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Dear Dr. Ava, My 6-year-old daughter weighs almost 75 pounds. When she was two and a half, she gained a lot of weight and the pediatrician classified her as obese because she was 20 percent above normal weight. She craves junk all the time, and she's always looking for something to eat. She doesn't like to exercise or play with other kids because she gets tired very easily. I went to a nutritionist, but she just lectured me about not giving in to snack requests. I'm heartbroken for my daughter. I'm afraid being overweight will hurt her self-esteem. What can I do?
Dear Heartbroken Mom: Don't despair! First of all, you're not alone. American children (and their parents) are gaining more weight than ever, despite all our efforts to stay slim. In fact, one in five school-aged kids is at least 20 percent above his or her ideal weight, so your daughter has lots of company!
Why are so many children overweight? One reason is that American children are exposed to food in so many places: huge supermarkets, concession stands at the movies, in ads. There are food wagons in parks, fast food restaurants in train and bus terminals, and more. Another reason is that a great deal of the food we favor is filled with sugar, fat, and calories. But not only are our kids eating the wrong foods -- and more of them -- they're also exercising much less than they need. American kids watch TV and/or log onto the Internet three to four hours each day (apart from the time they need to spend on homework each night). That means there's very little time in their lives to run or swim or play ball or skate or ride a bike.
These are all general problems that many families face. But there are also particular problems that you need to think about in relation to your daughter. Her constant need to eat, for example, may indicate that she's turning to food to comfort her against significant emotional distress. Her craving for junk food (which is usually high in sugar), her lack of desire to play or move, and her fatigue, could also be signs of childhood depression.
To help your daughter, you need to understand what triggered her overeating and weight gain when she was two and a half. Was there the death of someone she loved? The loss of a familiar babysitter? A separation or divorce in the family? The birth of a sibling? An illness or hospitalization? Any one of these events can emotionally disrupt a child's development, causing a change in eating habits. This change then initiates a vicious cycle: The more weight your daughter gains, the worse she feels about herself, and the worse she feels about herself, the more she turns to food for solace.
In addition to these emotional factors, environmental, genetic and physical factors need to be taken into account. If you or others in your family are overweight, your daughter is likely to identify with this overeating parent or sibling. Remember, too, that there is a wide range of normal weight levels due to differences in height, bone density, and body type, so make sure that you are taking these factors into account when evaluating your daughter's weight. Not everyone is slated to be tall and thin.
But, given all this, there's still a lot you can do now to help your 6-year-old lose weight.
1. First, you need to get your daughter's cooperation by creating a weight-loss plan that she's willing to accept. Make the doctor responsible for her need to lose weight and make yourself her ally. (Explain that she's got to eat in healthier ways, and you're going to help her). Make charts of healthy and unhealthy foods and place them on the refrigerator to remind her of what is good to eat and what's not.
2. Take control of the food you keep in your house. Don't keep any "junk" foods in your cabinets, and don't be afraid to say no when your daughter asks you to buy these foods at the supermarket. Remember, she can't eat junk food if it's not in the house!
3. When your daughter wants to eat, offer fresh fruits and vegetables instead of candy, ice cream, and potato chips.
4. Set a good example by eating in healthy ways yourself. Children do what we do; not what we say! If you want your daughter to learn healthy food habits, you need to practice them.
5. Don't offer food as a reward for good behavior. This is the way that food becomes over-valued; using food as a reward increases a child's food desires.
6. Don't make eating the focus of your family life. Go for a walk with your daughter instead of going out for pizza. Take her skating instead of making cookies. That way she learns that there are other pleasures besides food.
7. Increase your daughter's physical activities by supporting and joining her efforts to help her get started. (Swim together at your local community center, get an aerobics tape for kids and do it with her, sign her up for something of her choice that's physical but fun). Make it clear that not exercising is not an option. The option lies in what she chooses.
If you can follow through on these suggestions, you have a good chance of helping your daughter begin to lose weight and also of helping her to repair her emotional and physical health. Good luck!
Dr. Siegler is the director of the Institute for Child, Adolescent and Family Studies in New York City, and the author of two award-winning books for parents, "What Should I Tell the Kids? A Parent's Guide to Real Problems in the Real World," and "The Essential Guide to the New Adolescence: How to Raise an Emotionally Healthy Teenager." She is married and the mother of two children.