Weighty Issues for Parents

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Of course, whether a child can--or, rather, should--diet is a more complex question. Most clinicians don't even like to use the word; instead, they talk about "lifestyle changes" and "weight-management protocols." Says nutritionist and family therapist Ellyn Satter of Madison, Wis., considered by many a pioneer in the field of child feeding: "Even the most conventional people will say, 'Don't put kids on diets,' but then they'll go on to talk about how you should reduce their sugar or fat intake. There's an awful lot of dieting in disguise."

Does dieting even work for kids? Many clinicians say no. "We actually find that children who diet gain more weight than their peers," says pediatrician Dr. Alison Field from Children's Hospital Boston, who has been following the weight-control behaviors of almost 17,000 kids. It's not just that kids who diet tend to gain back the weight later; it's that dieting brings up all sorts of unbidden psychological responses that sabotage the process. After all, self-deprivation is one thing; being told by someone else that you can't eat--even when you feel hungry--is another.

"Renee whines to me about being hungry all the time," says Jo. "She knows I'm a softie and might just let her have another snack. I've done nothing but diet all my life, and I know how it feels." That feeling of deprivation, according to Satter, is a recipe for disaster. "You end up putting a lot of pressure on food," she says, "and the kids end up losing track of how hungry or full they are. They get into a habit of eating while the eating is good, instead of simply eating until they are full."

There's evidence to suggest that she's right. One study of preschoolers, for instance, found a link between overeating and overweight children--and an even stronger link between overeating and kids whose parents regularly control their portions. And so, Satter says, we need to start making the process of eating less fraught by letting kids decide whether they are hungry and how much to eat of the foods we provide at the times and in the places we provide it.

Carnell, who has also looked at the eating behaviors of children whose food choices are restricted, says the key is the way in which you seek to limit a child's food intake. "If you have a house full of goodies and say, 'Johnny, you can't have this,' then that could be damaging," she says. "But if the way you restrict your child is just to provide a healthy home environment where you allow them a little bit of choice--apples or grapes for dessert, for instance--then you're giving children a chance to decide for themselves while also helping them develop healthy habits."

For experts focusing on the best ways to control weight or increase activity, the job pretty much ends here. Parents, however, have it harder; they have to think about the whole child. "If dealing with my daughter's weight issues was as simple as following a few nutritional and exercise guidelines, she wouldn't be overweight," says a Southern California mom. "But the whole thing is so much bigger and messier than that. I don't just care about what she weighs; I care about her growing up healthy and happy and feeling good about herself. And that is where it gets difficult."

Dr. Beth Marcus, a family physician at Verdugo Hills Hospital in Glendale, Calif., knows all about these difficulties. "I don't think there's any way in our culture to have kids feeling 100% good about themselves when you're telling them they need to lose weight," she admits.

If that has always been the case, it's getting to be more so all the time. When billboards, magazines and TV shows are filled with Photoshopped, Pilates-toned, silicone-enhanced models, it's hard to maintain any kind of perspective on what a real person is supposed to look like. And while that's long been true for girls, it's increasingly true for boys, who now must measure themselves against waxed and buff athletes and models who are steadily raising the male-attractiveness bar higher and higher.

Then too there are the messages kids are bombarded with from well-meaning strangers ("Oh, he's a chunky one, isn't he?") and critical relatives ("Ah, she's going to grow up to be just like fat Aunt Sue!"). Schoolmates--at least those not yet claimed by the obesity epidemic themselves--may soon join in the chorus. All of this can hit a child's still developing ego hard. On the whole, overweight children are more likely than healthy-weight kids to be anxious, unhappy and depressed. The science is mixed on which kids suffer the most. One study finds that self-esteem takes a bigger hit in black kids than in white kids; another sees the problem as being worse for Hispanic children. One study finds significantly higher rates of depression in overweight girls; another finds overweight boys taking a huge self-esteem hit when teased by their peers. No matter who feels the most pain, however, they're all getting hurt.

What parents, who suffer all this pain by proxy, must realize is that they are never going to change the hard realities of schoolyard taunts and a thin-obsessed culture. What they must do instead is teach their kids to value those things less--and value other things more. Kelly Lowry, a postdoctoral fellow in the department of child and adolescent psychiatry at Children's Memorial Hospital in Chicago, says the key lies in accentuating the positive. "Parents need to emphasize health behaviors, not the numbers on a scale," she says.

Those behaviors should be positive. Maybe your son tends to scarf his food; rather than criticize him, get him to scarf fruits and vegetables instead. Maybe your daughter spends too much time on the couch; rather than scold her for it, applaud when she gets some physical activity. The reward of your approval may be enough to encourage her to seek more.

In addition, any changes made in terms of the kinds of foods served or the time allotted for TV viewing should be made "at the family-wide level," Lowry says. "This will prevent the overweight child from feeling targeted." And new self-esteem standards should be applied to the whole household too. If you're walking around commenting on how fat your butt looks in your new jeans, not only is your daughter going to hear you, but she may also begin making generalizations about how she looks.