04/02/2012 04:51 pm ET Updated Jun 02, 2012

It's Hard Being Mean

I liked Winnie right away. A robust 9-year-old, she threw herself on the floor with my therapy dog (technically, a Shih Tzu that comes with me to work). "Ahhhhh," she cooed. "She's so cute."

Binky is cute, so I knew immediately that Winnie had good taste. She also had the engaging manner unique to energetic prepubescent girls who are enjoying life. An exuberance that deteriorates under the influence of hormones a few years later, when they become Bride of Chuckie until they leave for college.

Winnie's mom, Jackie, had sent me voluminous background information so I would be careful not to use the F word ("fat") in front of her daughter. If she knew me better, she would have known there was a better chance of me performing a rap song incorporating the other more colorful four letter "F" word than indiscriminately using the word 'fat'(last year, I checked off "obesity" on an insurance form for one of my clients and she still has not forgiven me).

"Tell Winnie that it is not good for her to eat too many carbs," Jackie instructed. "My little sweetie sure does love her sweets," she added unnecessarily. I already had a diet diary in front of me. There were pancakes with chocolate chips added for breakfast because, as Jackie explained, that is the way she likes them. Lunch was pizza and cookies. After school came a sugary granola bar (more accurately described as another cookie), then some pasta for dinner with a dessert chaser.

I am fairly certain that even Paula Dean could identify the problem with this diet. Not a single health professional I know is mystified regarding the cause of the 30% childhood obesity rate. Jackie knew what was wrong with the diet and I suspected even clever Winnie knew.

They both looked at me expectantly. Winnie was probably wondering if a seemingly kind adult with a cuddly dog was going to turn out to be a big meanie in disguise. Jackie's pleading eyes begged me to play bad cop and scare Winnie diet straight without making either of them feel bad about themselves. This is a big, correction, impossible order.

I explained to Winnie that eating so many treats was unhealthy and that we were going to cut them down to one small dessert a day. As expected, she was not thrilled with the new plan, but she was already worried about being overweight (according to my preliminary intelligence) so she probably would have at least agreed while sitting in front of me had Jackie not jumped in. "Is that okay, honey?" she asked solicitously.

My eyes widened in alarm. This session was headed straight for the compost heap if I did not intervene quickly. "Stop right now," I snapped. "You may not ask her that."

Jackie looked confused. I explained that it certainly was not okay with Winnie to cut down her treats. She is a nine-year-old sugar junkie and asking her to make a complicated decision about her future health is developmentally completely inappropriate. The brains of children in elementary school have not matured enough so they can adapt their behavior now for a long-term goal. The prefrontal cortex (PC) allows you to think ahead, plan and bide your time. It does not fully mature until the late teens/early twenties (though we all know someone in their forties who still does not have a functioning PC).

Even though Winnie agreed to the idea of eating better in general in the future, when faced with a donut, she always ate it in the present. There was no insincerity or lack of will because she was committed to the idea in theory. She lacked the brain maturity to follow through with the behavior. Her mom's job was to use her adult PC to help Winnie meet the goals.

Unfortunately, like many parents, Jackie wanted Winnie to possess the adult capacity to turn her back on an endless parade of temptation. Jackie was banking on Winnie saying "no" because she could not. This juxtaposition of kids with immature brains, ridiculous amounts of junk food and adults who can or will not step in and say, "this is the limit" is why our kids are getting heavier by the minute.

To address this difficult problem, I have composed a quick reference list of developmentally appropriate vs. inappropriate diet questions for kids.

Are you in the mood for green beans or broccoli with dinner?

I am making lentil soup. What should I make you for dinner?

We have apples and grapes, which do you want in your lunch?

What size latte (ice cream, soft drink) do you want?

I don't have time to make dinner, should I order in Indian or Chinese food?

Do you want soda or milk with your Happy Meal?

In a world of too many choices, kids need parents to create a structure for healthy eating. Otherwise, overwhelm and overeating ensues. It is only too bad the parents don't have a PC godmother to do the same thing for them.

A therapist friend of mine told me I should have taken Winnie out of the room. The idea occurred to me, but there had been so much pressure on her to adult up, I wanted her to be a kid. She would likely complain about the change and perhaps not like me, but ultimately have a more manageable food environment with adult support. I would feel bad about myself if I believed setting food boundaries was mean, but I believe the cruelty to our children has been in not setting them.

Winnie sat through my explanation and now I waited for her response hoping there would not be tears. Winnie would be fine but if she started crying her mother might throw in the burrito. "She really understands me," she said, looking at Jackie and smiled slyly.