Your Child’s Weight: Top 10 Mistakes Parents Make

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The beautiful Zoe enjoying her nuggets and who can run circles around everyone she knows

I remember when there was only one McDonald’s in the entire state of Connecticut. It was a big treat to go once or twice a year, usually during the summer with my family. There was no drive-through and only a few choices on the menu: cheeseburger for 15 cents, hamburger or fries (just one size back then) for 10 cents and milkshakes (we shared one between four kids….it was the size of a small one today, they gave out tiny water cups). Times have changed but still, going to McDonald’s once on awhile isn’t really that big of a deal when it comes to having healthy children and helping your child grow into his or her own unique normal body size.

I have been plugging away at a book about kids and weight because after working for many years in the world of “childhood obesity” I see parents getting it all wrong. These are good parents who have been informed by their child’s pediatrician that their child is “obese” and so they typically are trying to do the right thing. I would like to share part of a chapter on what I have seen as:

10 Most Common Mistakes Parents Make

 If you are like most parents who are worried about their child’s weight, the logical thing to do is to focus on what the child is doing, right? WRONG! Well, maybe not totally wrong, because you do need to figure out how it happened that your child’s weight has become an issue. What is “wrong” is believing that your child has much power or control over his weight without you. In fact I would dare to say that your child does not ever need to hear the word “weight” to be able to be healthy and ok.

Let me describe a typical scenario I saw often as an outpatient dietitian working primarily with families whose children who were referred for issues with weight. One patient, 8 year old Peter (not his real name) had been referred for being “obese” since at his last physical his BMI was above the 95th percentile. His mother appeared a bit embarrassed as she is clearly tall and thin and it seems she feels a bit uncomfortable with having a “fat” child. She openly let me know that her other child, Suzie, is thin. So yes, they do have snacks in the home and they do get pizza on the weekends, but Suzie needs the snacks and Peter needs to learn to control himself. He also needs to exercise more but he won’t stop playing those video games. Mom often catches him very late at night with his Game Boy under the covers, still playing games at midnight. He just doesn’t listen. Poor sleep, by the way, leads to cravings for fat and sugar, a great set up for weight gain. Mom, I find out does not like vegetables so rarely cooks them. She is a snacker and tends to eat most meals and snacks on the couch in front of the TV. Although she prefers foods like chips, cookies, frozen pizza and wings, she states she is willing to cook whatever he needs for his “diet”. She also is not happy that he refuses to exercise. The family actually bought a treadmill that is in the basement and he won’t use it.

One more scene that is more common than you may think. I once had a patient (we will call her Tammy) who was referred for “abnormal weight gain”. She came to the initial visit with mom and her aunt who helped care for her. Mom was a very busy career woman who traveled often, and dad was a busy executive who worked in a business where health and appearance were important.  Mom appeared slightly overweight and admitted to struggling with weight issues. The aunt did not like to cook and because the family could afford it, she tended to take the children out to eat several times per week. The older sister was thin and gobbled up cookies by the boxful. She also liked teasing her little sister about her weight. When obtaining the history, Tammy made random comments about dad’s “crazy eating”. Apparently, dad believed in a restrictive vegan organic diet and had been following it for years. He pretty much starved himself during the day, worked out daily and then ate the same large vegan meal in the evening almost every day, with occasional binge eating (he clearly had an eating disorder that was not addressed).  Mom also tended to yo-yo diet. Auntie just enjoyed eating out. Mom was in agreement to focus on health and really understood that focusing on the number on the scale was not a good idea (she lived a life of dieting and clearly did not want this for her daughter who was only 12).  Unfortunately, over time Tammy only gained weight. The pressure from dad to diet was a bit too hard to overcome, and Tammy ended up binge eating when no one was around, which contributed to her weight gain. She did see an endocrinologist to rule out any physiological reason for her weight gain, but it clearly was due to the binge eating that resulted from the confusing messages and pressure she was experiencing at home.

My intent in sharing these stories is to help you understand the following 10 MOST COMMON MISTAKES parents make in trying to help their child lose weight. Time to “hold the mirror up” and ask yourself honestly if you have done or still do any of the following:

10 Most Common Mistakes Parents Make

  1. Treating your child differently than other children or family members when it comes to food and eating, including commenting on or judging his eating (he is such a good eater compared to you, she is a junk food eater, he always eats too much, etc).
  2. Expecting your child to behave any differently than you do.
  3. Expecting your child to behave exactly LIKE you do (or like their sibling).
  4. Expecting your child to resist any food or beverage that is in the home.
  5. Expecting your child to be able to discipline himself regarding any limits on video games or TV (Buying “live” interactive video games in the first place; allowing a TV in your child’s room).
  6. Expecting your child to exercise on his or her own (especially if the mode of exercise is your idea and not your child’s idea!).
  7. Ignoring or denying your own eating and body image issues (or failure to recognize that you have a problem).
  8. Weighing your child, talking about weight loss, a good weight goal, YOUR weight or the weight on the scale in general.
  9. Allowing verbal abuse such as name calling (fatso, chubby, etc) by ANYONE in your home or in your presence (or even verbally comparing bodies, such as “his sister’s tummy is flat” or “he has all his weight in his tummy”).
  10. Catering to a “picky” eater.

Now we are going to take the time to truly go through each and every one of these ten mistakes in a bit more detail so you can identify if you have fallen into some of these detrimental patterns. Remember, the purpose here is NOT to make you feel guilty! If you are doing any of these things, or if you have been allowing them to occur, it is most likely because you truly do care, or you may be very worried about your child’s health. Also, there of course may be other mistakes many parents make that are not listed here, however these tend to be some of the most common we see that parents may not recognize as harmful.  Many of these simple statements seem like the exact right thing to do. So do not waste a minute blaming yourself or feeling badly! You are reading this book because you care…..so now is the time to set things straight. Let’s go through each mistake to be sure you understand completely.

Mistake #1: Treating your child differently than other children or family members when it comes to food and eating.

This mistake typically happens at the dinner table, but it can happen at other places like school, celebrations, family gatherings, picnics, etc. If it is dinner time, you may have prepared a nice healthy meal that you know your family enjoys. Maybe you put some hot delicious breadsticks on the table. You watch as your family dives in, but then you notice the child who you are worried about, who people may have commented on, or even more importantly, who the pediatrician has identified as “obese” and he has grabbed a second breadstick (as did your thin daughter). What do you do? You feel you need to stop him to help. So you comment “John that is enough! You have already had one!” Or take another scenario: You are so concerned that you have talked to the school nurse and asked her to tell the lunch workers to not allow your child to have seconds, or to have dessert. They are now your food police. You can watch him at home, but now you have someone at school to keep tabs. It goes on and on, but hopefully you get the picture.

How is this harmful? It backfires. Consider this: years of research indicate that even when adults are restricted, they become more obsessed with food, and more likely to binge eat and gain weight not lose it! What do you think will happen to a child? Paying so close attention and singling out a child like this not only makes him feel embarrassed and like something is wrong with him (not good for building self-esteem), it makes him want those breadsticks even more. So when you wrap up those breadsticks and put them away, Johnny is still thinking about them after he goes to bed. He gets up when everyone has fallen asleep and sneaks down into the kitchen, quietly unzips the plastic Ziploc bag holding the forbidden breadsticks and begins to eat, when he should be sleeping. He eats in solitude, where no scolding eyes can see him. He eats, because he knows tomorrow will bring another day where all eyes at the dinner table will be on him. And he continues to gain.

Commenting on or judging your child’s eating, or in fact ANYONE’s eating is also not a good idea.  It seems to me the entire population has become totally wrapped up in eating, body size, and even health (which sounds like a good thing, but extremes of anything are not healthy and definitely not normal). Commenting on the way people eat and on bodies has become a social norm. Think about any time you go to a social gathering, especially where there is eating involved. Comments such as “she can eat whatever she wants, and be skinny! I’m so jealous!” or, “You look so good! What diet are you on?” At home it may sound like this: “Mary eats her vegetables, why can’t you?” Or consider a sibling complaining to mom that Johnny ate all the ice cream again, and he is not supposed to have it!

How is this harmful? When we talk about people’s eating as if it is a character judgment (he is good; she is bad) it has the potential to really mess up a child’s relationship to food. It becomes a judgment on character, not a naturally healthy behavior (enjoying eating). It can absolutely ruin a child’s natural ability to self-regulate (listen to his body signals) and creates great confusion about what to eat, whether to eat or how much to eat. So saying “he is such a good eater compared to you, she is a junk food eater, he always eats too much”, or any other judgmental comment is not helpful.   It makes children feel bad. It even makes adults feel bad, not a way to develop a healthy and normal relationship to food.

Mistake #2: Expecting your child to behave any differently than you do.

The truth is, parents who expect their child to behave differently than they do is more common than you could imagine. We see it every day while working with parents who truly do care about their child’s weight and health. It may seem like a no-brainer to some of us who understand that children tend to do what we do; however it clearly is an issue that many parents are not even aware of.

Here is a very common scenario: Mom sits down in the counseling room with 10 year old Joey who is overweight. She wants me to tell him that he needs to start eating vegetables. He also needs to stop drinking soda because the doctor said he had elevated insulin levels and should not have sweetened beverages. After going through the diet history, the reality is that mom hates vegetables also and does not eat them. She may cook them for the family on occasion, but neither she nor Joey eats them. In addition, it appears that she has a Coca cola habit. She starts drinking it in the morning because it gets her going, similar to those of us who love our morning coffee. But she does not have any weight issues or anything wrong with her insulin, so she feels she can drink her soda. He (10 year old Joey) should have the will power to skip the soda and he needs his vegetables (not sure why mom doesn’t feel she needs them, but it seems because she is an adult, she has earned the right to eat whatever she wants).

How is this harmful? The old saying holds true: The apple does not fall far from the tree. Your child will do what you do, not what you say to do. Your child just will not believe you. Why should they? Your actions speak louder than your words. So many clichés, I know, however in this case, all true. If you really want your child to eat vegetables, you need to not only prepare them, you need to eat them. If you don’t want your child to drink soda, you may need to stop drinking it too. (Note: nothing wrong with enjoying a soda but if you were told your child has hyperinsulinemia or pre-diabetes, a healthy move would be to decrease it).

Mistake #3: Expecting your child to be exactly like you (or like their sibling).

What does this look like? It may involve body size, eating or exercise. Imagine a tall thin dad and a tall thin mom. Then Betsy is born. She tracks at the 95th percentile for weight and at the 50th percentile for height for most of her young years. She does not appear tall and skinny like her parents. Then her brother Brian is born. He falls at the 10th percentile for weight and the 75th percentile for height most of his young life. He looks skinny, just like mom and dad. All of Betsy’s young life the difference between them is pointed out. In fact, her parents have tried to work with her to lose weight as she appears chubby next to her brother and they feel they can fix this.

Not only is Betsy different in body size and shape than her younger brother, he absolutely loves sports and competition, “just like his dad”. Betsy, on the other hand, prefers art and reading. Her parents however force her to join the basketball team and she dreads every minute (although she does enjoy after the games when she gets to run around and just play with her friends on the court for fun!) She just hates the pressure of competition. Brian, on the other hand, thrives on competing. He is not only plays basketball but also plays hockey, soccer and lacrosse.

How does this harm? Expecting a child to change their genetic body type and tendency is impossible. It instead typically makes a child feel “less than” and contributes to low self-esteem.  As mentioned earlier, it also tends to backfire, and causes a child to become more, not less obsessed with food and eating (remember, restriction leads to “food insecurity” and food obsession). So, we tend to see the “chubby” child slowing become even more overweight, and eventually going off of their growth chart due to sneak eating, etc.

Expecting a child to be active like you or a sibling sets up all kinds of problems. Forcing a child to do something they do not feel comfortable doing may alienate them from all activities and being active in any way. Even worse, they may grow to really dislike that sibling who you seem to accept just because he is like you.

Mistake #4: Expecting your child to resist any food or beverage that is in the home.

Do you just love your potato chips? Do you need your chocolate fix? Gotta have that caffeinated soda to keep you going? Many parents are of the mind-set that their children need to respect them by not eating “mom’s chips” or drinking “dad’s soda”. Or, they feel a child should be motivated to resist the goodies that are there for the other thin people in the home. I am so baffled by people who expect a child or even a teenager to have “willpower” when even adults do not have the ability to resist foods they love.

How I explain it is usually like this: Imagine your very favorite food. For me, it may be white chocolate mousse, which is very hard to find. For someone else it might be Godiva chocolate or even something luxurious such as lobster. Now imagine that someone brings it home, and puts it in the fridge. Everyone can have some except for you. How would you feel? What would you do? I can tell you what I would do, and that is wait until nobody was around, then take some! Starting to see a theme? Not only does restricting food make you want it more, having it around and expecting a child to have willpower is not going to happen.

Mistake#5: Expecting your child to be able to discipline himself regarding any limits on video games or TV (Buying “live” interactive video games in the first place; allowing a TV in your child’s room).

I feel bad for the children and teens today because it is not their fault they were born into this era of technology. Ask yourself these questions: Does your child have a TV in his or her bedroom? Do they have an IPod? An IPad? Or how about a notebook or laptop? Smart phone? Are you even aware of how many hours your child or teen is on these devices? Do you allow them to have them in their bedrooms at bedtime? Does your child tell you the TV helps him fall asleep? Do you trust your child to turn off the device and go to sleep on his or her own? Big mistake!!

Why is this a problem? Children who do too much screen time get affected in so many ways, but one of the major issues in how screen time, TVs in the bedroom and video games interfere with sleep.  Because poor sleep has been identified as one of the major contributors to childhood obesity, I sometimes say “fix the sleep problem first” as the other issues are almost impossible to address without adequate sleep. And if you think your child is turning off the TV or Game Boy or laptop to go to sleep, you are kidding yourself. These devices are sometimes addicting and simply, just way too much fun. Don’t expect your child to control themselves.

Mistake #6: Expecting your child to exercise on his or her own (especially if the mode of exercise is your idea and not your child’s).

Often we see parents who are extremely physically fit, into a sport, or maybe dad works out at the gym and does marathons. Or mom goes for a walk or jog after work every day while their child or teenager prefers to sit on the couch and read. Or watch TV. The word “lazy” comes up frequently.

Consider this scenario. Everyone in the family is sedentary. A family of couch potatoes, some thin, some not so thin. When “Jose” is identified as “obese” at his doctor’s visit, he is now expected to exercise (that is what the doctor recommended) while the rest of the family continues in their couch potato mode of living.

Or how about this situation: mom is an avid tennis player who belongs to a league. She meets her friends at the club almost daily after work. “Steven” comes home to an empty house almost every day during the week, because mom is at tennis. He is supposed to be exercising. When mom gets home at 6:30 pm to cook dinner, she is appalled that again he did not use the treadmill. Again, this is a case where the teen has been identified as obese and mom is taking this seriously (or so she says). So seriously that she invested in a treadmill for him. It was not cheap and she is pretty disgusted that he can’t discipline himself to use it.

What is wrong with this picture? You can’t expect a child to do something he does not enjoy, and you certainly can’t expect him to do it without your support. It is unfair to require one child to exercise while another is allowed to sit on the couch just because of differences in body size. It is understandable that a parent would not want to give up their fun or exercise (such as the example of the mom tennis player) however if we want our children to develop healthy habits, we may need to sacrifice, or at least compromise. Again, role modeling is good, as children eventually do what you do (not what you say), however they don’t drive cars, can’t take themselves to the gym and so they need your support.

Mistake#7: Ignoring or denying your own eating and body image issues (or failure to recognize that you have a problem).

This may be one of the most important mistakes parents make. Answer these questions honestly:

  1. Do you weigh yourself every day? If not, do you talk about your weight or your body? ”I need to lose this stomach! I’m not putting on that bathing suit until I lose ten pounds!”
  2. Do you count calories? Measure portion sizes? Talk about “bad” foods or being “bad” because you ate something unhealthy?
  3. Do you have a history of an eating disorder? Have you ever received treatment?
  4. Are you a slave to your exercise routine? This means you just have to do it almost every single day or you feel bad. Or, you go to extremes (run for 2 hours on a treadmill, or outside, but do not enjoy it at all)
  5. Do you use food for comfort? Were you rewarded with food when you were a child?
  6. Did your parents restrict your food intake as a child, or were you put on a diet?
  7. Were you forced to eat everything on your plate as a child and feel that all children should clean their plates?
  8. Do you ever binge? This involves eating a very large quantity of food (such as a box of cookies or half gallon of ice cream) and feeling very out of control.
  9. Do you feel like you had a binge (felt out of control) even if the amount of food you ate would not be considered too much by most people, but felt like too much to you? Such as eating a grinder or finishing an ice cream cone. This is sometimes referred to as a “subjective binge”. It may not be a lot of food, but how you feel about it is similar to those who have an “objective binge” which means pretty much everyone would say it was a large amount (such as an entire package of something).

This is not a test, where if you answer “yes” to 2 out of 9 you may have issues. These questions are only meant to help you reflect on your own history with food, body image and eating so that you may start to understand how you may be affecting your child. Certainly, if you had an eating disorder such as anorexia nervosa or bulimia nervosa when you were young, and never received treatment, or even if you did, it is important to be aware of your relationship with food now that you are a parent. If some of these statements resonate with you, chances are you may have some work to do, or at least should really pay attention to what you say or do in front of your child.

Mistake#8: Weighing your child, talking about weight loss, a good weight goal, YOUR weight or the weight on the scale in general.

It amazes me how socially acceptable weight obsession seems to be. It also strikes me that so many people, parents, teens, health professionals and even children seem to be so intensely interested in that number. Ask yourself, what answer does that number give you? Does it tell you if you look good? Does it tell you if you are healthy? Does the number measure how much fat you have? Why is it that a mother would be so focused on the weight of an eight year old, when they have so many more years to grow? Why do so many of the young women I have seen for eating disorders want to weigh 100 pounds? Why do people think their weight is going to possibly stay in one place on that scale? Why do people weigh themselves so often, as if something big could change in one day? Or one hour? I actually have had one mother tell me she weighs herself before and after a shower because she often loses a pound! Wow, that’s a lot of dirt!

Why is it a bad idea to focus so much on a number, on the scale, on weighing yourself or your child so often? Why is it bad to openly ask the doctor “how much did he weigh?” Well, your anxiety and worry over that number teaches your child about what is important. They will begin to worry too. When they see YOU feel bad after you get off the scale, or talk about your weight, they learn it is very important and they need to worry about it too. They may attach a lot of meaning to it, just have you may have learned to do. You may have heard the slogan “Don’t weigh your self-esteem, it’s what’s inside that counts”……well, focusing on that number on the scale is bound to make you feel bad, not too good for a child’s self-esteem. Not too good for a parent’s self-esteem either.

I know what you may be thinking. I hear it all the time! “Then how am I supposed to make sure he is not gaining too much weight?” Ask yourself, has this helped? Does it motivate your child to want to eat healthier? The opposite tends to be true. Just like adult “weight watchers”, children tend to become more, not less focused on food. The scale (and that darned number) tends to go up, not down. Yes, it is ok, and definitely a good idea to be aware of your child’s growth pattern. You do want to ask the doctor to see the growth chart. But be sure to do this privately if possible. You can check to see if your child is trending off of the curve or not. Then, it is time to focus on health and what YOU can do as a parent to be sure your child stays on track. Your child does not need to know the number. The “talk” should NOT be about weight! Talk about healthy eating, talk about being active for a healthy heart, but please, do not talk about weight. If you absolutely cannot get rid of your scale, consider at least not leaving it in a family bathroom. Please do not weigh yourself when your children are present. And absolutely do not complain about or even talk about your weight. Do you really want your children to have the number attached to the force of gravity on their body be a priority in their life?

Mistake#9: Allowing verbal abuse or name calling (fatso, chubby, etc) by ANYONE in your home or in your presence (or even excessive “body talk”-she is so skinny! Wow, he gained a lot of weight!).

Bullying is front page news these days. We all have heard the horror stories of people who have been bullied, and the sometimes extreme consequences. Bullying is taken so seriously in some states that it is even against the law in schools, and violation of the anti-bullying laws may result in a permanent bad mark on a school record or transcript.

Why is it that teasing about weight, especially in homes often goes unnoticed? Why is calling your sister “fatso” ok in some households? I have heard parents say, “oh we tease her all the time. She doesn’t care, she knows we are just kidding!” Seriously?

It is not that family members or friends are intentionally trying to hurt someone they love. It seems to me that it has just become socially acceptable to tease in this way. I also believe, as I stated in Mistake#9 that it is harmful to regularly engage in “body talk”. Body talk involves making comments about someone’s body, either your child’s, your own, your neighbor’s, your spouse’s, or even a movie star or someone you don’t even know. How is this harmful? When we talk so much about bodies, it just reinforces that body size is what is important. Or body shape. It suggests to a child that HIS or HER body size matters to you.

Avoiding talk of bodies is not an easy task. Think about someone you know who has lost a lot of weight. Of course you want to say “you look great!”  What could be so bad about this? You are trying to pay a compliment to someone who clearly has been dieting and exercising and working really hard to change their body. But how do you know what they did to lose the weight? What if it was not a healthy way to lose weight at all? What if they are suffering from disordered eating and feeling imprisoned by their disease? Hearing comments like “you look so good!” just serve to reinforce the bad behavior and eating disorder (a disease that people die from). So what should you do in this case? Well, if you don’t know the person well, why even comment? Why risk the chance that this person may not be healthy at all, not in a good place, and you just did your part in keeping them unhealthy. Compliment her hairdo, or dress, or shoes if you feel the need. “That color looks so beautiful on you!” feels good to say, yet does no harm.

What if, on the other hand, the person who lost weight is a good friend and you know they have been working on getting healthy for a long time. Instead of focusing so much on talking about weight and body size, why not compliment how hard they worked, or ask how they feel? Have they started doing yoga? Zumba? Walking? Are they sleeping better? Feeling energetic? Why not enjoy talking about all those good things? Yes, it does feel good to be able to fit into clothes you may not have before (especially if they are clothes you used to wear, and can now wear again because you got back to your original healthy lifestyle). But our culture unfortunately places way too much emphasis on bodies and if we want our kids to be healthy and fit, talking about body size is not the answer.

Finally, another reason to avoid complimenting weight loss is that often, those who do succeed in losing weight also succeed in gaining it back. How do you think they will feel next year when you see them again and they found the weight they lost? I see this happen over and over, and I am sure you do too.

As for name calling in your home, I always recommend forbidding it. What do you do if your child swears? Just laugh it off?  Typically there are consequences for inappropriate behavior (good parenting). Name calling is like swearing, but worse in my mind, as it hurts someone. Hold the mirror up: what have you allowed to occur in YOUR home?

  Mistake # 10:  Catering to a “picky eater”.

This big mistake may surprise you. How could being picky with what you will eat affect your child’s weight? If anything, most people think picky eating actually may make it harder for a child to gain appropriately. This may be true when a child is very young, however as time goes by and if the issue is never addressed, it often promotes too much weight gain.

Here is what we tend to see happen with many picky eaters. It starts out when a child starts to refuse foods (at a young age, such as 2). They typical scenario is that mom and dad get a bit worried when Johnny won’t eat anything on his plate. How is he supposed to grow? So they make him his macaroni and cheese because they know he loves that and will eat it.  He also likes McDonald’s chicken nuggets and fries, so dad often picks that up on his way home from work, since he knows Johnny will never touch the chicken, carrots and potatoes mom has prepared.

Fast forward 10 years. What do you think happens to Johnny by the time he has turned 12? Without any vegetables whatsoever, very few fruits, and even limited protein foods (well, except chicken nuggets and maybe some bologna and salami), his diet is not too good. He does not consume enough fiber, is constipated, and because his diet is predominantly starch and fat, he has gained an excessive amount of weight, and now falls far above his normal growth curve for weight. Some lab values may be slightly elevated now (related to abnormal weight gain and poor diet). Are you starting to get the picture?

What then is a parent supposed to do?  There are some excellent resources by experts on this topic such as Ellyn Satter website as well as Give Peas a Chance, a wonderful book written by dietitian and feeding expert Kate Samela, MS, RD, CSP. These will give you some great strategies to deal with this very common problem.  In the meantime, tell your doctor about your child’s picky eating as soon as you notice it. Your pediatrician may be able to refer you for some specialized help (such as feeding therapy).

So there you have it, just a few things to reflect on to hopefully help you help your child have the healthiest body they can have while maintaining a great relationship with food, eating and YOU! More to come on actual strategies and ideas to help, but in the meantime, keep loving your child for the wonderful person they are growing up to be. And that has nothing to do with the number on that dumb scale.

 

 

 

 

Plea to Parents of Fat Kids

lookHave you ever been in a situation where you witnessed a parent doing or saying something to a child that you felt was wrong? Did you say something, or did you bite your tongue? Sometimes, don’t you just want to say “are you kidding me? You did not just say that. Do you not realize how stupid that is???” Well, I have felt that way, many, many times when I worked almost exclusively with “obese” children and teenagers as an outpatient dietitian. I felt like saying not-nice things to parents, siblings. and even other health care professionals (such as the pediatricians who referred them). I just could not believe the stupidity (not a nice word, and I never use it, however it is how I felt at the time). But, it is not stupidity at all as most of the people and a majority of the parents I worked with were very intelligent. Really smart. But when it came to how they treated their children, or how they treated their patients, well, they just were not wise. Not wise at all. And it truly broke my heart…..I wanted to scream, but I couldn’t because, well, I would have lost my job and then I could never help anyone at all.

This is a topic I am passionate about, and I already vented a bit in 5 Things You Should Never Do if your doctor tells you your child is overweight. But I want to take it a step further. I think it was something I saw in a little girl’s face that touched something in me last week, and I can’t forget it. I was leaving the Nutrition Office where I am temporarily covering an afternoon here and there, and as I was walking out at the end of the day I noticed a little girl sitting in the waiting area. She was with her mom, kind of clung to her, waiting to see the dietitian. She was probably 6 or 7 years old and was likely starting the weight management group program (or maybe was already going and just coming for a follow up, I don’t know….but from the look on her face, she looked as if she was on death row). Just to be clear, this “weight management program” does NOT focus on losing weight for children. It is expertly organized and run under the guidance of a very experienced, sensitive and wise psychologist. The focus is on the family as a whole with an emphasis on everyone improving their lifestyle to get healthier. The name of the program has absolutely nothing to do with weight, which is a good thing. The problem is what happens when the child goes home.

Just as with picky eaters, parents of “overweight”or “obese” or “chubby” or “fat” kids (however they are labeled by family, friends, doctors) tend to get treated in an “old-school” way of thinking. For picky eaters, for instance, we learned way back when to make a child “clean your plate”, or “finish those peas” or you won’t get dessert. Just because parents have been doing that for decades does not mean it works or is the right thing to do. We now know this promotes even pickier eating, kids growing up to be adults obsessed with sweets (because when you are 32 you can skip the darn peas and go straight to the dessert). It doesn’t work.

The same holds true for children and weight. The minute the child gets wind that a parent is concerned about his weight or body size, things change. The first mention of “do you really need that?” starts the ball rolling. Sometimes parents start making comments like this after a yearly check up when the pediatrician may mention something about BMI. Sometimes it is just the parent noticing a change in their child’s body. Often times, I have encountered parents, usually those with body image concerns of their own who are the worst offenders. They “don’t want their child to go through what I did” so they are going to make them skinny NOW. Or upper class, professional parents where it is important to portray a certain image, and having a larger size child or teenager does not reflect well on them. Everything needs to be perfect, including everyone’s bodies. I know this sounds crazy, but trust me, I have seen it. These cases especially trigger me and I have to use all of my personal resources regarding counseling skills and self-control to avoid saying something I will regret. What I want to say is “don’t you see how your failure to accept your kid for who they are is affecting their self-esteem? How can you be so shallow?” But I don’t because the reality is these are all good, loving parents who care about their kids. They are doing the best they can. Their intentions are good. The repercussions are really bad though, so I need to say something.

Not everyone accepts what I have to say. I usually try to focus on the research regarding restricting children, or even what happens when adults diet. This almost always leads to more focus on food, binge eating, eating disorders and yes, weight gain. When I ask if they notice any sneaking of food, inevitably the parent says yes. It starts when the child is restricted. So that often opens the door to the parent considering a different approach, such as focusing on health for the entire family. But it still is not easy for parents to change. They truly do want to help their kids, but it is complicated because of the parent’s relationship with food, their own body image concerns and dieting history, their beliefs about weight and healthy, their values, etc.

So what is my plea to parents? First ask yourself these questions:

  1. Do you feel that your child’s body size reflects on you as a parent?
  2. Do you feel you are a failure or did something wrong because your child does not have a thin body like their friends?
  3. Do you make comments about your body, your children’s bodies, other people’s bodies?
  4. Do you weigh your child EVER at home? Do you talk about that number?
  5. Do you allow anyone in your home to talk about another’s weight or body?
  6. Have you changed your behavior toward your child’s eating after a pediatrician visit where you were told something about weight?
  7. Do you forbid one child from eating certain foods but allow others in the home to have it? Do you limit portion sizes for just one child and not others?
  8. Do you force your child or teenager to use a treadmill, exercise bike or other forms of exercise to help them lose weight even if they do not enjoy it?

If you answered yes to any of these questions, my guess is your child or teenager is getting a few messages from you that may harm them, either now or in the future. The messages are:

  1. I am not ok the way I am.
  2. My body size is important in life. That number on the scale defines me.
  3. I should feel bad if I eat certain foods.
  4. Exercise is not fun.
  5. If I lose weight my parents will be happy.

Are these the beliefs you want your kid to carry with them on to their adult lives? Do you carry these beliefs as an adult? How has it worked for YOU?

What is the alternative? It is never too late to create a shift to a healthier relationship with food, eating and weight. You CAN help your children grow up to be the best they can be in every way including body size. You just need to accept the fact that we have absolutely no control on what are bodies want to be (that is in our genes). You can however work on your family’s lifestyle to promote health. You can work hard to accept the goal of feeling good and being healthy instead. Now that is a pretty good message to send to your kids I think. How do you do that? Here is a way to start:

  1. Throw away your scale. Vow to focus on promoting healthy behaviors and not the force of gravity on your body.
  2. Treat every single person who lives in your home the same when it comes to food.
  3. Talk about health, not weight or bodies.
  4. Defend your child. Do not allow anyone at anytime in any place to talk about your child’s body. That means siblings, dad, mom, aunts, uncles, grandma and grandpa.It also includes the doctor. Warn them ahead of time. Tell them you do not want to draw attention to weight. Assure them you are educating yourself about healthy eating and exercise (you can actually ask for a referral to a Registered Dietitian for help with healthy eating, but be sure the dietitian also knows you do not want to focus on weight, just health). Remember, your pediatrician is trained to look at numbers such as BMI and is obligated to diagnose “obesity” however they do not need to talk about it, especially in front of a child.
  5. Do not give your child a “look” when they are eating something, or taking a second helping. They will sense your judgement and it will hurt them. Remember, if you are offering healthy meals and opportunities for fun movement, your child will be fine. They need to learn to listen to their own bodies, and when the emphasis is not on restricting and controlling every morsel they eat, eventually they become less focused on food and eating. All kids are different and it depends on what they have already gone through, as well as their own genetic and psychological make-up. Your job is to set an example of a healthy lifestyle, that is how your children will know what matters. If they see you jumping on a scale every day followed by a reaction from you depending on that number, they learn that is what matters.
  6. Get help. If this is really hard for you for whatever reason, consider getting some support. If you have eating issues of your own, or if you are stuck in a diet mentality, or are afraid of getting rid of your scale don’t give up. I have worked with many women with eating disorders who fear they will somehow pass on their issues to their children. Just their awareness of their own issues really helps.

So my plea in a nutshell is, please let go of it. Let go of our culture’s focus on body size. Let go of thinking you and your entire family have to look a certain way, otherwise you are not a good parent. Instead, embrace caring about health. This does not mean eating perfectly or exercising a certain amount of time every day. It means moving in a direction that feels good and makes sense. If you could have seen that little girl’s face in the waiting room that day, you would understand. Please don’t do that to your child.

 

 

Normal Eating, Dieting and Weight:Finding Your Way Through the Jungle

Finding peace with eating may take time, just like finding the perfect sea shell….but it is worth it

“Don’t listen to this Joanne” one of the teachers said as she walked into the office at work the other day. I knew immediately what the story was going to be. I knew it would be about food. I was right…..she proceeded to tell my co-worker about the peanut butter cheesecake she made for a baby shower. As well as she knows me, how could she still think of ME as the food police? But after I thought about it, I realized it is not about me, but about all of the cultural confusion about food and eating, and what normal is. Despite the increase in awareness that dieting does not work and intuitive eating is better, it is a mighty task to find a way to stand up to the utter illness in our society when it comes to food, bodies, weight and eating. This may sound extreme, but after you have been around for as long as I have I can say that (recently celebrating a BIG birthday to prove it…born in 1956, if you do the math, you will agree!).I have also spent years struggling to help those with eating disorders fight against the barrage of unhealthy messages coming at them from all directions each and every day.

Think about this scenario: Jessie is in her last year of college, but after losing too much weight and developing an eating disorder she has to take a leave of absence from school in order to get better. She attends a day program where she has group therapy, meals and snacks and also sees me for nutrition counseling. Jessie seems to get it that she needs to gain weight and eat more because she feels awful, is obsessed with food, is always hungry and now it has affected her life, having been forced to leave school. Although she is working through her issues, she is very confused about why she needs to gain all this weight back. Everyone she knows is dieting so why is it ok for them and not her? She lists some famous actresses along with their heights and weights (which are horrifying) and again wonders why it is ok for them? Plus, both her mother and her grandmother are on a low carb diet because they are trying to lose weight. On top of this, she watched Dr. Oz and learned some random things about certain foods and so now did not want to eat those anymore. Oh, and on the radio in the car the DJ was talking about some place that actually can sculpt your body to get ready for swim suit season….why can’t she do that?

How is this poor girl going to block all those unhealthy messages coming at her from all directions? There is such a thing as “normative discontent” which is just what it sounds like. It is pretty normal if you have something about your body that you just don’t love (great roots, for instance, curly hair, short legs, big ears, bulging tummy, you name it, we all have something probably). But we live with it, and don’t think about it that much and certainly don’t starve ourselves to change it. It seems to me we have become immune to what is happening in our world when it comes to food and eating and bodies, and slowly over the years it has become “normal” to talk about bodies, and avoid certain foods and exercise to lose weight (not for fun, not to feel good, but solely to change the body). It has become normal to praise people for body parts (either natural, genetic endowments-“she has such beautiful long legs”, or changes resulting from some drastic measure-“your legs look great since you’ve been going to the gym nine million hours a week”). It drives me nuts. Everywhere I go, every single day, it strikes me. In the car, on the radio, on TV, visiting friends or family, inevitable the talk turns to eating and weight and bodies and body parts.

So here I am, along with many other intuitive eating, “listen to your body”supporters, trying to help people live a life focused on what actually IS important, and it is very difficult. I feel like the odd man out most of the time. Even my own husband sometimes looks at me like I am a weirdo when I talk about this stuff. He does not understand why you would not want to compliment someone on achieving a weight loss. Unless you know a person well, it is dangerous to do this because we never know how the weight was lost, it could be through very unhealthy means and I for one do not want to compliment or reinforce anyone’s eating disorder. If, on the other hand, someone has done a lot of work to change an unhealthy lifestyle and now eating healthier and loving it (and maybe has lost weight) complimenting healthy changes feels ok to me. As a dietitian that is what I like to see if it is the goal of an individual to be healthier, and they are happy with what they are doing and it serves them well both physically and psychologically, that is different. But focusing on the body size alone is what most people tend to do, and that is the mistake.

As far as eating, I can totally understand why my mom calls me at least once a week to ask some pretty funny question about food. She watches Dr. Oz sometimes, and the news and so I often have to clarify. She also asks funny questions about what she cooked and if she can still eat it. “I made this beef stew on Sunday, is it still good? I hope so because I ate it!”Those questions I don’t mind : ) But sometimes she is triggered to start reading every label (lately, it is all about corn syrup…”that’s bad, right? But why? My gluten free crackers have it, does that mean they have gluten?”). Ugh.

And then there is the low carb craze that never seems to go away. You know what I mean, I bet if you go out on the street and ask every random stranger you meet if carbs are good or bad, you will see how we have been brain washed. Our culture just seems to love labeling foods. Is it good? Is it bad? I get that question all the time. “Joanne, kale is good, right? Potatoes are bad, right? White bread is bad, right? Is rye bread good? Are cheerios good? Are Froot Loops bad? It is 100% fruit juice, so that’s good, right? It is gluten free, so that is good right? ” You get the picture. No wonder we are all confused, the messages we get every single day are hard to ignore.

How do you see the forest through the trees? How do you know what to believe, and more importantly, what kind of relationship do you currently have with eating and food and your body, are you happy with it and content, or do you want to move in a different (and happier) direction? Then here is some advice:

  1. Remember, you are unique. Your eating style and lifestyle is a complicated matter that is unique to YOU. Your environment, habits and emotions all play a role. It may take time to unravel how each affects you. That is why one diet or another is not the answer. We are not all the same.
  2. Be kind to yourself as you go through your exploration of how you want to eat. You may feel that our culture judges you (trust me, every time I am spotted with a non-healthy food item in my hand, I get a comment, “your’re eating THAT! Aren’t you a dietitian???”). Remember, they are the crazy ones, not you!
  3. Be aware of the messages coming out of the mouths over everyone around you either on the radio, on TV, at work or even at home. Realize that you are being bombarded by messages you should question (and even stand up to if you have the inclination). On Facebook the other day someone shared how McDonald’s labeling of all of the calories was actually not helpful at all to those with eating issues, and many people agreed.
  4. Educate yourself about health and nutrition from reliable sources.I recommend even one consultation with a registered dietitian (preferably a Health at Every Size RD). There are some good websites such as Choose My Plate, but unfortunately, even reliable sources are slanted toward weight control, so be sure to put your own filter on it and ignore that focus. Stick with learning about what you need to have energy and feel good.
  5. One of my favorite definitions of “normal eating” is from Ellyn Satter. Check it out at What Is Normal Eating?  The important message is that it is not perfect : )
  6. If you are not able to get out of a rut of dieting and weight gain, or find yourself getting depressed about your body or weight or eating, get help. Ask your doctor about a referral to a therapist who specializes in eating issues. The sooner you get help, the better.

The bottom line is that eating and dealing with our bodies and weight can be a very complicated matter because of our cultural focus on dieting and weight and eating perfectly. Don’t accept everything you hear. Be aware of the amount of bombardment of these messages you get on a daily basis. In the end, you are the expert of your own life, and you get to decide how you want to live it.

As for that peanut butter cheesecake, I will share the recipe once I get it!!

Should You Care About Your BMI?

hips-don-t-lie-1324351Friday morning as I was having my coffee, doing my usual multi-tasking, kind of listening to the news from my bedroom, something I heard made me stop what I was doing and run to the TV. “Indiana Teen refuses to calculate BMI”. What? I am a huge anti-fan of BMI. I was dying to hear this story. In case you have not heard, this young eighth grade athlete has received national attention after her Facebook Post about refusing to calculate her BMI in a class at school. She had been shamed in the past when she was told she was “obese” according to her BMI. Although she says she knows she is a bigger girl, it never had bothered her before but after that incident she felt bad and so the next time, she refused. Instead she wrote an essay about why BMI should not be used to determine health, especially in a middle school where girls are already super body conscious and insecure. Check out just one article  Indiana Teen Refuses to Calculate BMI to read more. She went to her doctor who did a complete physical with labs and let her know she was fit and healthy. Her message is simple yet powerful: BMI has nothing to do with health.

An eighth grade kid understands perfectly, yet unfortunately, the medical community still does not get it. Besides falsely labeling larger sized people as unhealthy, people who are very ill but have a “healthy BMI” fall through the cracks. I have story after story of eating disorder patients I have worked with in the past who have been starving themselves, purging in all kinds of dangerous ways, yet when they go for their yearly check up, the doctor responds: “You look great! You lost weight!” Which leaves the poor patient who is suffering in a confused and sometimes angry state. Most of the time the health care provider never asks how the weight was lost. It seems assumptions are made that the weight loss was a result of some healthy eating and exercise, but in these situations it is not the case. As long as that number is where it should be, it seems it does not matter.

The reality is that having a healthy  body  is not a simple task. Eating a perfect diet or having the correct BMI does not result in a healthy body, and does not negate unhealthy behaviors such as smoking or starving yourself or being stressed out. Genetics play a gigantic role (we all joke about the old man who smokes a pack a day and drinks whiskey and lives to 100). How it is that we have come to rely on some number based on a calculation using height and weight to tell us anything about someone’s health is beyond me. I believe part of the reason could be because it saves time. It is so much quicker to get a height and weight measurement and calculate BMI than it is to ask someone about all of the details of their lifestyle. Most health care practitioners don’t have time for this. In the hospital where I worked as an outpatient dietitian, we moved into a “productivity” based practice, so instead of an hour with a new patient, I was now expected to assess and counsel a patient and family in 30 minutes. If they were 10 minutes late, I was in trouble. It was heartbreaking to me. How could I even start to help a family with so little time to even find out about who they were? I left that job because of it, but I imagine that office is not unlike many others. Time is money.

So, it you ask me, you definitely should NOT worry about your BMI. Instead, you should worry if your health care providers give you advice without ever asking you about your lifestyle. Oh boy, does it make my blood boil when I hear stories from both friends and patients alike about the assumptions made based on weight or body size. It is prejudice, plain and simple, and it is wrong.

Forget the numbers, and keep it simple. How do you feel? What things run in your family that you need to be aware of? Look at all aspects of your life, both physical and mental (which is why I left that job, the stress was affecting my health). What you eat does matter but just to a degree. For instance, if you don’t drink enough to stay hydrated, you just won’t feel good and it can hurt you, especially in hot weather. If you live on sweets, you will likely not feel good either. If you don’t consume any calcium your bones may eventually be at risk. If you don’t eat any fruits or veggies, you may experience constipation which is not fun. So yes, nutrition matters, over time. You can eat brown foods for a week with no repercussions. You can eat sugar every day and have no ill effects. It is all in the big picture, with all aspects of your life having an impact on your health. Food, sleep, stress, movement, fun, family, friends, all of it.

So when someone brings up your BMI, tell them you want to talk about your health, not some dumb number that is meaningless.

 

5 Things You Should Never Do if Your Doctor Tells You Your Child is Overweight


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We all have heard it a thousand times. We have an obesity epidemic among our children and we need to do something. Back in July of 2013 when the American Medical Association declared obesity a “disease”, pediatricians took action. If a child’s Body Mass Index (BMI) was equal to or greater than the 95th percentile on a growth chart the child would be labeled “obese”. If the BMI was equal to or greater than the 85th percentile then they were “overweight”. Parents needed to be informed so they could do something about it.

There is lots of controversy about using BMI as a criteria to determine health. To calculate BMI all you need is a height and weight. Unfortunately, although this is what pediatricians use to diagnose and label “obesity”, BMI has little to do with health. Check out this BMI article for some great scientific background on why BMI is not a useful tool.  Anyway, if you are a parent, and you take your child for a yearly check up, you may be informed of your child’s BMI (especially if your child is out of range according to the Center for Disease Control (CDC) growth charts) See CDC Growth Charts.

What should you do if your pediatrician tells you your child is overweight or obese? Here is my advice on what you should NOT do:

  1. Never assume your pediatrician is correct to have any concerns about your child’s health due to his or her BMI. Instead, ask to see your child’s growth chart. Typically, children tend to follow along a curve. So, if your child has always plotted around the 50th percentile for weight, that is their “norm”. If they have always plotted along the 95th percentile for weight, then that is their “norm”. If their length or height has always plotted along a certain curve, the same holds true. Therefore, if a child happens to genetically be on the lower side for height and on the higher side for weight, their BMI may fall into a range that is above normal for BMI. Does that mean something is wrong? No! In fact, I have had several children come to see me who were referred for “overweight” who were actually very healthy and growing normally. One case I clearly remember is a little boy, about 10 years old I will call Johnny. Poor Johnny looked terrified when he came into my office. When I asked what brought them here, he blurted out “The doctor said I am overweight! Am I going to die? Am I too fat?” It was sad to me how frightened he appeared. When I looked at his growth chart, it was clear he was one of those kids who was a bit shorter and a bit higher on the weight chart. He was an athlete who played several sports and appeared very muscular and was definitely very fit and healthy. I had to tell him “your doctor made a mistake! He forgot to look at your growth chart! You are growing perfectly! But let’s go over what you eat anyway so I can be sure you are getting everything you need, ok?” He showed a visual sign of relief as he let out a big breath and sighed. I thought, this is so wrong. This athletic young boy should never have to worry about his weight. The doctor should have looked at the growth chart and known that this kid will probably never have a BMI that falls in the “normal” range and that his healthy lifestyle was what mattered. So the bottom line is be sure to ask your doctor to see your child’s growth chart. If, on the other hand, your child has veered off of his or her normal growth that may be a different story. Sometimes when there are big changes in lifestyle (that are not conducive to health, such as getting a new video game and discontinuing playing outside everyday to sit on the couch and play videos), well, weight can increase in a way that is not normal for the child. In that case, working on decreasing screen time and going back to healthy outdoor play is what is important. Again, working on having a healthy lifestyle is what matters, not the number on the scale, and certainly not a child’s BMI.
  2. Putting your child on a diet. Yes, after getting the news your child is overweight, a good parent wants to fix it. Often, a parent will come to me and ask for a “diet” for the child. Because of all of the cultural emphasis on dieting to lose weight, parents fail to stop and think that these are children, not adults we are talking about. And, the ironic thing is that research has proven that even adults are not able to diet successfully. Dieting leads to binge eating. Why would we think children can do it?Don’t you think if an adult ends up sneak eating and binge eating after restricting that the same thing will happen to children? It will.  Diets don’t work, not for adults and definitely not for children.
  3. Expecting your child to do something you can’t or don’t do. Do you expect your child to eat vegetables and fruits and salad, yet you don’t eat them? Do you drink soda yet expect your child to just drink water? Do you sit for hours in front of the TV yet expect your child to go exercise on the treadmill? Children do as we do. You can talk until you are blue in the face about the benefits of eating fruits and vegetables, and about how good exercise if for your body, but if you have an unhealthy lifestyle, glued to the TV, bringing home fast food every day, then your child is likely to be just like you. If, on the other hand, you have a healthy approach to eating and moving, with a focus on being healthy, then your child will likely adopt the same healthy attitude and lifestyle. This does not mean living on health food and driving yourself into the ground with exercise. It means using a healthy guide such as My Plate to help make your meals healthier. It means taking your child to the park to run around and have fun instead of handing them a video game to sit in front of a screen for 4 hours. It means planning some outdoor play and limiting the use of screens (TV, cell phones, video games) to less than 2 hours a day (yes, it is easier when they are occupied in front of a screen, but not healthy for their bodies if it is excessive). So work on this instead of thinking your child is going to be able to diet.
  4. Treating children differently when it comes to food depending on their body size. This is a pet peeve of mine. When a family says they have cookies in the house, or chips, or soda, because “her brother is skinny, he needs it”, this drives me crazy! What typically happens is the child who is overweight sits there in my office looking guilty. Their head is down, no eye contact. The mom goes on to say how little Cindy is sneaking her brother’s cookies. Mom also caught her sneaking some of her brother’s Doritos. Could I please tell her that she does not need them? Maybe she will listen to the dietitian! So what do you imagine my response is? I whisper (loudly), and look straight at the sneaky little criminal “you know what? I would be sneaking those chips too!” Now at this point, the mom usually looks at me like I am crazy, until I explain. How would you feel if your very favorite food were in the home and yet you were the only one who could not have it? It simply is not fair. Instead, I believe in trying to have a healthy food environment. This means having healthy snacks in the home, not having soda around (since most kids might fill up on it and say heck with the milk). Have soda when you go to parties, don’t restrict it, however be smart about it. The same goes for chips. Make them a part of a meal with other healthy foods (like a tuna sandwich, you really do need a few chips with that). Just because brother Johnny is skinny does not mean he does not deserve to be healthy too. He should also be eating fruit and vegetables and not filling up on soda. Everyone needs to care about health. It has nothing to do with body size. So stop treating children differently depending on their weight. It does not help anyone and it only serves to make the labeled child feel bad. It also usually increases a focus on food and sneaking. This is not a way to move toward healthy eating.
  5. Talk about weight at all. Your child’s weight, your weight, your friends weight. Just stop talking about it. In fact, I would also recommend you have a talk with your pediatrician to request he or she avoid commenting about BMI or weight at all in front of your child. If there are any concerns, ask that they talk to you privately. You do not need your child worrying about weight. This is not a good thing at all and only serves to make them feel bad. Instead, get the details about their growth chart (ask to see it, ask them to explain it and why they are concerned). If your child truly has gone way off of the chart then don’t talk about it. Instead, look at your entire family and the habits you have fallen into. Work on getting more physical activity for the entire family. Look into healthier cooking and less eating out, and other strategies to promote a healthy lifestyle. Seek the help of a registered dietitian by going to Eatright and finding a dietitian in your area. Or check out the My Plate link above and work on it yourself. But don’t talk about weight in front of your child. It is not helpful and will most likely be harmful. Think about it. How would you feel if everyone was watching every morsel that you ate, and pushing you to exercise when everyone else in the family was sitting on their butts playing video games? It is simply not fair.

So there you have it. There are also many things you definitely should do to promote the healthiest body possible for your child. Stay tuned for that. In the meantime, give your child a hug and accept them for the beautiful blessing that they are in your life.