The Growing Problem of Child Obesity: What We All Get Wrong

New reports indicate childhood obesity is on the rise. Here's one way to fight.

Posted Jan 13, 2020

Kayla marches into my office, clearly upset, stating: 

"So, her doctor tells me that Lana’s inattention and low energy are not ADHD. She has sleep apnea, and he told me she must lose weight right now. He said her triglycerides look like those of a forty-year-old overweight truck driver, her liver numbers are elevated, and she’s at risk for developing diabetes. I mean, she’s only seven! How can he say things like that, right in front of her? He openly said – your kid is overweight. You need to put her on a diet. Everything I’ve read says you don’t talk to kids about their weight, because it will make them develop an eating disorder."

Kayla, Lana’s mother, has her own history with using food as a source of comfort. Kayla is particularly attuned to the risks of low self-esteem due to body image. On the one hand, she’s being told that talking to kids about their weight can do untold harm. On the other hand, she’s being told that her daughter’s weight is an actual problem. After years of struggling with her weight and body image, Kayla has finally found a healthy place. She doesn't want to lead her daughter down the disastrous path she followed, but she also can't ignore her daughter's health.  

Childhood Obesity Rates and Psychosocial Sequelae:

Lana is not alone. Recent research from the Robert Wood Johnson Foundation reveals that childhood obesity rates remain alarmingly high, with 4.8 million American children between the ages of 10-17 estimated to be obese. The AAFP recommends that children ages six and older be screened by their pediatrician for obesity and be referred to more intensive health management if the screening reveals risk factors.

Unfortunately, childhood obesity is the gift that keeps on giving. Research recently published by the journal Pediatric Obesity demonstrates a clear connection between obesity, weight, and being a victim of bullying, particularly among females. In addition, being obese as a child is associated with an almost 80% chance of being obese as an adult, with all the associated health concerns.

At the same time, parents report fear of addressing their children’s weight, and they are right to be concerned. The "Health at Any Size" movement has raised public awareness of the potential harm associated with putting kids on diets; the shaming and blaming that frequently accompanies such interventions can be harmful. But what’s a mom to do?

New research recently published in the peer-reviewed journal Appetite reveals a new family-based approach towards helping children manage their eating behavior. The research points to the emotional toll parents of obese children bear, the sense of support they received from being members of the research study, and the empowerment that a nutritional and behavioral approach towards their children's eating provided them. Let's examine how we used a similar approach with Kayla and Lana. 

Picky Eating and Obesity:

Like many overweight kids, Lana is actually a picky eater. She will only eat foods that have the exact right taste and texture. She also tends to eat a lot of food, particularly when stressed out. I asked Kayla to bring Lana in so that we could talk about what’s going on.

Lana is an adorable girl, with sparking eager eyes, and a tendency to bounce forward in her chair when excited. She tells me she loves school, and that art class is her favorite. When I ask her about her least favorite part of school, she says:

"I hate recess. We have to walk so far down to the playground, and I get worried that if I need the bathroom, I’ll have to climb all the steps back upstairs. Sometimes, I walk so slowly up the steps, and then the kids behind me call me “slowpoke” and they laugh at me, but I can’t go faster because it’s hard to breathe. Also, I don’t like the outdoor games because I’m not good at them. I can’t jump rope so fast like the other kids, and I don’t like playing with a ball. I wish my friends would want to play with me at recess, but they all like to play jump rope and go on the monkey bars, but I can’t do that. It makes me feel very sad."

I am conscious of my own feeling of sadness looking at Lana. She is significantly overweight and it seems to be holding her back from the joys of childhood. She is an extroverted, socially aware child, and she’d like to be joining her peers.

I ask Lana about her picky eating. She shrugs.

"I only eat food that I really, really, like. I don’t like so many things, only chicken nuggets and mashed potatoes and pizza. And treats. I love treats, but my mother doesn’t like it when I eat so many. My mother doesn’t like it when I don’t like to eat her supper. But I can’t help it if I don’t like the food."

Lana’s problem isn’t really an obesity problem, and it really isn’t about her weight. Kayla is correct in resisting her doctor’s recommendation to “put that kid on a diet.” Like many overweight children, Lana is both overweight and undernourished. But what both Kayla and the doctor are missing is a piece of the puzzle – learning to tolerate discomfort in service of a goal.

Food as Nutrition:

The first thing Kayla, Lana, and I start to do is work on understanding nutrition. Not just the concept of protein, carbohydrates, and fats, but also the concept of using nutrients to boost our goals. What foods can I eat to make me better at focusing in class? What can I eat that will make me better at jump-rope, or make me feel calmer, or make it easier to fall asleep at night?

Instead of focusing on what we’re not eating, we need to focus on using food as a nutrient, and a way to fuel Lana’s goals. We can use little cognitive shortcuts – I want to be better at art class? What can I eat that’s orange and has some beta carotene in it? I want to have more stamina for jump-rope? It would probably be a good idea to gets some protein in. I need sustained energy for morning classes, so I can concentrate and do my best? Let’s have a whole-grain breakfast, then!

We also directly target tolerating discomfort in service of a goal. Lana, Kayla, and I watch some videos of training montages – you know the ones, where a character starts out a novice, but trains until she is strong? That’s uncomfortable, but the end results are powerful. Can we practice holding an ice cube, to train ourselves to be uncomfortable? Our hands say to our brains: “Let go! This hurts.” Our brain says back “Yeah, but I’ll get an awesome smelly eraser if I just hold on for a minute. I can do this!” What about chewing a piece of carrot or a bit of red cabbage? It’s true our tongue isn’t happy, but our stomach and muscles will be! We can train ourselves to tolerate discomfort, in service of the goal of providing ourselves with nutrients that make our bodies stronger.

A year later, Lana comes into my office. Art class is still her favorite, and she’d still prefer candy to carrots. But she’s no longer a prisoner in her own body. She can go downstairs to the playground for recess, with no fear of climbing the steps on the way back to class. Her doctor is no longer concerned about her weight, and her health numbers have stabilized. “Dr K., Dr. K., I won the jump-rope contest at Field Day! I jumped for the longest number of jumps.” "Wow!" I exclaim. Enthusiastically, she responds: "How did you do that?" "I wanted to give up. I was so tired, and it was hard to breathe. But I thought “I can be uncomfortable for a little longer, and then I’ll get the medal for my class. So, I did!"

Managing Our Own Discomfort:

We can’t be afraid to talk to our children about their health and about nutrition. As long as we keep the focus on health and nutrients, it’s okay to talk to kids about their eating. The minute we stray away from that, focusing instead on things like appearance, is the minute we run the risk of fostering eating problems. But just like a parent is meant to teach a child about time management, good hygiene, or sleep, we also have to educate our children about eating.

I get the discomfort. I get the fear. We don't want to foster eating disorders, but we also can't accidentally foster disordered eating. Just as Lana and Kayla learned, the key to success is learning to tolerate discomfort in service of a goal. Let's manage our own discomfort, so we can help teach our kids to be healthy. 

References

Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999‐2016. Pediatrics 2018;141

Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315:2292–2299.

Waasdorp TE, Mehari K, Bradshaw CP. Obese and overweight youth: risk for experiencing bullying victimization and internalizing symptoms. Am J Orthopsychiatry. 2018; 88( 4): 483‐ 491.

Andorko, N. D., Getzoff, E. A., Gelfand, K., Demeule, M., & Scheimann, A. O. (2019). Sociodemographic outcomes from an urban pediatric obesity program. Clinical Practice in Pediatric Psychology. Advance online publication.

Wilfley, D. E., Hayes, J. F., Balantekin, K. N., Van Buren, D. J., & Epstein, L. H. (2018). Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice. American Psychologist, 73(8), 981–993.

Ek, Anna; Nordin, Karin; Nyström, Christine Delisle; Sandvik, Pernilla; Eli, Karin; Nowicka, Paulina, (2019). Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity.Appetite, ISSN: 1095-8304, Vol: 145, Page: 104488