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.