Balancing empathy and encouragement
There is such a thing as being overly empathetic. Some parents find it hard to believe that at times you can become so empathetic with a child that they start to think, “I am okay where I am; I don’t have to make changes.” We try to help parents see that there is a balance to be struck, so that they can empathize with their child’s feelings, yet also express concern about their need to make changes. In empathizing we really encourage parents to reflect back what the child is saying about their feelings.
Allison Lauretti, PhD, Staff Psychologist
Being Empathetic
I think you can be empathetic and sympathetic by saying that some people have different metabolisms, and it’s not fair. It’s not fair that you can’t eat what your really skinny sister or your really thin friend does. It’s quite reasonable to say that it’s not fair that this is the body type you have, but that you have to deal with it. Parents can be empathetic by being role models, and certainly not eating differently than they’re asking the child to eat. Parents can also get out and be role models in terms of exercise, so that they’re not asking the child to do things they’re not doing. If they’re sedentary and eating potato chips but then asking their child not to, that’s not going to fly.
Colleen Kochman, RN, MSN, PNP
Early Challenges
A lack of family support is sometimes a problem. Maybe one parent is really committed to helping the child, but another parent doesn’t feel so strongly and doesn’t follow our recommendations. We also see a lot of kids who are depressed, so we have to really deal with that underlying depression before we can make much headway with nutrition or activity recommendations. Sometimes we don’t know which came first; did the overweight make the child depressed, or did the depression make the child overeat and become overweight? That is always something we look at.
Colleen Kochman, RN, MSN, PNP
As a Team
I think one of the most important things is to have [weight loss] be something that is approached by the entire family, as opposed to just saying, “This child is overweight and needs to change his or her eating habits.” I think we tend to see the most success when the whole family jumps on board and says, “These are things that would benefit all of us: eating more healthfully, getting out and walking around, and doing more physical activity.” When everyone is doing it together, I think that children feel less ostracized than when they try to make the changes completely on their own. When the whole family is involved, children often tell me that they then feel as though they are part of a team.
Nicole Eldridge Marcus, PhD, Behavioral Therapist
Children and Adolescents
I generally like to say that it’s the parents’ role to make sure that the right kinds of foods are in the house. They are the ones who really need to understand the concepts of our prescribed dietary plan and have the right foods available. It’s the child’s role to eat the right kinds of foods. Of course, in the case of a younger child, the parent is going to do everything for them, and be largely in control. On the other hand, an adolescent can be perfect at home under the watchful eye of their parents, but then go out and do whatever they want to, so they have to own wanting to lose the weight. However, the most successful kids are those who have very supportive families, in which the whole family eats the way we’re asking the child who goes through the clinic to eat.
You can’t separate that child out and make them feel different if you want them to be successful. In fact, some parents have been amazing, and have gone above and beyond what you would expect them to do. I know of a nursery school mom who makes sugar free snacks and sneaks them in so her child has them but never knows she is getting anything different from the rest of the kids. The parents who are supportive of their children are the most successful.
On the other hand, particularly for teenagers, it doesn’t work very well if the parents are the “food police,” saying, “That’s not on your list; you shouldn’t be eating that.” That’s not going to work, because there are enough conflicts in adolescence as it is. So I really feel that adolescents have to own what they want to eat; they have to want to do it. If their parents drag them in here, it’s very unlikely that they are going to be successful. They really have to make some lifestyle changes, so they have to be committed to change.
Colleen Kochman, RN, MSN, PNP
Not Singling a Child Out
The other thing that I point out clearly is that there is stigma associated with food and weight. So if families have one shelf of food that is just for the overweight child, that’s not going to work. The child would be all by himself and would feel singled out and targeted, and that’s not the goal. And most parents will say, “No, no– I don’t want him to feel different.” The challenge comes when one kid needs to gain weight and one kid needs to lose weight– how do you balance that? I also really focus on asking people, “If you’re cooking a meal, isn’t it a whole lot easier to cook the same thing for everybody? Work on making enough food to feed everyone there, but don’t worry about having seconds or thirds or leftovers.” In fact, we don’t need leftovers.
Jennifer Rein, MSW Social Worker and Clinical Coordinator
One Step at a Time
Sometimes parents are frustrated by how long it takes for a child to lose weight. In general, the child didn’t put the weight on overnight, so it’s not going to come off overnight, and actually a slow, steady weight loss is much healthier than a dramatic one. Also it depends on the age of the child; with really little kids, we’re just hoping to maintain the weight rather than have them lose weight, because they have so much growing to do. Kids will ask, “What do I do about parties and Halloween?” We like to help them through those types of things, and to be helpful and supportive. I also like to see myself as a cheerleader; when they come in, I’ll say, “Great job staying on track.” If they haven’t lost weight or they’ve gained weight, I let them know that it’s okay; we’re not expecting perfection, and we need to take it one step at a time.
Colleen Kochman, RN, MSN, PNP
Parent and Child Roles
I often talk with parents and children about who is in charge of what within the family: Who is in charge of buying your food? Who is in charge of cooking? How can you help your mom? How can you help your dad? We really define clearly which are the grown ups’ roles and which are the kids’ roles. We also reassure families, because sometimes what we say just goes right over younger kids’ heads. We tell these parents that weight should be important, but that the child’s reaction is an appropriate one developmentally. What is important to the child are things like playing outside, making friends, and remembering to hand in their homework so that they don’t get into trouble. What should be important to parents is not necessarily important to their kids. We highlight those things, because if we define this issue clearly, then frustrations are less likely to happen.
Jennifer Rein, MSW Social Worker and Clinical Coordinator
Parental Involvement
When children are young, between five and nine years old, they really need their parents to be the ones preparing their snacks. This way, the parent knows that when a daughter opens the refrigerator and sees that her mom has already made her a fresh fruit cup, she’ll have the opportunity to make a healthy snack choice. The parents have so much responsibility at this point that they really need to become quite involved in the food preparation. But as children grow older and especially into early adolescence, I have noticed that parental involvement with food preparation and choices can sometimes start to backfire. There is a very fine balance that needs to be forged somehow: parents need to be supportive but also allow the child to realize that this is his life and he needs to be responsible for the decisions he is making. Everyone in the family should certainly be educated about food choices. However, I think that sometimes parents need to step back a little bit at this point and let the older child or adolescent know, “I trust you, and I trust that you are going to make some of these good decisions,” so that we do not have food issues becoming a source of conflict and power struggle between parent and child. I also think that this step of indicating confidence in a child’s decision making capabilities can provide an important and empowering message for the child as well.
Nicole Eldridge Marcus, PhD, Behavioral Therapist
Parental Weight Issues
We ask parents, “Is there a family history of people who have been obese or struggled with their weight?” Parents will generally tell you if they’ve struggled with weight as a child, and sometimes it’s obvious by looking at them that they have a weight problem themselves. We also ask for a history of the parents’ weights and heights. This can be instructive if you see a parent who looks overweight and they say that there isn’t any history of overweight; we can see where they’re coming from in that thinking process. They might have a different set of values than we do in terms of what they consider overweight. I think it’s common for a parent to say, “I went through this as a child, and I don’t want my child to go through the same thing.” I hear that a lot.
Colleen Kochman, RN, MSN, PNP
Support and Praise
Setbacks and disappointments happen. I think group support is important, because children need to know that setbacks and slow progress, or lack of progress, are common themes in this population of kids trying to lose weight or manage weight. One important thing is to let children know that they’re not alone. This might be done by establishing contact between their family another family, so that they can be in contact with other children. Or it could be done by having them be part of a group, even a special exercise group.
The other really important thing to remember in dealing with setbacks is that certainly a long term goal is being in an ideal body weight range, but leading up to that goal there should be numerous small goals. Meeting small goals should be rewarded, and there are many types of rewards that don’t need to cost money. For example, a reward can be verbal praise. I used to photocopy children’s hands and then have them put the photocopies on the wall and high five themselves when they had a great day. I also encourage parents and guardians to give verbal praise. I often encourage parents not necessarily to keep a food journal, but to keep a praise journal to celebrate short term goals. At the end of the day, they sit down and write two things in the journal that the child thought went very well. Then parents can look at those two things and ask the child if he or she thinks that one of those two positive things could be improved a bit. The idea is to focus on praise and not on foods, but to make the foods a part of the praise. Also, we’re building on the positives; we’re not saying, “How did you mess up today?” In fact, that may come out in the conversation at the end of the day, but in general I like to keep a very positive chain of events going. Focus on the positive, and build on the positive.
Jan Hangen, Clinical Nutritionist
Support during a Challenge
I think something that I really want to emphasize to patients and their families is that the task of making lifestyle changes to become healthier is really tough work. I think that a lot of times they might be expecting it to be easier, and if so they can become really disappointed and upset by the amount of effort, work, and persistence that it can often take. I think that this is really important to emphasize, because sometimes we may forget to share this without patients as we are going forward. This is not say that it can’t be done, because we have seen it be done very well. One of the biggest keys to being successful and making healthy lifestyle changes is having adequate support. Children need support in terms of what foods are available and having opportunity to exercise, but they also need good family and friendship support as they take on this really challenging task.
Allison Lauretti, PhD, Staff Psychologist