of the puzzle, a person’s activity level, genetics, sleep and stress can also influence body size. Cardel suggests focusing on these things holistically and rather than trying to control the number on the scale (which is beyond anyone’s control), focus on positive changes you can make. “As parents, we can control the foods we purchase and have available at home and how much physical activity we’re getting as a family. We can control screen time in the bedrooms and encourage positive sleeping habits,” she says.
The American Academy of Pediatrics (AAP) recommends setting boundaries around media time and paying close attention to make sure that screen time isn’t interfering with other healthful behaviors (including sleep). They offer an interactive tool to help you set up your family’s media plan so that you can develop more structure around your family’s screen time. Muth recommends a no-screen time policy within an hour of bedtime and during meal times.
Establishing a consistent and relaxing bedtime ritual is another way to improve your child’s health. The AAP says school-aged children need from eight to 12 hours of sleep each night, depending on age.
And when it comes to activity, encourage family participation and make movement fun! “Making exercise fun and social will motivate kids and teens to be more physically active,” says Taylor, who suggests walking, bike riding, and swimming as some ways to get fit as a family. She also suggests encouraging kids and teens to weave more movement into their day-to-day lives — say, by walking the dog or biking to and from school — in order to promote long-term behavior changes. Finally, Taylor cautions against making exercise about burning calories or connecting it to weight loss in any way, which can make it feel like a chore. In other words, it should never be about working off a piece of cake or any other food.
When adults obsess over their own body fat in front of children, they model that behavior and anxiety as normal.
Nicole Taylor, Associate Professor of Anthropology at Texas State University
How do parents balance the risk of disordered eating against the risk of an overweight or obese child?
Again, experts warn against concentrating on weight. Focus instead on encouraging a positive relationship with food and their bodies. Taylor recommends talking with children about how people's bodies come in a variety of shapes and sizes and reminding your child that what matters is not how anyone’s body looks, but instead how our bodies feel. “Help children become critical consumers of popular media by talking with them about unrealistic body image ideals that are promoted in social media and television. Popular media normalizes a narrow body image ideal that does not reflect how most people look in real life,” she says. “Help children understand this cultural dissonance through open, honest dialogue.”
And don’t forget that how you act matters, too. If you’re critical of your own body, you’re modeling that behavior for your child and though it may be unintentional, you may be teaching your child to worry about his or her body size, explains Taylor. “When adults obsess over their own body fat in front of children, they model that behavior and anxiety as normal,” she says.
What red flags should you be on the lookout for when your child starts to eat healthier?
The AAP warns that it’s not unusual for an eating disorder to begin as an attempt to eat more healthfully, particularly among teens. They also note that about half of teenage girls and a quarter of teen boys are unhappy with their bodies, and body dissatisfaction is higher among overweight teens. A higher degree of body dissatisfaction is linked with a higher risk for eating disorders and unhealthy weight control behaviors. With that, it’s a good idea to be aware of some warning signs.
“If a parent hears a child become very obsessive about weight or notices a child has started skipping meals, talks about wanting to be ‘skinny,’ says negative things about her or his body, becomes more secretive about food and eating, shows signs of starving or purging or using laxatives or diet pills or supplements, or starts to gain or lose a lot of weight, consider reaching out for extra help,” advises Muth. Cardel says changes in demeanor, mood, and academic success are also cause for concern. “If you’re worried your child is developing disordered eating, it’s important to take them to a doctor right away as eating disorders can become life threatening if not treated,” she says.
Dr. Muth says that by focusing on positive, healthy behaviors, de-emphasizing weight talk, and taking some important steps as a family, you can have a big impact on your child’s health. “When families strive to have mostly healthy foods at home, eat family dinners together, make physical activity a priority, and enforce regular bedtimes and screen time rules, then the family is healthy. The weight is less of an issue.”
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