Thursday, October 18, 2012

Taking the "Weight" Out of Pediatric Weight Management

Had a nice chat yesterday with some great folks from Sudbury, including an exercise physiologist/kinesiologist who works in a paediatric weight management program. We were chatting about whether or not I would consider a trench talk that highlighted paediatric obesity topics.

Now I've often been asked about whether or not I see kids, or whether I'd be interested in setting up a program to help.

Here are my two lines in the sand.

1. I'd only ever recommend involving kids directly in treatment if they already suffered with weight responsive conditions (diabetes, hypertension, sleep apnea, etc.), and then only within the context of a program that explicitly excluded weight as a focus of treatment.

2. For kids without weight responsive conditions I'd only want to work with their parents.

I worry about the impact a tertiary or community based medical weight management focus might have on kids' relationships with food, body image and self esteem, and so for the kids with problems, they might benefit from a clinic focusing on improving their specific health problems through lifestyle change and a non-weight centric focus, while for kids who don't have problems - studies to date suggest parent exclusive treatment is just as good or better than treatment that directly involves the children.

Now I know nothing about the program in the graphic up above - and truly it may be a world class program - but how might you feel if you were a kid who needed to go there? Would you feel "new hope"? Or might you feel shame? I'm not saying it's fair, just that society has associated weight with personal failure, and while I disagree with the linkage I don't think my disagreement will change the fact that there are likely kids going to New Hope, where fair or not the name alone gives them cause not for hope, but for despair.

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  1. Anonymous9:03 am

    Completely agree! We dont want to do more harm then good which i worry about with counselling children. As a Dietitian I have been referred many children over the years for "weight loss" by MD's and I always cringe. As much as we try to talk 'healthy eating' and not weight loss, a child can easily take things out of context. It took one particularly cringe worthy session where the parent kept looking to the child (7 years old) saying "are you hearing this?" "did you hear what she said" to realize how wrong this was to even have the child in on the session. When its the parent buying and making the foods why have the children involved? Beleive it or not this is sometimes a hard sell to docs who want the child in on the session... Do you have links to those studies you cited that suggest parent treatment is just as good? Thanks so much!

  2. Anonymous9:04 am

    My son's paediatrician focuses so much on my son's BMI and this started with our first visit at 1 week old. My son has always been off the charts with his weight and around 99% for his height. His dr told me not to put him on a diet but then proceeded to tell me nott to give him juice. At that point because he was under a year old I had never given him juice and her reply to this was 'oh ok then just continue to feed him a varied diet'. I don't give my son juice and only on rare occasions does he have access to sweets and thats if only if we're visiting someone's house and given he's only 15 months old the most of what he eats ends up on the floor. Between our 2 last appointments my son has stayed the same weight but grew 5 inches. I'm glad I didn't put him on a diet but it bothers me that the dr focuses so much on his BMI I'm sure some parents would put their kIds even at such a young age on a diet.

  3. Anonymous10:55 am

    At what age do you think it is ok to start counselling for weight management? Do you think young teens (13y) is an ok age to be counselling the child rather than the parent?

    1. Yes and no.

      Ideally, no. I think 13 year olds, despite what the old testament might say, aren't adults. I don't think teens as a general rule have the insight or maturity to approach weight management in non-traumatic or nonsensical means....nor am I convinced that counselling will help.

      That said, the already weight-centric 13 year old might well benefit from reeducation that in fact decreased their focus on numbers.

      The non-interested, non-distressed 13 year old - definitely not.

  4. Perhaps you might also consider those kids who present who are distressed with their climbing weight, as it impacts them socially and physically--even before they have metabolic syndrome or hypertension. Those kids who themselves are frustrated by their abnormal increase in weight need constructive and supportive guidance--to help the families and to provide strategies for them, so they don't resort to radical and unhealthy approaches on their own--because that, too, is a consequence.

    1. Please see the comment I left up above - agree kids already distressed better served in ethical program.

  5. We've been focusing on healthy eating with our kids in the last six months after getting off track for a while. While it's taken patience and a lot of reading of "Parental No Files" for moral support, the "produce, not products" mantra has caught on with both boys. They are happier, more active and more positive about food overall and have taken it upon themselves to make healthy choices on their own. This has happened without ever talking about weight, which for my eldest, had started to become problematic. The other day, he finished first in his class in a cross country race! I am a proud mama.