Weight regulation difficulties are faced by a growing number of children and are an emotionally charged topic. When the issue is recognised, parents are faced with the pressure of treating the issue but are often fearful that this interest in their child’s body shape and size may start up a lifelong battle with weight and body image disturbance, and a negative relationship with food and mealtimes.
If the intervention chosen does not relieve this burden but adds to it, then it is unlikely to be helpful.
It’s important to understand that obesity is a complex disease and that there are many mechanisms, quite out of a young child’s control, which may lead to overeating. The treatment for childhood obesity should aim to stop further weight gain helping your child develop a healthy weight as they grow.
Overly aggressive dieting results in relapses
Overly restrictive energy intakes (aggressive dieting) almost always result in severe relapses. Ultimately the goal is to establish lasting, healthy dietary habits that reduce the overall kilojoule intake.
At this point in your child’s life there should be no assigned weight objective – only positive lifestyle goals. Any changes you make to your child’s diet and lifestyle are much more likely to be accepted if the changes are small and involve the whole family.
Managing an overweight child MUST include an understanding of the behavourial and psychological factors that affect our eating habits.
Extreme dietary restraint (starvation diets) stops one from relying on physiological cues of hunger and satiety. The hunger caused by diets that are too strict makes following them very hard. This can lead to breakdowns when the child is emotional and tired, causing feelings of guilt and triggering the child to overeat, leading to a vicious cycle whereby, paradoxically, energy intake becomes greater.
This breakdown in control causes distress, which in turn promotes low self-esteem, and this is likely to increase new, even stricter dieting. Therefore, dietary restraint is identified as an important psychological factor which can hinder treatment.
Be aware of eating as an expression of anxiety
Watch out for eating as an expression of anxiety. You may observe a trend of eating in the absence of hunger, but with specific preference for the consumption of comfort foods. Watch your kid’s snacking behavior and eating speed around higher stress times of the school year e.g., before orals, sports days and galas, exam time or if there is something that is happening in the child’s life that is or has resulted in undue stress.
The support of a psychologist may be very helpful in these situations and finding constructive ways of dealing with stress important.
Low satiety at the heart of overeating
Low satiety is often at the heart of overeating. Help your child distinguish between thirst and hunger and encourage the use of only water for thirst. Reduce the sugar content of favorite drinks and ban calorie dense sweet drinks.
Strive to enhance satiety, by using mindfulness techniques around each mealtime, making meals a joyful occasion. Encourage the child to eat slowly, chew well, and focus on the tastes and textures of the food. Eat in an environment free from distractions.
Appropriate plate sizes
Use appropriate plate sizes and avoid feeding your child large portions. A good rule of thumb is to start meals with small servings and let your child ask for more if they’re still hungry.
Try not to make your child finish everything on the plate or eat more than they want to. Avoid using adult-size plates for younger children as it encourages them to eat oversized portions.
Use balanced dietary practices Learn about healthy, balanced dietary practices. A visit to a registered dietician may be helpful here, as the amount of misinformation about food that we are bombarded with on a daily basis makes finding the truth about balanced diets rather challenging! Remember that the goal is to develop sustainable and healthy habits.
- A strict weight reducing diet is not recommended for children. The goal of diet therapy is rather to maintain current weight or to prevent further weight gain and let the child grow into his/her weight.
- Reduce energy intake by avoiding obvious sources of high calorie foods (particularly fatty foods or foods high in refined sugars). High calorie snacks should not be available. It will be much easier for your child to avoid the temptation of high energy foods if you do not have them in the cupboards.
- The food your child eats does not have to be any different from the food you eat. Incorporating healthy eating habits for the whole family will benefit everyone. This also prevents the child from feeling different to anyone else.
- A child’s stomach is smaller than your stomach: avoid serving portions that are too big.
- Remember to look at your own eating habits, and lead by example!
- Mealtimes should always be happy; food should be eaten in a relaxed environment. Do not offer food rewards to your child for finishing his/her food. Never force-feed your child: children will eat according to their appetite. One skipped meal will not result in starvation! However, if your child continues to refuse food for an extended period, consult your dietician or doctor.
- Food likes and dislikes are quite common in childhood. If a particular food is refused, don’t fuss but ignore it and offer it another time. Food dislikes are usually outgrown, and the food will be accepted at another time.
- Treats and rewards are important but should preferably not consist of food! Star charts may be used successfully in younger children: offer a reward once a certain number of stars have been accumulated. Non-food treats may include an outing, a new item of clothing, special toy. Older children can be offered the money that would have been spent on a food treat instead of the food itself. This money can be saved up towards something big: a new toy or item of clothing. This gives the child a sense of responsibility and makes them feel included.
- Get active as a family! All children need about 60 minutes of moderate to vigorous physical activity a day for good health, but it doesn’t need to be all at once: several short 10-minute, or even 5-minute, bursts of activity throughout the day can be just as good as an hour-long stretch. Keep screen time to under 2hr/ day.
Claire McMahon is a registered Dietician who graduated with an honors degree in Nutrition and Dietetics from the University of Cape Town. She has been in private practice for over 20 years and specializes in eating disorders and the management of obesity in children and adults.
T +27 82 668 0668