Recently we had a client reach out to us with concerns about their pre-teen daughter’s weight. They were concerned about her health and were looking for advice on how to approach the subject. Like most parents, she wanted this to be a positive conversation and not one that would result in her daughter feeling shame. Our Chief Science Officer, Natalie, has compiled her research for you to review. We hope you find this helpful!

 

Answer: 

Childhood weight management can be a complex and challenging issue that may require a multifaceted approach. Strategies involving family support, physical activity, nutritional, and educational interventions are likely to yield better outcomes than single-component strategies. Depending on the severity or individual situation, personalized approaches produce more favorable results, which may require gathering more information for an in-depth discussion. However, without knowing specifics (such as underlying health issues, genetics, and behavioral aspects), we can use general guidelines that are established in research, which include a combination of the efforts below. 

Research supports many ways to help children with healthy weight management:

 

Talk to your child and create a supportive, positive environment: Talk openly about the benefits of being healthy with your child. It will be best to avoid shaming or blaming your child but instead focus on the benefits of being healthy, such as having more energy and feeling better overall. Several studies suggest a link between family dynamics and child weight, with impaired dynamics associated with higher weight in children.

 

Positive reinforcement is an effective strategy to encourage desired behaviors and promote healthy development in children. It involves acknowledging and rewarding good behavior, increasing the likelihood of repeated behavior. For example, praising a child for completing a task or exhibiting positive behaviors can reinforce those behaviors and encourage the child to continue behaving positively. Positive reinforcement can also help to build self-esteem and confidence in children, as they feel valued and appreciated for their efforts. We can also avoid using food as a reward or punishment, which can create a negative relationship with food. Instead, reward children with non-food items, such as a special activity or privilege.

 

Encourage healthy eating habits: Research strongly supports nutritional approaches focusing on healthy food choices instead of restricted energy intake. When prioritizing metabolic and mental health for long-term weight management, a shift towards healthy food choices is more favorable than a restrictive approach (also refer to the critical considerations regarding calorie counting and food labels). This mindset is essential when determining an appropriate nutrition strategy for children.

 

Therefore, encourage your child to eat a balanced and nutritious diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats. Without labeling foods as bad or off-limits, perhaps avoid purchasing more processed junk food, sugary drinks, and snacks. Next, we can lead by example and model healthy eating habits ourselves. Children often learn by observation, so parents should model desired behaviors. To accomplish this, we can involve children in healthy meal planning and preparation, such as by letting them choose a new vegetable to try or assisting with meal prep. Involvement can also allow autonomy and help them feel empowered and more invested in healthy eating habits.

 

Practice mindfulness: Evidence suggests that mindfulness interventions and forethoughtfulness, a future-oriented mindset, may improve overeating and behavioral patterns. Mindfulness, characterized by purposeful present-moment attention and non-judgment, is a reasonably easy intervention to practice and implement. Therefore, we should promote mindful eating and teach children to eat when hungry and stop when they are full. We can encourage them to listen to their bodies and pay attention to how food makes them feel.

 

Promote regular physical activity: Promoting physical activity is an effective intervention strategy and a critical component in pediatric weight management. Physical activity could also result in favorable improvements in mental and physiological health, and both are indirectly associated with further weight-related advantages. 

 

In children and adolescents, the most common barriers to regular physical activity programs are:

• Lack of self-discipline.
• Lack of someone to engage in physical activity.
• Self-consciousness about appearance.

 

Health organizations recommend aiming for at least 60 minutes of moderate to vigorous physical activity each day. We can encourage youth to engage in regular physical activity, such as sports, bike riding, jumping rope, playing tag, walking, hiking, dancing, or simply playing outside. It’s important to note that physical activity can be structured and organized to be beneficial. Providing opportunities for children to engage in active play and incorporating physical activity into daily routines, such as walking to school or taking the stairs instead of the elevator, can also contribute to overall physical activity levels.

 

Further, it will be helpful to find ways for your child to take regular movement breaks during long periods of sitting, such as standing up and stretching every 30 minutes. Tracking steps can be a helpful tool for promoting physical activity in children. Still, step tracking should only be done in a developmentally appropriate way and in combination with other strategies to encourage active lifestyles (rather than solely relying on step counts). Parents should ensure that the focus remains on enjoyment and engagement in physical activity rather than solely on achieving a certain number of steps.

 

Limit screen time: We should also limit the amount of time your child spends on screens, such as watching TV or playing video games, or scrolling on phones, to no more than 2 hours per day. Research suggests a link between more screen time and overweight children. If this is an issue, some strategies to limit screen time with kids include setting limits, establishing clear rules and consequences, encouraging alternative activities, modeling healthy behaviors, and using parental control software.

 

Improve sleep quality and quantity: Sleep quality and duration are important modifiable risk factors for managing overweight children, as they can impact eating and physical activity behaviors. Modifying sleep patterns in school-age children can lead to healthy dietary habits, including decreased food consumption, resulting in favorable weight outcomes. According to the American Academy of Sleep Medicine, children between 6 and 12 should sleep between 9-12 hours per night.

 

Seek professional help: If your child’s weight is a significant concern, consider seeking help from a healthcare professional, such as a registered dietitian, therapist, or pediatrician. They can provide personalized advice, referrals, and additional support.

 

Important considerations: It is generally not recommended for children to track calories. Calorie counting and restrictive diets can lead to an unhealthy relationship with food and negatively impact a child’s mental health and growth. Further, labeling food as “clean” or “good/bad” can create a negative relationship with food and contribute to disordered eating habits. When we label certain foods as “clean” or “good,” we are implying that other foods are “dirty” or “bad.” This creates a dichotomy of “good” and “bad” foods and can lead to a restrictive and unhealthy relationship with food. Further, it can perpetuate food moralism, where we associate moral values with food choices. This can lead to feelings of guilt or shame when eating foods that are considered “bad.” As such, instead of labeling foods or counting calories, we should focus on promoting a balanced and varied diet that includes a variety of foods. All foods can fit into a healthy diet, and there is no need to demonize or glorify certain foods.

 

Parents can help their children understand portion sizes and make healthy choices by offering a variety of foods and modeling healthy eating habits. It’s essential to help children understand that food is fuel for their bodies and that all foods can be enjoyed in moderation. Children need to establish a positive relationship with food and their bodies at an early age, and focusing solely on calorie counting can lead to an unhealthy obsession with weight and body image. Remember that it’s essential to approach the issue of weight positively and be supportive, focusing on overall health and well-being rather than just weight loss. Ultimately, through a multifaceted approach, encourage your child to make healthy lifestyle choices while modeling those behaviors yourself.

 

References

Barlow, S. E., & the Expert Committee. (2007). Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics, 120(Suppl 4), S164-S192. doi: 10.1542/peds.2007-2329C

Daniels, S. R., & the Committee on Nutrition. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275-e292. doi: 10.1542/peds.2015-1558

Epstein, L. H., Paluch, R. A., & Roemmich, J. N. (2007). Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychology, 26(4), 381-391. doi: 10.1037/0278-6133.26.4.381

Golley, R. K., Hendrie, G. A., & Slater, A. (2011). Beyond “eat less and move more”: A review of low-intensity interventions to promote healthy eating and physical activity for children. Obesity Reviews, 12(5), e126-e138. doi: 10.1111/j.1467-789X.2010.00845.x

U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services. Available at: https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Golan, M., & Crow, S. (2004). Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obesity Research, 12(2), 357-361. doi: 10.1038/oby.2004.45

Huang, J. S., Norman, G. J., Zabinski, M. F., Calfas, K. J., Patrick, K., & Sallis, J. F. (2007). Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors. Journal of Adolescent Health, 40(3), 245-251. doi: 10.1016/j.jadohealth.2006.10.008

Moore, L. V., Fulton, J. E., & Kruger, J. (2008). Parental beliefs and attitudes about exercise and obesity in American youth. Journal of Physical Activity and Health, 5(3), 409-421. doi: 10.1123/jpah.5.3.409

Motevalli, M., Drenowatz, C., Tanous, D. R., Khan, N. A., & Wirnitzer, K. (2021). Management of childhood obesity-time to shift from generalized to personalized intervention strategies. Nutrients, 13(4), 1200. https://doi.org/10.3390/nu13041200

National Institutes of Health. (2013). We Can! (Ways to Enhance Children’s Activity and Nutrition). Retrieved from https://www.nhlbi.nih.gov/health/educational/wecan/

Rhee, K. E., De Lago, C. W., Arscott-Mills, T., Mehta, S. D., Davis, R. K., & Woo-Kyoung, A. (2005). Factors associated with parental readiness to make changes for overweight children. Pediatrics, 116(1), e94-e101. doi: 10.1542/peds.2004-1817