When you have an overweight child, fighting our country's obesity epidemic is exhausting. With the problem now almost as old as Justin Bieber, virtually every parent knows what to do. We've heard it all thousands of times: healthier foods, fewer snacks. More activity, less TV. Takeout, no; family meals, yes.
It's doing all those things consistently that wears families down. The drive-through is easy; buying, chopping, and then cooking vegetables is harder. Our best intentions get railroaded by a world that seems to conspire against us: classmates with "better" (unhealthier) snacks; the bank that gives out lollipops; the grandmother who always arrives with a little bag of cookies. And then there's that most disheartening word of all: yuck, as a preschooler spits out the healthy meal we worked hard to buy, prepare, and serve.
We're battle-weary, and the misleading message so many of us want to believe -- that there's no need to do anything drastic, and every little bit helps -- isn't working for many families today. To put it bluntly, we're losing the war. "We live in a culture with a toxic food environment, and it undermines practically everything families do to stay healthy. It takes a lot of effort to work against that," explains Parents advisor David Ludwig, M.D., Ph.D., professor of pediatrics at Harvard Medical School and director of the New Balance Foundation Obesity Prevention Center at Boston Children's Hospital. The fight against what's unhealthy in society is way beyond any one parent, it's true. "We can immediately change what we do in our home, though, making it a sacred space that supports health," Dr. Ludwig adds.
Last month, we introduced you to the Evans family of Youngstown, Ohio, who are helping 7-year-old Morganne get on track toward a healthy weight. (See link to their story below.) But every family has its own challenges, of course, from working night shifts to dealing with interfering in-laws. Dr. Ludwig and other experts help parents of overweight children overcome nine common obstacles.
Denial is a major problem in treating overweight children. A University of Maryland study recently found that mothers of overweight toddlers were 87 percent less likely than those of normal-weight kids to accurately perceive their child's body size. Because so many kids are heavier these days, those with a weight problem don't look unusually big, says Vandana R. Sheth, R.D., a registered dietitian in Los Angeles and spokeswoman for the Academy of Nutrition and Dietetics.
But a child's Body Mass Index, or BMI, doesn't lie. This measure is a ratio of height and weight, adjusted for age and sex, and then plotted against national percentiles. Parents should now get the percentile for BMI at every checkup, starting at age 2, according to the American Academy of Pediatrics. A child with a BMI in the 85th to 95th percentile is overweight. And a child with a BMI above the 95th percentile is obese.
If you have a relative who's in denial, take him to the next doctor's visit. "I sometimes even write a prescription for the other parent to come in for an appointment, so I can explain," says Dr. Ludwig. "After hearing about the health risks, the other parent may better appreciate the importance of addressing the child's size." Your child probably won't just outgrow his weight problem, he adds. Without some kind of intervention, overweight toddlers are five times more likely to still be overweight at age 12, found research from the National Institutes of Health.
"Time is a huge issue," agrees Amy Jamieson-Petonic, R.D., director of wellness coaching at the Cleveland Clinic and a spokeswoman for the Academy of Nutrition and Dietetics. "It's important to put your supermarket trips on the calendar, sketch out a meal plan for the week, make a list, and get your coupons organized," she says. If possible, avoid shopping on weekends. "Tuesday and Wednesday are typically the least busy days in stores, so you can get in and out more quickly," says Jamieson-Petonic. And although it's fine to shop alone for the sake of efficiency, take your kids along now and then. "The more involved they can be in making food choices, the more cooperative they'll be at home."
Prewashed and chopped vegetables may cost a little more, but they're a big time-saver. And many frozen veggies are just as nutritious as fresh ones. Keep a few other fallbacks in the freezer too: Kashi, Amy's, and Digiorno all make reasonably healthy and kid-friendly pizzas. Serve with milk, vegetables, and fruit for dessert, and you've turned a cop-out into a solid supper.
And don't rule out takeout altogether. "Bring home a rotisserie chicken and put it in a salad, or add it to chicken broth with brown rice and vegetables," suggests Columbus, Ohio, dietitian Sally Kuzemchak, R.D., who blogs at realmomnutrition.com. "Asian rice dishes -- like chicken or shrimp with veggies -- are great, if you can request brown rice and sauce on the side."
You don't have to! What matters is creating a healthy food environment in your home, says Dr. Ludwig, who is coauthor of Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World. After all, it's harder to resist the foods if they're easily accessible. "Make a rule that if it doesn't support health, it's not allowed in the door," he suggests. "But that doesn't mean you can't have a special treat outside the home once in a while."
Dr. Ludwig believes the ritual of dessert is so important that it should happen every night. "It actually helps prevent overeating, because it makes you more satisfied. The trick is to redefine dessert. Make it a square of dark chocolate with at least 70 percent cocoa content, which can be a health food; a few roasted pecans; and maybe warm cider to add a bit of sweetness."
Sadly, until you get the whole family on board you won't be able to help your overweight child very much. "What parents do has a far bigger impact on kids than what they say," explains Lori Fishman, Psy.D., a psychologist who consults with families through Boston Children's Hospital's Optimal Weight for Life program. "As long as your child sees you, your husband, or her siblings drinking soda or eating chips, she'll want them." This can lead to resentment and sneaking food.
So avoid sending a mixed message. Soda is either a healthy choice or it isn't, no matter who is drinking it. "Help your child understand that you're not punishing her with restrictions, you're improving her health," says Dr. Fishman. Ask your husband to drink his soda outside the house and not around your child.
On the nights your child won't eat what you're serving, don't make a new meal. Try Dr. Ludwig's technique: "When our 3-year-old won't finish his dinner, we cover the plate and stick it in the fridge. Then later, if he says he's hungry or asks for a snack, we serve him the same food." If your child still refuses, you may have to let him go to bed without dinner. Saying something like, "We're sorry. Maybe tomorrow you'll have an easier time eating dinner" will make it clear that he'll have to learn to like what you serve. (Obviously, never do this with a child who is sick.) Just keep the conversation calm, says Dr. Ludwig: "Your job is to remain peaceful, loving, and firm. Children do not starve for the lack of mac 'n' cheese." That said, if your child is having a particularly tough day, you might offer a healthy snack, like an apple or plain yogurt, as a fallback.
Once the harassment for snacks starts up, change the conversation from food to play. Experts say it's too easy to get sucked into the food side of your child's weight problem and neglect the importance of activities. But new studies show that being too sedentary is an even bigger health risk than being overweight -- and besides, kids usually want to play. Family walks and bike rides or just a game of freeze tag can get their mind off the food fight.
It's okay to let her have candy or treats with other kids, as long as it's in moderation and supervised. "There's no reason she should feel singled out because of her weight," says Dr. Fishman. "Occasional treats at school or at parties are fine. You don't want to be too strict. What matters most is what happens inside your home, where you have more control."
It also helps to remind kids that everyone needs to make healthy choices; people who are at a normal weight stay that way through conscious decisions, not by eating anything they want. "Saying things like, 'You know, I'd rather have a candy bar than an apple sometimes too. It's not easy to make the healthier choice,' lets her know that this is a lifelong journey for everyone," explains Dr. Fishman. "If you can, avoid words like good and bad, or fat and skinny. Instead, focus on the simple concept of healthy and less healthy. It's a message your child will need throughout her lifetime, no matter how much she weighs."
It really does take between ten and 20 tastes for a child to warm up to a new food, which means tons of rejection for the cook along the way. "In our house, I suggest that everyone at least taste new foods that are offered," says Dr. Jana. "We call it the 'No-thank-you bite.' They don't have to eat more. That way they at least have to try a little." Meanwhile, experiment with sneaking grated vegetables into sauces and meat loaf, or buying fruit-juice blends that contain vegetables. (Just be mindful of serving sizes; fruit juice can be highly caloric.)
Research shows that families who eat together have a much lower incidence of obesity, says Jamieson-Petonic. The good news is that it doesn't matter which meal it is. Start small and try to schedule three family meals per week. A new study from the University of Illinois at Urbana-Champaign reports that those three meals have a major impact, reducing the odds of children becoming overweight by 12 percent and increasing the likelihood of kids eating healthy foods by 24 percent. (As kids get older, having meals together lowers the risk of disordered eating by 35 percent.)
Children, like adults, take about 20 minutes to accurately assess how full they are. To the average 4-year-old, 20 minutes can seem like two hours, so there's often a major disconnect between what's happening in his brain -- as in "I'm staaaarving!" or "I'm bored now, so I must be full" -- and what's actually in his belly.
The secret to slowing down mealtime? "Have fun at the dinner table," says pediatrician Laura Jana, M.D., coauthor of Food Fights. "Keep it light. Play games." For example, the whole family can try eating with their nondominant hand or with chopsticks. Ask questions about your child's day to slow the pace of the meal. You can also encourage kids to sip water or milk between bites, and try serving food in courses once in a while, to teach kids that, at least sometimes, they can eat at a more leisurely, mindful pace.
It's even trickier for kids with special needs to maintain a healthy weight because of mobility limitations, medication side effects, and food aversions. The Centers for Disease Control and Prevention reports that children with disabilities are 38 percent more likely to be obese.
If you have a child with special needs, daily routines are especially important. For kids who are mobile, running games, walking to destinations, swimming, and bike riding are all good ways to increase activity levels. If you're not part of a special-needs family but have friends who are -- or even if you see some kids in the park -- make an effort to start playground games that include them too.
While all children need about 60 minutes of activity per day to stay healthy, encouraging a heavy child to move more isn't easy. By age 4, children are already developing a physical concept of themselves, and by age 5 they start to get self-conscious about their weight. Many heavier kids are shy about group play and need coaxing. Try involving your child in these activities:
Originally published in the September 2012 issue of Parents magazine.