Everything You Know About Obesity Awareness Is Wrong

figure-and-mirror-installation

Recently, Childhood Obesity News spoke of Dr. Eric Robinson of University of Liverpool, who looked into the question of whether awareness of one’s own obesity is a good or a bad thing. It seems evident, on the surface, that a person needs to know the problem exists before it can be effectively addressed. But strangely, and counterintuitively, he found that when people are aware of being overweight, they are actually more likely to gain weight. As the old saying goes, ignorance is bliss.

But that finding has to do with adults and the relationship to the self. What about parents and children? Dr. Robinson wondered the same thing, and followed up with another study in which he collaborated with Asst. Prof. Angelina Sutin from Florida State University College of Medicine, to look at how parents perceive a child’s weight.

Much has been made of the widespread blindness among parents to their children’s obesity. For a while there, it seemed as if the obliviousness of moms and dads was the worst problem in the arena.

Along came the Robinson and Sutin study, to rock the boat and possibly even send it to the ocean floor. Parental misperception of a child’s weight status can actually affect future behavior, but not in the way the public had become accustomed to think.

Background, objective, and more

The study Abstract begins by addressing the problem of parental cluelessness, and defining the query:

Although these misperceptions are presumed to be a major public health concern, little research has examined whether parental perceptions of child weight status are protective against weight gain during childhood. Our objective was to examine whether parental perceptions of child weight status are associated with weight gain across childhood.

The subjects were more than 3,500 Australian children and the conclusion is anxiety-provoking:

Contrary to popular belief, parental identification of child overweight is not protective against further weight gain. Rather, it is associated with more weight gain across childhood.

Common sense dictates that anyone who is aware of her or his own obesity would take positive steps to change and improve the lifestyle causing it. But “what should be” often bumps up against reality, and in this world it now appears that awareness of one’s obesity does not always lead to positive change, and neither does a parent’s awareness of a child’s obesity.

This looks chillingly similar to a Catch-22, or a “damned if you do, damned if you don’t” quandary. What good is awareness? What is the purpose of Childhood Obesity Awareness Month, if there is no right answer?

Yet Dr. Robinson tends to believe there are answers, even if we haven’t figured them out yet. He says:

The way we talk about body weight and the way we portray overweight and obesity in society is something we can think about and reconsider. There are ways of encouraging people to make healthy changes to their lifestyle that don’t portray adiposity as a terrible thing.

Your responses and feedback are welcome!

Source: “Can the perception of a child’s weight cause weight gain?,” Liverpool.ac.uk, 04/21/16
Source: “Parental Perception of Weight Status and Weight Gain Across Childhood,” AAPPublications.org, April 2016
Source: “Believing you are overweight may lead to further weight gain,” liv.ac.uk, 08/06/15
Photo via Visualhunt

Too Much Awareness?

stressed-is-desserts-spelled-backwards

This topic belongs in the “Everything You Know Is Wrong” category, especially during the official Childhood Obesity Month. Is there such a thing as too much awareness? Dr. Eric Robinson of the University of Liverpool’s Institute of Psychology, Health and Society, set out to “test the common assumption that being ignorant to one’s weight status is always a bad thing,” as he told Reuters journalist Madeline Kennedy.

The research team learned that people who perceive themselves to be overweight are at greater risk for weight gain. This holds true whether they actually are overweight, or not, although the people who actually are overweight are more likely to gain.

The U.S. National Longitudinal Study of Adolescent Health provided data on 4,000 young Americans. The meta study also consulted a study called Midlife in the United States, and the U.K. National Child Development Study. The latter followed its subjects from age 23 until 45, although the followup periods of the other two studies were shorter (7 years, and 9 to 10 years).

Methodology

In any soft-science meta study, a considerable amount of number-crunching has to be done to persuade figures to line up in such a way that they can usefully be compared with other figures. Kennedy wrote:

The researchers also used demographic information to control for factors such as sex, age, race/ethnicity, education level, income, and health conditions… The study team sought to control for factors known to increase the risk of weight gain and found that the results were not due to outside psychological, health, or environmental factors.

As we mentioned, there is a great need for research that is both long-term and more detailed, to keep track of the ever-increasing number of variables. To get involved with a longitudinal study is not the smartest career move. In an atmosphere where credentials are everything, the best practice is regular and frequent publication, even if there is nothing much to report. To invest the capital of time and brainwork in something that will not come to fruition for 50 years takes real commitment.

Longitudinal studies are more necessary than ever, but they need a stable population, an environment with at least some degree of continuity, dependable funding, and a secure storage place for the data. Those are not wartime conditions. Contrary to the comic-book mad scientist stereotype who thrives on chaotic destruction, scientists have an enormous stake in maintaining peace.

Vicious cycles

The 2015 study also learned that overweight people are more likely than others to use overeating as a tool for coping with stress. Consciousness of being overweight, said Dr. Robinson, “is in itself likely to be quite stressful.” The researchers suggest that this accounted for a big share of the weight gain. Also very stressful is the experience of being or feeling discriminated against, and indeed prior studies indicted that the perception of being a target of bigotry was probably causing people to gain.

This is just one of the vicious cycles that Dr. Pretlow has often discussed, all of which result in weight increase.

Your responses and feedback are welcome!

Source: “People who see themselves as overweight more likely to gain weight,” Reuters.com, 09/22/15
Source: “Believing you are overweight may lead to further weight gain,” liv.ac.uk, 08/06/15
Photo credit: rick via Visualhunt/CC BY

Childhood Obesity Awareness in New Jersey and Beyond

family-exercise

In New Jersey, nearly one child in four is overweight or obese. The YMCA that covers four townships is so enthused about Childhood Obesity Awareness Month they celebrate it in August rather than the more typical September. Their Healthy U program was designed to promulgate behavioral change, going at it from three different directions: nutritional education, exercise, and the involvement of the whole family.

Yesterday we mentioned the importance of water, and here it is again, as the first on a list of tips from the Healthy U game plan:

Make water the drink of choice… Place a full pitcher of water on the table during meals, and allow children to pour their own water.

Also, they encourage a family to not only eat together, but to collaborate in the planning and preparation of meals, and in the cleanup process afterward. Less screen time, more exercise, and more sleep are the items that round out this list.

In the effort to end obesity, there is conflict. During the last presidential administration, the main project of First Lady Michelle Obama was Let’s Move! — and a big part of that was an effort to improve school lunches.

In some circles, the whole program was always profoundly disturbing. In present-day Washington, enforcement of the 2010 Healthy, Hunger-Free Kids Act is very low on the priority list. It would not be surprising if every school district in America were to ignore the rules, because local authorities increasingly wonder why they are jumping through these hoops.

In the hills and hollers

In Appalachia, education department officials are disgruntled over being forced to stock their vending machines with healthier items than were allowed previous to the Smart Snacks in School regulation instituted in 2014. Throughout the bioregion, children are already at risk for obesity simply from being born into an economically deprived rural cultural environment with a shortage of clean water.

Virginia Tech researchers looked into the habits of Virginia students (and it some critics found flaws in the methodology). The university’s press release says:

“We thought the legislation would have a profound effect and assumed there would be changes in snack behavior at school and at home,” said Professor Elena Serrano, who co-authored the study. Instead, Serrano and Georgianna Mann, a former Virginia Tech graduate student, discovered that while there were improvements in the nutritional value of snacks available to students, teens did not report making healthier choices.

Prof. Serrano also added that the situation would likely improve with time, which is always an important dimension to remember. Like other people, children introduced to a new idea do not immediately change their ways.

Awareness is seldom instantaneous. Sometimes, a concept percolates in a brain for years. It might be taken out and mulled over occasionally, and pieced together with other ideas, and correlated with life events. The idea of making an active effort to escape obesity might eventually come to fruition.

In the soft sciences, the relative brevity of a five-year followup period, or even a 10-year tracking system, is a source of frustration. Especially in such a complicated multi-factorial field as obesity, many researchers agree that longitudinal studies need to be more comprehensive and, well, longer.

Your responses and feedback are welcome!

Source: “Program recognizes Childhood Obesity Awareness Month,” MyCentralJersey.com, 08/19/17
Source: “Federal snack program does not yield expected impacts, researchers find,” MedicalXpress.com, 08/17/17
Photo credit: rawpixel/123RF Stock Photo

Awareness Month — a Good Time for Change

be-the-change-quote

Childhood Obesity News has been looking at long-term effects of bad parenting decisions. In the early 2000s, several important studies delved into the mysteries of eating behavior. They explored such topics as obsessive-compulsive personality traits, sugar addiction, brain dysregulation, neuroadaptations, aversive food stimuli, and altered reward processing, all in relation to eating disorders.

When the idea of rewarding exemplary behavior around food is extended to adults, sharp criticism can result. A couple of years back, a high ranking official in Britain’s National Health Service suggested the companies should bribe their employees to lose weight, and should be given government funding to do it.

Columnist Carole Malone’s scornful opinion was that people would gain weight on purpose in order to collect the pay bonus, or whatever other enticement was on offer. She wrote:

Many fat people are fat precisely because they’ve been bribed before. With food. By their parents — to shut them up, to make them feel loved or because they were being a nuisance.

Childhood obesity is a parenting problem, NOT a health problem. Kids who are fat are made fat by parents who are lazy, stupid or trying to buy their children’s affection with food… Rewarding people for stuffing their faces is not the way to go.

Malone is kind of hard on parents, and it is not our intention, during Childhood Obesity Awareness Month, to load parents with more guilt and shame. Instead, we have collected a few suggestions.

For instance, Reddit correspondent “Uncle_Erik,” who brought his weight down from 300 lbs to 170, gives this advice:

If you don’t have a pet, think about it… cats and dogs are really affectionate. They give you something to look forward to and something to look after. If you got a dog, you could take it out a couple of times a day. A good excuse to get outside and exercise, plus the dog will love it.

Dr. Claire McCarthy suggests family walks, with or without a dog, as a way of setting a good example for kids, and also reminds parents who use the services of a child care center, to choose one that offers lots of physical activity. Registered dietitian Maryann Jacobsen reinforces the point that so many other advisors and counselors repeatedly make: The best way to influence children is by consistently demonstrating the behavior you want to see them adopt.

In describing how to raise the expectation bar, she writes:

Model the behavior you want for your child in terms of eating, let them know you believe in them 100% and then keep giving them plenty of opportunities to do it in a supportive environment. The moral of the story is children will rise or fall to our expectations of them. When it comes to eating, let’s aim high.

The same idea is heard again from writer Maria Trimarchi:

Instead of making food a battleground at mealtimes, offer healthy food choices, let kids decide when they are hungry and full, and maybe most importantly, model your own healthy relationship with food and exercise.

Jacobson explains why it is such a poor idea to praise a child for cleaning her or his plate. It is basically saying, “Congratulations for finishing all that even if you weren’t really hungry and didn’t need it.”

Another bad idea is to offer a sweet treat as a reward — even for eating those repulsive vegetables. When the delivery or withholding of food is used as either a promise or a threat, the child begins to assume that normal, non-disruptive behavior should always earn a treat. Jacobson says, “Let them know ahead of time the consequence that will happen if they misbehave — and leave food out of it.”

Your responses and feedback are welcome!

Source: “Reward,” NationalEatingDisorders.org, undated
Source: “Bribing obese people to lose weight will do a fat lot of good,” Mirror.co.uk, 10/25/14
Source: “FatPeopleStories,” Reddit.com, 2014
Source: “The four habits that can keep your child at a healthy weight,” Boston.com, 08/23/12
Source: “The Feeding Strategy Every Parent Needs in Their Toolbox,” RaiseHealthyEaters.com, 12/07/12
Source: “Big Kids: 10 Things Parents Can Do to Fight Childhood Obesity,” HowStuffWorks.com, undated
Source: “10 Things You Should Never Say to Your Child About Food,” RaiseHealthyEaters.com, 09/07/12
Photo credit: Charm2010 via Visualhunt/CC BY

A Few Pointers for Parents

drop-of-water-closeup

In honor of Childhood Obesity Awareness Month, here are some suggestions for parents who want to avoid or reverse obesity in the home.

Dr. Dyan Hes, Director of the Pediatric Weight Management Program at New York Methodist Hospital and author of a piece titled “What I Wish Everyone Knew About Childhood Obesity,” is in favor of the baby-steps approach to change. She offers a number of behavioral tips for parents. First, leave the weigh-ins for doctor visits. Weighing a child at home can set the stage for eating disorders and body image issues.

Another recommendation is to encourage the child to drink two cups of water before going to a birthday party or, presumably, any other food-intensive event. A parent can make water interesting by letting the child pick a special superhero cup that is not used for any other beverage. Exploring natural no-calorie water flavorings could be a family project.

Water is, of course, useful for many health-related purposes. There is almost no such thing as too much. Parents might hesitate to encourage more water, because of the hassle of changing diapers, or finding and dealing with a public restroom. At the very least, a parent can try for energetic water promotion on days spent at home. Conscientious parents will soul-search for places where they might be sabotaging their children’s health without even realizing it.

Parents have strong feelings about their children. Of course a mother would pick up a car that was resting on the body of her child. Of course a father would slay a regiment of home invaders to protect his children. But the challenge of long-term parenting is just that — it lasts forever. To make rules is a thankless task, and to stick with them can be a tedious, stressful, ongoing chore. Any parent who has the chance to take a Parent Effectiveness Training course is a lucky parent indeed.

Dr. Hes also recommends packing a healthful school lunch at home, rather than counting on the cafeteria’s offerings to do nutritional justice. And don’t buy breakfast cereal with added sugar.

Perhaps the most important recommendation, and one that goes along with the notion of taking it slow, is to consistently give positive reinforcement rather than the negative type. In a moment we will say unkind things about using food as a reward for kids, but there is perhaps one instance where it is forgivable. If a child who struggles with weight asks for a pint of raspberries rather than a candy bar, it might be a good idea to spring for the fruit, even if it is heinously expensive.

Food rewards for kids

Some parents are defeated by the sheer length of time that parenting lasts. Children just keep on being childish, day after day, until they aren’t children any more, and then it gets even more complicated, because now they’re teenagers. But parents always need to remember to take the long view, and play the long game.

When the focus is short-term, warns registered dietician Maryann Tomovich Jacobsen, “we are more tempted to employ feeding strategies that are counter-productive for kids’ eating down the line.” She says:

The more frequently parents use food as a reward or punishment, the more likely it is their kids will grow into adults who eat in the absence of hunger.

The problem is that when kids equate food with winning they tend to become adults who go after food rewards, and even unnecessarily complicate their own lives in order to feel entitled to these rewards. This is how people are trained to believe the advertising slogan “You deserve a break today,” when the so-called break is actually a pile of cholesterol, sodium and grease.

Your responses and feedback are welcome!

Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
Source: “What Rewarding Kids with Food Looks Like 20 Years Later,” RaiseHealthyEaters.com, 05/27/11
Photo credit: Public Domain Photography via Visualhunt/CC BY-SA

Childhood Obesity Awareness Month Is In Session

whipped-cream-eating-contest

Once again, September is Childhood Obesity Awareness Month. Suggestions and resources for activists can be found at HealthFinder.gov which offers starter-kit suggestions.

Let’s look at the implications and ramifications of some. Here’s one:

Encourage families to make small changes, like keeping fresh fruit within reach or going on a family walk after dinner.

Maybe the whole “butterfly effect” story is a bit much, but without getting into nonlinear equations and chaos theory, it is possible to say that the potential impact of a small change should never be underestimated. It is true that change is difficult to bring about in families, which are sometimes too proud of being set in their ways.

Kids are especially prone to rebellion of different kinds, at different ages. Like most of us, they don’t like to be told what to do. In a family setting, a demand that everyone go on a hike because it’s good for us might be resisted.

A crafty parent will start with a child’s interest, which might be to find a certain kind of rock, or a bird skeleton. Plan a hike with the one kid, and see how fast somebody else gets on board. You welcome that next one, and pretty soon, who knows? All family members might come along.

Or maybe they will next time. The point is, you never know until you try. And once the horizons open up a bit, you never know what might happen. Going for a walk, you might run across a place that teaches martial arts; and a year from now, have the fittest former fat kid on the block.

Here’s another suggestion:

Motivate teachers and administrators to make schools healthier. Help them provide healthy food options and daily physical activities for students.

On a local level, one secret of exerting influence is to not just show up for your own hot-button issue. It helps a lot to build your street cred by joining the PTA, or going to every city council meeting. Volunteer. Earn the reputation of a reasonable, level-headed citizen who works and plays well with others. This is the path to becoming a motivator of teachers and administrators.

Ask doctors and nurses to be leaders in their communities by supporting programs to prevent childhood obesity.

This suggestion might need some thought. Doctors and nurses are already asked for a lot. Could time and energy be more effectively applied to the root, namely, their education? It might be more effective, in the long run, to look into the requirements to graduate from medical school.

What are doctors taught about obesity? It might be very dangerous to assume that we know what goes on there. What else should be added to the curriculum?

Pediatrician Dyan Hes wrote “What I Wish Everyone Knew About Childhood Obesity,” which includes these words:

I try to make recommendations that I think a patient can accomplish in a week or two, whether it’s “stop all soda and sugar sweetened drinks,” “walk up and down the stairs, do not use the elevator” or “no more rice with dinner.” Rome wasn’t built in a day. If I overwhelm a parent or child with extreme recommendations, they usually won’t come back. However, if they can actually stop drinking soda for two weeks, they’ll be proud of their accomplishment and get a lot of positive feedback at their next visit with me.

Next time, we look at some of Dr. Hes’s specific tips for parents, and also some suggestions from other experts.

Also recommended are past Childhood Obesity News posts about the various aspects of awareness, and the importance of calling attention to the issue.

Your responses and feedback are welcome!

Source: “National Childhood Obesity Awareness Month,” HealthFinder.gov, 2017
Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
Photo credit: William Wootton (wwootton1) via Visualhunt/CC BY

The Tribal Urge to Belong

i-beat-anorexia

Belonging is an acknowledged basic human need. To be part of a group makes a lot of people happy, to the point where the traits, qualities, or purposes of the group take a far second place behind the fact of belonging to it. Could it be that, as time goes on, more obese people experience a higher quality of life simply because they come closer every day to being a part of the majority?

The Framingham Heart Study learned that if, during the study, a person became obese, there was a significant chance that their sibling or spouse would become obese also. Genetics and proximity could explain those cases.

However, there is more to it:

But if study participants had a friend who became obese, the chance the study participant would become obese rose by 57%. Sure, friends share some meals, but nothing like most meals.

Dr. Anthony Komaroff goes on to say:

Although scientists don’t fully understand how obesity spreads, they suspect that a social network influences what its members perceive as normal and acceptable. If people see their friends becoming heavier and heavier over time, they may accept weight gain as natural, even inevitable. Instead of exercising more or eating less when their weight begins to creep up, they may simply go with the flow and join the crowd.

Bingo! Joining the gang is what it’s all about. This could explain the twisted appeal of aligning with the extreme “fat acceptance” side of things — to be part of a rowdy crowd of misfits, like the gentlemen in the illustration.

Or maybe not. Maybe everybody is overthinking it, and the mystery isn’t all that complicated. What if, Dr. Pretlow asks, “they simply love the pleasure of food/eating and are willing to tolerate the obesity side effect?”

In “Obese Youth and Motivation,” Dr. Pretlow says:

It’s difficult to distinguish willful pleasure-seeking with food versus true out-of-control eating and inability to change in obese young people. The quandary is whether obesity is due to brain changes, which the individual cannot help, or is it a voluntary choice?

The idea of committing suicide by sugar is hard to assimilate, but it really should not come as that much of a shock. People are willing to die for things — for a flag, or a rush, or a chance to play professional sports. Why not for food?

The first place where a person wants to feel a sense of belonging is in the family of origin. One of the findings of the landmark 2007 meta study on Quality of Life amongst the obese young makes it clear that healing needs to start at home.

Led by Dr. Rebecca M. Puhl of Yale’s Rudd Center for Food Policy and Obesity, the study showed that teasing by parents is common. The text reads:

A growing body of research shows that parents and educators are also biased against heavy children. In a 1999 study of 115 middle and high school teachers, 20 per cent said they believed obese people are untidy, less likely to succeed and more emotional.

It is possible that parents may take out their frustration, anger and guilt on their overweight child by adopting stigmatizing attitudes and behavior, such as making critical and negative comments toward their child.

The study authors suggest, as always, that more research is needed.

Your responses and feedback are welcome!

Source: “Social networks can affect weight, happiness,” Harvard.edu, 10/29/15
Source: “Quality of life for obese kids same as cancer patients: analysis,” CBC.ca, 07/12/07
Photo credit: genebrooks via Visualhunt/CC BY

Are Obese Kids Miserable? Maybe.

laughing-crying-masks

Ten years ago a study caught the attention of obesity experts by comparing Quality of Life in obese children with that of cancer patients. The lead author was Dr. Rebecca M. Puhl of Yale’s Rudd Center for Food Policy and Obesity.

The text spoke of stigmatization and suicidal thoughts. An Associated Press story noted some of the details:

The stigmatization of overweight children has been documented for decades. When children were asked to rank photos of children as friends in a 1961 study, the overweight child was ranked last. Children as young as three are more likely to consider overweight peers to be mean, stupid, ugly and sloppy.

Still, difficult as it may be to believe, one of the big mysteries of obesity is whether the children and teenagers are happy or not, and particularly, how obesity affects their quality of life. This is important to know, because in the effort to reverse the obesity epidemic, we can’t afford to waste resources.

Dr. Prelow says:

Once and for all, we need to resolve this happiness versus misery question for obese young people. If they are unhappy, then this can generate motivation to go through withdrawal and break their addiction to overeating. If they are happy in spite of their obesity, then no intervention is going to work.

As it turns out, overweight or obese children and teenagers will pretty consistently shy away from talking about it, to the point of outright denial that anything is amiss in the emotional department. While it is obvious that their quality of life is negatively impacted, they seem very reluctant to openly acknowledge the specific challenges or their feelings about them. When information is so hard to come by, the next best thing is to consult grownups who, thanks to therapy or merely because time has passed, can discuss the traumas of their younger years without inhibition.

Or perhaps there is, after all, nothing to talk about. The introduction to a 2009 study of health-related quality of life (HRQOL) in obese children and teens observed that while previously these age groups had been studied less than adults, “the last 6 years has seen an increase in the number of pediatric studies examining the relationship between obesity and HRQOL.”

However, the researchers had found no earlier meta study attempting to bring it all together, so they designed one. They came up with few clear conclusions, most of which emphasized the need for further study:

[T]here is a lack of information on the specific effects of obesity that contribute directly to poor HRQOL in obese children and adolescents in both community and treatment-seeking samples…

Furthermore, studies of long-term follow-up of HRQOL after weight loss are needed to ascertain whether improvements in HRQOL, which occur concurrently with weight loss, are maintained over time…

It appears that obesity is inversely associated with pediatric HRQOL, in particular, physical and psychosocial functioning with school functioning being largely unaffected.

The Wiley publication “Correlates and suspected causes of obesity in children” states:

Although there exists some ambiguity in the research regarding the degree of happiness in children with obesity, treatments that promote the child’s psychological wellness and happiness should continue to be examined relating to promoting enduring weight reduction.

As so often happens, what we are left with is the need for more research.

Your responses and feedback are welcome!

Source: “Quality of life for obese kids same as cancer patients: analysis,” CBC.ca, 07/12/07
Source: “Health-related quality of life in obese children and adolescents,” Nature.com, March 2009
Source: “Correlates and suspected causes of obesity in children,” Wiley.com, 07/13/09
Photo credit: elnur/123RF Stock Photo

Are Obese Kids Miserable? No.

heart-chocolate-cupcake

Dr. Pretlow has heard from thousands of kids, speaking with the freedom of anonymity, who express unhappiness, and either state or imply that this is a direct result of their obesity. Because of this experience, it is puzzling to run across the occasional Quality of Life study that reports a large quantity of happiness and contentment among obese kids.

Dr. Pretlow says:

In the more than 140,000 bulletin board post on the weigh2rock.com site, the level of human misery (virtually) expressed by the obese young people was staggering. Yet, it might be claimed that those who post such struggles are either faking or only a small percentage of obese youth.

In all fairness, many Weigh2Rock comments affirm that being an obese child or teen is not all that bad. Here are some:

Age 14, female, 5’5, 119 lbs
My life isn’t horrible, but it’s not amazing either 🙂

Age 14, male, 6,0, 230 lbs
i like being fat

Age 13, female, 159 cm, 219 lbs
Im okay with being fat and all my friends are fat too. Were all pretty happy, noone makes fun of us for being fat

Age 13, female, 52, 113 lbs
I am happy with my weight, hieght and who I am

Age 16, female, 6′, 190 lbs
I feel fine about my life no matter what because God makes us this way for a reason. I don’t feel overweight, but sometimes I feel like people look at you funny. I just don’t care anymore.

Age 13, female, 5’4, 123 lbs
my life has its good times and its bad times,but thats life and so im satisfied wid my life cuz i no its normal cuz every1 goes thro it at 1 point.luv

Age 12, female, 5.3, 154 lbs

its okay

Age 15, female, 5’1, 180 lbs
i’m more satisfied with myself than my weight

Age 14, male, 6’1, 243 lbs
i guess my life is ok…my weight doesn’t bug me at least, i dont really like school but who does…im pretty satisfied i guess

A 2012 study looked at 3,227 sets of parents and children in the “Be active, eat right” program. The kids were of all types — underweight, normal weight, overweight, obese, and severely obese. The conclusion could suggest two things — either overweight kids are no more unhappy than others — or perhaps, all are equally miserable.

Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Dr. Pretlow conducted a poll of overweight kids in the wild (not study subjects) asking about their satisfaction with themselves and their lives. There were 141 replies:

I am very satisfied: 26 votes (18%)
I am satisfied: 34 votes (24%)
I am neutral: 32 votes (23%)
I am dissatisfied: 17 votes (12%)
I am very dissatisfied: 32 votes (23%)

Dr. Pretlow remarked, “Our poll results are also consistent with the quality of life level of the 87 obese youth in our two studies, none of whom seemed particularly unhappy about being obese.” In other words, from the outside, not much motivation toward change is apparent.

Is it possible that obese youth actually are not miserable? Could it be possible that few are even mildly disgruntled? The reason these questions need to be asked and, hopefully, answered, has at least two parts.

There is the simple preference to not have a bunch of unhappy kids moping around the place. People are, of course, marvelously resilient, and every day we see our fellow humans manage to enjoy life under circumstances that astonish more fortunate people. Some obese people of all ages seem to enjoy fulfilling the jolly fat person stereotype. Still, good function and lack of pain are goals worth pursuing for both ourselves and others.

And there is the more complicated drive to understand motivation. If we start with the premise that obesity is not a desirable condition, and learn that there are people who don’t enjoy being in that state, of course we want to know what could kickstart their motivation to change. There are so many ways for obesity to negatively impact a young life, it seems unlikely that anyone could remain emotionally unaffected.

Your responses and feedback are welcome!

Source: “Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry,” Springer.com, June 2012
Photo credit: Janine (nina.jsc) via Visualhunt/CC BY

Are Obese Kids Miserable? Yes.

frowning-teen

In previous posts, Childhood Obesity News has mentioned many of the physical and emotional consequences of obesity in the lives of children. When young people apply to participate in one of Dr. Pretlow’s W8Loss2Go studies, they fill out questionnaires.

One question is, “How much does being overweight bother you?” With 1 as the lowest score and 10 as the highest, most of the respondents check 10, indicating that the amount of distress constitutes an important problem.

Yet, once the study period is underway, in face-to-face or phone interviews, the subjects become strangely reticent, and claim that everything is going fine or (this happened twice) burst into tears and hang up. It is easy to see why kids don’t want to talk about this stuff because, really, who does?

A person of any age is embarrassed to be unable to fit into a restaurant booth, and the post-op patients who frequent BariatricPal.com are not shy about discussing the other problems they remember or, very possibly, are still dealing with. Sometimes the best we can hope for is that grownups will reveal some fat-kid secrets from their own pasts.

A woman wrote to the discussion forum about how, as an obese teen, she used to develop rashes in her skin folds. Dr. Pretlow says:

In a recent talk by Dr. Grace O’Malley […] she noted that markedly obese youth have a nightmarish fear of falling down in front of their peers (e.g. at school) and not being able to get up, like a turtle on his back, with devastating humiliation.

Acid reflux is increasing along with childhood obesity, but the two are not always both present. It can make eating so difficult that a teenager might actually lose weight.

The manifestations are pretty gross. The Daily Mail quotes these words of pediatric gastroenterologist Dr. Mike Thomson:

Often adults with acid reflux realize they had it during childhood without knowing what it was. And even GPs don’t always recognize that children and young people can suffer acid reflux, delaying their treatment. Often the symptoms can be vague. But acid reflux should be considered by GPs if children experience pain when eating or when they wake up.

Treatment is available, in the form of an implant called a Linx band. Of course, it is much preferable to not have acid reflux in first place, but many obese kids and teens do.

In an newspaper opinion piece, two doctors wrote of obese children who had been teased and bullied by their own families, making them feel as if there was nowhere to turn:

This has significant consequences: Overweight children have higher rates of depression, stronger feelings of worthlessness and inferiority, and even higher rates of suicide. This consequence is not new, despite the fact that we seem to largely ignore it; as early as the 1940s obesity was described as a “psychological handicap” because of the social stigma associated with it, something that has only continued to get worse.

Childhood Obesity News has mentioned the sad life and death of a young man who grew up piteously obese, apparently with the full cooperation of an enabling mother. His dearest wish, to have a wife and children, was never fulfilled.

He told reporters who worked on his video biography, “I learned at an early age that it was better for me to keep to myself.” Why? Quite possibly, because the mother’s jealousy was too high a price to pay. It looked like a classic case of emotional incest, with an exotic folie a deux delusion thrown in for good measure, allowing both of them to pretend it was normal for the son to weigh 600 pounds.

Eventually he became unable to leave home at all, which may have been exactly what the mother, consciously or subconsciously, wanted all along. His last words were, “Mama, I can’t breathe…” How appropriate for someone who seems to have been assisted to his grave by smother-love.

His mother told the press, “I don’t know what I’m going to do without him…” It is a banal sentiment, voiced by many bereaved people, yet in this case of extreme and fatal codependence, uncomfortably on the nose.

Your responses and feedback are welcome!

Source: “Anyone want to be fat again?,” BariatricPal.com, 08/18/14
Source: “Children suffer acid reflux too — and it can cause years of misery,” DailyMailco.uk, 02/09/15
Source: “Op-Ed: Once a Fat Kid, Always a Fat Kid,” TakePart.com, 03/27/13
Source: “A Life Apart: The Toll of Obesity,” ExpressNews.com, 12/27/14
Photo credit: Paul De Los Reyes (Noize Photography) via Visualhunt/CC BY

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
Copyright © 2014 eHealth International. All Rights Reserved.