Weight Loss: A Family Solution
By Dr. Joseph Skelton
When I was a young resident in pediatric training I met a 12-year-old boy who changed my life.
He was morbidly obese – at least 100 pounds overweight. I was working in Wisconsin then and the specialists ran a slew of blood tests and told his mother that she needed to put her son on a high fiber diet. When he returned for a check-up and hadn’t lost any weight, the doctors, nurses, and dietitians scolded the boy’s mother for not following his advice.
I saw her shame and her son’s and thought there had to be a better way of helping overweight youngsters and their families than blaming them for their children’s weight.
Over the years, I have learned that obesity is a complex condition, but with the right kind of guidance and support, children and their families can learn to control a child’s weight for improved health. The national epidemic in childhood obesity is old news, but perhaps you didn’t know that North Carolina ranks high -- among the top five states. Nationally, nearly 20 percent of children ages 6 to 11 are obese and 18 percent of teenagers. At last count, almost every school system in our region of the state reported that 40 percent of its students were overweight or obese. And I’m sure I don’t need to remind anyone about the health risks associated with childhood obesity, ranging from diabetes to high blood pressure, once rarely seen among children.
Two years ago we started a program here at Brenner Children’s Hospital of Wake Forest Baptist Medical Center to help overweight children and their families. Each family works with a team that includes a doctor, a family counselor, a dietician, a physical therapist or exercise specialist and a social worker with the idea of helping the entire family change its lifestyle. Before we judge we try to understand. Some children are overweight because they eat too much. Others sit at their desk in school all day and in front of the television or computer screen all evening with no physical activity in their lives. Maybe mom works and the neighborhood is too dangerous for the child to play outside alone. Or maybe there’s no time to make meals, so the family relies on fast food.
Finally, we try to set reasonable goals. We don’t believe in putting children on a restrictive diet, or banning all sweets. Losing weight shouldn’t be a punishment. But the family might reasonably be able to adjust its schedule and eat at home three nights a week and cut soft drinks altogether. We teach them how to plan a weekly menu and buy healthy foods on a tight budget. Fresh organic produce might be out of reach for many families, but frozen fruits and vegetables are reasonably priced and healthy too. The family might also be able to take a walk before dinner three nights a week and once during the weekend. Or maybe three nights is too much, but one night works. We measure health here in small steps.
Families want their children to be healthy, but as we remind our patients, we live in an unhealthy world. Many schools offer physical education only once or twice a week, if at all. Youth sports have become so competitive that many children lose out on the chance to play ball. Children crave fast food, sodas, fatty lunches and sugary cereal – encouraged by advertising. At the end of the day, TV and video games win out over a walk in the park. Finally, families are so stressed and pressed for time that they rarely sit down to a home-cooked meal together.
I like to get back to basics. To start, we use 5-4-3-2-1-0:
5- Eat five servings of fruits and vegetables each day.
4- Eat together as a family at least four times a week.
3- Eat three meals a day – no skipping meals.
2- Limit screen time – computer and TV – to less than two hours a day.
1- Aim for one hour of physical activity each day.
0- Reduce the number of sugar-sweetened drinks – sodas and juice – to zero.
Here are some other simple tips to help your child lead a physically active, well-nourished life. Don’t skip breakfast. Skipping meals only makes you hungrier for the next. Don’t ban dessert; serve smaller portions instead. Plan a weekly menu so that you have the ingredients you need in the kitchen when it’s time to make dinner. At 4 pm each day, 80% of families don’t know what they are having for dinner, which makes fast food tempting. And if your budget’s tight, stock up on canned fruits and vegetables, grains and beans.
We hear a lot about the health risks associated with obesity, but sometimes the experts forget to talk about the emotional risks. Overweight children rarely forget them. They know how they are often taunted at school and on the playground. Many children suffer from teasing at home too. They look different from other children, and know it. They feel different, and know it. But they can’t make the changes they need to make on their own.
Change is hard – especially for busy families. Forget about the Biggest Loser on TV. Most of us can’t afford a personal trainer. But I know that even small changes help overweight children. We see such changes every day in our clinic. And pride. One of my patients lost 9 pounds in 10 weeks. We cheered. His mother cried. The last time he lost that amount of weight his doctor scolded him for not losing more. The boy’s mother was so grateful he was on the path to better health.
Dr. Joseph Skelton is the director of the Brenner FIT (Families In Training) Program and a pediatric gastroenterologist at Brenner Children’s Hospital part of Wake Forest Baptist Medical Center.