“How do you do your job?” “I wouldn’t touch those kids with a 10-foot pole!” “Your clinic is a mini-psych ward!” “Nothing works!”
These are just some of the comments I've heard throughout my career as a pediatrician who specializes in obesity medicine. What's worse is that these comments come from other members of the health care community. So you can only imagine what these kids go through in school and out on the playground.
The pediatric obesity epidemic is so overwhelming to most doctors that they don't know where to begin. Great strides are being made in the United States to try to educate physicians about preventive medicine — to talk your patients and their families about healthy nutrition at each visit in order to prevent them from becoming obese. But what about those kids who are already obese at age three years? How do you tell a parent that their child is overweight? Can anyone succeed with these children? What if their parents are obese or overweight? They may be insulted.
I've spent the past 14 years trying to answer these questions, and I've found that one thing works: compassion.
No one wants to be judged, and no one wants to be blamed. If I chide parents in front of their children for buying junk food, I don't empower that parent. If I scold a teen for eating three slices of pizza in a sitting, is that patient going to come back to me? Of course not.
In my office, I lay down rules very quickly.
1. No teasing allowed.
2. No blaming allowed.
3. No lying to the doctor or hiding the truth, because I am here to help, not pass judgment.
4. We are all in this together. If you are going to single out one child as “fat,” this won't work. The whole family eats and lives the same healthy way.
I can't tell you how many times patients have thanked me for this. Once this fear of being judged is lifted, I can make a much better connection with the parents and the patients.
Many parents ask me for a “diet” or a “print out” of exactly what their child should be eating daily. They're often surprised that my reply is “No.” I'm not a nutritionist. My job is to examine your child with a medical eye. I'll point out complications from weight that you may not have been aware your child already had, like worsening asthma, acanthosis nigricans (a dark, velvety skin change commonly found around the neck, underarms, and groin), obstructive sleep apnea that can lead to school failure or school issues due to hypoxia (low oxygen levels) while sleeping.
There are many obese children with undiagnosed attention deficit hyperactivity disorder that leads them to graze in the kitchen all day. Sadly, there are also children with more severe complications like pre-diabetes, diabetes, nonalcoholic fatty liver disease, joint disease, headaches, and hypertension as a result of their obesity. On a patient’s first visit I'll send her for fasting blood work and assess her vital signs. I'll then ask for a brief food diary and request that she and her parents come back with an honest, detailed one.
I try to make recommendations that I think a patient can accomplish in a week or two, whether it's “stop all soda and sugar sweetened drinks” “walk up and down the stairs, do not use the elevator” or “no more rice with dinner.” Rome wasn’t built in a day. If I overwhelm a parent or child with extreme recommendations, they usually won't come back. However, if they can actually stop drinking soda for two weeks, they'll be proud of their accomplishment and get a lot of positive feedback at their next visit with me. Obviously, if a patient has a life-threatening illness and drastic measures have to be taken, I'll make the necessary dietary changes immediately.
Once I earn a family's trust, my job is a whole lot easier. My true reward comes when the kids run into my office to show me how well they are doing and how many new foods they tried. I try to turn what can be a very unpleasant medical visit into an opportunity to educate families and empower them to help their children.
Here five tips that a parent of an overweight child should be aware of:
1. Don't weigh your child regularly at home.
We do not want to create eating disorders or body image issues. A child may just stop gaining weight and continue to grow taller. This is a success. If a child’s clothes are getting loose this is a great sign as well.
2. Drink two cups of water before leaving the house for a birthday party.
It will give a sense of fullness and hopefully limit the amount of junk food consumed at the party.
3. If possible, pack a homemade lunch.
School lunches generally have very poor nutrition quality (high sodium and mostly processed ingredients).
4. Stop buying sugar cereal.
Swap it out for a low-sugar bran or oat-based cereal.
5. Use positive reinforcement with your kids.
All children do better when they're built up (a sticker for trying a new vegetable), rather than punished for failing.