Photography: Roberto Caruso, Illustrations: Nica Patricio
Ed.’s Note: A new Senate committee report on the obesity crisis in Canada was released this week. It includes 21 recommendations to combat the high rate of obesity, including a ban on food and drink advertising aimed at children, a tax on sugary drinks and creating government subsidies for healthy food.
Feeding a child can be simple—in the beginning, at least. Weight gain is celebrated: We smother plump bellies with raspberry kisses, gush over dimpled knees and happily dole out extra helpings. After all, food is love; it’s warmth; it’s family. Until suddenly it’s not. Baby fat blossoms into a fleshy frame. Bullies take their toll. Maybe food becomes a solace, consumed mindlessly while staring into screens, turning flesh into flab. As a parent, do you even see it?
Many of us don’t. Parental bias can stack its own mental blocks. In the past year, three major studies have concluded most parents fail to recognize when their child is overweight. One study from New York University, involving nearly 7,000 kids, found the vast majority of parents felt that even their obese children were “just about the right weight.”
Yet it’s also true that overweight kids don’t stand out as they once did. Children all over the world are heavier than they ever have been. As the World Health Organization reported in January, 41 million children under age five are now overweight or obese—in 1990, the number was 31 million—a spike blamed largely on the consumption of processed foods and not enough physical activity. In Canada, the rate has tripled over the past 30 years; almost a third of children between ages five and 17 are overweight or obese.
“It’s quite natural that parents don’t recognize it, because we assess ourselves by comparison and look at everyone else,” says Tom Warshawski, a paediatrician and chair of the Childhood Obesity Foundation in Kelowna, BC. But experts agree this is a worrisome gap in perception, as parents who don’t see a weight problem are unlikely to help a child overcome it, and there’s no sugar-coating the end result: Most children will not grow out of it. “If you are obese at 16,” says Warshawski, “there’s an 80 percent chance you will be obese as an adult.”
With obesity comes a long list of life-threatening ailments: hypertension, Type 2 diabetes, heart disease, cancer, respiratory problems, bone conditions and many more. Some scientists predict that with the record-high rates of childhood obesity, today’s kids will be the first generation to live shorter lives than their parents. Last November, the American Heart Association reported that obese kids as young as eight are showing signs of heart disease. Says Warshawski: “We are setting our children up for a life of ill health.”
Of course, it’s a prognosis no parent wants to hear. Yet even if you recognize that your child is overweight, figuring out what to do next can be daunting. There’s no magic potion to make pounds disappear, and most obesity research has focused on adults. In fact, helping a child reach or maintain a healthy weight may be one of the thorniest challenges of modern parenting.
It’s hard enough for adults to lose weight, and we presumably have more patience, reason and willpower. No one wants to police the pantry or make a kid count calories. In most families, fat is the other F-word. So how—in a conflicted world that’s thin-obsessed but awash in junk food—do you manage a child’s weight without creating lifelong anxieties around eating and body image?
Very carefully, says Laurie Clark, an Ottawa psychologist at the Centre for Healthy Active Living (CHAL) at the Children’s Hospital of Eastern Ontario. At CHAL, there’s a team of specialists who help children with severe obesity and their families improve their health through behavioural and lifestyle changes. But none of it is set in the context of losing weight or slimming down—rather, it’s all about getting fit and healthy.
When kids are just starting to develop their relationship with food and themselves, Clark says it’s important they hear that healthy bodies come in different shapes and sizes, and that the goal of making healthier lifestyle choices is “to be active and happy in our bodies.” So instead of talking about calories or diets, which “sets kids up to be preoccupied with that,” she says, discuss choices in terms of good health and overall happiness. “If a child is functioning well and has no other health issues, a parent needs to step back and say, How are we running our household?”
The most critical step in managing a child’s weight, experts say, is to recognize that the issue is not about the child—it’s about the family. When lifestyle changes are the best (and usually the only) available treatment for a kid carrying excess weight, those changes have to be adopted by everyone.
“You may see the problem with one child, but weight is a reflection of genetics and environment,” Warshawski says. “So it’s actually a problem with the whole family that’s just showing up in this one kid.”
About 16 different genes impact an individual’s propensity to gain weight, Warshawski says, and you can see the effect even in infancy. One baby will be content after four ounces of milk, while another needs three more to feel full. “That will continue into childhood, but now the food you’re filling him with is rich in fats and sugars. So one child can eat whatever she wants and never gain, while others just see food and pack on the pounds. That’s the way genetics interplays with the environment.”
But unlike genes, the environment is something parents can generally control, especially in the younger years, when we hold more sway than peers and when the chances are highest of forming healthy lifelong habits. Yet studies suggest that many families have a long way to go: Most kids—seven out of 10 of those between ages four and nine—do not eat the recommended five-serving minimum of fruits and vegetables each day, and only seven percent of five- to 11-year-old kids get the daily recommended minimum of 60 minutes of physical activity.
Which is why, in 2013, Warshawski’s foundation helped launch a family-based program in BC called MEND, short for Mind, Exercise, Nutrition, Do It! Started in the UK in 2004, the program takes a hands-on approach to helping parents and kids with weight issues become fitter, healthier and happier by teaching them how to make healthy food choices and live more active lives. Run out of local recreation centres, the free 10-week program involves at least 20 visits with a team of specialists. It also includes a three-month membership to the community rec centre and a tour of a grocery store to learn how to shop healthily.
It’s a big commitment, says Warshawski, but studies suggest it can make a difference in reducing weight and body mass index. However, he cautions, it may not work for everyone: “I saw a family yesterday, and they are all still gaining weight; another is doing really well. It’s not one-size-fits-all.” What is key, he says, is that “the whole family has to buy into the lifestyle solutions for this to work—if you get the habits right, you’ll get the body that’s right for you.”
At the CHAL program in Ottawa, dietitian Anna Aylett says that any attempts to change the lifestyle of just one child are likely to backfire. “I often see families where they have started to restrict the overweight children by not giving them dessert or treats, but it can lead to food sneaking,” she says. There may be genetic differences in a family that make one child prone to gaining weight, but the food available has to be the same for everyone in the household, Aylett says. “You have to have the same rules for everyone.”
Doing otherwise can make your kid feel unfairly singled out and cause her to associate feelings of guilt and shame with eating. Instead, experts say, it’s up to parents to create a healthy food environment for everyone and then practise a clear division of responsibility on food matters—parents decide what, when and where the family eats; children choose how much they want to eat.
If a child, however, seems to suddenly gain weight, there could be underlying forces at work. Stasia Hadjiyannakis, a paediatric endocrinologist and director of the CHAL program, says parents should find out if there are genetic factors that could be influencing weight or whether kids are eating in private, skipping meals or not getting enough sleep. Screens, especially in the bedroom, she notes, can interfere with sleep and lead to hormonal changes “that can impact your appetite and increase the risk for obesity.”
Emotions can also figure powerfully into food relationships. After all, the idea that people eat their feelings has been around longer than ice cream binges have been associated with breakups. Alex Jadad, for instance, a renowned University of Toronto physician and founder of the Centre for Global eHealth Innovation, learned the hard way that unhappiness was at the root of his 10-year-old daughter’s overeating.
Jadad and his wife hadn’t even realized their daughter Alia had gone from chubby to obese. “I think sometimes familiarity breeds blindness,” says Jadad. But then she told them that she was being bullied at school because of her weight. “They called her ‘Blue Marshmallow,’ because of her blue jacket…. They taunted her with chocolate,” he says. “That’s how we found out [she]—we didn’t realize it ourselves. You know your child, you see her all the time, and she’s perfect—and she was perfect.”
Only when they took Alia to the doctor did they discover that school bullies were not the true source of her sadness—as Alia diagnosed herself: “She said, ‘I’m jealous.’” Jadad explained that his wife’s niece had recently come to live with them, and Alia felt displaced. “She was overeating to compensate. Weight was the issue, but it was a manifestation of other things.”
Alia’s revelation marked the beginning of a long journey—one the Jadad family took together. They bought bicycles, educated themselves about nutrition and eliminated most sugar from their diet. They even grocery shopped together, making a game of it to find packaged products that did not carry one of the 50 sugar synonyms on their labels. (It was almost impossible, he says.)
Alia, now a grown woman, did eventually lose weight, but more important, says Jadad, is that his daughter and the whole family created a new and healthier—and happier—lifestyle for themselves. Alia also switched to a new school, where she thrived and regained her self-confidence.
The point, he says, is that “it’s not an individual’s responsibility to solve—it’s not ‘Oh, there’s something wrong with you.’ It wasn’t her fault, and it cannot be a case of telling your child, ‘Don’t do this. Don’t eat that. Don’t eat this.’” It’s about getting the family back to fundamentals, says Jadad, who is a founding member of the Canadian Obesity Network.
Blaming individuals for being overweight only contributes to the discrimination and isolation they already face. “What makes this problem so monumental,” Jadad says, “is that it’s one of those rare cases where the stigma alone can become a public health problem because of the toll it takes on mental health.” In fact, Warshawski notes, kids who are obese rate the quality of their lives lower than children undergoing cancer therapy.
What’s important is that children feel good about themselves by making healthy choices. “We know a lot comes down to the way our body was designed, and there’s a strong biologic response to weight loss —that’s why it’s often regained. Ideally, prevention happens early on,” says Hadjiyannakis. For example, encouraging kids to move, play and be physically active is a huge step in the right direction.
“I think it’s about shifting the outcome we’re celebrating,” she says. “So we might not see a big change in body weight, but if we have patients that find a new physical activity they love—that’s a success, and that’s something people can control, more than a number on a scale.”
By the numbersThe MEND program encourages families to follow the daily 5-2-1-0 formula: five servings of fruits and veggies; no more than two hours of screen time; at least one hour of activity and zero sugary drinks.
Taking measure The body mass index isn’t a fail-proof way to diagnose childhood obesity—if your kid is muscular, for instance, the results might be skewed. That said, tracking BMI is a good starting point to help you and your paediatrician monitor your kid’s growth.