Susan R. Johnson MD, FAAP, 3/10/2000 (revised)

By the time I reached 6th grade, I was probably 25 to 30 pounds overweight for my height. My pediatrician placed me on lots of calorie restriced diets all of which didn't work. I even tried the high protein diet that is now back in vogue. All of this dieting just made me focus more on food (by 7th grade, I was a walking dictionary for the amount of calories in just about every type of food). As a young teenager, all this emphasis on losing weight made what I looked like on the outside seem more important than of who I was on the inside. It wasn't until medical school when I had cancer and underwent surgery and 6 months of chemotherapy that I finally could see my body as a vessel for a spirit; a sacred vessel that needed to be cared for and loved.

Childhood is the time for prevention of obesity. Health habits are not yet well established and recommendations to improve nutrition and increase the level of physical activity are more easily made when a child is young and eager to learn and before the child has become overweight. Placing the child on a "diet" focuses the family's attention and their interactions on "what the child is eating" instead of "who the child is as a person". This makes the child feel singled out and picked on for having a problem. The FAMILY is the key for change since children's preferences for foods, level of physical activity, coping strategies in response to stress, and even communication styles are closely related to those they see modeled by their parents and other significant people in their life. Here are some things that we can do right now to improve everyone's health and well-being.

To improve nutrition and foster healthy eating habits:

1) We all need to be eating more whole fresh fruits and vegetables and less junk foods (like those foods containing mostly sugar and/or partially hydrogenated (trans)fats). High sugary foods like fruit juices, pasta, and white breads stimulate an over-release of insulin from the pancreas and lead reactive hypoglycemia (low blood sugar). The low blood sugar stimulates cortisol production by the adrenal glands which then leads to the formation of tryglycerides (extra fat).

2) We all need to eat lots of dark leafy green vegetables like kale. They are a great source of nutrients. Nutritional Yeast (grown in molasses) is a great source of B vitamins while organic black strap molasses provides magnesium and iron.

3) It is better to bake or broil foods instead of frying because the process of frying converts many oils into an unhealthy source of fat. Cook with coconut oil if high temperatures are used and with olive oil or butter if cooking under lower temperatures. Butter is a healthier source of fat then margarine.

4) Drink and eat plenty of good quality fats like eggs, avocados, almonds, walnuts, organic raw cheese and raw milk. Organic raw whole milk is considered more healthy than non-fat milk because the fat contains minerals and the enzymes haven't been destroyed by heating (pasteurization). Non-organic, homogenized, ultra-pasturized whole milk is the worst milk to buy because the enzymes have been inactivated by heat (making it very hard to breakdown the milk protein-casein), the fat globules have been disrupted by homogenization, Vitamin B 12 has been inactivated,and pesticides and hormones are contained in the fat. Also take Nordic Natural cod liver oil (1/2 tsp/day for 3 to 5 year old children and 1 tsp/day for children 6 years and older) for a good source of omega 3 fatty acids. Homemade almond milk also provides an excellent source of protein and fat in addition to being a good source of calcium and magnesium.

5) Encourage three regular meals plus 1 or 2 healthy snacks. If our child constantly snacks, then he or she never experiences hunger between meals and doesn't learn to eat in response to his or her own hunger cues. Avoid unscheduled snacks which teach a child to eat in response to many different feelings such as boredom, loneliness, frustration, anger, and sadness instead of only hunger. Children need to learn that food only solves the problem of hunger and never resolves these other feelings.

6) We need to avoid discussions about eating or food during meals. Mealtime should be enjoyable and a chance for a family to share in each other's day. Discussions about food at the table will make mealtime a battleground and an unpleasant experience for all.

7) Children need to learn how to recognize their own internal cues of hunger and to eat only when hungry. Children need to decide if they are going to eat and how much (from what is served on their plate) they are going to eat at each meal. Parents are in charge of the kinds of foods that are served and the timing of meals. If a parent is always telling a child how much to eat, then the child learns to respond to the parent's needs and not to the needs of his or her own body.

8) Be sure children get plenty of sleep at night. Lack of sleep stimulates their stress nervous system and increases their appetite for sugary foods.

To increase the activity level of the entire family:

1) We need to decrease the amount of time watching television, videos, and playing on the computer. TV encourages all of us to be passive and inactive and the commercials promote junk foods. TV, videos, and computers keep us from communicating with each other and from developing other interests and hobbies.

2) We need to encourage continuous aerobic activities like biking, hiking, walking, swimming, or dancing for 20-30 minutes, 3 to 5 times per week. Physical exercise not only gets rid of excess fat but it is a wonderful way to release stress and it actually converts fat to muscle and increases the body's metabolism. Regular exercise also speeds up the metabolism and allows children and adults to eat more without gaining weight.

3) We also need to encourage little bits of activity throughout the day such as taking the stairs instead of the elevator and parking farther away from our destination so we walk more.

4) It is important that our children do chores for at least 30 minutes per day. Chores are a wonderful source of exercise. Children also feel valued and part of the family when they do chores.

5) We need to change family activities and even holidays so they are not just centered around food. For example, it would be healthier for everyone to play a family baseball game on Thanksgiving instead of just eating. We could take a walk to the park instead of a drive to the ice cream parlor. We could take a family walk together at night to talk instead of talking over a second helping of dessert at the dinner table.

To improve the communication and expression of feelings in the family:

1) We need to avoid making food the main symbol of nurturance and love in our family. Food often becomes the main way we reward and nurture ourselves and our children. It is important for all of us to find different ways of expressing our love for each other. We need to become more of an "Eat to live" and less of a "Live to eat" family.

2) We also need to improve our ways of communicating with each other and learn to speak up about our feelings. Feelings, especially anger, that are not verbally expressed and resolved often lead to overeating as a way to cope. We need to help each other recognize what moods, other than hunger, trigger eating, and explore other ways of dealing with our moods, such as talking about feelings, problem-solving, or exercising. We need to teach children that eating only solves the feeling of hunger and can't offer any long-term solutions to the feelings of anger, depression, or boredom.

3) We need to seek the help and support from friends, relatives, ministers, physicians, or counselors if problems like alcohol use, drug use, depression, or fighting, are interferring with our families ability to relate with each other and share feelings and needs.

To serve as role models to our children:

1) As parents, we need to be physically active, eat mainly nutritious foods, and get plenty of sleep at night.

2) As parents, we need to be good communicators and talk about our feelings. We also need to reduce multi-tasking and be more present to the moment. Our children need our full attention (heart, mind, and physical presence). They need to be filled-up with our presence. Sometimes we only are there physically with our children while our hearts and minds are somewhere else. Children feel this disconnect from us and sometimes use food as a way to comfort themselves and fill in the gap.

3) It is important that we avoid criticizing our own body shape or our children's body. Otherwise, we teach our children that bodies are something to be ashamed of. Our children then start believing that the way their body looks on the outside is more important then the kind of person they are on the inside.

4) We must discourage jokes and laughter aimed at people that are overweight. This reinforces our society's messages to children that being fat means more than just being overweight, and it supports all the negative stereotypes associated with being overweight.

5) Finally, we need to teach our children that "All bodies, regardless of size and shape, are good bodies."

With respect to weight loss goals:

1) Overweight children and growing teens can often maintain their weight to achieve their weight goal. By maintaining their weight, children can lose up to five pounds for every inch they grow in height.

2) It is important that adults, teenagers, and children never try to lose more than 1/2 to 1 pound per week; otherwise they may lose protein or muscle instead of just fat. Rapid weight loss in a child can also supress their growth and lead to vitamin deficiencies.

3) Parents and children that are trying to lose weight need to weigh themselves only once a week. Our weight can fluctuate anywhere from 1 to 4 pounds during a single day because of water gains and loses. A consistent loss of weight over a weeks time represents loss of fat. Having a child (or adult) use a scale to weigh themselves should be viewed simply as a way for that child (or adult) to learn about their bodies. Weighing the body each week teaches us how much we can eat and how active we need to be in order to either maintain our weight or lose 1/2 to one pound per week.

4) Weight goals can be made, but rewards and praise should be given for accomplishing changes in nutrition, actiity level, or problem-solving and not for weight loss. Focusing on weight and attaching rewards to weight loss will increase battles around food and heighten a child's preoccupation with weight and eating. Many feel that it is the preoccupation with weight and dieting that has led to the increase in disordered eating among our children.

All our bodies are beautiful and serve as a vessel for our Spirit. It is our task to love them and take care of them as best we can.

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