Being consistent
I think it is sometimes hard for parents when these children have siblings. Frequently, the siblings are not overweight, and they are sometimes even underweight. Parents can have a difficult time trying to determine which foods to keep in the house. They often explain to me that they do not want to “punish” the sibling who seems to be doing okay weight wise. However, we also do not want parents pointedly making all types of contradictions by giving the siblings tons of ice cream and other snacks that they are not allowing the other child to have. I have noticed that it becomes very tricky within the family to try to be consistent but not be overly restrictive with siblings. In addition, a lot of the time, parents are accustomed to having junk food in the house and to eating in a certain way. Unfortunately, in these cases parents may be trying to get their child to change his or her eating habits, but the parents themselves still want to be able to eat their same unhealthy and fattening foods in front of their child. In that sense, I think parents can inadvertently send their children mixed and confusing messages.

Nicole Eldridge Marcus, PhD, Behavioral Therapist

 

Change
Change is very difficult, and it’s daunting to most people. One interesting thing that I’ve found from treating adults and children is that it’s less daunting for children than it is for adults. I think a lot of times we’ll place our own perceptions of change on our children, but it might be harder for us than it is for them; it goes back to the idea of teaching an old dog new tricks. I think we need both to be open minded about change and to model the behavior. Change should also occur slowly, because new foods are almost like new people. It takes a lot of time to develop trust in new foods and new activities. For a child for whom food is like comfort, and especially for a child for whom there hasn’t been a lot of food variety at a young age, trying to increase variety at the same time that you are introducing weight plans can couple things in an unfavorable way. Model the behavior; show that you’re willing to do this. And encourage slow changes–changes that the child likes. For example, if your kid is not a sports person, don’t put him on a team.

Jan Hangen, Clinical Nutritionist

 

Is this a good time?
Sometimes when you see a patient or family not coming to appointments very regularly, or not showing progress over a period of time, I think you need to present to them the questions that you’re considering, like, “Is this a good time to try and make these changes?” I think it is especially hard when you are talking about a child’s health; maybe the child is motivated to make changes and show up and they want to do this, but they may be lacking parent support and family support. So there isn’t any really specific time period after which we say, “Okay they have been here a year and they’re not showing signs of success, so we are going to suggest that they go elsewhere.” It’s not like that; it’s much more on a case by case basis. We have to look at a lot of factors, like where they started, what changes they have been able to make, and what kinds of support that particular family has.

I think what we do is think carefully as a team about whether we need to ask the family if they are willing to do some of the small things to try and keep on the path towards a healthy weight. That is usually our biggest factor in determining whether their time here needs to be stopped. Some families will say, “You know what? No, we are not ready to do this anymore. We just can’t do it.” Then maybe we need to refer them to other things that they need to do. We invite them back too, though. I think one thing that we always do is to say, “You can come back when you feel more ready.”

Allison Lauretti, PhD, Staff Psychologist

 

Mixed messages
Parents play an important role in helping a child to lose weight, because parents are the ultimate role models for their children. If you want your child to eat more fruits and vegetables, you need to eat healthier. You can’t tell them, “I want you to eat more of these foods,” and then sit there eating a bag of potato chips, because that sends a mixed message. Parents frequently think that they’re not as major a role model as they actually are when it comes to food choices. In fact, they are the most important role models that their child has.

Kelly Sinclair, Clinical Nutritionist

 

Modeling behavior
Parents need to model the behavior. That is the most important predictor, I believe, of the children doing well.

Jan Hangen, Clinical Nutritionist

 

Role models
I think it sometimes can be helpful for a child to be able to talk to a parent [about weight issues]. We once had a father who came in with his son, and the father was very proud that he himself had changed the way that he was living. He had increased his activity level, he had lost some weight, and he really wanted to serve as a role model for his son. This dad also wanted to make sure that his son was aware of the fact that the father had been very heavy previously and had been able to change his entire lifestyle. I feel that children can really learn from their parents. When they see that their parents are perhaps also struggling with weight issues, I think it often actually helps them. Then they know, “It’s not just me; I’m not alone in this. This is something that has been an issue in my family: my grandfather struggled with this, my dad is struggling with this, and now I am too. And hopefully, I am going to be able to overcome it.”

Nicole Eldridge Marcus, PhD, Behavioral Therapist

 

The entire family
I tell parents that a child won’t be successful at weight loss if the entire family doesn’t decide to change their eating habits. It can’t be something that just the child does, or just the child and one parent does; families are most successful are when everybody in the family agrees to do this together because they know it will be healthy for everyone. Then they all do it together and face the challenges together. We advocate a low glycemic index diet because we feel that is the best way to help someone lose weight. Different things work for different people, but if you don’t have family support, no matter what approach you take, it’s not going to work.

Kelly Sinclair, Clinical Nutritionist