Monday, November 28, 2011

Why Parents Seldom Seek Professional Help For Their Obese Kids

One can perhaps argue about the causes, scale, and consequences of the increasing number of overweight and obese kids and there is no doubt often parental ‘denial’ about the potential impact of excess weight on their offspring.

Yet, even amongst those, who do recognize the issue, there appears to be a widespread reluctance to seek advise from their family doctors or other health professionals.

The possible reasons for this, from the perspective of parents, was explored by Katrina Turner and colleagues from the University of Bristol, UK, in a paper just published in Family Practice.

The researchers conducted in-depth interviews with 15 parents of obese children aged 5-10 years, to explore their views and experiences of primary care childhood obesity management.

Although parents clearly saw primary care as an appropriate setting in which to treat childhood obesity, they were reluctant to consult their family doctor due to a fear of being blamed for their child’s weight and a concern about the impact of raising this issue on their child’s mental well-being.

“If we’re going to get things like ‘we are going to take your child away if they’re fat’, you’re not going to get a parent in the door. That was the worst bit of publicity they ever did [media reports about children going into care] … parents thought, I’m not going anywhere near the doctor’s surgery because they’re going to take my child away from me.”

“He [the GP] said in front of [daughter], ‘God she’s obese, how on earth can you let her get that size?’ You know, ‘You’ve just simply got to cut down, you’re giving her the wrong foods,’ and ‘Do you realise how much health issue that is?’ You know, ‘She shouldn’t be that size,’ … I took the kids out, went back in and said it was absolutely disgraceful, no way would I take the children back there again.”

In addition, the parents had considerable doubts as to whether practitioners had the knowledge, time and resources to effectively manage childhood obesity.

“I don’t think the GP has ever really had very much constructive to say about my weight … so I suppose I just think well, if I went to the GP they’d probably just say ‘well, just get them [her twin daughters] to eat less and do more.’”

Thus, there was a wide range of responses in terms of how helpful parents had found consulting a practitioner helpful.

Explicit in these findings, is how much of this parental concern leads back directly to the issue of weight bias and the culture of ‘blame and shame’ that health professionals (and everyone else) often perpetuate, largely due to their poor understanding of the complex psychosocial and biological drivers of excess weight and their inability to provide professional advise that goes beyond ‘eat-less-move-more’ platitudes.

“They [the GP] just says ‘oh, give her exercise, make her walk more.’ But she walks to school every day and its right down the bottom, and she walks home, goes to the park on her way home. “

Not surprisingly, the researchers conclude with a most important message to practitioners:

“To encourage parents to seek help about their child’s weight, practitioners should be accessible, discuss childhood obesity in a non-judgemental manner, tailor advice and give attention to broader issues, such as low self-esteem, where necessary.”

Unfortunately, we are still graduating health professionals who do not have the least idea on how to begin addressing this issue.

AMS
Edmonton, Alberta
Turner KM, Salisbury C, & Shield JP (2011). Parents’ views and experiences of childhood obesity management in primary care: a qualitative study. Family practice PMID: 22117082

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18 Responses to “Why Parents Seldom Seek Professional Help For Their Obese Kids”

  1. Jim says:

    Arya,

    Your final comment is spot on!

  2. fredt says:

    You will not have good lasting success with adults or children until you learn to deal with cravings. So what causes cravings? Nobody seems to have an good answer. How do we avoid them? What is the solution to cravings? Why is it easier to lose weight than maintain? Why are the cravings so much worse in maintenance?

    Ultimately, all I ever got was ELMM, not ever ELCMM.

  3. laffin says:

    I was a fat kid and all my visits to the doctor were emotionally painful because of the anti-fat bias in their attitudes. My mother was never directed to a nutritionist or dietitian, she was just told to feed me less and encourage exercise. Fortunately, I was a very healthy kid and only needed to go for annual physicals/vaccinations. Once I hit my teens, I refused to go anymore.

    It wasn’t until I had to find a doctor later in my forties that I found one who was non-judgemental and who had me spend several sessions with a dietitian to come up with an eating plan to help me lose weight and control the diabetes I developed.

    How much time is spent on nutrition as it affects overall health in courses for medical students? Maybe not enough.

  4. WellnessTheRace says:

    I sympathize with parents of overweight children. Many of their children’s friends reinforce their status because they gravitate to each other. This might be as a buffer for those who bully or make them unhappy. Then there are those friends who accept them unconditionally as is and do not make a judgment or discuss health issues. Back at the home front, there may be one or both parents who bring the chips and junk into the home and give mixed signals. Unfortunately this makes the parent who is trying to get through to the children the bad guy. It is frustrating.

  5. DeeLeigh says:

    Well, I’d imagine my mom didn’t ask for doctors’ advice on my weight because she’d noticed how following their doctors’ advice had made aunts and uncles on both sides of the family much, much larger over the years. She knew that I was already eating a healthy diet and was already physically active. I suppose she thought that maybe I would grow out of the chubbiness, and that does happen with some people. However, I just grew into my adult size and stabilised.

    I’m so grateful that she never tried to put me on a diet! Everyone I know who was forced to diet as a child has ended up suffering so much psychologically and gaining so much weight as an adult. Better to encourage a healthy lifestyle and let the weight take care of itself. Being a fat kid who grows up into a fat adult isn’t so bad.

  6. Rachel says:

    Every point in the article is exactly why I have avoided doctors with my child. When I was growing up, they did me more harm than good and I have protected my child from going through what I went through. As you say, most health professionals don’t know the least thing about the problem. I was referred to a pediatrician for my daughter’s asthma when she was four. What I got as well as advice on the asthma, was a lecture on my daughters weight. We got the asthma treated and I never went back to the pediatrician. My daughter’s gone through a number of stages of chubby and slim, its just the way she’s grown. I trusted my instincts and am glad I did. Her mental and physical health are far better than mine were at her age now, which is 14. Love your children unconditionally, give them healthy food choices and defend them out in society, because its a very cruel world for a heavy child.

  7. Anonymous says:

    More reasons to avoid drs when trying to deal with a child’s obesity:

    1. they gloss over it and say it’s not a problem (my daughter was way off the doctors own weight per height charts, this wasn’t a cosmetic issue, and i wasn’t imagining it.)

    2. they give terrible advice.
    my dr ( and public health nurse) said “provide good food and let the child decide what to eat” – the only thing they warned me about was anorexia nervosa . .
    That worked with 2 of my children – the always-moving atheletes who actually like to eat vegs.
    It was a disaster for my other daughter, a quiet gentle reader, who ate too much of any food. I later met moms who were quite strict about food and deliberately talked to their sons and daughters about avoiding overweight, had rules about what kids were allowed to eat when, and had no hesitation adjusting a child’s diet for a good outcome even if that meant treating different children differently. That was just part of their culture – the kids were proud of the fact that they ate well and kept healthy and were proper weight.

    I wish I met those others moms before I tried to follow my dr’s advice.

  8. PJ says:

    I was very chubby when I was 8 and totally grew out of it. I didn’t get fat until my 20′s. So when my daughter started getting chubby around 8 I didn’t worry about it. By the time she was 10 and growing even chubbier I was scared. I tried to be gentle and supportive so as not to destroy her self esteem the way many friends told me their mothers did when they were heavy very young. I put her on lowcarb with me and she lost a good chunk of bodyfat and was pretty happy about it.

    But after about a year she wouldn’t stay on it. The school removed salt “to be healthy” but had almost nothing but deep-fried in veggie oil gluten foods and cookies and crap. She wouldn’t eat lunch taken and thought the hot lunch was mostly vile and frankly school lunch is a nightmare anyway. She became a total carb addict and at home would spend her allowance at the nearby store, voraciously eat every carb that ever thought of coming near the house, as well as eating everything ‘extra’ that I might keep on hand for small addition in my lowcarb foods (e.g. peanut butter, cream cheese, etc.). She gained weight at a speed I haven’t seen since my OWN body went nuts in my 20s — but for her it happened around age 13. It was frankly a nightmare for both of us.

    I was 300#, profoundly insulin resistant, when carrying her. She had a period in her childhood (not all of it, just one period) when I became a single mom when for about a year we ate a ton of fast food — mostly subway and Arby’s because I was under the delusion that they had ‘whole grains, some meat and veggies, it’s healthier!’ That resolved, and things seemed fine, but I had to wonder later how her prenatal health had affected her. She was colicky all through babyhood which might have related to my own bizarre hormones at the time (I had huge, thumb-thick red welts all over my back half the time for no apparent reason).

    Now she eats about 20x better than all the close friends/family/neighbors we know the eating habits of, but she is seriously obese and her friends, who eat like hyenas and live on utter crap, are often thin. She mourns the disaster it has made of her social life and the seeming unfairness of it all.

    I could go to the doctor who would tell me to make her eat less, eat low-fat crappy veg oil stuff, and move more. In other words, who is a complete moron, despite his I’m sure impressive education. How would that help her.

    I work in the publishing industry and my company makes beautiful university textbooks and interactive products for nutrition which everyone studying nursing, nutrition, medicine, etc. has to use at some point. I am not making this up, I have seen them recommend redbull soda and protein bars while recommending against vitamins, and then warn about the horrible dangers of low-carb ‘fad’ and the profound need for everybody to consume grains and avoid saturated fat. It’s like the absolute worst of bad science, non-science, and superstition and this is what people pay $40,000 a year to be taught so they can graduate to be expert nutritionists, nurses and doctors someday. I love my company and we have a lot of quality products but man, every time I have to work with health/nutrition I feel like leaping from a ledge at the horror of it all.

    And based on exactly this kind of education, I’m supposed to take myself or my kid to medical professionals for advice?! Please.

    PJ

  9. Anonymous 2 says:

    Anonymous – I wish my parents had taken the “strict” route with me too. When I was a child, there was a lot of passive/aggressive behaviour, bullying and shaming over my weight, but no-one ever sat down with me and set out some ground rules.

    Like your daughter, I was a quiet gentle reader, who ate too much of everything. I know it couldn’t have been easy, raising me and my older brother, who like many teenage boys could put away astonishing amounts of food while remaining lean, but still, things could have turned out very differently…

  10. Anonymous 2 says:

    I just wanted to add that I strongly disagree with DeeLeigh (above) who said, “Being a fat kid who grows up into a fat adult isn’t so bad”. For me, it was hell on earth, and the main reason I never had children.

  11. ruthdemitroff says:

    Historically, the medical world taught students that the cause of asthma was over-anxious mothers, the cause of autism was cold, distant mothers, the cause of homosexuality was powerful mothers who dominated weak fathers, the cause of A.D.H.D. was mothers who didn’t discipline their children, the cause of dyslexia was mothers who didn’t read to their children. Obesity is no different – if there’s a deviation from the typical, it is assumed there’s a flaw in the mother’s personality or her parenting skills. How often do fathers bring their children to medical appointments and are told they are responsible for and therefore are expected to fix whatever society doesn’t like about their children. Women walk out a medical appointment feeling like they’ve been sucker punched or go crazy trying to create perfection in the entire family to create a superior breed of children and are met with resentment and rebellion by a family who doesn’t want to live with a control freak. There is no progress until medical practice is evidence-based as opposed to the ancient default of “who sinned – this child or its parents”. The debate about whether medicine should fall under science or theology was supposedly settled once and for all with the debate over where to place Psychiatry.

  12. jake3_14 says:

    Obesity is a dysfunction of hormonal regulation. Carbohydrates drive insulin, and insulin drives fat accumulation. It’s really that simple. The evidence is before our eyes, and it’s literally mounting every day.

    Cut down on the carbs, especially grains. Increase *animal* fat (not vegetable fat) in the diet, because that’s proven to restore health in those with broken carbohydrate metabolism. Listen to Malcolm Kendrick and John Briffa, two respected UK doctors with a record of helping patients with obesity, diabetes, and the so-called “metabolic syndrome” — all without starving their patients on diets that the body fights tooth-and-nail to abandon.

  13. DeeLeigh says:

    Anonymous 2 – for me, it hasn’t been bad at all. I’ve got three degrees, I’ve had an interesting career, I’ve been in happy long term relationships for most of my adult life, and if I’d wanted children, I’d have them.

    I understand that things don’t work out so well for everyone, though. We live in a world where fat people are treated very badly. I think the answer is to try to get rid of the bias and discrimination rather than trying to get rid of the fat people.

  14. Anonymous 2 says:

    DeeLeigh – Despite being overweight or obese for most of my adult life, things have worked out well for me too. I have two degrees, have had an interesting and financially rewarding career, and have been in a happy relationship since I met my now husband at age 20.

    But now that I’m living as a normal-weight person, I’m painfully aware of how much easier and happier my life could have been had I been normal weight all along. I’d rather be part of society that continually fight against it.

    But since you have apparently always been fat, you would have no way of knowing how different life can be.

  15. DeeLeigh says:

    Anonymous 2 – Life would certainly be better if I didn’t have to deal with other people’s baggage regarding my size. But, my body itself? It’s always been healthy and resilient; strong and coordinated. I don’t know how you can claim to know more about how it feels to live in my body than I do. My experience has been that when I’m a bit lighter, I don’t necessarily feel any different. In fact, the only time my BMI was under 30, I was injured and extremely ill and I felt much better once the problem was fixed and my body returned to normal.

    Frankly, I don’t see any point in hating my body because it’s not fashionably small. Surely if I were thinner I’d have been treated better by a lot of people over the years. Hell, I’d also have been treated better by some if I’d looked less “ethnic,” with lighter hair and skin and different features. However, an easier life is not always a better or a happier life and it is not my responsibility to change my appearance (in a way that would require constant discomfort, micromanagement, and investment of time) to dodge other people’s biases.

  16. Lori Lieberman, RD, CDE, MPH, LDN says:

    Here’s three more reasons, both exemplifying that many, perhaps most, MDs just don’t get it. Perhaps you can change that and direct the last link to your MD community.
    Many thanks!

    http://dropitandeat.blogspot.com/2011/02/where-bmi-goes-wrong-lessons-from-cupid.html
    http://dropitandeat.blogspot.com/2011/04/lies-theyre-feeding-you-about-your.html
    http://dropitandeat.blogspot.com/2011/12/what-your-healthcare-team-needs-to-know.html

  17. anon says:

    Dr. Sharma you ask catalytic questions – great! keep them coming! – the very first assumption that drives this entire post is in the title – it is subtle – but just what exactly is a “professional”?

    Sounds like the bloggers are more professed than the professionals you imply exist.

    What is the due diligence of the professionals you are talking about? And who sets the due diligence criteria?

    A “professional” could be someone like you… but there’s only one of you, and a handful like you. So obviously that’s not what you mean because you are asking if all parents of all children… whereas your professional boundary is limited to stage 3 and 4 obese adults. So obviously that’s not the “professional” a parent can seek. If there are only a few like you for stage 3 and 4 obese patients, then the trickle down effect to children tells me the answer is parents are waiting to get an appointment and will wait for quite a few years because the professionals you speak of don’t exist yet. Gotta start with the title right off the bat… do a competency profile on the “professionals” in your title. I’m sure parents would seek out whoever you match to that competency profile – I suspect there will be very few current “professionals” matching it. Be sure to use all domains in the profile – including the affective domain. Many of the bloggers might match the profile more than the “professionals” do.

    Certainly, one of the competencies would be who professes to be on board with you? at least half on board with you? at least a quarter on board with you? … heard of you? … and so it goes… back to waiting for that appointment…

  18. Adriana says:

    I believe that Childhood Obesity is on the rise and now is not the time to point fingers at anyone. It is a problem and there is a solution. There is too much time placed on blaming people as to why children are obese or getting to that point. Focusing on what can be done and how it can be done changes the perspective of the problem. There are so many different communities out there that offer tips on how to engage with your children and influence them to live a healthy life, though it is up to the parent to make that lifestyle change with the child.

    #LetsMove

    Adriana

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