What Families Should Do

It doesn't really bother Janelle Marino, 10, that she packs 140 pounds onto her 4-foot-2-inch frame. True, she has difficulty catching her breath when she climbs stairs, and her eyes once welled up when she didn't look as sleek in her dance costume as her slimmer sister did. Still, "my friends are very nice to me," says the soft-spoken little girl, who lives in Slidell, La., takes dance lessons twice a week and swims throughout the hot Cajun summer. "Nobody really notices my weight." Actually, at least two somebodies do. Her mother has put Janelle on umpteen diets, and recently hauled her to a weight-loss specialist. For the last four years her father, who was an overweight child himself, has been warning Janelle away from the sugar-dusted Mardi Gras cakes and other junk foods she loves, and telling her in no uncertain terms, "You've got to lose weight." At this, the little girl cries.

For Janelle, like so many other overweight children, it isn't the extra pounds themselves but her parents' reaction to the extra pounds that takes the greatest emotional toll. As a result, families with an overweight child face a delicate balancing act: how do you save a child's health without breaking her heart? Telling a child that she needs to lose weight or attend a camp for "husky" children risks imparting the message that the people whom she trusts to love her unconditionally, dimpled knees and all, and to take her side against the pint-size sadists calling her "bubble butt" (as one boy labels his obese sister), have turned against her. The repercussions of that can go far beyond crushed feelings. There is a danger that the child's obesity will be compounded by depression, anxiety or a life-threatening eating disorder. "Pressure to lose weight can make a child feel that he, not his weight, is being criticized," says psychologist Michael Lowe of MCP Hahnemann University in Philadelphia. "Sending a message of rejection over something a child doesn't have total control over can be very destructive."

Families with an overweight child face three questions: whether, when and how to intercede. The first guideline is not to worry about baby fat. Only 20 percent of overweight 4- and 5-year-olds will become overweight adults, notes pediatrician Nancy Krebs of the University of Colorado. "The older the child, the higher the chance [that overweight will persist]," she says. That's why parents of an obese teen can't afford complacency. "An obese adolescent has a greater than 75 percent chance of being an obese adult," says Krebs. Degree of obesity matters, too. Is the child twice her desired weight? Or does she have only a little roll of belly fat? Boys and girls both bulk up around puberty, with girls adding more of the weight as fat and boys adding it as muscle; seeing your teenage girl get a little soft around the middle seldom requires intervention if she is eating healthy food and staying active. Finally, a child's horizontal expansion may outpace her vertical increase before a growth spurt. Kids will gain 30 or 40 pounds and then grow 10 or 11 inches several times. The pounds typically precede the inches.

It's important for parents not to regard a plump child as a blight on their own image. "So often I see judgmental parents who feel they've failed if their child is overweight," says Beth Braun, in-house psychologist at KidShape, a Los Angeles-based program. "Parents need to focus not on themselves but on the child." In assessing whether to intervene, a more important factor than weight itself is the child's eating and activity patterns. A child can get pudgy "but still be eating healthy, showing self-control and being active," says Lowe. "In this case you are likely dealing with a biological predisposition to overweight, and the extra pounds are less likely to pose a health risk." If a teen is 40 pounds overweight, he may be able to lose 20 of those pounds, "but the idea that he can reach and stay at an ideal weight might require a lifestyle change that is simply not worth the health gain you would achieve, and that might even trigger eating disorders," says Lowe.

If a child's body-mass index, eating and activity patterns all spell trouble, ferret out emotional contributors to weight gain first. Teens, even more than younger children, are at risk of substituting cookies for companionship. "If they're lonely, then food is their friend," says KidShape's Braun. "If they come home to an empty house, food keeps them company. Parents should always look beyond the weight itself: Is it a warning sign? Is the child depressed?" If the answer is yes, then address the cause, not the symptom.

Sean McCune's weight gain was pretty clearly triggered by emotional stress. When his mother, Val, separated from her husband two years ago, Sean was devastated. "He'd always been a chubby kid," Val says.

But Sean's weight ballooned when he moved with his mother to a new house in the Chicago suburb of Glenview, entered a new school and never saw his father except on alternate weekends. He became morose, shunning exercise, watching 15 hours of TV a week, indulging in too many school lunches of pepperoni pizza. By the time he turned 7 this year, Sean measured 4 feet tall and weighed 96 pounds. "I think maybe I contributed to the weight thing because I was so emotionally stressed about this divorce," says Val. "I wanted him to feel OK, so I didn't deny him anything." Sean just recently asked his mother to help him lose weight. "There were some kids at school who were teasing me, and I wanted it to stop," he says simply.

The worst thing a parent can do is restrict food, says Janet Laubgross, a clinical psychologist in Fairfax, Va. No matter what the child's age, "don't become the food police," she says. "Don't ask, 'Aren't you full?' If you try to restrict too much, your kid will hide food in his room. That begins a lifelong pattern." Teens, of course, are more likely to eat outside the home than toddlers are; if they don't learn to say no to megasize fast food, a parent's cantaloupe-for-cake substitutions won't make much of a dent. With younger children, parents are not obliged to explain that the family has switched from deep-fried chicken to broiled because of his extra avoirdupois. Instead, adopt prudent weight-busting measures without singling out the obese child, especially if she stands out from her svelte parents and siblings like a plump little marshmallow amid the string beans.

Focus on health, not appearance, and more activity, not less food. "The kids know they're fat," says psychology professor Joan Chrisler of Connecticut College. "They get the message every day. I'd encourage parents to get the child involved in more activities." Attacking the weight itself could push a child to turn even more to food for emotional sustenance--something hot-fudge sundaes offer a lot more of than carrot sticks do. One reason weight is such a highly charged subject is that these days, even 6-year-olds have fallen prey to the body-image demon. When Chrisler showed first graders silhouettes of different body types and asked the kids whom they'd like to be friends with, they ranked the images from thinnest to plumpest. In another study, Chrisler found that 68 percent of fifth graders said they were scared of being fat.

Preadolescent girls require special handling. "It is so important to help the child through this problem by giving them unconditional love," says KidShape's Braun. "You have to say 'I love you no matter what' a lot." If parents approach the problem in a judgmental way, she says, they risk tipping a girl into depression and an eating disorder. One reason is that over the last century, girls' source of self-esteem has shifted from the quality of their character to the shape of their bodies, finds historian Joan Brumberg of Cornell University. "The shape and appearance of their bodies is a primary expression of their identity," she says. "In our culture, mothers often send their daughter the message that the source of her worth and power is her appearance." When Samantha Ginsburg of Highland Park, Ill., turned 10, it was obvious she was heavier than other girls her age. "At first I didn't want to make too much of an issue of it," says her mother, Holly. "Sometimes that can backfire, and they'll eat more." But when Samantha turned 12 and was carrying 30 pounds too many for her 5-foot-1 frame, her mother told her it was time to tackle the problem: "I just realized that she's very social, and I think she would feel better [about herself] if she loses the weight." Samantha readily agreed. "I've never had a boyfriend, and I think it's partially because of [my weight]," she says. Although Samantha has lost about seven pounds in 10 weeks, raw emotions are never far below the surface. When her family recently went out for Chinese food, and Samantha's appetite kicked into full gear, her mother demanded afterward, "Did you think about anything you ate?" The two fought. Says Samantha, "I try to ignore it, but sometimes when she says stuff like that we have problems." And yet her mother is only trying to help.

A child who feels loved, not judged, is more likely to accept a parent's message about the need to lose weight. Being overweight in a Slim-Fast culture is devastating enough for sensitive children. Overweight children are often the last ones picked for a schoolyard team, the ones whom teachers and others adults tend to judge by the size of their waist before the content of their mind and heart. The one thing they don't need is to be called fat by the people who are supposed to love them most.

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