Health Guide     Teen Health    

Parents' Say Has Less Weight with Heavy Teens



Managing or supporting a child's weight loss program is never an easy job, regardless of the child's age.

But compared to helping older children and teens, weight management for little kids is a walk in the park?a brisk walk, perhaps, but it's still not the heavy lifting of familial dietary change.

U.S. teens are the heaviest in the world, by a notable margin. We know our cultural habits have changed much in the last couple generations and kids that might once have walked to school are now on buses or carpools. Instead of running around and playing outdoors, they're mostly parked in front of TVs and computers. And the adolescent age group consumes nearly two-thirds of the snack foods sold in this country.

And all this is to say nothing of the emotional stress and pressures older children and teens feel to fit in, be attractive and accepted. Overweight teens have painful self-esteem issues associated with their body image.

So environment alone makes it a thorny enough problem, and when you add in a little pre-teen angst or adolescent rebellion, weight management for older children is indeed a challenge for families. But achieving healthy goals is possible. We see it all the time.

And we know that from our own experience that it's better to use a family-based approach to weight loss, where it's the lifestyle that gets fixed, not the overweight youth. While not all overweight children have overweight parents, that is overwhelmingly so.

We often see parents who profess not to be interested in their own weight, though they are very worried about their child. But once they recognize that a collective approach is most effective, those parents can often use their genuine concern for their children as an impetus to take a greater interest in their own well-being, and in changing the lifestyle habits that are unhealthy for the whole family.

With younger children, parents essentially need to do the whole job, so much so that if it's done subtly, a younger child might not even notice those changes. Walks might become a regular part of the day, sweets and treats become special occasion foods rather than daily indulgences.

But just try subtly slipping changes like that past the average 11-year-old. With older kids and teenagers, the parents are still crucial as models, but the kids themselves need to take some responsibility too, and not just as compliant participants.

In one recent study of kids in weight-loss programs, the parents were encouraged to practice an "authoritative" parenting style, in which they offered leadership and modeled appropriate eating and activity, as opposed to an "authoritarian" style--that old "do as I say because I said so," approach. We find that's pretty ineffective, as a rule.

It's best if older kids have some ownership of the decisions and process, because there's plenty of evidence that if they have choices, they'll make good ones. Research on snack vending in high schools showed that when students were offered fresh fruit or other healthier foods, and bottled water instead of soda in those vending machines, they often took the healthier choice--and that's without mom looking over their shoulder!

A maturing child should be given a meaningful role in approaching a weight-loss program for the whole family, not as a part of the problem but as part of the solution. For instance, a child might take on planning the family menu for the week, or deciding what physical activities they will engage in. The parents are still laying down the ground rules, but older kids and teens need to feel some ownership of the process and the goal.

But as with many other things, you can't just tell a teenager to go exercise and expect the kid to jump on board. In fact, if the teen in question is testing boundaries in that vexing but age-appropriate way, he may decline simply because you suggested it. It takes some finesse, and some respect for the child's role in choosing.

For example, for the teens in our program, a typical meeting with the dietician might start with the question, "How much do you want to lose this week?" This offers the child a controlling role.

We follow up by asking what activity or exercise they'll do to achieve that goal, and with those simple questions, we've started them on the first step of their own activity plan. And if they come up with nothing they are willing to do, then we let them know that they need to change their goal, because they probably won't lose any weight that week.

But all of those decisions are controlled by the child or teen. That kind of ownership is far more likely to lead to planning and follow-through than a parent's orders, or even gentle instructions.

A child may need to work with a parent on meal planning, or even go along on the grocery trips, but the more involved the child is in every aspect of the effort, the more likely they are to follow through with behavioral changes that make it successful. It's important to recognize the ongoing nature of the challenge, and the fact that it doesn't get better over time, and grows progressively more complex and harder to deal with.

Another recent study revealed an interesting paradox in the problem. The research sought to contrast overweight girls and normal-weight girls and their parents, and see how their perceptions and attitudes about weight and exercise differed.

The overweight girls reported feeling more pressure to lose weight from their families, even though their parents reported less attention on the matter or discussion of it with their daughters, than the parents of normal weight girls.

And while that may be reflective of the social pressures overweight youth feel in general, we often see that parents of heavy teens are so worried about hurting their child's feelings, that they are reluctant to say anything at all.

But as that study shows, those youth are hurting anyway, and not addressing the problem is only likely to deepen it.

Teens and older children can be given responsibility and ownership of their own health in a family-based weight management program, but they can't be expected to succeed without an environment that supports and advances the goals they set out for themselves.

Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). Dr. Cederquist is the founder of Diet To Your Door, a home diet delivery program that specializes in low calorie gourmet food that is delivered to your home or office. Diet To Your Door serves as culmination of Dr. Cederquist's expertise and experience in the world of medical weight loss.