Feature Story 05-Nov-2012
By Justine Urbahn APD
Obesity rates amongst both children and adults are overwhelming. Currently 1 in 4 children are obese or overweight in Australia. These rates are showing no sign of slowing down with predictions that in 2020 rates will be as high as 80%. This trend is consistent in other developed nations. America followed by Mexico are the two heaviest nations. Australia is ranked 6th.
The reasons for these alarming statistics are mostly environmental. Our lifestyle is physically easier than in our grandparent’s day. Computers, remote controls, smart phones and transport allow us to do so many daily activities at the press of a button. Although our lifestyles are mentally more demanding than in our grandparents day, we compensate by taking part in sedentary leisure activities such as computer games, X Boxes, iPods and DVD’s. We are often busy and tired and participate in far less physical activity.
This lifestyle that was unheard of 50 years ago is taking its toll on our health and public health resources. Health problems associated with obesity such as diabetes and heart disease are costing taxpayers into the billions of dollars.
For many years chronic diseases such as type 2 diabetes have been considered problems that only affect older people. Today with the rising rates of obesity we now see obese children suffering from the following:
• Type 2 Diabetes
• Heart Disease
• High Blood Pressure
• High levels of harmful cholesterol
• Low levels of good cholesterol
• Fatty liver disease
• Disturbed sleep
• Insulin resistance
In addition to these physical problems, psychological issues manifest themselves usually during primary school and can have devastating consequences lasting throughout life. Overweight children often have self-esteem issues and can be the target of bullying.
Causes of obesity?
An imbalance of energy intake versus energy output is what causes unnecessary weight gain. If you eat more calories than your body burns off you will gain weight. The environment we live in makes it all too easy to buy cheap, energy dense foods. Advertising leads us to believe many mistruths about our food. Our children know less about fresh food, many thinking food comes from a box. Food is used too often as a treat by many parents rather than treating children to a trip to the park or the beach.
What about Genes?
Our genes determine the colour of our eyes, our hair and our skin. It is thought that 40% of our body shape is determined by our genes. So genes determine if we have an apple shape, a pear shape or if we have a tall lean build or a short stocky build. But only about 1% of the population is thought to have a genetic defect that predisposes us to gaining weight. This is a very small percentage that highlights the influence our environment has on our weight.
Recognizing the problem
For some parents it is obvious their child is overweight when they look at them. With so many overweight people around us though, it is difficult for some families to tell if their child really has a weight problem. Many times excess weight is put down to ‘Puppy Fat’ that he or she will ‘grow out of’. Unfortunately, ‘Puppy fat’ can be the start of a life long battle with weight problems. The sooner you address issues with weight the more hope you and your child have of controlling the problem. Excess weight in childhood is likely to continue into adulthood. Some children will ‘thin out’; however waiting for this can be problematic. It becomes much harder for an overweight teenager to lose weight because they are no longer growing than for an overweight child who can maintain their weight as they grow taller.
If you are concerned that your child is gaining excessive weight then it may be a good idea to have him/her assessed by your GP or Pediatrician. They will measure your child’s Body Mass Index and plot this on a chart designed specifically for children. They will assess whether your child’s weight may be the result of a medical problem or whether it is environmental.
How do you talk to your child about weight?
If you know your child has a weight problem you need to start making changes now. If your doctor tells you your child has asthma and requires medication, then of course you would immediately take action and begin the medication. It is no different to when your child has a weight problem… you need to act on it now!
Many adults who have battled with their weight their whole life, often talk of their sadness as a child when a family friend or relative called them fat. Many speak of feeling inadequate and unloved because of their weight. Your child may already be aware of their weight, particularly if they have slim siblings and friends. So how you approach the issue of weight needs to be handled sensitively.
Before you talk to your child, have a look at your own lifestyle and assess what changes you can implement to make it healthier. If you can make your lifestyle healthier, you will automatically help your child. If you are motivated to improve your own health and wellbeing, you may be able to make all the necessary changes that will help your child without even needing to discuss their weight with them. If you feel you need help with this speak to a Dietitian or a GP. Often when I am seeing an overweight child I like to speak with the parents first. I look at what the family eats, what they buy at the supermarket, how many times they have takeaways and how much time is spent doing physical activity. From this information I can suggest healthy changes that can be implemented for the whole family. It is important that the overweight child is never made to feel different. Dietary advice is based on healthy eating principals that benefit the entire family.
‘Healthy Eating’ is definitely the message to give to your child, avoid the word ‘diet’. The term Healthy Eating is a positive phrase. Teaching your child about healthy choices helps them now and well into their future. You can provide them with positive messages about food when you serve dinner, do the shopping or unpack the groceries. Talk to them about the food you are buying and explain why it is good for them. When your child makes a healthy choice you may take the time to compliment them.
As your child gets older be mindful of the words you use to describe weight. Avoid terms like ‘fat’ and ‘chubby’ and use terms like ‘above average weight’. Avoid stereotypical comments like ‘she is fat she must eat lots of bad foods’ or ‘she is fat and lazy’.
Tell your children you will love them unconditionally regardless of their body shape. Remind them of their positive attributes and how much you admire them. Children also need to know that part of loving and respecting themselves is about making healthy choices to keep their bodies healthy.
In all aspects of parenting our children learn from their parents. Again be mindful of the language you use to describe yourself and your partner. Avoid phrases like ‘do I look fat in this?’ or ‘I am going to start my new diet Monday’.
The engine inside our body
We’ve all heard of people say ‘I only need to look at a piece of cake and I’ll gain 2 kg.’ We know that some people gain weight more easily than others. This may be related to our metabolism. When you have an older child you can talk about the engine inside their body. Explain to them that some people have a really fast engine that uses food up really quickly. These people usually have a very slim build. Some people have a slow engine that uses less food more slowly. Ideally we want to speed up our engines. We can do this by fuelling our bodies with regular, healthy meals, lots of water and plenty of activity.
This is a concept children can grasp. It explains why their super slim sister can eat and eat whilst they have to be more careful about their choices.
No food is bad food.
There are Healthy Foods and Sometimes Foods.
When children are young their food intake is easy to control. But as they get older and start going to school and on play dates, suddenly you are not around to decide what food they eat. Children who have a very restrictive diet tend to go crazy when Mum’s not looking. Being too restrictive inflames a child’s desire to eat forbidden goodies.
Avoid phrases like ‘junk food is bad for us’, or ‘potato chips make us fat’. I like to refer to foods as healthy foods and sometimes foods. As a family you need to decide when it is appropriate to eat ‘sometimes foods’. This way your child will learn that all foods are to be enjoyed but some are healthier for us than others and need to be eaten in moderation.
Understand your child’s relationship with food
Time and time again I see overweight children who are obsessed with food. They think about food all the time, they have a tendency to eat when they are emotional or anxious and they eat very quickly. These children can be harder to manage because they are always nagging you for food. If you have a child like this you may find it helpful to include a small serve of protein such as egg, lean ham, peanut butter, nuts, chicken, baked beans or yoghurt at each of their meals. Ensure that each meal and snack has some low GI carbohydrate such as grainy bread, yoghurt, grainy crackers, fruit bread or sweet potato.
You are not doing your child any favours by giving in to them and allowing them to eat food freely. Children need boundaries for their behaviour and for the foods they eat. It is important to let them know that you have set meal times; 3 meals and 2 snacks. If their intake is appropriate at these meals they shouldn’t be hungry.
Some children ask for food when they are bored, happy or sad. It is important to identify these triggers. If you see this pattern occurring, talk to your child and understand what is going on so that you can help them cope with these feelings in healthier ways. Sometimes it helps if you direct them to an activity. You will know that they are not hungry if they are absorbed in the activity and no longer asking for food.
Children and adults who eat very quickly are likely to eat large portions. Talk to your child about this and come up with a strategy that will help to slow them down. I often suggest timing meals so that meals take 20-30 minutes instead of 10-15.
Should you weigh?
When a child comes to my practice I will weigh them to obtain a clearer picture on where their weight is in relation to their height. Weighing regularly at home is counterproductive. Weight varies from day to day and even week to week.
As a child begins to exercise, muscle mass can change and this can show as increased weight on the scales. I think the effects of regular weighing can be damaging. Remember for a growing child you are not expecting to see weight loss. Weight maintenance is your goal – you want your child to grow into their weight.
Reduce screen time and increase activity
One of the big hurdles families have today is finding the time to be active. High-density living means we don’t often have vast amounts of space for our children to use outside, we are more wary about letting our children walk to school and ride their bikes on the streets. Money is another consideration. Some families just don’t have the money to enrol their children in organised activities.
Sometimes you need to be a little creative when it comes to family activities. The best change you can make is reducing screen time. When children are not in front of their screens they are likely to be moving their bodies.
Think about how you can participate in activities as a family. For the health of your child encouraging physical activity is as important as giving that asthma medication.
A healthy relationship with food and exercise should be a goal for all families – weight problems or no weight problems. I think that just as it is the parents responsibility to teach a child how to dress themselves, cross the road safely, be kind to others and so on, it is also their responsibility to teach their children how to eat well. For families where children are gaining excess weight it is important to act quickly. The younger the child the easier the weight problem is to control. The longer you leave it or deny that there is a problem the more likely your child will battle with their weight well into adulthood.
Justine works at the Sunshine Coast Children’s Development Centre in Minyama. This is a multidisciplinary centre focused on the health and wellbeing of children.
Justine is an accredited practicing dietitian.