Prevention and Treatment of Child Overweight and Obesity
Step 2: Conventional treatment destroys the utility of the Division of Responsibility

Any method, treatment, conceptualization, or educational guideline that attempts to achieve an agenda with respect to what, how much, or whether your child eats or how much your child weighs is inconsistent with the Division of Responsibility (sDOR). Any method that targets the child rather than the parents contradicts sDOR. These child-targeted methods include those that encourage the child to “eat moderately,” emphasize “healthy” foods, or limit or avoid “unhealthy” foods. Systems that put food-management concepts in children’s language, such as the Stoplight Diet, particularly contradict sDOR because they reinforce the expectation that children are to restrict themselves. It is also child-targeted to tell, motivate, encourage, or guilt-trip the child with respect to what or how much activity s/he does. Other less direct child-targeted methods include asking the child, “what is your tummy telling you,” giving the child “the look,” talking to the child about being “healthy,” or giving rewards or praise for eating less or being more active.


Conventional treatment of child overweight

At times children’s normal eating behaviors and/or growth patterns get medicalized and children are subjected to treatment to get them to lose weight or “slim down” by managing their body weight in some way, often trying to keep it at the current level while they get taller. Methods used in these agenda-driven child-overweight treatments include any or all of those listed in Avoid pressure. Other, more systematic approaches include the following:

  • Having a target or cutoff point for the child’s BMI (Body Mass Index): Defining the child as overweight if BMI is above the 85th percentile, obese if BMI is above the 95th and trying to get the child’s weight to level off.
  • Emphasizing the what and/or how much, not the how of feeding: Trying to get the child to eat more low-calorie foods such as vegetables, fruits, skim milk, and whole grains, and fewer high-calorie foods such as sweets and fried food. Imposing portion sizes.
  • Targeting interventions toward the child: Giving the child instruction in food selection or prescriptions for activity.
  • Miscellaneous: Giving calorie prescriptions, limiting eating out, particularly at fast-food restaurants, encouraging eating breakfast, all for the purposes of weight management.


The
Satter Feeding Dynamics perspective on conventional treatment

From the Feeding Dynamics perspective, here are the reasons that conventional interventions are unnecessary and even counterproductive:

  • Having target or cutoff weights or BMI: Children naturally grow. While moderating accelerated weight gain is desirable and likely to result from following sDOR, making that the goal puts pressure on feeding. Even the seemingly modest goal of getting the child’s weight to remain the same puts pressure on feeding and carries the risk of distorting a child’s normal growth pattern.  
  • Emphasizing food selection: Children’s eating healthy food is desirable and naturally grows out of parents’ following sDOR. However, stipulating “healthy” food is problematic because it backfires. Stipulating “healthy” food complicates planning enjoyable family meals, teaches the concept of good-food-bad-food, and precipitates feeding struggles between parents and children. The child who is expected to eat “healthy” food and avoid “unhealthy” food loses interest in “healthy” food and gains interest in “unhealthy” food, which pulls parents in to be enforcers. Stipulating “healthy” food gives the impression that eating the “right” food and avoiding the “wrong” food is the critical element in child weight management. It is not. The critical element is maintaining sDOR, which preserves the child’s ability to regulate food intake and grow in a genetically appropriate fashion.
  • Encouraging fruits and vegetables: These foods are nutritious, and families are to be supported in including them in their usual way, but there is no evidence that eating fruits and vegetables is slimming. Encouraging is pressure, it is doing the child’s job, and it decreases the child’s acceptance of these important foods.
  • Encouraging low-calorie foods: Encouraging low-calorie foods is pressure, and pressure backfires. Planning meals that include both high- and low-calorie foods supports the child’s food regulation: s/he can eat more high-calorie foods when s/he is hungry, fewer when s/he is not.
  • Restricting high-calorie foods: As long as sDOR is in place, even the relatively large or fat child (or small or lean child) knows how much s/he needs to eat and is able to regulate food intake and grow appropriately when offered meals and snacks that include high-calorie foods along with other foods. When high-calorie foods are restricted, even the best-intended children sneak to get them, overeat when they do, and feel ashamed of themselves.
  • Limiting portion sizes: When sDOR is in place, even relatively large or fat children can be trusted to manage their own portion size and eat as much or as little as they need.
  • Usurping recommended feeding practices as a weight-loss strategy: Offering vegetables, managing high-calorie foods, having breakfast, offering a nutritious diet, and managing eating-out occasions are all part of maintaining sDOR. However, in and of themselves, the practices don’t promote children’s weight management.  
  • Pushing activity instead of offering chances to play: Good parenting with activity demands a Division of Responsibility. Children naturally play and enjoy moving their bodies. Some children are more active than others. Getting a child to be more active than is natural for him or her makes activity unappealing.

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©2016 by Ellyn Satter published at www.EllynSatterInstitute.org. You may reproduce this article if you don't charge for it or change it in any way and if you do include the for more about and copyright statements.