An Adult's Guide to the Overweight Child

Many parents or adults find it challenging to adjust to the transformation of a child's body into an adult's. We all have certain psychological and emotional associations with a child's body that shift markedly as that child grows up. There's a dissonance people experience between the feelings towards a child juxtaposed with the child physically looking like an adult. Too difficult to manage emotionally, adults hope that ignoring the change will make it go away. 

Similarly, the way a parent reacts to the idea of an overweight child is much different than reacting to a child one knows or a child of one's own. Adults, in a hypothetical situation, would easily brush off the idea of a child on a diet. We can all quickly realize the detriment of teaching a child about restricting food, and my recent posts to this blog highlight the dangers of dieting. But what happens when this is a child you know? Or if it is your child?

There is so much media attention to child and adolescent obesity that a child one knows on a diet might feel appropriate, the risks outweighed by the fear of obesity. For some parents, having an overweight child may even signify a sign of failed parenting. Then, in a much more personal situation, a diet might not be so absurd after all but a needed step to right a wrong. 

Rather than reflexively jump to a diet, an adult needs to survey the entire situation. Not only does a diet run the risk of triggering a starvation response and perhaps even an eating disorder (as explained more fully in the last two posts), the diet also sends a message to the child that he or she is doing something wrong: their weight is a personal fault that needs to be fixed.

Body weight and shape are largely fundamental aspects of body both genetic and based on developmental stage. Fully assessing the child's situation is already a way to put weight and shape in its place and not give them too much importance. 

The first step is to assess the child's general food intake and exercise. If the child eats normally for that age and within the norm of most children, then it is a fair assumption that the child's diet is not an issue. Similarly, if the child's physical activity falls within the norm then that is also not relevant. It can be surprising for adults to realize that children all of whom eat about the same amount and types of foods and engage in moderate activity can end up in a wide range of body weights and shapes. Many factors affect what anyone's body looks like. The goal is health, not some preferred body shape. 

The second concern is the child's developmental stage. For boys and girls, the few years before puberty can be a time of weight gain. Often this seems to be preparation for the vast changes the body is about to undergo. If a child gains weight around that time without any lifestyle changes, it is likely a response to development. 

The third critical piece of information is family history. If the parents or other close relatives have a larger shape, then it is likely the child will as well. If the parents gained weight at certain times of childhood, then it's not surprising if the child does too. In other words, the child has the parents' genes so his or her body will likely grow in ways that are similar. Punishing a child for having a similar body to his or her parents is paradoxical. The goal is acceptance of who we are, not pressure to be something different. 

An adult can approach a child's change in body weight and shape with reasoned, thoughtful questions. The reflexive jump to a diet sets the child up for self-doubt, if not worse, over time. Acceptance and self-worth are necessary goals for any child that clearly overshadow any goal of ideal weight and shape, which only seem to derail development and risk disordered eating and worse.

More about the Main Risk Factor: Dieting

After more thought and discussion, I realize that pronouncing dieting as the most important risk factor for a child to develop an eating disorder is both confusing and terrifying. To imagine that something so ubiquitous and considered fairly harmless could trigger an eating disorder can be quite alarming for parents. I thought it was worth writing more on the topic. 

Dieting is basically a self-imposed type of starvation. Originally, starvation started from a person's inability to find food, likely famine. Now starvation is often a choice; however, the body can't distinguish between dieting and famine so the lack of food triggers an innate biological reaction to survive lean times.

The initial reaction is universal and includes slowed metabolism, conscious focus on finding food and energy conservation. However, the long term effect of starvation is dependent on one's genetic predetermined response.

A small percentage of people are programmed to respond to starvation in a way that can precipitate an eating disorder. They can thrive on restricted food intake for long stretches, a boon for the species in the distant past but a clear hindrance in today's world. The eating disorder symptoms begin as an adaptation to a harsh environment, but, over time, the survival instinct goes awry and hijacks a person's life. Eventually, the obsessive thoughts about food combined with constant starvation become a way of life. 

The idea that such a basic mechanism of our body, namely hunger and fullness, can go so wrong is terrifying. Parents spend years feeding their children, assuring them their basic needs to live in the world. It doesn't seem possible that all that work can disappear suddenly and turn into a horrible illness. 

What's more confusing is that a diet, something so banal and innocuous, can be the catalyst. Most people take for granted that dieting or cutting back certain foods on and off throughout the year is a staple of modern life, a natural response to our world of plenty. For better or for worse, focusing on weight has become a right of passage into adulthood. No one expects dieting to last but instead comes and goes over the years. Having a scale in the bathroom is like having your toothbrush there. This is just part of normal adulthood, right?

The juxtaposition between the universality of dieting and the rise in eating disorders makes it clear that we are all ignoring an enormous risk. Adolescents are ripe for new experiences and change. The draw of a diet to transform their lives and help them create a new identity is very strong. The positive feedback from weight loss is addictive to vulnerable children. But if this step is so easy to make without any supervision, then all children seem to be exposed to the risk of an eating disorder. 

Food restriction triggers a body's adaptation to lean times. There is no way to know how a child will react to the change. A teenager's first diet can be the start of a long and harrowing illness. The answer to this problem is education: parents, adults and schools can counter the power of dieting by making clear the risks.  I'll elaborate in the next post.