Childhood Obesity: The Familial Influence

Is there an excuse viable enough to not make your family's health a priority? Effective treatment and prevention of childhood obesity, a growing epidemic with multiple aspects, should include the entire family in addition to the child. According to the Centers for Disease Control and Prevention (CDC), childhood obesity has tripled since the 1980's (CDC, 2005). The first step is to recognize and accept the child, or other family member, is overweight; only then will treatments be effective.

To assist in raising a healthy child, parents can invite medical professionals to join the family team. The pediatrician should screen for common medical problems at a yearly physical, which should include screening for weight related issues. Tools used to diagnose overweight in children include: height-to-weight ratio of peers in the same sex and age categories; calipers to measure abdominal skin-fold; or by using height and weight to determine the child's BMI or body mass index. The pediatrician can determine if the nutrition, physical activity level, or existing behaviors are linked to obesity.

In some cases, genetics may be a contributing factor; the CDC (Contributing, 2006) reports genetics, "... may increase...susceptibility to overweight. However, this genetic susceptibility may need to exist in conjunction with contributing environmental and behavioral factors..." (p. 2). A variety of tests can rule out genetic or other contributors to weight gain including: fasting glucose and insulin levels; hormone and thyroid levels; cholesterol and triglyceride levels; and liver function tests. The child may be referred to a specialist if a medical anomaly is suspected.

A nutritionist should be consulted to identify nutritional problem areas. A nutritionist will assess nutritional needs; develop a care plan; monitor the effectiveness of dietary changes; teach appropriate portion sizes; help prevent disease; increase access to healthy food; and enhance personal control of health.

The family's mental health should not be ignored; counselors can address emotional and psychological issues pertaining to weight; assist each member of the family with management of stress; emotional eating; social acceptance and peer-pressure; self-perceptions in regard to physical appearance; and emotions pertaining to self-worth.

Self perception and body image is garnered by watching, imitating, and internalizing parental behaviors. Derogative remarks can be devastating to a child: as a 10-year-old child and at a healthy weight, my mother called me fat; this was a traumatic incident that drastically changed my body image and self-perception. I began engaging in unhealthy eating behaviors which escalated to a suicide attempt. Negative or positive, the attitudes and behaviors of parents toward their children (and others) has a tremendous and lasting effect.

Changes made in family behavior and environment can be successful in countering the imbalance of calories consumed versus calories expended (Lindsay, Sussner, Kim, & Gortmaker, 2006). Physical activity can be successfully incorporated into family living in a variety of ways. Weekly activities might involve family dance night, bike rides, afternoon walks, swimming, or a physically active game such as dodge-ball. Some of my favorite childhood memories include monthly camp outs or hiking. Some families may challenge each other to learn something new, such as roller blading, horseback riding, or golfing.

The fact is that children cannot manage their weight on their own; they need familial support, but parental support is paramount. Rewarding successful behavior changes provides positive reinforcement. However, food and toys are inappropriate rewards: using food undermines healthy eating behaviors and the use of toys is a bribe, not a reward, and will result in more unwanted behaviors. A child's preferences can indicate appropriate rewards; rewards might include star gazing, backyard camp-out, sleep over, or scavenger hunt (Ward-Begnoche & Speaker, 2006). Reward your child with quality time; such as a make-over; trip to the park; kitchen raid for "musical" instruments; board game; or give your child hugs and kisses, letting him or her know how proud you are (CDC, Healthy, 2006).

Make healthy eating a family affair by not focusing on weight, but rather on making healthy lifestyle changes. While healthy foods are not inexpensive, living a physically active life and losing weight will save money by reducing health-care "costs associated with hypertension, type 2 diabetes, heart disease, stroke, and high cholesterol..." (CDC, 2005, p. 2). Choice is crucial; fast foods restaurants now offer healthier alternatives. Make meal time family time, by setting regular meal times, and sitting everyone down together to share events of the day. Turn off the television while eating, this is an unhealthy behavior linked to obesity (Ward-Begnoche & Speaker, 2007). Get children involved in meal preparation; this reduces preparation time by sharing labor, teaches children how to prepare healthy, balanced meals, and allows children to feel pride for their contribution (CDC, Healthy, 2006).

Monitor, but do not police food; forbidding foods makes them more desirable; instead, practice portion control. Provide healthy foods for the family to snack on; the earlier children are exposed to healthy foods the more they will develop a preference for them. Provide healthy, sugar-free drinks like water, Kool-Aid, or milk; studies show sugary juices and sodas contribute to obesity in children as young as 2-years-old (Lindsay, Sussner, Kim, & Gortmaker, 2006). Children should not be coerced members of the "clean plate club;" allowing children to eat until satisfied, instead of until the plate is clean, teaches them to acknowledge signals of hunger and satiety, and increases their ability to self-regulate food consumption (Hodges, 2003).

Children do what you do, not what you say; parents can set a good example by eating healthy themselves. Habits started in youth continue into adulthood; if poor nutritional choices and a sedentary lifestyle are the parents choice, their children will do the same (Ward-Begnoche & Speaker, 2007). Studies have found that overweight parents increase the odds of their children becoming overweight (Danielzik, Langnase, Mast, Spethmann, & Muller, 2002). When parents overeat or use food for comfort, instead of sustenance, their children are more apt to adopt those behaviors (Lindsay, Sussner, Kim, & Gortmaker, 2006).

Children spend considerable time in school, yet do not receive the recommended daily physical activity. In 1997, less than half (48.8%) of all students were enrolled in physical education; of those, only 21.7% were active in class on a daily basis (Lowry, Wechsler, Kann, & Collins, 2001). Parents should advocate for their children with the local school system, State Board of Education, and Governor, to address this infraction. Ensure children are getting the activity they need at home, by reducing time spent on television, computer, and video games; make these activities conditional on completion of adequate physical activity (Ward-Begnoche and Speaker, 2006).

Prevention truly is the best medicine; in the infamous words of Ben Franklin, "An ounce of prevention is worth a pound of cure." Children are the number one priority for a majority of parents; supplying healthy foods and encouraging physical activity is not a punishment, but rather a priceless gift of a lifetime of good health.

References

Centers for Disease Control and Prevention. (2005). Chronic disease prevention: Preventing obesity and chronic diseases through good nutrition and physical activity.

Centers for Disease Control and Prevention. (2006). Healthy children, healthy choices.

Centers for Disease Control and Prevention. (2006). Overweight and obesity: Childhood overweight: Contributing factors.

Lindsay, A. C., Sussner, K. M., Kim, J., & Gortmaker, S. (2006). The role of parents in preventing childhood obesity. The Future of Children, 16, 169-187.

Lowry, R., Wechsler, H., Kann, L., & Collins, J. L. (2001). Recent trends in participation in physical education among US high school students. Journal of School Health, 71(4), 145-152.

Hodges, E. A., (2003). A primer on early childhood obesity and parental influence. Pediatric Nursing, 29(1), 13-16.

Ward-Begnoche, W., & Speaker, S. (2006). Overweight youth: Changing behaviors that are barriers to health: Practical advice for dealing with the family, the child, and socioeconomic environment. Journal of Family Practice, 55, 957-964.

Hudson C., Stotts, C. R., Pruett, J., & Cowan, P. (2005). Parents' diet-related attitudes and knowledge, family fast food dollars spent, and the relation to BMI and fruit and vegetable intake of their preschool children. Southern Online Journal of Nursing Research, 5(6), 1-23.

Danielzik, S., Langnase, K., Mast, M., Spethmann, C., & Muller, M. J. (2002). Impact of parental BMI on the manifestation of overweight 5-7 year old children. European Journal of Nutrition, 41(3), 132-138.