How would you support a child trying to live healthier?

Daivd Ludwig, MD, MPH

Every month the Journal of the American Medical Association (JAMA) publishes an article called Clinical Crossroads, where a patient case is presented and medical professionals are invited to share their thoughts on how they might treat that person. A few weeks later the case is presented again, this time with commentary from an expert who specializes in the medical condition profiled in the article.

The most recent Clinical Crossroads was written by David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. Ludwig’s case focuses around Ms K, a 14 year-old girl struggling to lose weight.

Unlike typical medical case studies that focus on diagnosis and treatment of acute illness, Clinical Crossroads often takes into account the ethical, emotional and economic issues related to the patient’s health and treatment. All three of these elements figure heavily in Ms K’s story, making it ideal for the Clinical Crossroads treatment.

But as Ludwig himself would tell you, overcoming childhood obesity isn’t just the job of pediatricians and their patients; parents play a vital role in helping children achieve and maintain a healthy weight and lifestyle too. With that in mind, we are presenting Dr. Ludwig’s Clinical Crossroads piece to you on Thriving and asking for your input as parents.

Given the following situation, what are some ways Ms K and her parents could work as a team to help her live healthier? If you were her mother or father, what would you do to support her efforts?

Ms K is an obese 14-year-old girl who is struggling with weight loss. She lives in the greater metropolitan Boston area. Ms K began to gain weight at age 8 years. Over the past 7 years, her weight has gone up by 20 to 30 lb annually … She reports trying various weight loss programs but either she did not follow through or they did not work. She has never lost more than 5 lb with any focused effort.

On a typical day, Ms K skips breakfast, so her school lunch is her first meal of the day. She eats whatever is served there, often something “greasy,” with a small salad and chocolate milk. When she comes home from school, she begins to snack on “good” junk food. Over the course of the afternoon, she might have several of the following: baked chips, a cereal bar or 2, 2 or more “100-calorie packs,” a glass of (1%) milk, crackers, or pasta with cheese. She eats dinner with her parents, which is often fried chicken, pasta with cheese, or a hamburger. There are rarely vegetables on the plate. After dinner, she will routinely eat more, ingesting 1 to 3 snacks while working on her computer. She does not routinely eat dessert at dinner and does not drink sugar-sweetened beverages. She does not watch television regularly. She used to ride a horse several times a week but has not done so in several years. Her only regular activity is walking home from school, about mile daily.

Ms K was told by her pediatrician that she needed to lose weight or she might develop diabetes. She has experienced harassment at school and online related to her obesity. There has also been significant tension between Ms K and her parents—especially her mother—about her eating habits and progressive weight gain.

   Ms K’s mother was interviewed for the piece, and said the following:

“Probably the biggest challenge that my husband and I have had is backing off. I constantly watch her, correct her, and stop her from doing things. I am almost obsessive about what she eats, what she doesn’t eat. My husband and I went to a counselor locally, and he was the one to tell us we need to back off because it is making things worse. That’s been the biggest challenge. I think I feel like I am the food police sometimes.”

Please share your ideas with us on how families can work together to improve eating habits by commenting on the blog, leaving a message on our Facebook wall or connecting with us @ThrivingKids on Twitter.

To speak with a member of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital please visit their website.

  • Vtalise

    It sounds like the whole family needs a healthy eating and exercise plan. Children are more likely to participate and follow things that the whole family does. How about a family walk in the evenings? Or a game of kick ball?  Involve the family in making the dinners together – talking about healthy food.  This poor girl must feel very alone in her struggle.

  • http://ipodteacher.blogspot.com/ A mom

    The parents have clearly been making *some* effort – buying 1% milk, baked chips and the 100 calorie snack packs and not providing desserts.  Clearly they still need to learn how to plan better meals though. It’s not a 14 year-old’s fault if the food available for her evening meal is high fat, high calorie, with no vegetables or fruit (probably low in fiber.) The girl doesn’t need a weight-loss program – she needs a lifestyle change.

    Her family needs to see a nutritionist and plan together the kinds of changes they can make. Maybe start  by switching to fat-free milk and taking a lunch to school rather than buying what’s on offer there. (Sadly, school lunches often offer too many unhealthy options.) Veggies need to be part of the family’s diet – canned or frozen would be better than none if buying fresh is an obstacle.

    As Vtalise said, exercise needs to factor in there too, and it might help if the parents were setting an example.

  • Lee

    I would try to get the unhealthy snacks out of the cabinets. Fill the fridge with fruits, veggies and try cooking healthier foods. Maybe a fun family (or mother/daughter) walks or going to the gym. I would not make a huge deal out of her weight but at age 14 I would discuss the benefits of eating healthy and exercise. I would not criticize her but would encourage her when she is doing well. As an overweight adult I know I eat much better when the unhealthy snacks are not available. I think she is old enough for a program like weight watchers too if she would be interested in this. Kids love to do things on the computer and she could track her progress online.

  • Revjsm

    Yes, whole family changes are needed: serving fruits/vegetables with meals at home, lean meats, cutting down on sauces, etc.  She’s made some good choices (no dessert, sugared drinks) but they’re being sabotaged by other ones (skipping breakfast, too many snacks, little exercise.)    She seems motivated, so adding more fresh fruits and veggies to her diet, eating a healthy breakfast, and getting more exercise (even 1/2 hour a day) should really help.  She may not need to be on a “diet”, but just adopt healthier habits that can last a lifetime.  But her parents really need to get on board here – serving her healthier food will work better than “policing” her. 

  • SuStreets

    I could be this mother!  Add to that, however, the young lady has Down syndrome and it gets more complicated.  The one tool that has really worked for my daughter and our family is journaling:  a food diary, excercise diary and a feelings journal.  The food diary has been very effective and my daughter takes an active role in this daily.  It’s a slow, arduous process but we have been successful,  Good luck!

  • Lauriecomey

    The family should sit down with a nutritionist. Most often parents do not realize how to cook the same foods they are used to eating, but with a lot less fat and calories. I think this needs to be taken very seriously before her weigt gets totally out of control. Exercising daily has to be a routine. My son will play at the playground, roller skate, ride his scooter, or just dance to music at home to name a few. Most parents just need to be educated! Little changes will make a big difference. Seems like she is having too many snacks and needs to be given the choice of snacks that are more filling.

  • Pelkster01

    I agree the whole family needs a change in their shopping and eating habits. Those baked chips and 100 calorie package snacks are expensive and dont have much nutritional value. I would recomend replacing most of those snacks with fruit and veggies. I usualy make at least two soups every Sunday and cut up lettuce and other veggies so they are readily available for quick meals, snacks or use them for preparing healthy diners. If the budget is to tight for fruits and veggies, we are lucky to have the http://www.fairfoods.org/dollarbag.html in the greater Boston area, I would advise the family to take advantage of it. Breakfast should be a must and fruits would make a wonderful breakfast for this young lady with some whole grain cereal, youghurt, etc. I would advise the family to look into programs at the local Y, swimming would be a great way to have fun as a family and help this childs struggle.

  • Eeclare55

    I would suggest the whole family meet with a nutritionist. Go food shopping as a family with tips from the nutritionist. The family meal preparer should keep in mind the meals for the week, so they don’t fall back on bad habits because the proper food isn’t there. Incorporate  exercise, something fun, maybe with friends or neighbors. Maybe  a walk in different places, like a beach or park. Keep “weight talk” to a certain time, perhaps two or three times a week. Remind family members that it is important to keep on the healthy eating track to help encourage this young girl.

  • http://www.teenspeak.org/ Erica

    My thoughts on how to help Ms. K: http://bit.ly/wUgMXj