Medical

What You Should Know: Talking to Parents about their Obese Children

According to the Center for Disease Control, childhood obesity is reaching what some are calling an epidemic proportion in America: nearly two out of every three children under the age of 18 are considered to be either overweight or obese. Because of this, many doctors will find themselves in the potentially awkward position of having to talk to parents about their child’s weight problem. Because of the potential for negative parental reactions to this, it is a topic some doctors will avoid.
However, doctors who are planning to practice in family medicine or pediatrics in particular need to be able to have meaningful and positive conversations with parents so that they can work together to help the obese child to achieve a healthy body weight. Here are some things to keep in mind while having this conversation.

1. Don’t Place Blame
This is one of the most important points to keep in mind when having these kinds of conversations. In one recent study of parents with obese children (who were overweight due to Bardet-Biedl syndrome), parents reported that they felt they were being denounced or seen as unfit/incompetent parents due to their child’s weight problems and that they felt they were victims of what is called a courtesy stigma. This stigma is a well-researched phenomena where a person perceives that they are being judged due to their close association with another person who has a stigmatizing factor (in this case, the obese child).
It can be easy for doctors to get frustrated and place blame on parents whose children are overweight–mostly because doctors understand so well the health risks that these obese children are running, for everything from cardiac disease and diabetes to joint problems and psychosocial issues that can have a serious and negative impact on the a child’s quality of life. However, the blame game only succeeds in alienating parents and interfering with therapeutic communication between a doctor and his or her patients and their families.
2. Be Sensitive to Language
In a society where overweight/obese people face discrimination at school, work and in relationships, being sensitive to language and choosing words carefully is also an important skill to cultivate. It can, in fact, make the difference between a therapeutic conversation and one which becomes contentious. In a study which focussed in on Hispanic Spanish- and English-speaking families, parents were interviewed about a variety of terms which could be used to describe excess weight in a child and asked to describe their reactions to it. Terms like “obese”, “fat” or “overweight” were considered to be offensive or pejorative, while “BMI” merely confused parents across the board. What most parents agreed on was that terms like “too much weight for the child’s health” or “unhealthy weight” were the most acceptable.
It is good for doctors to keep in mind that presenting excess weight strictly in terms of a health problem is useful: words like “fat” or “obese” can imply a problem with a child’s appearance, which parents can find offensive. Keeping the conservation about a doctor’s concern about a child’s health can help parents to realize that there are real consequences to a child’s excess weight. Being extra careful when talking about weight problems with parents in front of the child is important as well, so that the child does not feel stigmatized or judged. If you are truly concerned and empathetic to these problems, this will be communicated to parents and child alike and can set the stage for healthy changes to begin.
3. Understand the Barriers
Much research has gone into the topic of barriers to compliance with diabetes. But diabetes is not the only health issue in which these barriers exist. Another important thing for doctors to keep in mind is that there can be real barriers between families and the kind of lifestyle (with a balanced diet and adequate rest and exercise) that promotes a healthy weight. One study looked at what common barriers there were in families of low-income children attending Head Start. These barriers included the short attention span and particular eating habits of the child as well as lack of time, lack of cooking skills, a tight budget and lack of education about good nutrition. In this study, one of the interventions which was effective in helping to overcome these barriers was a support group which included cooking and nutrition classes, outings to the park for exercise, and other activities that helped to promote a healthy lifestyle.
The Lifestyle Behavior Checklist, or LBC, is a user-friendly tool that helps parents to conceptualize the behaviors in their children that are leading to problems with their weight. Identifying the barriers to begin with can be the first step in coming up with concrete ways to overcome them.
4. Be the Educator
Another thing to remember is that many parents of obese children do realize that their child has a problem, but often feel confused about ways to approach solving it. The amount of information–much of it conflicting–on the Internet and social media, as well as magazines and books is partly responsible. This parental confusion, however, can be an opportunity for a physician to act as an educator and to teach parents about ways in which they can promote healthy habits in their kids.
The kind of healthy behaviors that you should talk to parents about include:
● Consuming extra fresh fruits, vegetables and whole grain products.
● Opting for low-fat dairy products and lean meats, beans and nuts as opposed to protein sources that are higher in saturated fat.
● Learning to prepare lighter, lower-calorie versions of favorite dishes so that children do not feel deprived.
● Decreasing sources of sugar in the diet, particularly candies, sweets and sugary drinks.
● Encouraging kids to drink water, milk and other healthy choices instead of sodas and juices.
● Finding ways to be active, such as joining a sport at school, taking family outings to the park, or just incorporating more exercise into the day.
● Decreasing screen time: in other words, limiting the time the child spends with computers, television and other devices.
For parents who have access to a computer and an interest in learning more, two great websites to refer them to are Let’s Move and Choose My Plate. These sites are user-friendly and give parents plenty of science-based nutritional and healthy lifestyle information in regards to diet and exercise. The goal with this education is to empower parents so that they, in turn, can have a positive effect on their child’s weight and overall health.
5. Go With a Family-Based Approach
In an article entitled “Parents as an Agent of Change in Childhood Obesity” the authors note that, unsurprisingly, “The home environment is undoubtedly the most important setting in relations to shaping children’s eating habits”. Much research has gone into the fact that one of the best ways to promote healthy weight in children is to implement a family-based approach: instead of trying to work with the child on his or her own, these programs work with the entire family to develop healthy lifestyle habits. This can benefit not only the child but parents and other siblings. As conditions like heart disease or diabetes tend to run in families, this can help improve the health of the whole family.
The family-based approach is also a more holistic one which takes pressure off of the overweight child and can help improve the underlying causes of obesity that can be endangering the health of children and other family members alike.
6. Remember: Weight is Not the Only Issue
This might sound strange, but another helpful thing to keep in mind when dealing with overweight children is that what parents should be focussed in on is not what the scales are saying but what kind of healthy lifestyle habits a child is developing. Paying attention just to the weight itself can be frustrating for parents and children alike, whereas putting an emphasis on these healthy changes can help keep the conservation positive and encourage children to develop the kind of lifestyle that will help them reach their highest health potential–and even instill habits that they will keep into adulthood.
It is also important that parents know that many health parameters, such as blood pressure, cholesterol levels and blood sugar levels, can improve dramatically with even modest weight loss and that the most important thing here should be adherence to a healthy lifestyle.
In short, when talking with parents about their obese children, the goal is not to make the parents feel ashamed, judged or hopeless about their children’s health. What works best is an approach which presents the excess weight as an issue of health instead of appearance and which goes on to identify barriers to a healthy lifestyle and find ways to overcome them. These conversations, if handled right, can be empowering for parents and give them the tools that they need to help their children–and themselves–to make the shift towards a healthier overall lifestyle.
References
Boscoe, W. and Peterson, M. Talking About a Child’s Obesity: What Words are Best?.
Medscape. 2014. www.medscape.com/viewarticle/843491
Ek, A. et. al. Childhood Behavior Associated with Obesity and Parents’ Self-Efficacy to Handle Them:Confirmatory Factor Analysis of the Lifestyle Behavior Checklist. International
Journal of Nutrition and Physical Activity. 2015. doi: 10.1186/s12966-015-0194-4
www.ncbi.nlm.nih.gov/pmc/articles/PMC4403705
Golam, M. Parents as Agent of Change in Childhood Obesity: from Research to Practice.
International Journal of Pediatric Obesity. 2006. 1(2) 66-76
Hamlington, B. et. al. Characterization of Courtesy Stigma Perceived by Parents of
Overweight Children with Bardet-Biedl Syndrome. PLoS One. 2015 10(10).
Ling, J. Perceived Parental Barriers to and Strategies for Supporting Physical Activity
and Healthy Eating Among Head Start Children. Journal of Community Health.
2015. www.ncbi.nlm.nih.gov/pubmed/26660100
Pediatricians: How to Discuss Weight with Parents of Obese Children. Weight Bias Resources
for Pediatricians. University of Connecticut Rudd Center. 2015.
https://biastoolkit.uconnruddcenter.org/toolkit/Module-6/6-01-PediatriciansHowTalk.pdf
Preventing Childhood Obesity: Tips for Parents and Caregivers. American Heart Association.
2013. www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/Preventing-
Childhood-Obesity-Tips-for-Parents-and-Caregivers_UCM_456118_Articlejsp#VqOfWDHJbml

Tips for Parents: Ideas to Help Children Maintain a Healthy Weight. Centers for Disease
Control. www.cdc.gov/obesity/childhood

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Brian Wu graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School o...