My child is fat, help!

• Obesity = condemnation to poor health (that’s wrong!)
• Obesity = fault of your child/yourself (that’s wrong too!)

Let’s take a deep breath, and face the facts. Obesity is not your child’s (or your) fault, and is not a sentence to death!     What is childhood obesity?   Theoretically, childhood obesity is determined according to growth charts, which are based on population averages. You know, these curves where your family doctor indicates the weight and length of your child at each appointment. The World Health Organization defines it as “an abnormal or excessive accumulation of fat that poses a risk to health”. In concrete terms, it is a multifactorial and complex problem. The determinants of obesity act synergistically. No, obesity is not the result of simply eating too much and being a couch potato! In fact, the physiological causes of obesity are far from well understood by scientists. At this point, be wary of anything that guarantee weight control. Be wary of your own beliefs even… We have to reflect on our beliefs related to obesity. Often, we want to believe that the solution to obesity is easy, so we adopt the arguments that confirm our opinion. On top of that, what some people think they know about weight control has been “taught” to them by the weight loss industry. The weight loss industry has all the advertising money to tell us exactly what we want to believe: the body is malleable, the weight loss is accessible, and anything is possible with enough willpower …and our weight loss products! But let’s be lucid, it’s an industry that wants to see us fail and come back for more products. It doesn’t have our best interest in mind! Nobody can guarantee weight loss.   Well beyond your child’s willpower   Body weight development is complex because it’s influenced by a multitude of factors. Many of these factors, and especially their interactions, are poorly known and out of our control. The determinants involved are:

• Genetic and biological factors
  • hormones, heredity, disease, gender, ethnicity, etc.
• Personal and psychological factors
  • anxiety, perfectionism, desire to please, low self-esteem, etc.
• Family factors
  • eating and physical activity habits, culinary skills, erroneous beliefs, family dynamics, parents’ attitudes towards their own weight, etc.
• Social factors
  • social norms of thinness and beauty, socio-economic status, type of work, peer pressure, etc.
• Environmental factors
  • place of residence, access to healthy food, presence of elevators and escalators, lack of bike lane, portion size, ready-to-eat food offer, public policies, etc.

  In other words, although it is clear that weight gain results from excess energy in (food intake greater than energy burnt), the reasons for this surplus are multiple, synergistic and changing.   Individual differences further complicate the picture. For a similar lifestyle, two children will not have the same body weight. Also, the fact that the rate of obesity is increasing around the world shows that the phenomenon largely exceeds people’s willpower. A multitude of factors influence body weight … the majority of which are not under your control.   Nobody is guilty of having obesity   We want to believe that weight loss is accessible (and why do we want to believe it so much?), that we’re ready to believe that obesity is the fault of the person with obesity. That it’s your child’s fault for eating too much, or your fault for not cooking balanced family meals every day. Because in the end, if people with obesity are responsible for their weight problem, that means they also have the possibility to change. They must simply choose not to change. They just must be lazy… As dietitians, our impression is that many people do not want to hear the truth, let alone believe it. Well, we have good and bad news. The bad news is that weight cannot be controlled. The good news is that weight cannot be controlled! Let us explain. No, despite some appearances, the body does not shape as want, and even when we manage to lose weight, we do not control the effect of this weight loss on our metabolism, our image, our hunger, our muscles, our potential weight rebound… In return, the good news of not being able to control our weight is that it can induce a certain peace of mind? Knowing that we are not guilty, cowardly, lazy, stupid, unworthy…or anything that deserves to be blamed. Could knowing and accepting that fact lead us to let go, to stop the guilt, and to force us to consider another approach? We say yes. Hear us out. It’s a good news to know that you cannot control your and your child’s weight.   Control and Power   Control involves authority, obligation, punishment, guilt. You know, all those things that we hate, and kids too!   But the notion of control in health science is illusory and harmful because it denies the reality of unique individuals and the biological complexity that makes us alive.   It also undermines real power by bringing guilt, shame, discouragement, too many “I must” and “I should have” thoughts. Let’s enter the era of power – the one that underlies possibility, capacity, permission, latitude, action. Because if we don’t have control over our child’s weight and many of its determinants, we have immense power over our behaviours. Our behaviours indirectly influence our family’s health and well being (and weight if you insist!). We have power over our behaviour, but no power over the consequences of our behaviour. We can take action by focusing on the immediate pleasure of doing it rather than being disappointed because our expectations are unrealistic. As soon as we adopt power over (inaccessible) control, it is no longer a question of stopping anything. It’s all about starting something new, something that we have the freedom to choose according to our desires, our tastes, our personality and our family reality. For example, you could choose to improve your diet for the sake of discovering new foods or cooking with your family, rather than having to skip breakfast because “I am so fat” and “it’s about time I take charge of myself”. One is an ability, the other is a punishment. And nobody likes punishment. If you don’t have control over anyone’s weight, the whole family has the power to act: to learn how to integrate new healthy habits, for pleasure and satisfaction!   What science says about the treatment of childhood obesity   First, let’s start by saying that all treatments should always depend on an individualized and exhaustive professional evaluation. No single treatment is suitable for everyone. Also, if you believe that your child’s health is at stake, please visit a health care professional that will guide your family. That being said, you and your family can take action now. A starting point for the nutritional treatment of childhood obesity is ultimately quite simple: adopt a balanced diet. However, from your kids point of view, it is not so simple since they are not usually responsible for meals planning and shopping. That’s where it becomes a little more complex. The nutritional treatment of childhood obesity must be part of a family plan. The whole family must engage in healthy habits, and a balanced diet must become part of the family’s lifestyle. Not only will all of the family members benefit from these good habits, but doing otherwise would only isolate and stigmatize the child with excess weight. The child isolated could think it’s unfair (with reasons) and feel helpless and lonely, ultimately losing motivation and being depressed. Besides, the whole family is encouraged to become involved, not to “support the child with obesity” but because acquiring good habits is desirable for all, regardless of their body weight. It goes without saying that to teach by example is always impactful. The nutritional treatment of childhood obesity must be part of a family plan, where everyone works together.

Get allies!

  Professional support may be recommended depending on the situation. If you think that professional help is needed, know that many professionals can help you in different ways: physicians, dietitians, psychologists, kinesiologists. And in that case, look for empathic and caring professionals. All family members should feel comfortable with their health team.

Empathic and caring professionals with whom the family feels good can help support lifestyle changes that will last.

 

What can I do now?

  Simple and concrete actions can be incorporated into your family routine now. The main goal is to choose what the family enjoys and which actions are likely to become a new habit. Let’s be realistic, a habit takes time to implement, so be kind to yourself! We suggest three simple ideas. Don’t hesitate to come up with your own modifications. Try out different things as it’s the best way to find what works for your family! Involve your children to suggest ideas to improve your family health and to adopt a healthier lifestyle (you understand at this point that it is better to avoid presenting the idea as “the little one must lose weight”).  

1. Have snacks easily accessible

  Try to keep healthy snacks ready to eat. You could of course cook home-made muffins or granola bars, but if time (or inspiration) is lacking, you could start with fruits – preparing them in advance. We are talking here about washing grapes, cutting a pineapple or cantaloupe into bite-sized pieces, or washing strawberries. Another winning and easy solution is to have mixed nuts in the pantry, or pre-cut cheese pieces. The idea is to have simple, tasty and accessible solutions on hand for you and the children.  

2. Avoid free-for-all without falling into restriction

  An abundant food environment encourages us to eat more than necessary. However, the line between not-at-all and way-too-much is sometimes blurry. Here are some ways to apply this principle. When cooking a meal including portions for next day’s lunch, put the lunch portions aside before serving the meal. This avoids having to say no to someone who asks for more (which could be associated with restriction). Nothing prevents them to eat something else if they are still hungry (yogurt, fruit, cheese, bread, etc.). But the simple fact that the serving dish plate is empty could be enough to realize (consciously or not) that in fact, they are not hungry anymore. Another example is to keep a limited number of temptation foods at home, such as cookies. When the one box of cookies is empty, it is done. No free-for-all, no restriction, there are just no cookies anymore! All of a sudden, the washed grapes are disappearing! And suddenly, a new habit is integrated, without effort and with pleasure … Because everybody knows that fruits taste like paradise!  

3. Involve the whole family and don’t isolate people with excess weight

  Health is good for everyone, regardless of the number on the scale. A child with excess weight (just like an adult, for that matter) doesn’t have to be marginalized, made feel guilty or be the only one to have to take extra care of himself. It is unfair and harmful for their mental and physical health. Stigma doesn’t motivate. Isolation is more likely to undermine the child’s self-esteem, leaving him feeling helpless, unworthy or rejected. Try to opt for inclusion and kindness.

Involve the whole family and don’t isolate family members with obesity: health is good for everyone!

 

You’ve just taken the first step!

  Finally, if you believe that professional help might be useful, don’t hesitate to consult. Sometimes it can be the little kick needed to know how and where to start.

Improvement is accessible to everyone, perfection, to no one!