It’s no secret: The U.S. is in the grip of a childhood obesity epidemic. While some reports have suggested that rates have stabilized, a February 2018 study in Pediatrics found no such plateau. In fact,…
It’s no secret: The U.S. is in the grip of a childhood obesity epidemic. While some reports have suggested that rates have stabilized, a February 2018 study in Pediatrics found no such plateau. In fact, the data for kids ages 2 to 19 from 1999 to 2016 revealed increases in obesity at all ages and a sharp uptick in severe obesity among those ages 2 to 5 and girls 16 to 19.
Far more than a cosmetic issue, obesity has been linked to an increased risk of just about every disease in the book, including Type 2 diabetes, heart disease, asthma, gastroesophageal reflux, sleep apnea, joint problems, fatty liver disease and gallstones. “For parents, it’s not that hard to envision the long-term health risks associated with [a child’s] obesity and the limitations on what a child can do because of the extra weight,” says Meagan O’Neill, a pediatrician at Riley Children’s Health in Indiana.
Meanwhile, the body positivity movement has been gaining momentum across the country, pumping out a steady drumbeat of messaging that promotes acceptance of different sizes and shapes and helps people feel comfortable in their skin regardless of weight. These are worthy goals, experts say, yet they may seem out of sync with efforts to curb obesity. Indeed, encouraging kids to achieve and maintain a healthy weight — without triggering body insecurities — can feel like a delicate balancing act for parents. But if the right strategies are used, experts say kids can shed excess pounds and improve their health, energy, well-being and self-esteem. “We encourage a big focus on changing behaviors — those are things parents and kids have control over,” says Brian Saelens, a child health psychologist and professor of pediatrics at the Seattle Children’s Research Institute and the University of Washington.
Various innovative hospital-affiliated programs are helping kids adopt healthy habits. For example, researchers from Massachusetts General Hospital have introduced a one-hour before-school physical activity program called Build Our Kids’ Success, or BOKS, in 24 schools; after 12 weeks, kids who participated three times a week saw improvements in their BMI as well as in their interest in schoolwork. Twice-weekly participants saw significant boosts to mood, vitality and energy.
At Seattle Children’s, a program called Success in Health: Impacting Families Together, or SHIFT, has been convening parents and kids for weekly sessions that teach healthy eating and physical activity behaviors. In 2016, Heather Armstrong, 44, and her daughter Lauren, 11, joined the five-month program because both had been struggling with their weight. By keeping a food journal and having weekly meetings with a counselor, “we really began to notice patterns between what we ate, how much physical activity we got, and our weight,” says Armstrong, a teacher who lost 12 pounds on the program while her daughter lost 8. Armstrong was so impressed that she has volunteered as a peer counselor.
Even if your kids don’t have access to such a program, they can still reap benefits from the lessons imparted. Here’s how experts suggest fostering healthy habits in your kids, while promoting body positivity:
Banish negative body talk. Strike words like “fat” and “chubby” from your vocabulary. Making critical comments about your child’s body or your own as a motivation tactic is “counterproductive,” says Elsie Taveras, who co-authored the BOKS study and is chief of the division of general academic pediatrics at Mass General and a professor of pediatrics at Harvard Medical School. “It’s almost a form of bullying. Some language that may be thought of as endearing can be demeaning and hurtful — ‘my big girl’ or references to love handles or baby fat.”
Instead, adopt a family policy nixing the practice of commenting on the shape of people’s bodies. “Body shaming creates more negative emotions and diminishes self-esteem, and many times children will turn to food to cope,” says Kevin C. Sloan, psychology department supervisor for the division of nutrition and preventive medicine at Beaumont Health in Royal Oak, Michigan.
Meanwhile, make an effort to promote a positive body image from the inside out. As a family, adopt a vocabulary that focuses primarily on how bodies feel and function. “Body image is competency-based — it’s about ‘this is what my body can do for me,’ ” Saelens says. “Encourage kids to think about what their body can do, rather than how it looks.” As a parent, you can model this behavior by commenting on how strong your legs felt while you were running or that you felt like a superhero when you hoisted your carry-on bag into the overhead bin.
Describe food as fuel. Draw a parallel between a high-performance car and your child’s body by discussing the importance of putting the right amount of high-octane fuel (food) into the tank and giving the engine proper maintenance with regular physical activity. That analogy sets you up to educate about “what types of foods we should be eating to enhance performance,” says Kristi King, spokesperson for the Academy of Nutrition and Dietetics and a senior pediatric dietitian at Texas Children’s Hospital in Houston. “Come up with a family definition of healthy foods,” she advises, and shop accordingly. It helps to distinguish between high-octane fuel (fruits, vegetables, whole grains, dairy, nuts and seeds, and lean proteins) and once-in-a-while foods like chips and cookies. “Don’t criminalize certain foods or make restricted foods rewards,” Taveras says. Doing so could lead kids to sneak, hoard or binge on forbidden items.
Promote the perks of healthier habits. When working with an overweight child, registered dietitian Sandra Arevalo, director of nutrition services and community outreach at Community Pediatrics, a program at Montefiore Medical Center in New York, will often say things like, “Wouldn’t you like to be able to run faster, breathe easier or be less tired in P.E. class?” The response? “They say yes! That opens the door for them to focus on the health benefits of changing their behavior,” she says. Parents can initiate similar conversations with their kids.
Lead the way. “You are your child’s first example for how to live a healthy life and take care of your body,” O’Neill says. “If you’re concerned about your child’s weight, you have to change your eating and activity patterns, too.” Consider changes you can make together, whether it’s ditching sugar-sweetened beverages or avoiding fast food. And aim to have at least one family meal each day, King advises. “Focus on getting back to basics: planning meals and snacks and doing prep work with kids, so they have healthy foods like fruit, vegetables, nuts and seeds ready to grab when they’re on the go.” According to a recent study, for kids ages 2 to 5, snacking eats up 28 percent of total calorie intake. And snack times account for 47 percent of beverages consumed per day. So it’s important to make snacking count nutritionally.
Make movement a family affair. Set a weekly physical-activity goal, O’Neill suggests. This could include family walks, bike rides, games of soccer or Frisbee, or anything else your kids like. If they’re into video games, find one that’s dance-based or involves some other movement-oriented activity everyone can enjoy. To get families exercising together, Riley Children’s Health has teamed up with The Children’s Museum of Indianapolis to open a center offering 12 outdoor and three indoor interactive sports experiences and physical activity exhibits, including soccer, basketball and tennis. Look for similar facilities near you.
Beyond the family time, it helps if kids can make physical activity part of the school routine, Taveras says.
“We have to look for ways to increase physical activity in places where kids spend their time,” she says. UCLA Health’s Sound Body Sound Mind program, for example, has installed state-of-the-art fitness centers — with weight machines, Spin bikes, cardio machines, agility ladders, a variety of resistance-training equipment and circuit-based exercise templates — in 141 middle and high schools, mostly in the Los Angeles area.
“We want to see this generation of kids who have been plagued by the childhood obesity epidemic and the physical inactivity epidemic take personal ownership over their fitness journeys,” says Matthew Flesock, executive director of the program. Before the curriculum was offered in 12 schools that received fitness centers during the 2016-17 academic year, only 38 percent of those students passed California’s state-mandated fitness test; after eight weeks on the program, 57 percent of those students passed. The program “has affected how I eat — it makes me not want to eat as much junk food as I used to; it makes me want to take care of my body more and stay healthy,” says Byron Ruvalcaba, 16, a junior at Benjamin Franklin High School in Highland Park, California.
Give kudos for their efforts. Rather than focusing on results of the changes your child is making, “give positive feedback about how hard they’re trying,” O’Neill says. “Even teenagers are desperate for positive affirmation from their parents.” Remember: Sometimes the goal isn’t so much to see the numbers on the scale drop but to either stop rapid weight gain as kids grow or hold their weight steady so their height can catch up, Saelens notes. Meantime, focusing on the good care they’re taking of their bodies will help strengthen their resolve.
Stay on top of social media. Numerous studies report potentially strong negative associations between social media exposure and kids’ body image. But 2017 research found that positive parental influence and a supportive school environment go a long way toward mitigating harmful effects among girls ages 12 to 14. So talk openly with your kids about what they’re seeing on their feeds. “Ask them who their friends are on social media and whether they’ve experienced negative encounters or comments that bothered them,” Sloan advises.
If they have, discuss these issues and help your kids put them into perspective, perhaps by emphasizing their positive qualities to help them view body type as just one component of their makeup. Also, encourage kids to “engage in social networks that are going to be helpful and self-affirming, such as groups that cater toward artistic or musical interests if that appeals to your child,” Sloan suggests.
If diet changes and fitness programs don’t sufficiently help an obese teen shed excess weight, bariatric surgery, particularly sleeve gastrectomy (in which the stomach is surgically reduced to about a quarter of its original size), may be an option. This is especially true if the teen has Type 2 diabetes, sleep apnea or severe fatty liver disease. Even then, the focus is on improving health, rather than looks.
“I talk about the surgery as a means to better health and longevity,” says Thomas Inge, director of pediatric surgery and adolescent bariatric surgery at Children’s Hospital Colorado and a professor of surgery and pediatrics at the University of Colorado–Denver. “For kids and teenagers, weight is a really big deal in terms of their quality of life. It affects their family and peer relationships, physical and mental health, their self-esteem and social competence. When they come back to see me a month or two after the surgery, there are often tears of joy in their eyes.”