Slow and kind approach
The best approach for families to take is to view this as a slow, kind approach that occurs over time. Let me just qualify: slow, meaning at the pace of the patient. Kind, meaning it feels kind to the patient. And time: encouraging the patient to view this as a process, or to give him or her the gift of time, so that he or she feels comfortable in the process and doesn’t focus on just one long term goal or weight.
Jan Hangen, Clinical Nutritionist
Empathy
Show empathy while still being matter of fact. We want to make it clear that their goal is good health. Parents want their children to have a healthful life and a long life. They need to view this as a process: they’re at Point A, where they’re not as healthy, and their lifestyle is not as healthful, and they want to get to Point B, where they are in a healthful ideal body weight range, and where they have better health indices (blood pressure, cholesterol, weight etc). They can travel from Point A to Point B in a fairly straight line or they can take a very jagged, long journey. But always put it back in perspective: “The concern is that I want you to have a good life and I want you to be happy, but I also don’t want you to take forever. Because from my perspective, I see people taking forever, and I don’t want you to go through the trials and tribulations that happen when someone takes a long time to do this.”
Another very supportive and empathic thing to do is to model the behavior, so that you serve as 1) an intellectual resource who has the knowledge; and 2) an emotional resource who can say “I know what it feels like to eat breakfast when you don’t want to. I know what it feels like to eat a half plate of vegetables when you don’t necessarily like vegetables. I don’t go off and sneak treats, where you can’t see, because I don’t want you to do that.” So I think we really have to model behavior, so we know what it feels like. Not only as parents, but also as providers– it’s imperative that providers model the behavior. For me to be effective at my job, I have to come in here and feel like I can provide some inspiration and help them become re committed to their vision as a healthful person.
Jan Hangen, Clinical Nutritionist
Giving control to the child
I’ve had a couple of sixteen or seventeen year old patients who clearly voiced to me that they didn’t want to be [at the clinic] and that they didn’t want to do this. Sometimes this was because they had other issues in their lives that were taking up their attention, and sometimes it was just because they didn’t see their weight as an issue. In these cases, you can really see the pain in the parents’ faces, because their child losing weight was so important to them, there were obviously health concerns around it, and frequently the parent had tried not buying certain foods for them and nothing was working. We try to explain to the parent, “It’s not really your responsibility to get them to eat healthily. You can want that for them, but you can’t do it unless the child or teenager wants to do it.” So in that case, I suggested, “There is no point in going through all the motions if it’s not something the child wants.” It really comes back to giving them the control, because so frequently a parent is taking the control away from the child around food and trying to police all of their decisions. If you finally just give the child or teenager that control and say, “Okay, it is your decision,” they end up finally realizing that this is something they want to do, because there is no power struggle there; there is no reason for them to rebel anymore.
So I tried in that session to say, “If you don’t want to talk about this anymore, we don’t have to. We can stop right here.” I’ve had a couple of kids who have decided they don’t want to talk anymore, and I don’t think they came back to the clinic. They said that they wanted to end [the program], and I said, “Please come back and see us if you are ever interested in doing this again; you’re more than welcome to.” But there was really no point in continuing right then, because they’ll just be going through the motions and not actually doing it. Changing your eating takes work, and if you don’t want to do it, it’s not going to happen. And other times, when I’ve suggested to kids, “We can stop right here if you like,” they’ve been shocked that they have that control and then said, “No, no– it’s okay. Let’s keep going.” So giving that control back can make a difference.
Kelly Sinclair, Clinical Nutritionist
Listening to patients
I like to listen to patients and families when they come in to the clinic. I think many times they haven’t had an opportunity to discuss just how it feels to be overweight in our society. I like to give them the opportunity to vent a little bit about that, if they want to, and to talk about the reasons they want to lose some weight and what differences it would make in their lives. Some kids want to be able to be more active; some kids are motivated to lose weight because teasing upsets them so much. Other kids would like to have more choice in clothes, or be able to make the football team, or have something like a prom coming up. So I like to hear why it is that they’re here. Whose idea was it? Are they here because someone made them come, or because they really want to lose some weight, and if so, why? So that’s the first thing.
Then, because I’m a health care provider, I like to talk about the complications of being overweight, particularly later in life. We’re seeing so much diabetes now in kids who are overweight. I want to make sure that families know that in addition to feeling better about themselves and increasing their self-esteem, there really are some serious health consequences if they don’t take weight loss seriously.
Colleen Kochman, RN, MSN, PNP
Goals
Because our clinic works with three to thirteen year olds, we see kids who are still growing taller, so sometimes they may actually gain weight. What we focus on is their BMI not moving. If their BMI stays the same or maybe goes down, but they grow taller and gain some weight, that’s fine. What I tell families all the time is that we’re working on stopping the rapid weight gain. If you never lose weight with our program, but you stay the same, you’ve met your goal. That takes some of the pressure off.
Also, I am very careful about the way I use the word “diet.” I don’t use it to mean “going on a diet,” but everyone has a diet, and I provide people with some education on that. There are some kids who just get down on themselves, and who really feel awful if they’ve gained weight. Then for other kids, it’s not on their radar, and they’re not thinking about it; they’re worried about, “Oh, I really want to play outside and this lady won’t stop talking to me!” So a lot of it depends on the child. If the child has gained a couple of pounds, that’s okay; they are working on figuring this out. The other thing that I tell parents and kids all the time is that if you’re eleven, it took you eleven years to get to where you are now. You learned all of this behavior in eleven years, and it’s only been three months that you have been unlearning some of that behavior. So give it some time. If it took eleven years to learn this, it might take three, four, five, or maybe eleven to unlearn it. We’re hoping to shorten that, but it could be that long; we don’t know.
Jennifer Rein, MSW Social Worker and Clinical Coordinator
Why are you here?
I start each session by saying, “Why are you here? I know your parent brought you, but what motivated you to be here? Why do you want to lose weight?” For girls, it’s typically because they want to be able to wear some particular style of clothing, or they want to fit into a different size. For boys, it’s usually that they tire easily when hanging out with their friends or playing a sport. So we try to link food choices back to that specific motivation: “Eating this is what is going to help you to be healthier, lose a little bit of weight, run faster, catch that football, or make that layup. Things are just going to be easier.” So we try to link the goals we’re setting with their particular motivations. Definitely, sports tend to be more of a motivator for the boys, and appearance and peer opinions more of a motivator for the girls.
Kelly Sinclair, Clinical Nutritionist