Eat Healthy Yourself
It's important that parents pay attention to their own eating habits, as example is the most powerful teacher. To get on the road to healthy eating, take grocery shopping seriously, as that's where good nutrition starts. Working parents can shop on their lunch hour, using a well-thought-out list to get in and out in record time. Office refrigerators can store perishables until the end of the day. Try online grocery shopping for bulk, non-perishable items. To avoid battles between parent and child for junk food or candy, enlist the help of family and friends—trade shopping trips without the kids. Whatever it takes, stock healthy foods in your home.1
Healthcare providers can help by asking parents if they would like to learn more about healthy eating. Sometimes education is the only thing standing between healthy and unhealthy habits. The nurse or nurse practitioner in your office may schedule a visit specifically to address this concern. Engage family members in sharing their ideas. Draw up a "Key Advice Statement" about what parents can do at home and plan for a follow up to add accountability and motivation.2
Allow Your Child to Self-Regulate
Help parents remember that developmentally, children may go up and down in weight, and too much focus on pounds can have an undesirable effect. Studies have shown that controlling behaviors actually increase a child's risk of overweight—even with infants who are breastfeeding. Instead, relax, enjoy mealtimes, and watch for your child's hunger and satiety cues.
Most young babies and toddlers will instinctively cease intake when they are satisfied unless they're upset, worried, or have had to respond to Mom or Dad saying, "Stop, you've had enough." Creating an atmosphere of enjoyable mealtimes and pursuing physical activity together will go a long way toward helping the child respond to his own inner sense of fullness. As Dr. Farrow recommends in this issue, more implicit rather than explicit use of control may be helpful—for overweight children, try limiting the availability of fatty foods rather than explicitly forbidding them. For underweight children, offer choices of more nutrient/calorie-dense foods rather than forcing these alternatives.
Spend Quality Time
Numerous studies have shown a strong association between overweight and feelings such as anxiety, loneliness, and low self-esteem in children.3 Although schedules can be tight, especially if both parents work, increasing quality time with your child can help keep him emotionally satisfied and less likely to turn to food for comfort. Creative ideas are out there—for example, "Saturdads," set up by Batley SureStart in West Yorkshire, provides a child-friendly forum where dads can spend quality time with their young children. "I'm at work all the time," says father Altaf Daji, 40, "so it's good getting quality time with the kids. A lot of parents get old and think they should have spent more time with their children before.4"
Health Supervision Summary
There's no question that childhood obesity is a difficult issue for pediatricians. You may already be doing some of these things, but to give families every chance of raising healthy children, here's a brief review of the most important steps.
Track families at risk—assess for activity, food variety, excess in fat, sugar, and calories. Calculate and plot BMI once a year on all family members, encourage breast-feeding and the child's autonomy in self-regulation of food intake, and monitor risk factors for adult chronic disease such as blood pressure, hyperlipidemia, hyperinsulinemia, glucose, and sleep apnea. Suggest family activity, smart grocery shopping and limited TV watching. Set one measurable goal and follow up in one-two months. Finally, give simple tips to avoid overwhelming parents. Patience will likely show these efforts to be successful if both parents and caregivers are dedicated and willing to take small steps toward a better future.7
Kathy James, DNSc, has over 20 years of experience working with overweight families in private practice and in school settings. She recently published Dr. Kathy's Health and Weight Loss Guide based on family questions.
- James, K. (2005). Dr. Kathy's health and weight loss guide. Bloomington, IN: Authorhouse. www.authorhouse.com.
- Gee S, Ravel J, Roberts S. & Wylie, A. (2005). Effective communication with families. Regional Health Education-Kaiser Permanente Northern California.
- NIHCM Obesity Brief, August 2004. Obesity in Young Children: Impact and Intervention. Accessed at: http://www.nihcm.org/OYCbrief.pdf.
- Saturdads father and toddler group. June 21, 2006. Fathers Direct, the National Information Centre on Fatherhood. Accessed at: http://www.fathersdirect.com/index.php?id=3&cID=486.
- Golan M. & Weizman A. (2001). Familial approach to the treatment of childhood obesity: conceptual model. Journal of Nutrition Education, 33; 102-107.
- Golan M. & Crow S. (2004). Parents are key players in the prevention and treatment of weight-related problems. Nutrition Reviews, 62; 39-50.
- Whitlock E, Williams RG, Smith P & Shipman S. (2005). Screening and interventions for childhood overweight: A summary of evidence for the U.S. Preventive Services Task Force, Pediatrics, 116; 125-144.