At first I thought “hooray! finally!”when I saw the report from the AAP (American Academy of Pediatrics). They are finally doing something to counteract the horrible way weight has been addressed with kids and teens. But, after reading the paper, it struck me that a lot is left unsaid. In particular, how are you going to help parents do the right thing? How does this translate into action? So, I have a bit of advice for parents who have been made to feel like a failure because their kid has not lost weight. I have a few words to share that I hope will help you at your next doctor’s visit. I want you to be armed and ready.
The new AAP report is meant to “address the interaction between obesity prevention and EDs in teenagers” and to “stress that obesity prevention does not promote the development of EDs in adolescents”. I believe we need lots more research to be able to be sure this is not true, as I have seen first hand children and teens who have developed disordered eating behaviors after a health class. Anyway, the good thing is the authors do bring out the point that many overweight teens actually do end up developing an eating disorder when they start trying to lose weight. Pediatricians and parents tend to celebrate the weight loss, often failing to realize the teen actually now has an ED. This delays the identification and treatment of the eating disorder, and sometimes it is entirely missed. The point is stressed that focusing only on weight increases the risk of this happening. This is extremely important in my opinion, I have seen it happen often. And when the ED is finally diagnosed, it can be harder to treat than if it were detected earlier.
Anyway, the paper reviews both the behaviors that are associated with obesity and eating disorders, mentions the use of “Motivational Interviewing” by health care professionals in the treatment of weight issues, and finally briefly discusses six points for pediatricians to consider in order to address weight and prevent EDs.
First, the following behaviors were associated with both “Obesity” and EDs” in teenagers:
- Dieting: defined as “caloric restriction with the goal of weight loss”, in a nutshell, research shows that dieting actually increases the risk of weight gain, and not loss. It also increases the risk of developing an eating disorder.
- Family Meals: eating meals together as a family promotes a greater intake of fruits and vegetables and a healthier diet; eating family meals was preventative of eating disorders.
- Weight Talk: any talk about weight, even a parent’s weight increases the chance that a teen will actually gain more weight 5 years later, and also increases disordered eating behaviors such as extreme dieting…..talking about weight, NOT GOOD.
- Weight Teasing: family weight teasing may lead to both weight gain, binge eating, and extreme weight control measures
- Healthy Body Image: 1/2 of teen girls and 1/4 of teen boys are dissatisfied with their bodies, and even more in overweight teens. Body dissatisfaction can lead to disordered eating behavior.
Second, the paper briefly mentions the “use of Motivational Interviewing” (MI) to counsel families of overweight children. I am a passionate believer in the use of MI, which is founded in “empathy”. In other words, it is an empathetic approach to helping people change behavior. I have attended every MI seminar I could in the past because I have seen how the typical approach to helping people change does not work. I will never forget the mother who came back to me for follow up with her teenager who had gained a lot of weight, had developed some health issues, and had seen the endocrinologist. “He made me feel like a terrible mother! I will never go back!” This mom and kid had done so much work and had made some good changes toward a healthier way of eating. His labs actually had improved! Yet, the doctor was looking at the lack of weight loss (which is never my focus, I was so happy his blood sugar was now normal). Anyway, I convinced her to go back because he really did need to be followed, and instead, I called the doctor. I gently informed him that he might want to know that this family was upset with how they were treated. He said “how do you deal with it?! They never do what you tell them to do!” I went on to tell him about how motivational interviewing has helped me so much. I told him I never tell people what to do, instead I treat them as experts in their own lives, and I try to find out what their motivation is. Then I ask them what they need and how I can help, and we work together on their goals, not mine. To make a long story short, I sent him some articles, apparently he read them because at their follow up, he actually treated them differently (so they told me) and I received an email from him stating “this MI has changed my life”. I am sure it has probably changed his patient’s lives, too!
The point though, is that MI is not easily learned. It takes working with expert trainers, being observed, practicing again and again and getting feedback from peers. You can’t learn it in a day. I was surprised that this endocrinologist hadn’t even heard of it. I am not confident that this new paper will result in everyone using it. But I am hopeful.
Finally, the paper discusses six points for pediatricians to consider in order to address weight and prevent EDs:
- Discourage dieting, meal skipping and diet pills and instead encourage a focus on healthy eating and physical activity. The focus should be on healthy living and NOT ON WEIGHT. YAY!
- Promote a positive body image, and especially do not focus on body dissatisfaction as a reason for dieting.
- Encourage more frequent family meals.
- Encourage families not to talk about weight but instead to talk about healthy eating and being active to stay healthy. Do more to facilitate this at home. My add in: Please don’t talk about exercise as a way to “burn” what you just ate.
- Find out about bullying and address it.
- Carefully monitor weight loss in adolescents who “needs to lose weight” to ensure they do not develop the medical complications of semistarvation. I need to translate this one to what I hope they mean: don’t ignore it when a teen seems to be losing too much weight, even if you think they needed to lose weight. It could be an eating disorder.
So, what does this mean to you, the parent? My advice is this:
- Ask yourself how you are treated by your child’s pediatrician. Are you told what to do even if you were not asked any details about what you are doing now? Do you leave feeling like you were shamed, or that you just don’t want to go back? If so, that may be an indication that your doctor does not know about motivational interviewing….or they do, but don’t know how to use it, or maybe just are too busy to learn. I recommend asking them. You deserve to be treated with empathy and respect, and your doctor should be the best he or she can be.
- Follow the advice above. But, if you need help, ask your pediatrician. It is really easy to tell people to “eat more meals together”, but that is kind of hard when dad is home at 8 pm, Johnny is at football practice until 7 pm, mom is picking up Suzie at daycare at 5 pm……you get it. So, if you need help or guidance, don’t feel bad. Ask for some resources.
- Don’t ignore weight loss. If your teen is losing weight, don’t ignore any red flags. If they are skipping meals, losing hair, running to the bathroom after meals, exercising too much, complaining about their body, or any other drastic changes in their social life, don’t ignore it. Tell your pediatrician.
The bottom line is, this is progress. But, it may not change much unless we all are aware and make it happen. FYI, it is noted at the beginning of the Clinical Report paper that “The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate“. In other words, your doctor will do what they feel is best depending on the patient. And it is important to treat each patient as the unique individual that they are.
However, I believe we all should be treated with respect and empathy, as we most definitely are the experts in our own children’s lives.
Check out the paper here: Preventing Obesity and Eating Disorders