How to Talk to a Child About Their Obesity

Published June 12, 2019

Reviewed May 2019

In today’s culture, weight can be a sensitive subject, especially for children and teens. The desire to be thin is reaching school-aged children, as girls as young as 6 years old express concerns about their body image and gaining weight.

Deciding how to approach weight issues with young people deserves careful attention; how you handle the topic can have serious and lifelong implications. Here are some tips for discussing weight with kids, and what to do if a child brings up the topic.

Encourage open dialogue. Go ahead and talk with your children about weight and encourage them to share their thoughts and feelings about body image whenever they arise. When children discuss feelings about weight with you, be sure to listen and acknowledge that the feelings are real. If you have had similar experiences, it may help to share them. Explain that people come in all different shapes and sizes and you love your child no matter what.

Don’t make negative comments. Judging your own body or your child’s can result in lasting detrimental effects to your child’s body image and relationship with food. Set a good example for children in the way you talk about your own body as well as others’. Skip the lure of fad dieting yourself.

Take action. Children learn fast, and they learn best by example. Teach children habits that will help keep them healthy for life. In general, if your child is elementary age or younger and you have some weight concerns, don’t talk about it; just start making lifestyle changes as a family. The best thing you can do is make it easy for kids to eat smart and move often. Serve regular, balanced family meals and snacks. Limit the time your child spends watching television or playing video games. Look for ways to spend fun, active time together.

Avoid the blame game. Never yell, scream, bribe, threaten or punish children about weight, food or physical activity. If you turn these issues into parent-child battlegrounds, the results can be harmful. Shame, blame and anger are setups for failure. The worse children feel about their weight, the more likely they are to overeat or develop an eating disorder.

A united front. As with any other important issue, make sure both parents and other important relatives are on the same page. Mixed messages about weight can have unhealthy consequences.

Talk with your healthcare provider. If a health professional mentions a concern about your child’s weight, speak with the professional privately. Discuss specific concerns about your child’s growth pattern and ask for suggestions on making positive changes in your family’s eating habits and activity levels.

Seek advice. For kids and teens, check out local programs and professionals who specialize in youth. Look for a registered dietitian nutritionist with a specialty in pediatrics. Many hospitals and clinics have comprehensive programs with education and activities for both kids and adult family members. Some of these options may be covered by your health insurance plan.

Focus on health over weight. The key is to consider your child’s overall picture of health, not weight. If your family starts eating better and moving more, your children may “grow into” their weight as their height increases. Compliment your children on lifestyle behaviors, such as choosing to play outside over playing video games inside, rather than on the loss of a few pounds.

What to Do if Your Child Says, “I’m So Fat.”

Learn where the thoughts about feeling fat came from. Did a friend or classmate tease your child about weight? Did another relative mention the size of your child’s belly or thighs? Is your child feeling embarrassed from having snug-fitting clothes? Was there something on television or online about overweight kids? Maybe some sports are difficult for your child, or perhaps they are chosen last for teams. These frustrating and painful issues are common among children of all sizes.

If another child or an adult is bullying your child, confront the situation directly and as soon as possible. If your child’s weight, eating and activity are normal and age-appropriate, reassure your child and don’t focus on weight.

If Your Child is “Overweight”

Weight loss among children can interfere with their growth and negatively impact their body image and relationship with food, so it’s important to work with your pediatrician and a registered dietitian nutritionist. Choose a few specific changes that you can make in your family’s eating and activity habits, then set realistic goals.

Be mindful that every family is different and change occurs slowly, so be patient and remember there is much more to health than weight.

One in five American children is considered obese, according to data from the CDC, but weight loss in kids is a touchy subject. Just recently, WW (formerly known as Weight Watchers) came under attack after launching an app aimed at helping kids lose weight. Reaction on social media was fierce with many dietitians expressing outrage and concern that the tracking system could lead to an unhealthy fixation on food and body image, and ultimately an eating disorder, which can be life-threatening. Their concern isn’t totally misguided. An American Academy of Pediatrics (AAP) Clinical Report suggests that among children, dieting with the goal of losing weight is a risk factor for both obesity and eating disorders. One study found that girls who weren’t obese who dieted in the 9th grade were three times more likely to be overweight in 12th grade compared to girls who didn’t diet. The case against dieting among kids is so strong that the AAP says it’s counterproductive to managing weight.

Still, we can’t dismiss the fact that childhood obesity (which is clinically defined as a BMI at or above the 95th percentile) is a problem that can lead to serious health consequences — both in the short and long term. Those health problems include a higher risk of asthma and other breathing problems, joint pain, gastroesophageal reflux, fatty liver disease, high blood pressure and high cholesterol (which increase the risk of heart disease), and type 2 diabetes. Being overweight as a child can also have a powerful impact on emotional well-being, with an increased risk of bullying, low self-esteem, and serious mental health issues, such as anxiety and depression.

So what’s a parent to do? We checked in with some experts to help you discover the right way to help an overweight child lose weight.

How should you talk to your child about weight loss?

You shouldn’t! As a parent, your job is to model healthy behavior, and that means you should also avoid conversations centered on your own weight, size or body appearance. That goes for anyone else’s weight or body size, be it a celebrity or a stranger on the street. “This sends the message to the child that it’s weight that matters, rather than health,” says Michelle Cardel, Ph.D., RD, an obesity and nutrition scientist and assistant professor at University of Florida College of Medicine in the Department of Health Outcomes and Biomedical Informatics.

Though you may curtail weight talk inside the home, you can’t control what happens outside your house, where overweight kids may be subject to teasing and weight-based bullying. If your child seems distressed, ask, “What’s bothering you?” and don’t assume that it has anything to do with his or her weight. (There are a number of things that can affect a kid’s mood, like a fight with a friend or a bad grade.) Whatever it is, create a safe, loving and open space to have a conversation about it. If it turns out your child is the target of fat shaming, be sure he or she has tools to handle the situation. That might mean thinking through a curt comeback (like, “I don’t appreciate that” or “That’s not a cool thing to say”) or it might be telling a teacher or another grownup. But it usually doesn’t involve encouraging them to take the abuse. Instead, help your child develop resilience, show love and support and respect at home, and encourage friendships and activities where your child feels welcome.

Does your child need to lose weight? We’ll help you talk about it without hurting her feelings.

Talking About the Problem

For parents of the 25 million overweight or obese kids in the U.S., it’s a common dilemma: If your child is fat, she probably knows it. Classmates may tease her, and she probably thinks her clothes are too tight when she looks in the mirror. So when you broach the topic, it’s important to be compassionate. “How you discuss a child’s weight problem can make a huge difference in helping her deal with it,” says Jamie Calabrese, MD, medical director of the Children’s Institute in Pittsburgh and a member of the American Academy of Pediatrics (AAP) Task Force on Obesity.

Bring It Up Gently

Look for a natural time to talk about your child’s weight in a low-key way. After a checkup, you might say, “You heard the doctor say you’re gaining weight too quickly. Do you want to talk about what we can do to help?”

If your child seems receptive, you can explain that he needs to get exercise every day so his body burns up the energy (food) he eats. Then offer some ideas, such as going to the playground three times a week or signing up for a sports class.

Let him know that being active is something you can work on together: “How about we take a bike ride together after dinner twice a week? It’ll be fun, and we can both get in shape.” Making fitness a group project, whether you’re washing the car, playing freeze tag, or signing up for a family swim, will help your child stick to a routine. Keep the goals modest at first so he doesn’t think of exercise as a chore or punishment.

Follow a similar approach toward food. If your kid eats ice cream every day, switch to a low-fat version or sorbet or limit him to three servings a week, and give him fruit on the other nights. Remind him why you’re changing the family’s habits: “Sweets taste good, but they’re not very healthy. If we want your body to grow strong, we need to make smart choices.” Encourage good eating by keeping junk food and soda out of your house and making your child feel like part of the process (“Let’s go to the store and pick out some healthy foods”).

Keep It Kid-Friendly

“Young kids usually don’t understand that their bodies look a certain way because of the foods they eat or the amount of TV they watch,” says Melinda Sothern, PhD, author of Trim Kids. Help your child make the connection. Say, “I know you don’t like being heavier than your friends. But you can change that by spending less time sitting around and more time moving your body.”

Likewise, a 6-year-old can’t relate to long-term health threats caused by obesity, such as diabetes and heart disease. Keep it simple: “If you eat lots of fruit and vegetables and play outside more, you’ll be able to run around the bases without getting tired.”

Girls may be more interested in hearing how lifestyle changes will improve their appearance. Tell your daughter how shiny her hair will look if she eats more fruits and vegetables. Or say, “If you keep playing soccer, you’ll get into better shape and we’ll probably need to go shopping for some new clothes.”

Walk the Talk

If you want your child to live in a healthier way, you need to set a good example. Mention how much fun it is to play in your tennis league, or let him know how satisfied (not stuffed!) you feel when you eat an apple instead of a fattening dessert. “Role-modeling a healthy lifestyle is no different from role-modeling kindness or honesty,” says Don W. Morgan, PhD, director of the Center for Physical Activity and Health in Youth at Middle Tennessee State University, in Murfreesboro. “Once kids see that daily physical activity is important to you, they’ll want to be more physically active too.”

That’s what happened with the Hernandez family of Irvine, California. When her 7-year-old son, Willy, gained 20 pounds in one year — and went from wearing slim- to husky-size clothing — his mother, Martha Hernandez (who has struggled with weight most of her life) took a hard look at her family’s eating habits and attitudes. “We piled too much food, a lot of it fried, onto our plates and encouraged our son to finish it all,” she says. Willy also snacked incessantly on store-bought cookies and other processed treats.

Martha began broiling or baking foods, monitoring everyone’s portion size, and packing Willy a healthy school lunch (fresh fruit and a sandwich made on whole wheat bread). She stopped buying soda, chips, and sweets, switching his snack choices to fruit yogurt or hummus and whole-grain crackers.

But Martha knew her son needed more exercise too. So she convinced him to sign up for a year-round swim team, and she joined a gym and started running herself. “I thought it was only fair that I practice what I preach,” she says. Today Willy, now 12, is at a healthy weight and swims competitively.

Play Up the Positives

Overweight kids tend to have low self-esteem. Just one “fatty” comment from a classmate can reduce your child to tears. That’s why it’s crucial to empathize with her (“I know that must have hurt — it’s not nice for anyone to make fun of your weight”) and to find creative ways to boost her ego.

When Kathryn Roe remarked about her “thunder thighs” one day, her mom, Valerie, figured that other kids had teased the 7-year-old. “We don’t say things like that at home,” Roe says. So she turned the negative remark into a positive one: Since Kathryn is passionate about ballet, her mom pointed out that professional dancers have big, muscular legs. “Now when we’re bouncing on an exercise ball, she’ll ask, ‘Mom, will this make my legs get stronger?'”

You shouldn’t lie to your child about her weight (“No, you’re not fat!”), but you should talk about it honestly — without letting it become an obsession. Don’t forget to focus on how pretty her smile is or how much fun she is to be around. And regardless of her size, remind your child every day that you love her.

When she has a setback (such as bingeing at a birthday party), give her a pep talk (“Everyone slips now and then. I’m proud of how you’ve cut down on junk food!”). Agree on a plan for next time (“You can have either one piece of cake or two cookies”). And celebrate small victories, such as when your child eats a piece of fruit and a serving of vegetables every day for a week. Choose your rewards carefully, though: Make the incentive a visit to the zoo or a game of mini golf, not an ice cream sundae.

Never Say Diet

Your overweight child needs a wake-up call to get more exercise and eat better. But don’t put her on a diet and don’t put her on the scale regularly. “Even young girls can become obsessed with losing weight,” says Cynthia M. Bulik, PhD, distinguished professor of eating disorders at the University of North Carolina at Chapel Hill. “We’re seeing classic anorexia starting as young as age 6.”

These tips will help your child feel good about her body as she gets fit:

Nov. 20, 2017

I weigh my words (pun intended) every time I address the topic of a child’s obesity in the exam room. Yes, I know, you probably want to tell me that I shouldn’t use that word — “obese” — and I promise that I don’t. But in the child’s electronic medical record, that’s the official coding if the child’s body mass index is at or above the 95th percentile for age and gender. And medical providers, just like parents, may find themselves walking a difficult line as they try to discuss this fraught subject without increasing the distress that many children are already feeling.

“Guilt and blame don’t motivate change, they just make people feel bad, and when people feel bad, they don’t tend to be motivated toward healthy behavior,” said Dr. Stephen J. Pont, an assistant professor at the University of Texas Dell Medical School.

Dr. Pont is one of the lead authors of a new policy statement issued jointly by the American Academy of Pediatrics and the Obesity Society titled “Stigma Experienced by Children and Adolescents With Obesity.” The statement, published online Monday in the journal Pediatrics, advises pediatricians to use neutral words like “weight” and “body mass index” rather than terms like “obese” and “fat.” The authors also suggest we use language that puts the person before the condition, as in, “a child with excess weight” rather than an overweight or obese child.

More broadly, the authors advise that medical practices need to look carefully at their procedures and their attitudes to make sure they aren’t building in biases against overweight children, and beyond that, they want us out there advocating against this kind of stigma in society. And they put this advice in the context of an extensive research literature on how very common it is for children to be teased and bullied because of their weight, and how very counterproductive that is.

For all the attention paid to weight and its health effects in medical settings, the social and emotional side is often neglected, said Rebecca Puhl, a clinical psychologist who is a professor in the department of human development and family studies at the University of Connecticut, and the other lead author on the policy statement. “Weight is now one of the most frequent reasons kids are teased or bullied,” she said. In addition to the well-documented effects on children’s mental health and self esteem, she said, research has shown very harmful effects on children’s eating behavior, and increased risk that they will stay sedentary and gain weight.

In a study published earlier this year in the journal Preventive Medicine, Dr. Puhl and her colleagues looked at the longitudinal effects of teenagers being teased about their weight. The study involved over 1,800 people who had been followed for 15 years and are now in their mid 30s.

“Weight-based teasing in adolescence predicted obesity, and also eating food to cope with emotions,” Dr. Puhl said. “These teasing experiences have long-lasting implications for health and for health behavior.” For women especially, these adolescent experiences of teasing by peers or family members were associated with binge eating, poor body image, obesity, and a higher B.M.I. 15 years later, she said; for men there were some of the same associations, including obesity as adults, if they had been teased by their peers as adolescents.

Research shows that two-thirds of adolescents in weight-loss camps report being bullied or teased about their weight, over 90 percent of the time by their peers, Dr. Puhl said. A third report that they are also teased by family members. “Pediatric health professionals may be one of the few allies to offer support and try to prevent harm.”

My colleague Dr. Mary Jo Messito, the director of the pediatric obesity program at Bellevue Hospital, said, “the worst thing to do is go into the room with an 11-year-old girl and say, your child is obese, the child will start to cry.” She recently saw a boy whose mother kept bringing up, “‘You don’t want to be like uncle so and so, he had to have this operation, he almost died’ — the kid is now terrified.”

Katherine Bauer, an epidemiologist who is an assistant professor in the department of nutritional sciences at the University of Michigan School of Public Health in Ann Arbor, cited what she called “the prevalent belief that people don’t know they’re heavy, and if we just inform them they will magically be motivated for behavior change.” In fact, she said, weight stigma does exactly the opposite; criticizing and inducing shame only make people feel terrible about themselves, not motivated or capable of making changes.

We are all, including our children, living in a culture that is profoundly critical of excess weight and at the same time constantly offering opportunities and advertisements for overindulgence. “It’s important to focus on positive reinforcement and not jump to negative,” Dr. Pont said. What this means, for parents and for health providers, is to make sure we see the child, not just the number on the scale. “Recognize that a child is far more than what their weight is, praise them for all the positives, so when we get to some of the more challenging topics, they can still maintain their self-esteem,” Dr. Pont said.

And that time in the exam room has to include talking about nutrition and exercise, but “the focus should be on health or health behavior rather than looking thin, fitting into certain pants,” Dr. Puhl said. So it’s absolutely reasonable to talk about eating patterns, about family meal times, about what foods kids choose at home and at school, about screen time and exercise. Of course, excess screen time or too much junk food are problems even if you’re thin.

The most effective way for parents to help a child is to make healthy changes for the whole family, regardless of shape or size, Dr. Pont said. Try making small changes slowly, like adding one new green vegetable into the family diet, not keeping sugary drinks in the home or walking to school instead of driving.

And yes, to bring up the big turkey in the room, Thanksgiving is upon us; here come the relatives. If you have a child for whom this is a sensitive subject, try to make sure that no one spoils that child’s day. When it comes to a child’s weight or eating habits, “the Thanksgiving table is not an appropriate place to be commenting,” Dr. Puhl said.

“Public discussions at the table that are teasing or negative are not helpful,” Dr. Messito said, and some people will overeat in response to feeling stressed.

And all the experts recognize that one essential message to children is that however important healthy changes in their diet may be, they can still enjoy special days and special treats and special meals. “Enjoy the holiday; make the changes not on a holiday,” Dr. Pont said.

“Food is our way of connecting with people, especially around Thanksgiving, our way of bringing people together and showing thankfulness,” said Dr. Bauer. “Let’s have a shaming-free Thanksgiving where we just enjoy ourselves.”

The conversation parents dread even more than the one about the birds and the bees? It’s the one about their kids’ weight.

Sure, the facts-of-life talk is awkward and needs to be age-appropriate and you want your facts straight, but it’s different when you’re talking to your kids about what they weigh. Your children never view such talks as positive, only as being about what’s “wrong” with them. But you can have this talk without damaging your children or your relationship with them.

The one thing you never want to do is tie weight to the children’s appearance or “acceptability.” I recently saw an obese 8-year-old and we discussed the health issues related to the child’s weight and some easy ways to get started changing her diet and lifestyle. Her mother then told the girl, “If you lose weight you’ll be so pretty and I’ll buy you lots of pretty clothes.” I halted the conversation and told the mother that her daughter was already pretty and that I just wanted her to be healthier and feel better, and that that was the point of changing her diet and lifestyle. I then spoke directly to the girl and told her the same thing.

It cannot be emphasized enough: this is a health issue, not a cosmetic one.

Here are some other critical things to remember before even considering discussing body weight with your child.

First, make sure there’s a health or medical issue that needs to be addressed. There’s a healthy and normal weight range for a child’s height: the body mass index, or BMI. It’s not a perfect measure of overweight and obesity, but your child’s pediatrician or health professional can determine the BMI and put it into context for your child.

Another issue is you. If the child’s BMI is within normal range but you want the child to lose weight, then your child’s pediatrician may need to have a talk with you about you, not your child. Children should never have a reason to feel they are not loved or accepted by a parent because of their weight. On the contrary, it’s often a good idea to clear the air about this right at the start of the talk and repeat it a few times during and afterward, to reinforce the importance of the health aspect.

Usually when I see overweight children, there’s at least one overweight parent. Studies and statistics bear this out, too. Whether this is due to genetics or the home environment has been debated by my colleagues for decades; when it comes to treatment, it likely doesn’t matter so much.

Permanent solutions require permanent but gradual changes. This is where there’s an opportunity for you really to do some good. If a parent is overweight or obese, it’s an ideal time for the parent to make his or her own diet and lifestyle changes. When kids hear “We’re going to do this together,” it becomes not “their” issue but “our” issue, and they feel supported, not isolated. Then kids will likely see the parent as an advocate, not an authority figure.

Changes in how the family approaches food, eating and lifestyle don’t need to be made suddenly. Indeed, if changes are to be permanent, they really should be made gradually and persistently.

Food often spells comfort for children and adults, and both need to understand that it’s not about “good vs. bad” foods, but about “how much and how often” they’re eaten. You can seize the opportunity to leverage the healthful foods the child may actually like and let the child know that those foods will be around a lot more.

Talking about physical activity can be especially touchy. Overweight kids can be teased and bullied about their weight and may have had negative experiences with team and organized sports. Let them know that becoming more active is also a gradual process and there’s no need to run marathons, start martial arts or join Little League, unless they want to. Getting the child an inexpensive pedometer to track his or her steps each day, however, is a good move, and the proof of activity is something kids love. Adding 2,000 steps a day is equivalent to about a mile, and simple nonfood rewards for achievement can maintain motivation and compliance.

Involving children in each aspect of the family changes can inspire success. Making them a part of the process just underscores that they’re important members of the family who deserve to have some say about how they achieve success. When parents see their children adapting well to the changes in their diets and lifestyles, praising the children is an absolute must. The only thing kids like more than achieving a goal is being told by their parents that they did a good job—and that isone talk all parents want to have with their kids.

Keith-Thomas Ayoob is director, nutrition clinic, Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.

What Is Childhood Obesity?

Children who have a body mass index (BMI) at the same level or higher than 95 percent of their peers are considered to be obese. BMI is a tool used to determine your “weight status.” BMI is calculated using your height and weight. Your BMI percentile (where your BMI value falls in relation to other people) is then determined using your gender and age.

Childhood obesity is a serious health threat to children. Kids in the obese category have surpassed simply being overweight and are at risk for a number of chronic health conditions. Poor health stemming from childhood obesity can continue into adulthood.

Childhood obesity doesn’t just affect physical health. Children and teens who are overweight or obese can become depressed and have poor self-image and self-esteem.

Family history, psychological factors, and lifestyle all play a role in childhood obesity. Children whose parents or other family members are overweight or obese are more likely to follow suit. But the main cause of childhood obesity is a combination of eating too much and exercising too little.

A poor diet containing high levels of fat or sugar and few nutrients can cause kids to gain weight quickly. Fast food, candy, and soft drinks are common culprits. The U.S. Department of Health & Human Services (HHS) reports that 32 percent of adolescent girls and 52 percent of adolescent boys in the United States drink 24 ounces of soda — or more — per day.

Convenience foods, such as frozen dinners, salty snacks, and canned pastas, can also contribute to unhealthy weight gain. Some children become obese because their parents don’t know how to choose or prepare healthy foods. Other families may not be able to easily afford fresh fruits, vegetables, and meats.

Not enough physical activity can be another cause of childhood obesity. People of all ages tend to gain weight when they’re less active. Exercise burns calories and helps you maintain a healthy weight. Children who aren’t encouraged to be active may be less likely to burn extra calories through sports, time on the playground, or other forms of physical activity.

Psychological issues may also lead to obesity in some children. Kids and teens who are bored, stressed, or depressed may eat more to cope with negative emotions.

Children who are obese have a higher risk of developing health problems than their peers who maintain a healthy weight. Diabetes, heart disease, and asthma are among the most serious risks.

Diabetes

Type 2 diabetes is a condition in which your body doesn’t metabolize glucose properly. Diabetes can lead to eye disease, nerve damage, and kidney dysfunction. Children and adults who are overweight are more likely to develop type 2 diabetes. However, the condition may be reversible through diet and lifestyle changes.

Heart Disease

High cholesterol and high blood pressure raise the risk of future heart disease in obese children. Foods that are high in fat and salt may cause cholesterol and blood pressure levels to rise. Heart attack and stroke are two potential complications of heart disease.

Asthma

Asthma is chronic inflammation of the lung’s airways. Obesity is the most common comorbidity (when two diseases occur in the same person at the same time) with asthma, but researchers aren’t sure exactly how the two conditions are linked. According to a recent study published in the journal Asthma Research and Practice, about 38% of adults with asthma in the United States are also obese. That same study found that obesity may be a risk factor for more severe asthma in some, but not all, people with obesity.

Sleep Disorders

Kids and teens who are obese may also suffer from sleep disorders, such as excessive snoring and sleep apnea. Extra weight in the neck area can block their airways.

Joint Pain

Your child may also experience joint stiffness, pain, and limited range of motion from carrying excess weight. In many cases, losing weight can eliminate joint problems.

Bringing up health concerns like body weight can be a challenge. It can be even trickier when speaking with a child. Dr. Cindy Gellner recommends a few strategies to constructively speak about lifestyle changes without damaging a child’s self-esteem or triggering a parent.

Transcript

Dr. Gellner: Bringing up health concerns with anyone close to you can be a challenge, but when it comes to parents bringing up concerns that their child may be overweight, it can be even trickier.

Announcer: Keep your kids healthy and happy. You are now entering the “Healthy Kids Zone” with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Parents often ask during a visit, “So how’s my child’s weight?” Sometimes it’s just fine. Sometimes they think their child is just fine, but their child is actually overweight and that gets us into a whole different conversation. As a pediatrician, it’s my job to tell you and your child the facts about their health. And while I don’t sugarcoat it, if your child is overweight, I do find that there is a very tactful way to discuss it and turn what could be a degrading self-esteem harming and accusatory conversation into more talking about, yes, your child is overweight. Let’s talk about what they like to eat, how active they are, your family genetics, and how we can make sure your child gets to a healthy weight.

You’ve probably heard me talk about childhood obesity a lot on The Scope. It’s an area that I focus a lot of time on in my clinic. I’ve gotten pretty good at talking to families and kids about weight. There are so many factors involved when talking to a family about their child’s weight. Are the parents overweight? Are there cultural or ethnic considerations that need to be kept in mind? Can the family afford to feed their child healthy foods, or are they struggling just to buy ramen noodles? Is their child such a picky eater that it becomes a battle and the parents just end up giving their child whatever they will eat?

When I talk to a child and their family about weight concerns, I spend a lot of time with them and try to come up with solutions that work for their home situation and their child. There isn’t a good cookie cutter fix for childhood obesity. Not only is it hard to get some kids to eat healthy and be active, but there is a huge self-esteem component when a child weighs more than their friends.

Telling a child they are overweight can really bring them down if you do it wrong. If you say, let me show you how you’re growing. This graph shows that your weight is more than it should be for your height. So let’s talk about what you’re eating. Do you like fruits and vegetables? Are you drinking soda or juice a lot? What do you like to do for fun? And let’s make a plan together to get your body healthy.

I’ve been doing visits with kids specifically to talk about their weight for years, and every patient I talk to leaves with a smile and a plan on how to be healthy and they feel empowered that they can do it. They are in charge of their body. They follow up with me regularly, and we see how we can make them successful in getting their weight where it should be. Sometimes it doesn’t work, the kids aren’t motivated, and the parents just drop the subject. However, for the most part, kids really want to be a normal size, not overweight, and they’re open about having this delicate conversation if you bring it to their level and provide positive encouragement.

So if you’re concerned that your child may be overweight and you don’t know how to bring it up with your child, talk to your pediatrician. We understand how kids think and can help start that conversation in a positive way.

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Rising obesity rates have been a nationwide trend since the early 1980s and currently Texas ranks 7th nationally in terms of the highest rate of overweight and obese children and adolescents. A recent study published in the New England Journal of Medicine notes that 10% of girls and 14% of boys ages 5 to 14 will develop obesity. A child is four times as likely to become obese if they are overweight at age 5, further proof that early childhood obesity is an indicator of obesity later in life. It is another reason why ensuring a child is healthy from an early age is so important.

What it really comes down to for children struggling with obesity is that they eat what the adults around them eat and if the adults in their lives are inactive, they tend to have pretty sedentary lives themselves. The good thing is that parents can do a lot to help their kids avoid obesity and the negative health effects of being overweight. First and foremost, a parent should talk to their child’s pediatrician regarding the child’s weight. Children’s height and weight must be charted using the appropriate growth charts in order to determine whether or not the child is at an unhealthy weight. Because kids bodies are growing, it’s sometimes difficult to judge a healthy weight by just physical appearance or the number on the scale. If the child’s weight is above the 85 th percentile for their age and height they are considered overweight and if they are above the 95 th percentile they are considered obese. Parents also need to be cautious when addressing their child’s weight, making sure their approach supports a positive body image. Parents should lead by example: involving the children in planning healthy family meals, going grocery shopping, and the actual meal preparation. This will also make it more likely that the child will eat the healthier food because they were involved in choosing and preparing it. Parents should also engage their kids in physical activity, whether it’s playing basketball at the park or taking the dog out for a long walk.

Programs aimed at curbing childhood obesity and policy changes affecting child nutrition are starting to take effect. The CDC released a study recently stating that the rate of obesity among 2- to 5-year-olds decreased by 43% in the last decade. This is an exciting finding since, like I mentioned earlier, early childhood obesity is a good indicator of obesity in later life. One change in particular was made to the Special Supplemental Nutrition Program for Women, Infants, and Children, otherwise known as WIC. They altered the subsidies provided to buy foods in order to incentivize purchases of whole fruits and vegetables over cheese and fruit juices. However, it’s important to note that the rate of obesity of youth overall remained relatively flat, so the effects are seen primarily in the very young. The obesity rate in some age groups of adults actually increased so we still have more work to do with older children and adults.

Around a quarter to a third of schoolchildren are overweight or obese according to a House of Commons report. These alarming figures have led governments to introduce policies to get children fitter and healthier, such as a sugar tax on soft drinks and restrictions on the promotion of sugary, fatty foods.

This may be great on a national basis but what should you do if your own child is overweight? Is it best to raise the topic and risk hurting their feelings, or should you ignore your child’s expanding waistline but worry in silence about their future health and well-being?

What do we mean by overweight?

Children are not little adults because they are still growing and developing. This means that their weight, shape and size can change drastically by the time they leave school. Because of this, we measure ‘weight for height’ as an age-dependent percentile (a way of comparing individual children to a healthy national average). You can check out your child’s percentile in the growth chart book you received when your child was born. Otherwise, you can find charts on the internet.

Children are at risk of being overweight if their body mass index (a ratio of weight for height) is on or above the 85th percentile for their age. Being on the 85th percentile means they’re bigger than 85% of the children they’re being compared to. They are at risk of becoming obese (one stage on from overweight) if their body mass index is on or above the 95th percentile.

Why should we be concerned about weight?

While some children will simply grow out of chubbiness or ‘puppy fat’, many don’t and this can lead to problems later on.

Overweight and obese children may feel breathless, have difficulty taking part in sport and games, and experience bullying or teasing due to their size. Obese girls can reach puberty earlier and have to deal with periods at as young as 8 or 9 years of age.

Overweight and obese children are more likely to stay overweight into young adulthood. This can increase their risk of type 2 diabetes and limit their ability to stay fit and healthy. No one wants this for their child, so what can parents do?

The big question

It can be very difficult to start a conversation at home about body weight but if you are concerned about your child, it’s worth the effort.

“If your children’s weight is not an issue, either to them or you, the less parents talk about weight the better,” says Tam Fry from the National Obesity Forum.

However, if your child’s weight does start to impact on their life and well-being, he suggests that parents start by expressing their own fears about how excess weight might affect their child’s health and happiness, rather than calling out their size or eating habits. Fry adds: “There are no guidelines which every family can follow except that the conversation should always be loving and honest. Tough love it may be but parents would be failing if they didn’t deliver it.”

Starting a conversation can be more challenging when parents are conscious that their own weight, eating habits and fitness are not an ideal example for their children to follow.

Parenting coach, Lorraine Thomas, says: “As a parent, look at the food you have in the house. Your child may be old enough to open the fridge. but you buy what goes in there! Talk to your children about family health so that they are not singled out and show them that you are working on yours too. Set some goals, have some fun, do exercise together and spend quality time cooking together.”

Tips for supporting your overweight child

If your children hear you being negative about your own body, then expect them to follow with opinions of their own. I remind my kids constantly of how unbelievably blessed they are to have arms and legs and fingers and toes and taste and sight, etc. I think family activities such as nature trails, or even a brisk walk around the block every day can help increase activity levels and fitness and also doing some exercise at home together can make fitness fun.”

Elaine Wyllie, a former headteacher of St Ninian’s Primary school in Stirling, knows that even a short burst of regular exercise can be a great way for children to take charge of their own physical and emotional health. She was instrumental in introducing a campaign called the Daily Mile. This is a daily 15-minute run or walk which includes all children in the school, even those who are disabled or unfit.

She explains: “We are trying to promote self-care in children so a Daily Mile was a great way of getting the children to take charge of their own health. It was aimed at improving fitness but it actually ended up helping to prevent obesity as well as getting children in the right frame of mind to learn. It is definitely a positive health promotion tool.”

The MEND foundation is another excellent place to find information about appropriate interventions for overweight and obese children. Parents can refer their child directly or ask a health professional to do this.

Avoiding negativity is vital, says psychologist, Emma Kenny. She continues: “Being body positive is essential.

Try these tips if you have concerns about your child’s weight:

Check the charts

Check out your child’s weight for height on the percentile chart or ask your health professional to help you do this.

Are there issues?

Explore with your child whether their weight is causing any issues. Can they take part in all the activities they want to, do they have happy and stable friendships, and is there any evidence of teasing or bullying?

Be sensitive

If your child’s weight for height is above the 95th percentile or if you think their weight is causing issues for them, consider having a sensitive conversation about their health and fitness. Children should never be put on a diet unless your health professional has suggested it.

Suggest positive changes

Focus your discussion on your own fears and hopes and suggest positive steps for making changes, such as taking more exercise as a family and eating healthier foods and drinks.

Don’t be cruel

Avoid making negative comments about your child’s weight or size, even in jest, as this can be counterproductive. Emma Kenny says: “Siblings often use ‘fat’ as a loaded insult as so many children know how hurtful such a term can be. As a parent it is important to communicate how unacceptable these types of comments are within sibling relationships.”

Make it a family activity

Children are more successful at managing their weight when the whole family makes healthy changes to their diet and exercise habits.

William T. Basco, Jr., MD, MS

Latino Parents’ Perceptions of Weight Terminology Used in Pediatric Weight Counseling

Knierim SD, Rahm AK, Haemer M, et al
Acad Pediatr. 2015;15:210-217

Study Summary

Previous studies evaluating preferred weight terminology when caring for overweight children did not include adequate samples of Latino families. This study was conducted in the Denver Health system where 20% of the Latino pediatric patients are obese. This proportion is higher than the Colorado state-wide obesity percentage of 15.5%.

This study consisted of focus groups of Latino parents selected from the Denver Health database in 2012. All participants were aged 18-80 years and were the parent or primary caregiver of at least one child aged 2-18 years. Focus groups were attended by 31 Spanish-speaking Latino parents and 23 English-speaking Latino parents. Knieram and colleagues wanted to obtain the opinions of parents of nonobese children as well as those of overweight or obese children. Six focus groups were conducted, with no mixing of Spanish and English language parents.

The focus groups followed a structured format. Parents were asked to brainstorm about terminology used to describe excess weight in children. The parents were also presented with preselected common English or Spanish terms for excess weight. Parents were asked about their perceptions of these different terms, including those that they had heard used by healthcare providers. They were asked which terms they would find offensive if used in their presence, which terms would be more motivating to have their child lose weight, and which terms might be offensive if used. Most of the participants were women. Spanish-speaking participants were more likely to have been born in Mexico, to be married, and to have a high school education. English-speaking parents were much more likely to report that their children felt teased or mistreated because of weight (44% vs 16%).

Among the Spanish-speaking Latino parents, only one phrase could be identified as being potentially motivating without being also offensive: “demasiado peso para su salud” (too much weight for his/her health).The term most commonly used by healthcare providers, “sobrepeso” (overweight), was identified by some Spanish-speaking Latino parents as motivating but by others as offensive, thereby reducing its potential value. Among English-speaking Latino parents, none of the terms that had previously been found in English-speaking populations to be preferred (example, “unhealthy weight”) were motivating and inoffensive. Parents in both language groups were confused by the meaning of the term “BMI.” Parents expressed that the method of delivery was as important as the terminology used, meaning that even preferred terminology could be delivered in an insulting way. Of note, both Spanish- and English-speaking Latino parents expressed that linking their child’s excess weight to future health risks would be motivating. Not explicitly linking the discussion of weight to concerns for future health led some families to take the weight discussion as an insult, related more to the child’s appearance.

Cultural nuances and even terms of endearment for overweight individuals were also evident in the Latino population. For example, many Latino parents expressed the notion that having a “chubby” child was not insulting or concerning but in many ways a sign that the child was actually healthy and growing well. They said that terms that would be considered offensive in English-speaking families were often used as terms of endearment within Latino families. While only one Spanish term (“demasiado peso para su salud” [too much weight for his/her health]) was found to be motivating and not insulting to Spanish-speaking Latino parents, no English terms could be found to meet these same criteria. The researchers also concluded that linking the discussion of weight status to future health concerns is both less offensive and potentially motivating to Latino parents.

Viewpoint

I reviewed a similar study in 2011, and that study was a real eye-opener for how poorly parents could take discussions about their child’s weight and how the terminology used by providers could be improved. The current study further demonstrates how complex the problem might be for providers. The study authors comment that they will be testing the preferred term in a larger sample of Latino parents and will report on how acceptable the term might be, so stay tuned for that. However, both this study and the one from 2011 are clear signals that discussions about excess weight should emphasize concerns for future health as a way to avoid offending parents and to increase their motivation to act.

A recent study provides new insight into how language impacts childhood obesity. The researchers found that the parents of obese children were more likely to use direct statements to prevent them from consuming calorific treats.

Share on Pinterest A new study investigates language and its role in childhood obesity.

Now that 1 in 3 children in the United States are either overweight or obese, every parent is concerned about their child’s eating habits. Understanding how and why some children become obese is urgent.

The way that parents behave and interact while feeding their children is known to be important, but the story is complex. Restricting food can actually, paradoxically, increase how much a child eats overall.

Researchers recently set out to investigate a part of this conundrum: the role of language. They wanted to understand how the way in which we speak to our children about what they should or should not eat impacts dietary choices.

It’s a given that the way in which a parent speaks to their child has an impact on their behavior. And, according to the latest research — which is now published in the Journal of Nutrition Education and Behavior — this also applies to eating habits.

Lead researcher Dr. Megan Pesch, who is a developmental and behavioral pediatrician, believes that the current study is the first to examine “the impact of parental direct imperatives in restricting a child’s intake of unhealthy food.”

Currently, there is little advice available on how to speak with children about their dietary choices. As Dr. Pesch explains, “So many of the guidelines are focused on what not to do. There’s a lot of emphasis on what parents shouldn’t be doing and what doesn’t work.”

In the study, Dr. Pesch and team — from the University of Michigan C.S. Mott Children’s Hospital in Ann Arbor — videotaped 237 mothers (or primary caregivers) and their children, who were aged 4–8. The caregivers were all from low-income homes, a demographic known to be particularly at risk of childhood obesity.

The caregiver-child pairs were alone in a room and were presented with different foods, including chocolate cupcakes.

There is a stigma attached to the parents of obese children. Often, people assume that they simply allow their child to eat whatever they want, whenever they want. This study demonstrated that the reverse was true. As Dr. Pesch explains, “They were attentive and actively trying to get their children to eat less junk food.”

However, the scientists noted a subtly different linguistic approach. According to their findings, the caregivers of obese children were 90 percent more likely to use direct language, such as “Only eat one” or “You’re eating both of those? No! Don’t! Oh my gosh.”

The mothers of children at a healthy weight, however, were more likely to use indirect phrases, such as “That’s too much. You haven’t had dinner.”

This is the reverse of what might be expected; a more direct, firm message is thought to be most effective when talking to a child regarding discipline, or sleep, for instance.

“ Indirect or subtle statements don’t seem to work as well in general parenting. Direct messages are usually easier for kids to interpret and understand where the limits are. But there’s more sensitivity around how to talk to children about eating and weight.”

The authors note a number of limitations to the study. For instance, the caregivers knew that they were being filmed as part of an experiment, which could have altered their behavior.

Also, only individuals from lower socioeconomic backgrounds were involved, and the new findings may not apply to other demographics.

As this is the first study of its kind, there will need to be much more work before firm conclusions can be drawn. Only then can solid advice be given to parents. Dr. Pesch and her team plan to continue this line of investigation.

“We hope,” she says, “to find better answers to the ultimate question of what parents should do to help set their child up for healthy eating long-term.”