Childhood Obesity

Do you have a young child whose weight or eating habits are out of control? Need some real world help with ‘taming the cookie monster'? Here are some things that worked for our family.

Our daughter, now 14 years old, was plump from birth and thrived happily for her first year on a combination of breast milk and formula. When she was completely weaned and eating only solid foods, however, she began to gain a great deal of weight at an unhealthy rate. This continued for the next year until, on the advice of her pediatrician, we began to modify our daughter's eating habits. She was barely two years old, but her doctor felt strongly that we should make some changes before her weight became a lifelong problem. The goal was to prevent further weight gain until her height could catch up with her weight, without depriving her of nutrition or having her feel deprived of the comforting aspects of food.

I'm happy to report that our daughter is now a slender, healthy teenager with good eating habits and no ‘food issues', but learning how to modify our family's eating behavior was a long trial and error process. Because she was still mostly pre-verbal, discussing nutrition or reasoning with our toddler was not an option. We kept trying new things and learned over time what worked for her. (These tips should prove useful with older children as well but are NOT meant to replace professional advice: Be sure to talk to your pediatrician before changing or restricting your child's diet.)

The first step is to explain thoroughly to grandparents, daycare providers etc., your concerns and those of your pediatrician's, pointing out that overweight children move more slowly, get less exercise and therefore develop less body confidence, often have social difficulties in school, and frequently become overweight adults.

Reassure them that you will follow good nutritional practices, that your child is under the care of a competent pediatrician, and that you will take special care to fill her psychological need for food in more appropriate ways.

Explain your goals for your child's weight (e.g. zero weight gain until weight catches up with height), and tell staff your child should not be praised OR punished where food is concerned, only encouraged to eat slowly and move on to another activity when a reasonable-sized meal has been eaten.

Once a month weigh your child and measure her height, being careful not to express displeasure if her weight has increased. Instead, praise her, saying 'how proud you are of the ways she is growing'. Get a copy of your child's growth chart (weight-for-height) from her doctor, and keep it updated monthly. This gives important feedback regarding whether your methods are working, and you can adjust meals, activity levels, etc. accordingly. Never scold your child for overeating or being heavy: Our daughter went through the chubbiest part of her childhood completely unaware that she was in any way 'different', and eventually succeeded in achieving a healthy weight.

This requires commitment and discipline! You will only make things much, much worse if you single out a child to eat differently than the rest of the family. The whole family should be working toward healthy life-long eating habits and it's your job as parents to make sure this happens. I do know it's HARD to not order pizza when you are too tired to cook, but make it a once a month treat instead of a mainstay meal.

Do the obvious things to cut down on fat in your diet, including switching to skim milk, eliminating butter, cutting back on cheese and fried foods, and cutting out desserts altogether. Snack only on fresh veggies or fruit, and an occasional Popsicle treat (no fat!). Serve water as a beverage with dinner, (think of milk as a food rather than a beverage) and allow unlimited quantities of steamed or raw veggies (no butter, no 'dip'). You as parents should decide how much 'main course' of a meal your family should have. Serve the heavier foods directly onto plates from the stove rather than bringing piles of food to the table, so there is less temptation to have seconds. Make sure portions are generous enough to satisfy true hunger, but not excessively large.

If seconds are requested, ask your child to wait a few minutes to 'let her food settle', or until everyone else has finished, and then give her a smaller second portion, and no third portions for anyone unless it's a low-fat Item. Do the same yourself, and save any 'Ben and Jerry's' binges for after your kid's bedtimes.

Sometimes waiting a few minutes in between servings did the trick and our daughter realized she was full before gobbling up a whole second helping, but she would often feel torn about leaving any food on her plate, and stuff herself to the point of a tummy ache just to finish what she started. (This happened even though we NEVER insisted she 'clean her plate', a misguided and outdated parenting policy!).

To help her 'let go' of a meal we promised that we would 'save it for her' in the refrigerator, and then wrap it in plastic and let her see us put it away. This really seemed to do the trick: She got to remain 'in charge' of 'her' food, but didn't have to feel any sense of loss if it went uneaten.

We did the same kind of thing with candy, too. (People love to give chubby kids candy!). We had a 'candy jar' on top of the fridge, where we put any gifts of hard candy she received (we weeded out the chocolate after she went to bed). After dinner, to help her know that 'eating time' was finished, she was allowed to choose one piece of hard candy for dessert. This solved the in-between- meal whining for candy issue as well as gave an endpoint to the meal without serving a heavy dessert.

If your child has some quirks around food (and don't we all?) think hard about what need the food may be filling, and try to meet that need more appropriately. Common needs are Control, Boredom, Anxiety, Anger, and Loneliness. Get creative and keep trying new things. The consistent message you should be sending is that her needs are important and you will help fill them, without using food as a substitute. Your child should always feel that she will get enough to eat when she is hungry, and if you don't keep junk food in the house, she will learn to eat healthy food to feel full.

It seems obvious but it's worth mentioning. Even the chubbiest kids get hungry and need to eat to keep up their energy levels. Regularly scheduled low-fat between-meal mini-snacks can help with this. The worst thing you can do (in my opinion) is make such an issue out of food that it becomes an unpleasant weapon of control. Your child should always feel in charge of her eating, and your job is to help her learn the best possible eating habits.

When you child does ask for food always offer something from the 'unlimited' list: a steamed or raw veggie, or occasionally some fruit, unless it's obviously NOT an appropriate time for snack (just before bedtime, or moments before a meal is served).

Consistently attempt to replace your child's need for comfort food with some activity that she enjoys: Say "Let's read that new library book together first!", and offer a snack AFTER the activity. In this way you can gradually learn to tell when your child is actually hungry and when she has some other need, such as feeling tired, bored, scared, sad, or just wanting some attention. Gradually she'll learn to tell the difference, too, and slowly stop using food as her first 'fill the need' strategy.

By consistently offering only healthy food in reasonable quantities, with 'seconds' allowed of the heavier foods, and some 'unlimited' foods always available, your child will retain a great deal of control. She will get to decide how much 'unlimited' food to eat, and won't constantly hear 'NO' when asking for more. ("You've already had seconds on the chili, honey, but you can have more carrots if you want").

Allowing a snack when requested eliminates the chance of anxiety developing over NOT getting something to eat when your child actually IS hungry. By stalling the snack for a few minutes to read with your child or play a game, you send a message that food will always be available, but it's really not an urgent problem, and in the mean time there may be a better way to comfort herself.

Changing family eating habits can be difficult, especially when food has been used as a source of family comfort or entertainment (and it occasionally is, even in the most 'perfect' of families!). Expect your overweight child and other family members to resist changes in eating habits, especially older children who have had longer to become entrenched in the junk food life. Keep firm in your knowledge that you are doing your best for your family, and even if it doesn't always go smoothly you will KEEP TRYING. Don't become discouraged or feel like a failure when your child gains weight or begins 'sneaking food'. This isn't a reflection on your worth as a parent, but instead shows how difficult this problem can be. If a family crisis or change in routine (i.e. vacation) throws you back into bad habits, start again. This is a PROCESS and is the best gift you can give your child.

Cathy Strahl, M.P.H., is the mother of two and the owner of www.ShopHopping.com, an on-line retail store featuring hand-selected developmental and educational toys for infants and children through age 13.

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