Tackling a child's weight issues is a touchy subject

Published: Friday, Jan. 4 2013 4:00 p.m. MST

The risks of mishandling something this weighty are real, experts agree. Marci Warhaft-Nadler, a body image advocate from Toronto who wrote "The Body Image Survival Guide for Parents," sees it professionally: The boy, 8, crying that he doesn't want to go to school because his shirt makes him look fat. The eighth-grade girl who says no one at school eats lunch because they don't want to get fat. The older woman obsessed with body changes. Kids as young as 5 treated for body-image issues. And the one-quarter of all girls 6 and 7 who have dieted. Dieting numbers, in fact, are nearly identical for average-weight and overweight girls. Everyone does it.

"The messages come from everywhere and many really are negative," she says. "We are so aesthetically obsessed, a genuinely fat-phobic society. It's crazy. We baby-proof for health, covering sockets and table edges. We can do that with images, too. … The more we can tell our children that fit bodies come in all shapes and sizes, the better."

Jessica Setnick, a Dallas pediatric dietitian specializing in eating disorders, believes parents should look at a child's growth chart before they conclude a child is heavy. "I have seen far too many children brought in by parents who don't recognize the slippery slope of dieting to eating disorder to lifelong misery. Looking at a child's growth chart is the single most important factor in determining if there is a problem, or if the child is simply bigger than the parents want him or her to be. We have to support parents in seeing a child as okay and helping the child feel good about himself, regardless of size."

A child who is a sneaky eater or eats constantly or steals food has an issue regardless of weight. It may take some sleuthing to sort out medical or emotional causes, as well as potential triggers for abnormal eating.

Sometimes a child just doesn't match the family's typical shape, a genetic difference. Besides that, Setnick says, "Kids get thicker around the middle before they grow and parents can see that and panic, but it's still perfectly normal."

Real weight issues must be addressed, but because the danger of disordered thinking about one's body is so great, Setnick recommends parents talk to a pediatric dietitian without the child initially. It's helpful to bring growth charts and photos. That session can determine need and perhaps simple changes. She calls weight and height less telling than whether a child has always followed the same growth pattern. A child who was always bigger is different than the kid who was average and is now in the 95th percentile sizewise.

The right discussion

Discussion and action should be about health, not weight, says Warhaft-Nadler. Rather than either assuring a child he's perfect or that she needs to lose weight, parents should explain that healthy bodies come in all shapes and sizes and it's okay to be different. "It's about how we feel."

That moves the discussion to health, where it belongs, says Tobie Baumann, a mom from Cartersville, Ga., who works in fitness consulting for Les Mills East Coast. "Weight is a physical repercussion of a larger issue, which is health."

Size may be what someone sees when a child is truly overweight; there are things that aren't readily visible, such as rapid mood fluctuations and short attention spans, she says. The unseen, the tension and attention lapses, has long-term effects, including delays in education and in growth, mood disorders and more.

Baumann's already couching food discussion with daughters Emerson and Covington, 3 and 5, in terms of health, not how they'll look. "Guess what, you will have so much more energy and be even smarter and think faster as your body grows stronger with good food and exercise," she says.

Warhaft-Nadler doesn't allow "fat talk" around her kids. "Love your kids, love yourselves and keep the focus on health and not weight."

Family challenge

Baumann clashes with the cookie culture that is part of an American childhood. At schools, "I've taken pictures at parties of what's on a child's plate: Three kinds of cupcakes, brownies, cookies, Cheetos, Kool Aid. Adults have encoded it into children that a party is about having fun with lots of sugar." Attempts to reduce the importance of food at the festivities or make them more healthy have been rebuffed.

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