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Obesity Fact #6: Childhood Obesity Programs Must Involve the Parents



sharma-obesity-family-centred-careObesity Fact #6 from the New England Journal of Medicine paper on obesity myths, presumptions and facts, also states the obvious:

“For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance.”

In contrast, Programs provided only in schools or other out-of-home structured settings, although convenient or politically expedient, are less likely to yield positive outcomes.

As regular readers may recall, I have often stressed the points that perhaps on of the most effective things we could possibly do to prevent and better manage childhood obesity is to treat the parents.

The key word in this previous statement is “treat” – this goes well beyond simply “involving” the parents in a program designed primarily to help their kids. Readers may recall the study showing that the amount of weight that parents lost was a good predictor of the “success” of their kids.

I really mean “treating” the parents as I am convinced (although this has yet to be formally proven in an RCT) that parents, who successfully manage their own weight can be much more effective in creating a home environment that could help their kids.

I do not think that it is merely a coincidence that the kids born to mothers, who have undergone bariatric surgery, are far less likely to become obese (even as adults) than kids born to obese mothers, who have not undergone surgery.

I do not believe that this is specific to surgery, but could well be common to any form of successful weight management in the mother.

My number one advise to obese parents wanting to help their overweight kids would be to themselves first seek obesity treatment (and I don’t mean join the next commercial weight loss program).

Thus, apart from rare exceptions (such as monogenic forms of obesity or obesity associated with developmental or other specific issues that affect the kid alone), I would at least propose the “presumption” that “Childhood obesity programs must also treat the parents”.

Obviously, this may not be something that childhood obesity programs are primarily designed to do – which is why I have previously suggested geographically co-locating pediatric and adult obesity programs so that everyone in the family can be treated at the same time.

This, may not be easy to accomplish but perhaps some of my readers have experience with such an combined program or at least the efforts needed to create one.

AMS
Edmonton, AB

6 Comments

  1. This brings to mind the ‘Treating the Dieting Casualty’ workshops Ellyn Satter used to offer. I believe their genesis was related to exactly what Dr. Sharma is speaking about.

    http://www.ellynsatterinstitute.org/st/speaking-training.php

    If you haven’t read her books, including Your Child’s Weight: Helping without Harming, I highly recommend them.

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  2. Excellent!!

    We should extend this to PREVENTING childhood obesity.
    In this culture, even normal weight parents need help preventing kids from becoming overweight, and then perhaps obese.
    These days kids are exposed to many overweight-creating situations that we as parents didn’t face. For example, on the Weighty Matters Blog “Parental No” posts there are many examples of how kids’ activities now include extra food outside mealtimes, especially junk food, and even kids sports activities now somehow have to include snacks and sports drinks.

    We teach our kids to eat veggies to get vitamins and other nutrients to prevent disease. We now need to teach our kids to consciously manage their energy intake so that excess energy in their food doesn’t cause overweight and then obesity.
    There are programs for kids that do this – one example is the “traffic light” system which identifies “green” foods which can be eaten in any quantity, and “red” foods (high calorie) which a child limits to a specified quantity.
    A teen might be interested in the “Eat This Not That” books which compare nutrition info on restaurant food. Some of the calorie counts are surprising.

    We teach kids to avoid deficiency diseases by eating to get lots of nutrients. These days, scurvy, pellagra, beri-beri, rickets, etc aren’t the problem. Overweight and obesity are now the problem, and our nutrition teaching has to include learning how to control energy intake.

    Two factors make conscious energy(calorie) control necessary:
    First, no amount of exercise can make up for unlimited eating of the very high-calorie food now available anywhere, anytime, and even as a part of formerly non-food activities
    Second, as Dr Sharma has pointed out – there is no cure for obesity. Once your child becomes overweight, perhaps even obese, that is a life sentence of having to manage a chronic condition. It is much better to make sure your child stays a normal weight from the start, and learns skills to stay normal weight and healthy.

    I include “overweight” as well as obesity, as necessary to be avoided. That is because “normal weight” isn’t one single ideal weight, it is a normal RANGE of weight. There is room for every child in the normal weight range. A child can be pounds heavier than a same-height same-age friend, and still be within the normal weight range. There is lots of leeway here, so it is necessary to have a point at which something needs to be done, and that is becoming overweight, not waiting until the problem gets extreme enough to become actual obesity. It is not fair to the child if the parent is in denial and says there is no problem because the child is only overweight , not really obese.

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  3. Regarding the link to ellynsatter above:
    I am sure some other people will find this approach helpful. However I got similar advice from my doctor – provide good food and let the child eat as much as desired because children naturally eat just what they need – and it would have been a disaster for one of my children.
    I have three children. The first two did fine following that. The third child would eat constantly, sneak extra snacks, spend allowance on junk food. All this eating was, of course, causing overweight.Luckily, overweight was not an acceptable condition among the peer group, so my child was motivated to change.

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  4. You know, I really do think that there’s a hereditary issue that you’re ignoring. My mom is thin. Some people in her family are on the heavy side, but she’s a restricted, nutrition conscious eater that you’d approve of. She raised me and taught me how to cook.

    My dad and and many people on his side of the family are very fat. I didn’t even live with him as an adolescent and teenager, let alone copy my eating habits from him. Yet, I’m built like his side of the family and always have been. I was raised to eat like my mom, but eating that way didn’t make me her size. To be honest, I’m smaller and in better physical shape than my dad and his sisters were at my age, but I’m a good 85 pounds heavier (and 5″ taller) than my mom. By BMI, she’s “normal weight.” I’m “obese.”

    So, I think it’s wrong to say that teaching children who are predisposed to have high BMIs healthy habits is going to stop them from having high BMIs. Maybe they’ll be a bit lighter than they would have been otherwise, but they may still end up in the overweight or obese range. It isn’t accurate to assume that all children who are heavy have been taught poor habits, either. When you see heavy parents with heavy children, you should be thinking that the kids may have inherited their build, and not just assume that the whole family has bad habits. Children tend to look like their parents. It’s not a radical new discovery.

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  5. As for getting pregnant after weight loss surgery, going through a pregnancy with nutritional deficiencies and an impaired ability to absorb micronutrients seems risky to me; much riskier than being fat while pregnant. I’m surprised that the children born to women who’d had WLS would be lighter as adults. I’d expect them to be heavier, because their anti-famine genes would be triggered in the womb. I’d expect them to have all kinds of problems compared to people who were fetuses in a nutrient-rich environment. After all, you’d never advise a pregnant thin woman to eat as little or as poorly as someone post-WLS has to.

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  6. I whole-heartedly agree with Dr. Sharma: the overweight/obese parents also need treatment when addressing excess fat. I am still amazed that my mother sent me to a nutritionist when I was 12 to help me with my problem. The nutritionist helped me set up an eating plan, but without those responsible for the cooking and shopping and general leadership in the home, what good was it? I also remember my overweight/obese father telling me I was getting big. I thought, when you get your own weight under control, then you can talk to me. I wonder now (30 years later), what my life could have been if my parents had led by example instead of labeling me with the weight problem.

    I have attempted to take control of my weight through surgery. I am down 130 lbs from my highest weight of 320. While my food choices still have a lot of room for improvement, I am leading by example for my children by being a “best weight” and eating smaller portions and leaving food on my plate.

    @DeeM, I have 3 children. 2 of them are bean poles. the third takes after me. She will never, ever be as small as her siblings. Even her feet are wide. I assume she will always be heavier than they are. But that does not mean that she cannot be her “best weight” either. Even if that is 50 or 85 pounds more than they are. In my own case, my BMI says I should weigh between 120 and 145 lbs. At 190, I am obese. My lean mass is also 120 pounds. Even at 20% body fat, (too low for me) I would weigh 150 lbs. My body will never be acceptable to those charts. I’m ok with that. Time will tell if my daughter will also be a powerhouse. My job is to help her be strong and fit regardless of her weight.

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