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The skinny on childhood obesity

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I don’t know what to do about Ashley, my 9-year-old daughter,” one of your clients confides. “She’s always been sort of chubby. Her doctor’s a little concerned, but the big problem is the teasing she gets from the other kids. Here she is, 9 years old, and starting to worry about her weight. Sometimes I see her frowning at her reflection in the mirror. I wish I knew how to help her without making her more self-conscious about her appearance.”

There is no magic answer for childhood obesity. With obesity rates on the rise, we know obesity in childhood is a serious problem that can’t be ignored. On the other hand, if we worry our children with diets, deprive them of the sweets they love and force them to participate in sports programs they hate, they may simply reject everything we say and do, or develop disordered eating and exercise behaviors. What’s a mother (or father, teacher or exercise instructor) to do?

Why the high prevalence of childhood obesity?

Surveys suggest that 15 to 25 percent of children in the U.S. are obese.1, 2 It is not surprising that obesity is a problem for children, since it is a problem for their parents as well.

After all, the same genetic and environmental factors responsible for adult obesity operate in childhood. Many people are genetically prone to obesity. Some infants, for example, are born with lower metabolic rates. Some children are less active than others and, thus, burn fewer calories. Add plenty of delicious, high-fat food, and risk for obesity increases even more.

Sedentary habits are also to blame. A positive relationship exists between television viewing hours and obesity. When children watch television, not only are they inactive, but they are likely to be snacking as well. While most younger children are inherently active, school-age children must learn to sit still. Many schools do not provide children with adequate opportunities for physical activity; either not enough time is spent on physical education or the programs are not appealing, especially to those who need activity the most. Once a child learns that physical activity is unpleasant, activity level declines even further.

Obesity health risks

Aside from the teasing, is childhood obesity a serious health problem? Although the real health problems associated with obesity, such as diabetes, hypertension and heart disease, do not usually develop until adulthood, the process of atherosclerosis begins early in life. Obese children tend to have higher blood pressure and higher blood cholesterol levels than children of normal weight, which can develop into health problems down the road.1 Fortunately many children “outgrow” obesity. Only about 40 percent of obese children develop into obese adults.2

Physical activity: A positive approach for prevention and treatment

Physical activity is the first line of defense against obesity. Children need opportunities to be active. Physical activity confers numerous health benefits and is essential for everyone, not just children and adults who are overweight. Young children are inherently active; older children will remain active if given encouragement and plenty of opportunity. Encouraging activity provides a positive approach to weight control, as long as the activities are perceived by the children to be pleasant and fun.

On the other hand, traditional dietary restrictions tend to be seen by children as unpleasant and unfair. Children should never be “put on a diet.” They should be given wholesome, nutritious food. If possible, the adults in charge should never make an issue of limiting fats and sugars, even as they are doing so. By simply providing delicious, nutritious meals and snacks, adults can limit empty calories and fat calories in a reasonable way without making the obese child feel penalized. Obviously, occasional treats must be enjoyed, especially in social situations. If everyone else at the party is eating birthday cake and ice cream, this is not the time for denial.

Good nutrition is essential for optimal growth and development in childhood. A diet based on the Food Pyramid that contains 30 percent of its calories from fat appears to be adequate for normal growth. Children who are only moderately overweight may “grow into” their weight, using some of their stored energy for growth.2

Adult role models: Walk your talk

Children learn more by example than by instruction in the early years. When parents and caregivers model healthful exercise and eating habits, these habits trickle down to the children under their care. During the early years, parents and caregivers also set the rules and buy the food, and can take advantage of their station to lovingly promote healthful lifestyles (I’m the mommy, that’s why.). A helpful household rule can be that all eating is done while seated at the meal table. This eliminates mindless snacking in front of the television. Portions can be given on plates; this helps prevent the whole bag of chips from being consumed in one sitting.2 Limiting television time is common among many families.

Most important of all are the caregivers’ attitudes toward exercise, food and weight, not to mention life in general. Young children seem to have a sixth sense in this regard. If you are looking forward to your morning walk, they want to come along with you. If you are stressed out about your weight, children will sense the problem. No words need to be spoken.

Obese children often have parents who are struggling with weight problems themselves. These struggles can spill over into the child’s life; parents want children to succeed where they themselves have failed. Weight control issues take on a larger, more emotional meaning as children try desperately to meet the expectations of the parents they love. It is unfortunate that in our culture thinness symbolizes goodness, so overweight children begin to believe that fatness means they are not good. Parents and caregivers must fight this powerful cultural message that can be so harmful to a child’s fragile self-esteem. Body size and goodness must be separate issues.

For many parents and caregivers, food symbolizes love. After all, giving food is part of nurturing. Some parents express their love by giving high-fat treats. It is possible, however, to show love in other ways. Give hugs and kisses, spend time with the child doing something you both enjoy, develop a hobby together. You can deny treats without denying love.

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