Childhood Obesity: A family affair

FARGO -- When a child has a weight problem, it can be a sensitive subject for medical professionals to broach with his or her parents.

After all, the kid isn't the one shopping for groceries. And frequently, the parents or siblings are waging a similar battle with weight themselves.

"It can be a difficult conversation to have sometimes," said Dr. Rebecca Bakke with Sanford Health. "As a pediatrician, my job is to review a child's growth and development with the parent. ... The best way I address it is to objectively look at the growth chart."

Children aren't diagnosed with obesity the same way adults are. While adults are classified overweight or obese by their BMI, or body mass index, pediatricians look at children's percentile on a growth chart, or how their BMI compares to other children of their same age and gender.

A child between the 85th and 95th percentiles is considered overweight, and obese at the 95th percentile or above. A child wouldn't be considered overweight or obese until at least age 2.

According to the Centers for Disease Control and Prevention, about 17 percent of U.S. children and teens ages 2 to 19 are obese. The prevalence of youth obesity has tripled since 1980, the CDC said, and lower income and minority children are more likely to be obese.

While the method of diagnosis is different, children become overweight and obese the same way adults do: by consuming more calories than they burn.

"It's a complicated problem when you look at solving it, but the causes aren't complicated," Bakke said.

Medical professionals note we live a more sedentary lifestyle. Kids aren't outside playing as much. Our lives are busier, so many parents rely on higher-calorie fast food to feed their families.

Some parents recognize their child has a weight issue and are eager to talk about it, Bakke said. Some are defensive. Plenty have reactions somewhere in the middle, she said.

To defuse defensiveness, Bakke focuses on healthy lifestyle behaviors, which she does with all patients and their parents, an effort to proactively prevent obesity.

She refers to a number-based acronym: 5, 2, 1, 0. It stands for five fruits and vegetables a day, no more than two hours of screen time, one hour of physical activity, and zero sweetened or sugary drinks.

And a pilot program at Sanford Health aimed at helping overweight children involves the whole family.

"There's a large number of kids we work with that struggle with healthy lifestyle," said Carrie Brower-Breitwieser, a Sanford child psychologist leading the pilot program. "It seems that when working with a family approach, involving

the parents, we have more

success."

Pediatric pilot

Because of the obesity epidemic, doctors are seeing more adult health problems in kids, Bakke said, such as early heart disease, high blood pressure, high cholesterol, type 2 diabetes and orthopedic problems. Obese children are more likely to become obese adults.

Then, there are the non-physical issues like teasing and social isolation, and low self-esteem.

The Childhood Pediatric Obesity Pilot Program underway in Fargo is hoping to curb these physical and emotional issues.

Ten families, with children ages 8 to 12, are taking part in the 10-week pilot program, which is funded by a Sanford Foundation grant. It started in October and runs through Dec. 18.

The goal is to offer the program several times a year to wider range of ages, depending on the success of the pilot, Brower-Breitwieser said.

Families meet weekly at Family Wellness, a health club facility that's a partnership between Sanford and the YMCA.

The parents and child split up. While parents are educated about healthy food choices and behaviors, the kids take part in a physical fitness component or learn how to make healthful snacks.

While overweight adults are counseled to lose weight, children are still growing. The goal instead is for them to maintain and not gain weight too quickly, Brower-Breitwieser said.

Angie Hasbrouck, wellness education and special events coordinator at Family Wellness, sometimes helps lead the kids' group. She said the activities are designed to be replicated at home.

"We really don't use weights or other things," she said. Instead they use balls, hula hoops and other household items in nontraditional ways. "It's getting them to learn how to live an active lifestyle that can be incorporated into every day at home, in school. Other people don't even need to know they're getting special help."

Separating the children and the parents for the education session also ensures the medical experts and parents can talk freely without the child feeling labeled, like he or she has done something wrong and needs to be "fixed."

In separate one-on-one meetings with the families, Brower-Breitwieser takes the emphasis off the child's eating patterns or behaviors.

"We don't focus on the child. We focus on the family," Brower-Breitwieser said.

Another example: At the weekly meetings, the whole family is weighed instead of just the child.

With families being involved this way, not only does the child make positive changes, the parents and siblings do too, Brower-Breitwieser said.

Hasbrouck said parental awareness of the obesity epidemic is important.

"Their choices really affect how the kids grow and develop. They need to be conscience of it," she said.

What you can do

Amy Hieb, a licensed registered dietician with Essentia Health in Fargo, agrees parents have a strong influence on a child's diet and weight, as well as in educating their children about good and bad nutrition choices.

"I think if you involve them in grocery shopping (and meal preparation), open up those avenues of education, open up that discussion, it's a less difficult process than, 'Here's what you have to eat tonight,'" she said.

Hieb encourages parents to talk about what food does for the body, such as milk promotes strong bone growth or protein helps build muscle.

Starting conversations and healthy choices early on in childhood can reduce the struggles. A preschooler may adopt healthy eating choices more readily than an adolescent with strong likes and dislikes, she said.

"There has to be some caution to not be overly extreme with it," she said, noting comments about a child's weight can make him or her self-conscious. "I think trying to be subtle with the changes and subtle with the conversation. Try not to make food a battleground."

When parents are defensive or resistant to make changes, Hieb said she listens to their concerns and acknowledges the barriers they may face. She offers tools or solutions that have worked in her own life, as a mother of 6- and 3-year-olds.

Parents also need to model healthful eating, and should avoid using food as a reward or comfort object, she said.

"I think it's important to keep in check, have patience and flexibility with the child," Hieb said. "Change isn't going to come quickly or easily."