Critical problems and risks

The first half of the book Children and Teens Afraid to Eat: Helping Youth in Today's Weight-Obsessed World examines the research and the realities of eating and weight problems impacting youth today, and documents the tragic effects of the current cult of thinness on our children and society.

From the book, below, is a listing of these major eating and weight problems. They are interrelated and intensifying. What affects one, affects the others. To help without doing harm, they need to be addressed in a comprehensive way.

Six major eating and weight problems:

- Children and Teens Afraid to Eat: Helping Youth
in Today's Weight-Obsessed World, p18 

Guidelines for parents

How to prevent weight and eating problems
 

• Be active with your children. Have fun together in a variety of physical activities.
  
  
• Promote communication and sharing of feelings.
  
  
• Teach positive self-talk, self-acceptance and self-respect. Praise and support each other.
  
  
• Promote respect for others and appreciation of diversity.
  
  
• Be a role model of normal healthy eating and lifestyle.
  
  
• Communicate that "Every body is a good body," and avoid focusing on weight or shape in a negative way.
  
  
• Promote normal eating and diet-free living.
  
  
• Eat family meals together at least once each day, if possible, and with the television off.
  
  
• Help children develop interests and skills that lead to success, pleasure and fulfillment in areas where appearance is less important.
  
  
• Encourage friendships with caring neighbors and other adults.

from Children and Teens Afraid to Eat:
Helping Youth in Today's Weight-Obsessed World, p200

In its second half, beginning on page 199, as above, Children and Teens Afraid to Eat gives clear guidelines for parents, teachers and health professionals on how to promote healthy living for young people. The author advocates a health at any size approach in which all children receive consistent messages to eat well, live actively, and feel good about themselves and others. Now in its third 2001 edition this book is highly recommended by health and nutrition experts and being used extensively in schools and health clinics in the US and Canada. First published in 1997, it has changed the ways that families, counselors and health professionals relate to children.

 7 steps to healthy living
and healthy weight

The book Underage and Overweight: Our Childhood Obesity Crisis – What Every Family Needs to Know explains the facts behind today’s eating and weight crisis for children. For parents, teachers and health professionals, it i ncludes a seven-point program for raising confident healthy-weight children who naturally enjoy good health in body, mind and spirit. The seven steps are listed below.

1. Normalize activity. Active living is basic to good health. Be active with your children. Have fun together in a variety of activities.

2. Normalize eating. Establish regular mealtime eating habits – three meals a day and one or two snacks – beginning with breakfast. Stop all dieting and food restriction. Instead, help your children respond to their own internal signals of hunger and fullness, so they eat when hungry and stop when full.

3. Balance sound nutrition. In this plan the child first learns to normalize eating patterns and tune in to body signals, then gradually begins to modify food choices, if needed. Good nutrition includes all five food groups – breads and cereals, fruits, vegetables, meat and alternatives, and milk and dairy.

4. Feel good about yourself. A nurturing environment in home, school and community promotes all aspects of growth and development for children, in mind, body and spirit.

5. Communicate feelings. Promote communication and sharing of feelings from the time children are young. How to listen attentively, calmly and noncommittally and provide feed back..

6. Feel good about others. Help your child develop good relationships, not only with their peers, but also with caring neighbors and other adults.

7. Balance the dimensions of wellness. As we consider the whole child in body, mind and spirit, keep in mind that weight and eating are only part of wellness, and need to be kept in perspective.

from Underage and Overweight: Our Childhood Obesity Crisis – What Every Family Needs to Know, p374-377 

Healthy living at home, in child care, community and health care

 The Iowa Program

The 48-page position paper Prevention of Child and Adolescent Obesity in Iowa gives guidelines for a healthy lifestyle that is preventive of both weight and eating problems in five areas: the home, child care, community, health care and school.

The components are in the three areas of regular physical activity, healthy eating, and positive lifestyle. Healthy eating respects each child’s right to decide what and how much to eat. Positive lifestyle is an emotionally healthy one in which size is accepted, differences are respected, and children are taught self reliance and resistance to society’s pressures to diet or be obsessed with weight. The guidelines emphasize the importance of adults as role models.

In Iowa, where children now spend an average of three hours a day watching television, parents are advised to limit television and computer time to no more than one or two hours a day. Child care providers are urged to limit TV and video time to one hour or less.

A sampling of Iowa recommendations in four areas:

AT HOME

• Include physical activity in family outings on a regular basis, even if only for short periods of time.
• Limit sedentary activities, such as television or computer time, to 1 to 2 hours a day.
• Start early to establish healthy eating practices in the home. Young children are quick learners.
• Plan healthy snacks. Snacks are needed to meet a child’s nutritional needs, add variety and satisfy hunger between meals without spoiling a child’s appetite. Be wary of continuous snacking, which may lead to overeating.
• Provide praise and positive comments to children that focus on their strengths and do not refer to body size either as a strength or weakness.
• Recognize that a child’s body shape will change as he or she grows. A short stocky child at age nine may grow to be tall and lanky.
• With older children discuss how the media uses unrealistically thin models to sell their products.

IN CHILD CARE

• Provide daily opportunities for large motor muscle activity daily through outdoor playtime or alternative activities during severe weather.
• Limit time spent watching TV or videos to one hour or less a day.
• Children and adults eat together and eat the same foods.
• Limit high sugar and high fat foods without being overly restrictive.
• Children are allowed to refuse to eat a new food, but the caretaker serves the food again. Repeated exposures to a food usually result in a child accepting new foods.
• Caretakers refuse to prepare additional foods for a child who chooses not to eat.
• Food is not used to punish or reward children. Instead, favorite activities or time with adults are rewards. Withholding food causes a child to fear hunger and overeat at a later time. Sweet foods appear more attractive to children when they are used as a reward.
• Do not refer to body size either as a strength or weakness.
• Avoid teasing a child about his or her body size.
• Recognize that children may be healthy at a variety of weights.

IN THE COMMUNITY

• Market physical activity through positive portrayal in the media.
• Plan new development to promote walking.
• Flood a park for winter skating.
• Promote after midnight recreational programs or other alternative recreational programs for teens.
• Use parenting classes provided through hospitals, schools, alternative schools and community action agencies to stress the importance of healthy eating and foster parenting styles that promote healthy feeding relationships.
• Encourage grocers and restaurants to offer healthy fast food options.
• Encourage local media to positively portray children with a variety of body sizes.
• Ensure that mental health professionals in the community are familiar with issues of body image disturbance, weight problems and their relationship to self-esteem.

IN THE HEALTH CARE SETTING

•  Nutrition assessment conducted by a licensed dietitian to assess etiology of excessive calorie intake including basic pattern of meals and snacks, frequency of fast food intake, frequency of juice or sweetened beverage consumption, leisure time activities, and caregiver nurturing style/feeding interactions.
• Establish goals: primary goal – develop healthy eating and activity patterns (general lifestyle changes); weight goal – maintenance.  

For Iowa school recommendations, see School Wellness Plans

To download the full 48-page Prevention of Child and Adolescent Obesity in Iowa: Iowa position paper go to www.idph.state.ia.us (click on Resources).

Help for the larger child

Large Children and Self-Esteem

 by Carol Johnson

Yes, more children than ever are overweight, and, yes, we must take steps to enhance their health and help them manage their weight -- but maintaining their self-esteem is equally important. Maintaining a child’s self-esteem is not an easy task under the best of circumstances. Overweight children are especially vulnerable to the harmful effects of weight discrimination. This damage can last a lifetime if not nipped in the bud. Here are some tips for parents and caregivers on how to help overweight children maintain their sense of self-worth.

DO:

• Do love and accept your child unconditionally – regardless of their weight. This will help them to love and accept themselves. Remember -- you love your child not for how they look, but for who they are.  
  
  
• Do treat size and shape as characteristics that contribute to a person’s uniqueness. Teach them that diversity is what makes the world so interesting. Nature provides many examples. Flowers, for instance, come in all shapes, colors and sizes -- and yet all are beautiful.
  
  
• Do examine your own biases and ask yourself whether your concern is for yourself or your child. A larger child may make some parents feel embarrassed, and some may feel that having an “overweight” child signifies a family’s lack of self-discipline. As with most forms of prejudice, these feelings stem from myths and misinformation.
  
  
• Do educate yourself about what causes some people to be larger than others so you can separate myths from facts for your children. Books that will help you do this are Self-Esteem Comes In All Sizes by Carol Johnson (Gurze Books, www.gurze.com) and Big Fat Lies by Glenn Gaesser (Gurze Books). Then educate your children. Have a discussion about heredity. Explain that body size and shape have hereditary elements, much the same as hair and eye color. Be sure to emphasize that it is not their fault and that they are not to blame if they are above average in weight.
  
  
• Do emphasize your child’s positive attributes and talents and teach them that these are the things that count. Help them to develop the things they’re good at.
  
  
• Do make an extra effort to help them find clothes similar to what their friends are wearing. It’s real important at this age to “blend in.”
  
  
• Do arm your children for dealing with the outside world and our culture’s obsession with thinness. Tell them that many groups of people have suffered discrimination and prejudice, and that larger people are one of these groups. Help them plan how they would react to negative comments about their weight. Do some role-playing.
  
  
• Do make your home and family a safe haven for them where they can always count on your support and encouragement. They’ll have enough to deal with outside the home in our fat phobic society.
  
  
• Do be a good role model. Don’t criticize your own body. You’re the most important person in your child’s life. If they see that you like your own body, they’ll find it easier to like theirs. Consider reading Like Mother, Like Daughter by Deborah Waterhouse (Hyperion, 1997), who writes extensively about the influence mothers have over their daughters with regard to body image.
  
  
• Do provide examples for them of attractive and successful larger people, both current and historical. Also give them an anthropology lesson and inform them that many other cultures value and desire bodies of ample proportion.
  
  
• Do help your larger child to unravel the “thin is in” media hype. There are about 400 top fashion models, and less than one percent of the female population has the genetic potential to look like them. Attractive people can come in assorted shapes, sizes and colors.
  

DON’T:

• Don’t tell your child that no one will want to date them unless they’re thin. First of all, it’s not true. Plenty of plus-size teens have boyfriends and girlfriends. Tell your child that lasting affection looks beneath the surface and is not bound by narrow definitions of beauty.
  
  
• Don’t ever put your child on a very restrictive diet. Most dietitians now agree that this is not the way to help them manage their weight. Focus on development of a healthy lifestyle. Make physical activity a family affair -- go for a family walk, buy family swimming passes to a community pool, have a family “dancing party,” go biking together or “go fly a kite!”
  
  
• Don’t become the “food police.” Continually nagging your child about what he/she is eating will surely backfire. Children can always find ways of getting “forbidden” foods. In the worst-case scenario, you could be contributing to development of an eating disorder such as anorexia or bulimia. Besides, foods should not be categorized as “good” or “bad.” All food has a place in normal eating. This is the view of registered dietitian Ellyn Satter in her book How To Get Your Kid To Eat, But Not Too Much (Bull Publishing, 1987).
  

Despite all your child’s best efforts, your child may never be as thin as you think he or she should be. This is not the worst thing that could happen. Some heavy children will still become heavy adults -- and still live satisfying, fulfilling lives. Researchers will tell you that there is much to learn yet about obesity and what causes it. Teach your child that a rich, rewarding life has just as much to do with development of a healthy attitude and self-image as it does with maintaining a healthy weight.

Reprinted with permission from Self-Esteem Comes in All Sizes, by Carol A. Johnson, p152-154. Available from Gurze Books www.gurze.com. A certified therapist with a master's degree in sociology, Carol Johnson is founder of Largely Positive, a support group for large people at http://www.largelypositive.com/