Little Kids, Big Problems
We've heard a lot about what it takes to prevent obesity, but what do you
do when your child desperately needs to lose weight? The Evans family is finding out, and their lessons can help all of us.
For Marianne and Mike Evans, the wake-up call came at the end of a checkup for their daughter Morganne, who was then 6. "We knew she was heavy, and starting in preschool she'd been consistently gaining more weight than she should have," says Marianne, of Youngstown, Ohio. "But this time it was different. It wasn't just that her weight was high. Now her blood pressure and cholesterol level were high too. Her doctor referred us to a pediatric cardiologist."
The scary news may have been lost on the good-natured first-grader who loves to chase Mitchell, her little brother, and Meganne, her big sister, around the yard. But for Marianne, a public-health registered nurse, the idea of Morganne seeing a cardiologist felt like a splash of ice water, and the doctor's suggestion that Morganne might even need medication to lower her cholesterol horrified her.
"I already felt bad about her weight," says Marianne, who also struggles with the scale. "I had recently switched from part-time to full-time work, so I wasn't able to cook the way I wanted to or spend as much time playing. When Morganne would ask me, 'Why can't I be thin like Meganne?' it almost broke my heart. But this was about her health. We knew we had to do something major, and Mike and I were afraid."
In fact, Morganne's situation is a reality for millions of American families. Today, 15 percent of children and adolescents are overweight, and another 17 percent are obese. Since the obesity epidemic began in earnest in the late 1990s, pediatricians have been warning parents about the health problems that overweight and obese children would face in adulthood, including the heightened risk of cardiovascular disease. But today, high blood pressure, a precursor to heart attacks and strokes, is common among children with weight problems. Obese kids -- those whose body mass index (BMI) is at or greater than the 95th percentile, meaning they're as big as or bigger than 95 percent of children the same age and sex -- are three times as likely to develop hypertension as those who are within a normal weight range. Of course, many of these heavier kids also face type 2 diabetes and liver and kidney disease, as well as a greater incidence of poor school performance and being bullied.
However, hypertension can cause symptoms immediately, including headaches and, in more extreme cases, chest pain, blurred vision, and seizures. Marianne knew that her whole family needed to act quickly.
The Cardiologist's Verdict
Morganne's first visit to R. Peter Vande Kappelle, Jr., M.D., a pediatric cardiologist at Akron Children's Hospital in Boardman, Ohio, was in April 2011. He determined that her BMI was 20.6, greater than the 95th percentile. She was no longer just overweight, but obese. Her parents expected Dr. Vande Kappelle to put Morganne on a diet. But experts now recommend treatment plans that are realistic and long-term, not restrictive. "With a child like Morganne, our goal is not weight loss, but to slow her weight gain to an appropriate level," Dr. Vande Kappelle says. He urged her parents to make small and sustainable changes. "By focusing on Morganne's BMI over time, and stabilizing the rate of her weight gain, our hope is that her weight will normalize as she grows taller."
The doctor sent them home to dig up their kids' growth charts, and Marianne did some soul-searching. "Morganne was a normal-weight baby, and a normal-weight toddler, and always active," she says. "But when she was 3, she gained 14 pounds in a single year, and she was in the 90th percentile for weight. It happened again the next year. Now I kick myself for not paying closer attention. We had so much going on: I was pregnant; we were selling our house and moving into a new one; I was working more because of the spread of H1N1, so my dad was helping out by watching the girls. We think maybe Morganne was bored when she got home from preschool and ended up snacking a lot. We were all just rolling along with the craziness of every day and the problem crept up on us."
The night of Morganne's appointment, her mom made an announcement at the dinner table, telling the kids what Dr. Vande Kappelle had said about changing their lifestyle. (She has fiercely avoided using words like fat, heavy, or obese, or referring to Morganne's weight in any way.) "All of us, even Mitchell, are going to be making some changes to be healthier," she explained. "We'll be more active, cut back on sweets, and learn more about choices. This isn't just about Morganne. We're all in this together."
New House Rules
One of the first moves was letting the kids know that Mom and Dad weren't just paying lip service to eating healthier -- they meant it. While the children were never allowed to eat in their bedroom (and TVs were forbidden there, in large part to discourage snacking), Morganne had been sneaking treats, and her parents started taking it seriously.
Next, at the suggestion of Dr. Vande Kappelle and the dietitian, they targeted beverages, cutting back on soda and juice, and offering more water and skim milk instead. "Sometimes, we give the kids CapriSun Roarin' Water. It's about 30 calories a pouch, and they all love it," Marianne says. They didn't give up juice altogether, but Marianne watched how much the kids drank more closely and began experimenting with vegetable juices, including V8 V-Fusion.
Both parents made an effort to model better eating themselves, which Mike says has been challenging, conceding that his habits are "really poor." "I have to make a conscious effort to make better choices around them," he admits.
Marianne started smartening up family meals. While the kids still occasionally get the buttered noodles they love, they've switched to high-fiber, high-calcium Ronzoni Smart Taste pasta, and I Can't Believe It's Not Butter! spread, made with heart- healthier fats. New rules govern treats too. They didn't banish their favorite cookies -- but they watch portions very carefully. "And when one of the kids celebrates a birthday, we make a big deal about getting a cake. Morganne gets a slice, because she deserves it as much as everyone else. I never deprive her," says Marianne.
In fact, she says, treating everyone the same way is her most important rule. "Everyone is allowed to eat the same things. I knew we couldn't single Morganne out."
"I wasn't thrilled at first," admits Meganne, 11. "But I knew we had to do it for Morganne. And I like having new foods now. I had a turkey wrap in my lunch today that was really good."
Building a Fitter Family
Adding activity and exercise has been tougher. Marianne quickly learned that finding one solution that worked for all five of them was practically impossible. For one thing, they couldn't agree on what to do. Golf would be Mike's choice, which is not exactly kid-friendly. The family had had a membership at the YMCA but didn't go enough to make it worth the money. "I'd joke that it was my $78 monthly swim," Marianne says.
Meanwhile, Mike has a demanding work schedule with lots of special events. He's on his feet all day, and comes home beat. Marianne, on the other hand, works behind a desk and wants to get moving when she gets home from work. Now that Meganne is in middle school, she has to keep up with her violin and French classes, plus both she and Morganne are Girl Scouts. And the fact that Mitchell is a toddler adds a logistical wrinkle to everything the family does.
Still, Marianne set a goal for of 60 minutes of exercise for everyone, every day. And while they don't often reach that goal, they're working on it. Mike, who joins in on family bike rides when he can, keeps everyone's tires pumped up. Marianne hitches Mitchell's trailer to her bike, and she and Morganne pedal to the local high school and back, a 2-mile trip. On bad-weather days, they play Wii. "We're trying to be active together whenever we can," Mike says. "We just bought a pool, so the kids can spend a lot more time swimming." And Morganne keeps an activity log: "She loves filling out what she does every day," says her mom.
Teaching Healthier Choices
While the whole family needs to focus on health, Morganne's issues require special attention, and her parents are working to help her develop better decision-making skills. That way, she'll achieve a healthier BMI as she grows, and have rock-solid habits by the time she enters her teens. This means teaching her to think about what she's eating. "When she's hungry, I'll ask, 'What are you hungry for?' and that's an important conversation. The point is to get her talking about her choices," Marianne explains. "When she asks for seconds, it's the same thing: 'What do you think would fill you up? What is the healthiest choice?' I don't want her to be obsessed with food or feel that she's being singled out or punished. I won't be so restrictive that I encourage closet eating. When parents are too strict, kids can develop eating disorders, and that's as scary as obesity." But it's all paying off, in Morganne's growing ability to control herself, says Marianne. "She's starting to be able to say things like, "Okay, Mom, that's enough -- I don't want any more."
Dealing with Morganne's need to lose weight has created a ripple effect throughout the whole family, in unexpected ways. Mitchell is still in the 19th percentile for weight, but he's loving all the fruits, vegetables, and extra time riding bikes. Meganne has actually lost weight and slipped down to the 64th percentile. "At first, we worried a bit -- there's some intense body-image stuff girls face at her age. But it seems to be the result of eating less junk and more produce, and of moving more," says Marianne.
And while Morganne's BMI hasn't declined yet, her weight has stayed level, and Dr. Vande Kappelle is confident that the number will go down as she grows taller and continues to eat healthier foods. And he's encouraged that her blood pressure has dropped. "Because she's addressing this now, she's started an upward spiral, building on the small, positive changes the family is making," he says. Her parents couldn't be prouder of the way Morganne continues to be genuinely upbeat, easily adapting to the many lifestyle changes they've thrown at her as if they were second nature.
But the most humbling aspect, Marianne admits, has been coming to terms with her own personal weight issues. "Even with all this happening with Morganne, I'm at my highest weight ever," she says. Her daughter's health has pushed her to work harder to lose weight. Marianne had her first child when she was 31, and Mitchell when she was 40: "It's so important for me to be around to see my children grow." In addition to her intended 60 minutes of exercise with Morganne at night, she and some friends have signed up for a "Biggest Loser" challenge at work, and she's adding in activity whenever she can. While those changes haven't resulted in much weight loss so far, Marianne, who has hypothyroidism and needs to have her blood checked twice a year, has numbers of her own to be proud of: "Just by biking and walking, my blood work results are now normal."
Even better, she says, "I get to let Morganne know she's not alone in this whole experience. It means a lot that I can say, 'I know it's hard. But Mommy has to work on being healthier too.'"
When Parents Lose, Children Win
The evidence keeps piling up: Parents are the most important role models for heavy kids. A new study from the University of California at San Diego tracked 80 families with overweight children for five months, evaluating the impact of parents losing weight themselves, changing the home food environment, and trying new parenting techniques, such as encouraging kids to be more active or to control portions. All three strategies are good, but the best predictor of a child's weight loss? Parents who lose weight too.
From age 2 on, doctors use a body mass index to track a child's weight. As with adults, the BMI for kids is based on height and weight. But while adults are considered overweight if their BMI is between 25 and 29.9, and obese if it's higher than 30, for children those cutoffs are determined using national percentiles that factor in gender and age. A child with a BMI in the 85th to 95th percentile is overweight; a child with a BMI greater than the 95th percentile is obese. Just as parents are typically told which percentile their child falls in for height and weight, they should now get the percentile for BMI at every checkup as well, according to the American Academy of Pediatrics. To determine your child's BMI, click the link below.
Originally published in the August 2012 issue of Parents magazine.