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    Types of Bias in Treating Obesity

    September 26th, 2017

    doctor-hand-illustration

    One of the big problems with treating obesity is the difficulty of getting some medical professionals on board with certain concepts — like compassion for the pain of obese patients and the challenges they face. An article by Dr. Dyan Hes begins like this:

    “How do you do your job?” “I wouldn’t touch those kids with a 10-foot pole!” “Your clinic is a mini-psych ward!” “Nothing works!”

    These are just some of the comments I’ve heard throughout my career as a pediatrician who specializes in obesity medicine. What’s worse is that these comments come from other members of the health care community.

    Sadly, some doctor-patient relationships are marred by callousness, indifference, disrespect, prejudice, bias, aggression, and bigotry.

    How Bias Stands in the Way of Addressing Childhood Obesity” is a presentation created by Ted Kyle, RPh, MBA, with the aim of defining and overcoming bias in the professions that concern obesity and nutrition because, as the Summary states:

    Bias causes profound harm: to people, to science, and to health promotion.

    The author defines the two types, one of which is weight bias that targets people with obesity, sometimes causing them to avoid the medical profession altogether. When personnel have preconceived notions that obese people are lazy, weak-willed, dishonest, or afflicted with any other undesirable trait, the result will probably not be good. That type of bias takes up only a small portion of the presentation.

    The other kind is “intellectual bias favoring personal convictions,” and most of the content comprises issues that the author seems to have strong personal convictions about. Kyle points out that, nationally, to service five million severely obese children, there are only 36 specialized clinics in operation.

    He classifies “Promoting breastfeeding prevents obesity” as a myth. On the other hand, he gives this idea the status of a testable hypothesis: “Taxes on SSBs and junk food will prevent obesity.”

    None of these points has anything to do with face-to-face office visits, but are more like arguments designed to influence voters. One of the slides says, “Evidence-based care is mostly out of reach for people with obesity.” Perhaps the author has not heard of W8Loss2Go.

    Kyle quotes Dr. Robert Doroghazi, who recommends telling patients the truth:

    Sir or Madam, it’s not OK to be obese. Obesity is bad. You are overweight because you eat too much. You also need to exercise more. Your obesity cannot be blamed on the fast food or carbonated beverage industry or on anyone or anything else. You weigh too much because you eat too much. Your health and your weight are your responsibility.

    Some would say that is only one version of the truth.

    Your responses and feedback are welcome!

    Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
    Source: “How Bias Stands in the Way of Addressing Childhood Obesity,” ConscienHealth.org, 2017
    Photo credit: Jared Rodriguez/Truthout.org via Visualhunt/CC BY

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    Ambivalence and Nutrition Education

    September 25th, 2017

    medical-school-building-brisbane

    Childhood Obesity News mentioned a few observations about the nutritional education that medical students receive, which is widely considered to be inadequate. Medical schools have been criticized. But, as with most obesity-related subjects, there is nuance.

    Of course everyone should be aware of some basic things, like the destruction wreaked on the microbiome by antibiotics, which affects the metabolism deeply, which in turn affects the body’s nutritional needs and failures. An orthopedic surgeon might be particularly interested in the whether any nutrients tend to help bones heal faster.

    But unless the physician aspires to dive all the way in and embrace functional medicine, nutrition info may not actually be that important in the overall scheme of things. For starters, dietary advice has the maddening habit of changing with ever-increasing frequency. Sometimes it turns out to be flat-out wrong.

    Doctors tend to hold onto what they learned in med school — which is, after all, the purpose of going there. But those teachings might result in actually giving bad dietary advice to patients. Nobody has negative intentions, but when absorbed in her/his specialty, that orthopod will probably sign up for continuing education opportunities that feature the newest hip replacement hardware. Staying current with the nutrition scene may not be a high priority.

    Buckle up, the ride gets rough

    Pediatrician Dyan Hes writes:

    Many parents ask me for a “diet” or a “print out” of exactly what their child should be eating daily. They’re often surprised that my reply is “No.” I’m not a nutritionist.

    At first glance this is rather shocking. But maybe she is on to something. Taking this stand certainly doesn’t let doctors off the hook. They should learn as much as possible about nutrition. But maybe it shouldn’t be their responsibility to teach patients, or get bogged down by the many mundane tasks that effective anti-obesity therapy necessarily includes.

    A convincing case is made, in some quarters, for increasing the number of professionals who do hands-on clinical obesity medicine. The point is for primary care physicians or any other specialists to refer patients to the obesity expert, just like they are referred to a physical therapist.

    Another factor comes into play. As Dr. Pretlow found from listening to thousands of young people, they mostly feel like they have enough nutrition information. Cheeseburger, bad. Apple, good. Got it. Many parents echo this sentiment. They know what is supposed to be eaten. They just can’t get their kids to eat it. Hopefully, the obesity specialist has creative solutions.

    Meanwhile, physicians can use their expertise in other ways. Dr. Hes says:

    My job is to examine your child with a medical eye. I’ll point out complications from weight that you may not have been aware your child already had, like worsening asthma, acanthosis nigricans (a dark, velvety skin change commonly found around the neck, underarms, and groin), obstructive sleep apnea that can lead to school failure or school issues due to hypoxia (low oxygen levels) while sleeping.

    Weigh the options

    A parent who seeks nutritional education from a doctor might want to rethink the priorities. That knowledge is available through classes, online, and from children’s books and in many places in many forms. Why waste valuable face-time with a doctor to ask for information that is so freely accessible?

    Granted, the Internet can be a wilderness of ignorance, so how does a parent know where to pay attention and give credence? Most parents don’t read journal articles. The primary care physician might pick a respected nutrition guru, and steer them in that direction. As for the rest, let the obesity consultant do the heavy lifting.

    Your responses and feedback are welcome!

    Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
    Photo credit: bertknot via Visualhunt/CC BY-SA

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    Functional Medicine and Obesity

    September 22nd, 2017

    sugar-cookie-craving

    Nothing beats the Western medical establishment when it comes to acute care. If you have a compound fracture, you want to be in a major American city. But once the bleeding is staunched and the leg is placed in a splint, subjectivity comes into play. Is this patient allergic to penicillin? How much anesthesia does he get, based on weight and other factors?

    In a major outbreak of contagion, epidemiology has automatic, first-response answers, providing maybe the most fitting and practical example of the one-size-fits-all treatment paradigm. Later, the fact that a person survived a plague becomes just another piece of their individual health history.

    Trauma and epidemics are different from chronic illness because nothing is more subjective than chronic illness, and every case is rife with individual factors. Take the autoimmune condition known as SLE, systemic lupus erythematosus, or simply lupus. Depending on the individual, it can manifest in a dozen ways.

    The thing about functional medicine is, the individual angle is the important part. It stretches to take into account the most seemingly unrelated detail of a patient’s history and circumstances. It’s tailored, customized like a fine bespoke suit, and one size definitely does not fit all.

    A strong proponent of functional medicine

    Some members of the medical establishment consider “integrative” a naughty word, but the concept is an important one that fits comfortably with “science-based.” Childhood Obesity News has more than once quoted Dr. Mark Hyman, Director of Cleveland Clinic’s Center for Functional Medicine, who says the following of his specialty:

    It treats the whole system, not just the symptoms… It seeks to identify and address the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties…

    Functional medicine practitioners look “upstream” to consider the complex web of interactions in the patient’s history, physiology and lifestyle that can lead to illness. The unique genetic makeup of each patient is considered, along with both internal (mind, body, and spirit) and external (physical and social environment) factors that affect total functioning.

    Dr. Hyman feels that most physicians have not received training adequate to fully understand complex, chronic disease. He sees in this particular area of medicine a “huge gap,” where practice may be as much as 50 years behind what research is revealing every day.

    Practitioners of functional medicine often trace the root of a patient’s problem to nutrition, especially as it impacts the gut microbiome. Dr. Kara Fitzgerald published the inspiring story of Frieda, a 46-year-old with fatigue, anxiety, depression, sleep disorder, bronchitis, sinusitis, thyroid imbalance, multiple skin problems, PMS, and morbid obesity.

    Over the years Frieda had tried various medications for the physical and emotional problems, as well as psychotherapy, but nothing led to significant or sustainable change. She had started bingeing in her 20s, especially on sweets, dairy products and bread.

    Dr. Fitzgerald writes:

    My strong suspicion was that in part, Frieda’s GI bugs were “running the show,” stimulating potent sugar cravings and contributing to depression, anxiety and metabolic syndrome… Giving into the cravings was, in turn, contributing to the metabolic syndrome, weight gain, inflammation, depression, anxiety, hyperlipidemia and estrogen dominance…

    I was confident that as long as she was willing to endure the potentially difficult but very short-term journey of “sugar detoxing,” she’d get to the other side — her cravings would subside and her health would rebound.

    And that is what happened. Dr. Fitzgerald relates in detail the other parts of the plan and includes Frieda’s “Baseline Medical Symptom Questionnaire” from both before and after treatment. According to the scoring system, less than 10 is optimal; 10-50 indicates mild toxicity; 50-100 is moderate toxicity; and over 100 is severe. Frieda went from 96 (right on the edge of severe) all the way down to 8. (Oh, and lost 79 pounds in half a year.)

    Your responses and feedback are welcome!

    Source: “About Functional Medicine,” DrHyman.com, undated
    Source: “Recovering from Morbid Obesity, Depression and Metabolic Syndrome Using Functional Medicine: One Woman’s Inspiring Journey to Wellness,” DrKaraFitzgerald.com, 12/27/16
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    Professionals and Nutritional Awareness

    September 21st, 2017

    medical-student-tag-joke

    Two years ago, the American Medical Association reported that, although 25 hours of nutritional education are recommended for medical schools in the United States, only 27% of them actually offer that many. (The average is 19.6 hours, and most of the content concerns biochemistry, rather than practical food choices in everyday life.)

    Some experts object because examinees for internal medicine certification are not asked a single question about nutrition. Cardiology as a specialty is no better, which is a shame because diet probably influences heart health. Some experts see this as an “educational void” and believe that better education in this area for medical professionals is key to the goal of changing trends on a societal scale.

    Researchers who polled brand-new medical students discovered that:

    71 percent think nutrition is clinically important. Upon graduation, however, fewer than half believe that nutrition is clinically relevant. Once in practice, fewer than 14 percent of physicians believe they were adequately trained in nutritional counselling.

    There is a new trend toward involving medical students in actual kitchen-level food preparation involvement, and investigating local food availability conditions, so forth, which is all to the good.

    These suggestions were made by the authors of the same Academic Medicine report. First, the students should take courses in nutrition, exercise, stress management, and sleep hygiene — all of which they will need for their own self-care, as well as to benefit their patients. Exams that lead to special certifications are proposed.

    Different institutions come up with different ideas. The Tulane University School of Medicine, for instance, offers “clinical rotation at a professional cooking school.” One suggestion carries extra weight, in light of the bad publicity hospitals have endured because of unpopular affiliations with fast-food empires:

    Create “hospitals and ambulatory care venues with exceptional cafeterias, restaurants, teaching kitchens, and inpatient menus showcasing foods that are healthy, delicious, affordable and easy to make,” the authors said, noting that nutritious foods should replace their processed predecessors in hospital eateries.

    Because doctors are such highly-regarded authority figures, one last recommendation is very important, and that is to lead by modeling the desired behavior. In the anti-smoking movement, many physicians and other health professionals realized the importance of setting a good example. The fact that they quit smoking served as a catalyst for at least some patients, which can also be effective in the area of weight management.

    Dr. Dyan Hes wrote:

    Great strides are being made in the United States to try to educate physicians about preventive medicine — to talk your patients and their families about healthy nutrition at each visit in order to prevent them from becoming obese.

    Your responses and feedback are welcome!

    Source: “What’s at stake in nutrition education during med school,” AMA-Assn.org, 07/23/2015
    Source: “8 ways med schools can take nutrition from classroom to kitchen,” AMA-Assn.org, 08/06/15
    Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
    Photo credit: sylvar via Visualhunt/CC BY

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    Different Strokes for Different Folks

    September 20th, 2017

    doctor-teamwork

    The concept of a one-size-fits-all solution to obesity has pretty much vanished. Fortunately, the multi-disciplinary solution has stepped up to make some sense out of the whole mess. Late in 2013, the Obesity Society, American Heart Association and American College of Cardiology teamed up to publish a set of guidelines for doctors, to help them manage overweight and obesity in adults.

    In order to glean the most current recommendations, 133 recent studies were examined. The subtitle of Nanci Hellmich’s article expresses the conclusion succinctly:

    New guidelines say that there is no ideal diet — whatever works to help obese patients lose 5%-10% of their body weight.

    Committee co-chair Donna Ryan told the reporter that the objective is “to get primary care practitioners to own weight management as they own hypertension management.” If such help were available everywhere and all patients could afford it, the ideal program would be “delivered by trained interventionists (not just registered dietitians or doctors) for at least 14 sessions in the first six months and then continue therapy for a year.”

    Of course these intensive therapeutic resources are not available to everyone. But many people, Ryan says, can benefit from phone- and web-based interventions, and even from commercial weight-loss programs. Just like with individual reactions to foods, it’s different strokes for different folks. There are satisfied customers enough to endorse just about anything, because they sincerely believe it worked for them, even if some other dynamic was in play.

    An interesting innovation

    South Dakota State University has designed a program especially to produce desperately needed childhood obesity experts. It is based on the premise that:

    The cause of childhood obesity is multifaceted and strategies to prevent and treat it need to be transdisciplinary.

    It pulls from the Health and Nutritional Sciences department, whose students include aspiring nutritionists, registered dieticians, athletic trainers, occupational therapists, physical therapists, community and public health administrators, PE teachers, and managers and administrators in sports and recreation.

    Graduate students in any of those fields have the choice to go after a TOP certificate, which stands for Transdisciplinary Childhood Obesity Prevention. The faculty includes experts who introduce additional perspectives from early childhood education, nursing, counseling, and statistics.

    As a corollary, the program teaches that there is no one-size-fits-all solution to obesity, because its answers are drawn from “evidence based transdisciplinary approaches to prevention.” According to the program’s literature:

    Experiences gained as a TOP student will prepare graduates for collaborations with individuals in other disciplines in a career aimed at reducing childhood obesity…. Students will obtain a TOP program certificate upon completion of the requirements for both the certificate and the Masters or Doctoral degree from their respective college.

    Your responses and feedback are welcome!

    Source: “Doctors urged to treat obesity like any other ailment,” USAToday.com, 11/12/13
    Source: “Transdisciplinary Childhood Obesity Prevention (TOP) Graduate Certificate Program,” SDState.edu, undated
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    Everything You Know About Obesity Awareness Is Wrong

    September 19th, 2017

    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

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    Too Much Awareness?

    September 18th, 2017

    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
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    Childhood Obesity Awareness in New Jersey and Beyond

    September 15th, 2017

    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

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    Awareness Month — a Good Time for Change

    September 14th, 2017

    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

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    A Few Pointers for Parents

    September 13th, 2017

    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

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Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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