Before Dara-Lynn Weiss's controversial Vogue article about putting her 7-year-old daughter on a diet (and before the backlash to Dara-Lynn Weiss's controversial Vogue article) there was already a fierce debate about the proper treatment for childhood obesity.
Children's Healthcare of Atlanta thought the solution was to advertise against it, using overweight kids as models. In February, Disney launched an anti-obesity attraction called "Habit Heroes" -- but the effort was roundly criticized, and the project has now been "closed for the time being." Food activists like Jamie Oliver lobby publicly to improve the quality of school food; Michelle Obama's "Let's Move!" campaign has been one of the major focuses of her tenure as First Lady.
The questions that always come up include: Should parents let kids eat what they want, even if their weight falls outside healthy limits? How closely do we need to police children's calorie intake and exercise? Are we hurting or helping young people by pointing out that they're fat? Should we even be allowed to say the word "fat"?
Below, two experts give their very different takes on the safest way to deal with children's weight problems. Dr. Joanna Dolgoff, who pointed out where Dara-Lynn Weiss went wrong here on HuffPost, believes parents should always put their overweight children on diets. WeightyMatters.ca blogger Dr. Yoni Freedhoff, who founded the Bariatric Medical Institute in Ottawa, feels passionately that weight-loss programs for children are always wrong.
Vote on what you think below. Then, read both experts' commentary and see if they change your mind.
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You Should Put Your Overweight Child On A Diet
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Parents who ignore their overweight kids' problems are as irresponsible as the physicians who misleadingly tell parents to wait for their obese kids to "grow into their weight." Once upon a time, kids developed baby fat before their growth spurts and then leaned out. That's not what happens anymore. That advice is outdated. That advice could kill your child at an early age.
I am a pediatrician. I am a child obesity specialist. I have helped thousands of overweight children get healthy. I am here to tell you that obese children need to lose weight. And yes, that involves putting them on some sort of diet. In fact, it is IRRESPONSIBLE not to put your overweight child on a diet.
And you need to start immediately. Before your child hits puberty. It is much easier for kids to lose weight and sustain weight loss before puberty. During puberty, body chemistry changes make weight loss harder; lower your child's calorie intake and your child's appetite increases and his metabolism decreases. Wait until then and you have set your child up for a lifetime of battling the scale. Start around age 6 or 7 and your child will learn healthy eating habits before she realizes she was ever eating the wrong way.
Our kids are getting heavier and unhealthier than ever before, yet many parents and doctors are reluctant to do anything about it. The facts are staggering. One third of children in our country are either overweight or obese and at risk for medical problems due to weight. The number of possible causes are overwhelming: portion size, processed foods, unhealthy school lunches. It doesn't matter. Parents need to stop pointing the finger and trying to figure out "why" this has happened and "who" is to blame. We are responsible. Parents would rather talk to kids about anything besides weight; it seems they are more afraid of causing eating disorders than they are of their kids dying young of heart disease. It is time for America's parents to wake up. We can no longer risk our children's health for fear of hurting their feelings. Our kids are obese, and unhealthy, and dying young. And we are responsible.
Parents need to stand up and make some changes. We need to acknowledge our children's unhealthy weight. It isn't going to kill them. In fact, it isn't going to even surprise them. Overweight children know they are overweight -- even if you haven't discussed it with them. Your overweight child is getting teased and scorned, whether he or she shares that information with you or not. This is your chance to talk to your child about it in the right way, using the right words. Don't talk about looks and don't mention fat or thin. Discuss your child's health. "Your weight is not the healthiest that it could be. We need to make some changes so we can all be as healthy as possible." And then the hard part starts. You have to actually make some changes.
Refusing your child a second piece of pizza will not cause an eating disorder -- regardless of what your neighbor or mother-in-law tells you. There is absolutely no evidence for this. In fact, it makes sense that treating an overweight child in a sensitive manner will decrease disordered eating. It is the obese child who wants to lose weight but doesn't know how to do so safely that is most likely to start starving or binging and purging.
It is okay to tell your child he or she can't eat something. Fortunately, you don't have to do that all the time. Treats can (and should be) allowed in moderation. At Red Light, Green Light, Eat Right, we encourage our patients to eat two Red Light (unhealthy) foods each week. Once those are eaten, however, it is time to make healthier choices -- and go out and exercise. Our goal is to teach kids how to make healthy choices on their own. However, as a parent, you do have the right to set limits.
Just don't make those limits public knowledge. Child weight loss does not need to be discussed in public and children should not be publicly criticized for poor choices. We all pick the wrong foods now and again. When around others, allow your child to make a poor choice and move on. Save discussions for emotionally-neutral times when behavior can be reviewed without being criticized. Allow poor choices to become teaching points. Remember, everybody in the family needs to (re)learn how to eat healthy.
It is okay to admit that you don't have all the answers. Your children will respect you more for being honest with them than for pretending everything is fine when everybody can see that it isn't. You monitor what your child watches on TV; you monitor your child's Internet use; it is time to monitor what your child is eating.
1. Reports From the Agencies: Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011 Shelley McGuireAdv Nutr January 2012 3 1): 56-57; doi:10.3945/an.111.001347
2. Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. Paul W. Franks, Ph.D., Robert L. Hanson, M.D., M.P.H., William C. Knowler, M.D., Dr.P.H., Maurice L. Sievers, M.D., Peter H. Bennett, M.B., F.R.C.P., and Helen C. Looker, M.B., B.S.N Engl J Med 2010; 362:485-493February 11, 2010
3. Okie, Susan M.D. Fed Up! Winning The War Against Childhood Obesity. Joseph Henry Press. Washington DC. P. 46
4. Ogden, C.L., et al. 2002 JAMA 299(14):1728-1732
5. "Birds and Bees Are Kid Stuff: New National Study Reveals Weight a More Difficult Talk Between Parents and Teens than Sex, Drugs" The Free Library 14 September 2011. 01 April 2012
6. Okie, Susan M.D. Fed Up! Winning The War Against Childhood Obesity. Joseph Henry Press. Washington DC. P. 59
There's no debate that childhood obesity is a tremendous concern. I went to medical school in the early 1990s, and even just 20-odd years ago, what we know now as "Type 2 Diabetes" was still called "Adult Onset Diabetes." Not anymore. Nowadays kids with single-digit ages are coming down with what was once a disease of adulthood, and kids younger than 20 are being found to have the once-only-middle-age conditions of hardening of the arteries and fatty liver disease.
And of course it's not just medical problems these kids face. Studies on bullying behavior demonstrate kids with obesity are 2 to 3 times more likely to be bullied than their skinnier peers (Kukaswadia, 2011). Add that to the incredibly pervasive societal stigma against those with obesity, and it's hard to imagine that obesity isn't having a terrible impact on these kids' self esteem.
So if childhood obesity is so problematic, why wouldn't I suggest we treat it?
It's not the primary problem.
I'll repeat that. Childhood obesity is not the primary problem -- or, to put it slightly differently, kids are not the problem. There's not an epidemic loss of willpower among 5 year olds, yet already by first grade, 1 in 3 children in America will be overweight or obese. The kids these days are no different than when we were kids. What's different is the world our kids are growing up in. Today's world is a Willy Wonkian dietary dystopia. It's an environment filled with nutritional misinformation, predatory advertising, misguided crop subsidies and aisles and aisles of ultra-processed boxes masquerading as food. It's a world where kids can't step on a blade of grass without being rewarded with a treat, where school fundraisers occur in Chick-Fil-A, and where Olympic gold medalists like Shawn Johnson, Chris Bosh, Apolo Ohno and Elana Meyers are busy helping to peddle chocolate milk to children as a "recovery" drink. (I've got to ask. What could these kids possibly be doing where for "recovery" they need a beverage can contain 20% more calories and double the sugar of a full-sized Snickers bar?) Our world is the disease, and childhood obesity is just the symptom, and as a physician I know that while it's nice to treat symptoms, it's always more important to cure diseases.
But I guess, given that we're not about to cure the world, it's fair to ask, "Shouldn't we treat the symptom?" Again, I draw on my training to answer. I was also taught that we shouldn't offer treatments without evidence to back up both the treatment's efficacy and its safety.
So is there a safe and effective diet for children? One that reproducibly, in a substantial and significant percentage of cases and in a sustainable manner, causes weight loss or prevents excessive gain? Unfortunately, the answer is plainly "no." And don't be lulled into thinking, "Yes, but we'll just have those kids eat less and exercise more." If it were that simple, do you think we'd still have a problem? Do you think these kids and society as a whole want to be bullied and victimized because of their weights? That they're choosing to purposely go out of their ways to "eat more and exercise less"? If you do, then I suppose you must also think playing the stock market is easy, because all you have to do is "buy low and sell high." But even if you're of the school that believes such an intervention or diet exists, is there data out there that tells me that administering that diet isn't going to irreparably damage a child's lifelong relationship with food, with their body image, or with their self-esteem?
I don't treat children in my practice, nor do I put my adult patients on prescriptive "diets." My oath as a physician to "do no harm" is one I take seriously, and given that I'm not aware of any diet plan for children that's actually proven to be safe, effective, and sustainable, picking up in my office where the schoolyard bullies left off, or suggesting that a parent do so, isn't something I'm comfortable recommending. And believe you me, as is evidenced by the story in Vogue, a physician's expectation of parental action isn't necessarily what's actually going to happen once that parent gets his or her kid home. Moreover, I've got to ask, if full-grown, insightful, incredibly motivated, intelligent, mature adults with clearly weight responsive medical conditions struggle with long-term weight management and "dieting," how can anyone imagine that a young, innocent, immature, not-fully-developed-frontal-lobed child is going to be able to pull it off?
There is good news, though. There have been a number of studies now that demonstrate treating the parents can help the child (Golan, 2004, Boutelle, 2012). That's why I'll regularly recommend that, to treat individual cases of childhood obesity, we should be treating their parents and not the children. What I teach the parents in my practice is to live the lives they want their children to live, and to never, ever, put an emphasis on doing so for weight-related reasons (their own or their children's). It's about cultivating and nurturing healthy living behaviors -- as regardless of a child's weight, every family, including those with skinny little rails, can benefit from more family-based cooking with whole, healthful ingredients, from active parents who carve out fitness time for themselves and their families, from less screen time and from more warmth. Those healthy living behaviors apply to every weight.
I've seen too many patients in my adult office who trace their struggle with food and weight back to a well-intentioned doctor and his or her straight talk about their "not so little anymore bellies" -- or to a well-intentioned Mom or Dad who took them at an incredibly young age to Weight Watchers. Coupling that with the clear-cut fact that studies on parental feeding behaviors in kids demonstrate that being more restrictive backfires and leads to further dietary disinhibition and weight struggles (Scaglioni, 2011), I can't in any good conscience recommend that children be placed on diets.
Until we have that reproducible, sustainable, effective and safe diet that we can prescribe with confidence, where we're assured we'll be doing no harm, I think we should stick to the parents, and also to rage against the world. The kids have it tough enough already.
Atif Kukaswadia, Wendy Craig, Ian Janssen, William Pickett (2011) Obesity as a Determinant of Two Forms of Bullying in Ontario Youth: A Short Report. Obes Facts 2011;4:469-472
Moria Golan and Scott Crow (2004) Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results Obesity Research 12, 357-361
Boutelle KN, Cafri G, & Crow SJ (2012). Parent Predictors of Child Weight Change in Family Based Behavioral Obesity Treatment. Obesity doi:10.1038/oby.2012.48
Silvia Scaglioni, Chiara Arrizza, Fiammetta Vecchi, and Sabrina Tedeschi (2011) Determinants of children's eating behavior Am J Clin Nutr December 2011 vol. 94 no. 6 Suppl2006S-2011S
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Joanna Dolgoff, M.D.Yoni Freedhoff M.D. Neither argumenthas changed the most minds