Managing the Overweight Child

 

Obesity  receives a great deal of media attention,  and is even the topic of high rating television reality shows.  The messages regarding management are well known but in reality this problem is very difficult. Studies on diets and exercise regimes have been disappointing. The main reason for this is that many of these interventions are time consuming, expensive, or simply not fun!  It is just too hard.  Exercise programs become tedious, diets too boring and bland, other family members are not supportive, and it all just gets too hard.   So what works ?  To answer this it is useful to study families who have been successful in improving their health. In most cases the changes were related to  lifestyle and parenting. These  range from something as subtle as changing grocery choices at the checkout, through to wholesale change of lifestyle such as moving to a suburb with better access to parks, beaches, sporting facilities etc. But what these families did not do, is make it difficult by using unrealistic diet or exercise regimes.  They made it as fun as possible until the change became part of their lifestyle.  Some examples of subtle parenting changes are outlined below, but first lets look at the well known contributing factors.

The factors that are responsible for weight issues include

• Parental Perceptions – One of the interesting side effects of seeing so many children who are overweight is that children who are ‘normal’ are now being called skinny.
• Of all the things you can do as a parent, becoming a role model if you yourself are overweight is the most powerful tool.
• Diet  – Families consume higher levels of  fast food then in the past – particularly when both parents are time poor.  These meals are often cheap and convenient.
• Food Behaviour – it is interesting as a health professional that I have never ever had a parent complain that their child ‘eats too much’.  The opposite is often the case.  Toddlers are encouraged and praised if they eat and this can set up a pattern of overeating as the child desires the praise. Beware when using food as a reward. See Fussy eating.
• Activity – Time poor families and concerns about safety have lessened opportunities for exercise, either organised or incidental. Fitting this into the day becomes a low priority. School sports have decreased in time and intensity over the decades as the academic curriculum has become more demanding.
• Screen time – The amount of time we (and therefore children) spend in front of screens has dramatically increased.
  These factors are  not unique to children and hence any program needs to be family tailored.

How can I check if my child is overweight ?

To assess growth you need to get an accurate height and weight and plot these values or standardized graphs called ‘percentile charts’.  General practitioners and child health groups will have these and they are freely available on the internet.  Click here for one example.  If the weight percentile is significantly higher than the height percentile that would indicate this needs to be discussed with a child health professional.  This is automatically done during the 4yo health check but unfortunately many health professionals are not keen to discuss this.  Reasons for this include that it is time consuming, or the health professional does not feel adequately trained, or they may feel this issue is too sensitive.

What are the health problems associated with being overweight ?

• Increased incidence of diabetes mellitus and other endocrine problems.
• Increased incidence of high blood pressure leading to stroke and heart disease
• Early dental caries
• Increased incidence of musculoskeletal problems such as hip,  back and knee problems.
• Increased incidence of depression and suicide associated with the psychosocial problems
• Increased incidence of coronary artery disease

Parenting and food

One of the simplest and easiest things to do is to change the way diet is managed.

• Don’t buy it – soft drinks, ice cream, high fat snacks – if it is not in the kitchen no amount of nagging will work.  So offer healthy alternatives.
• Do not encourage your child to eat. Drop the portions and if they are still hungry offer fruit.
  Teach the Grandparents – one night per week at grannies can undo a whole week of healthy eating.
• Do not use food as a reward. Stickers, stamps for the littlies, and trips to the beach or park (exercise) for the older children.
• Offer one or two healthy choices for dinner and stick to these. A hungry child will eat anything.

A child who is not hungry can afford to be fussy.

A few more comments

Changing the activity level of a family is harder. For some exercise is a chore and so it is unlikely to succeed. Far more successful is taking on activity that is enjoyable, and the exercise is the incidental reward. Finding a sport or active interest may well be the cure, as this will benefit all aspects of a family’s health. I have met families who have moved houses and even states to improve their general health and wellbeing, and this is a positive move that will have more chance of success than many suggestions that involve rules that ‘take away the fun’.  For example limiting screen time is a negative consequence and is ‘not fun’.  So instead of limiting screen time, add an activity that ‘takes away screen time’.  The key is finding a sustainable long term positive lifestyle change.