Working with an obese child

While childhood obesity is a serious crisis across the nation, I was truly stunned by an action that removed an 8-year-old child from his home and into foster care simply because he was obese.

ABC News out of Cleveland, Ohio reported that this boy was removed from his mother after officials claimed she “did not do enough” to help him lose weight. According to the news report, the family had been working with the child, including enrolling him in healthy children’s programs, but the weight hadn’t come off. Instead of working with the family on interventions, the state opted to pull the child from the family.

While the state strongly believed it could do better in assisting the child with the weight problem, removing a child from his or her rightful parents can often create other problems such as emotional and mental distress. In the same ABC News report, another parent had come forward with news that her child had once been taken away because of obesity, but the state’s plan failed to help the child lose weight.  Not only did the child return to the family still in an obese state, he likely suffered emotional and mental problems thanks to the state’s removal process. In this case, the state’s action seemingly created more grief for the entire family.

Child removal is generally performed when there is suspected or known abuse of a child. The fourth amendment states that citizens have the right to be secure in their persons, houses … but upon probable cause, the persons or things could be seized. In the case of the Cleveland child, I don’t see that enough probable cause warranted removal. I just don’t understand why the state or local children’s health agencies couldn’t have stepped in with interventions and suggestions rather than pull the child from their rightful parents.

Research has shown that numerous interventions can be helpful for obese children and teens, but almost all of them involve family and community assistance while the child remains with their family. One of the key ingredients to understanding obesity is to educate the parents. Parents often struggle from obesity themselves which affects their ability to talk with their child in a non-judgmental way regarding losing weight. This is where agencies and health professionals could step in.

In Meadville, there are several resources available to help you and your family learn about healthy weight. These include the Meadville Family YMCA and various fitness centers with qualified trainers, the WIC Program, your personal care physician, your child’s pediatrician, Weight Watchers programs that include educational components, and independent dietitians such as Rust Nutrition. You can find these places listed in the phone book. In addition, the internet can provide a plethora of information on dealing with obesity in your family. Working with an obese child is an emotionally and physically taxing experience. You need to be prepared yourself in order to be successful.

Exercise Prescription on the Net is a resource set up mainly for exercise professionals, yet it provides a basic checklist to help you engage your children in healthy habits.

1.       Educate yourself on obesity, and consider working with professionals who may better connect with your child on the issue.

2.       Choose a private place to speak with your child about obesity and weight concerns.

3.       Never associate the child’s weight with acceptance or approval. You do not want your child thinking that you will love them more if they lose weight.

4.       Discuss feelings and body image, being sensitive that their weight may be creating low self-esteem. A professional may be your best solution in helping your child with this issue.

5.       Emphasize healthy habits rather than weight loss, such as increasing activities or eating more vegetables at dinnertime.

6.       Work with a healthcare provider or dietitian on meal plans and snacks. You should not approach this as a diet, but should consider it a lifelong habit in which the entire family participates.

7.       Monitor eating and activity and stock up on healthy foods. Consider removing poor nutritional choices such as sodas, chips and candy from the home.

8.       Eat meals together as a family. The child needs to see you consume healthy foods as a positive influence and role model.

9.       Do not reward positive behaviors with food; and likewise, do not punish with lack of food. Food is a nutrient, not a reward or punishment system. Children will associate food with good or bad behaviors and eventually treat them likewise, which will promote eating disorders. Use stickers, praise or other favorite activities for rewards and try withholding favorite activities such as internet use as punishments.

10.   Do not “make” your child exercise. You should adopt language like “Let’s play” or “Let’s go …” At least 60 minutes of daily play is recommended for children, and the best way to motivate is by doing it with them.

Interventions that promote healthy behaviors should start early, even if you or your child doesn’t seem to have any signs of being overweight.

References

Exercise Prescription on the Net. (2011). Childhood and teenage obesity. Intervention strategies. Retrieved November 30, 2011 from http://www.exrx.net/FatLoss/ChildObesityIntervention.html.

Newcomb, A. (2011). Obese third grader taken from mom, placed in foster care. Retrieved November 30, 2011 from http://news.yahoo.com/obese-third-grader-taken-mom-placed-foster-care-201731761.html.

The Rutherford Institute. (2001). Social services investigations: the removal of children from the home. Retrieved November 30, 2011 from http://familyrightsassociation.com/bin/white_papers-articles/investigations.html.

Don't Blame Ronald for your Poor Health Choices

A recent report in The Wall Street Journal revealed that more than 550 health professionals and organizations have signed a letter to McDonald’s Corporation asking them to quit marketing their Happy Meals to children and to retire their mascot, Ronald McDonald. Supposedly this letter was printed in six metropolitan newspapers across the country on Wednesday, May 18.

While I am a public health professional and concerned about the high obesity rates – especially among children, I question whether this is a suitable approach to building a healthier nation. Is it really McDonald’s responsibility to feed our children low-fat, low-sodium, low-sugar, and low-calorie foods? Whatever happened to personal responsibility? Whatever happened to parenting that involves appropriately feeding their children healthy and nutritious foods? Whatever happened to families teaching our children that food fuels our bodies and that it is important to select healthy options?

While it is truly not their responsibility, McDonald’s Corporation has gone above and beyond to offer healthy alternatives to the greasy hamburger and overly salted French fries commonly ordered at the chain. In McDonald’s defense of marketing to children, let’s take a look at the child’s menu options. The traditional “Happy Meal” comes with one of the following main protein sources: hamburger, cheeseburger or chicken nuggets. After the main dish selection, the options become rather interesting: you have a choice of fries or apple slices. Parents who are mindful of their child’s health will ensure they select the apple slices (or order it for them). Furthermore, the drink is not a sugary soda, but either low-fat milk or apple juice. Total caloric intake: 250 for the hamburger, 100 for the milk, and 105 calories for the apple w/dip for a total of 455 calories (take off 70 calories if no dip is consumed with the apples). In fact, a nonscientific survey of several of my peers who have young children indicated that their child prefers the healthy alternatives at McDonald’s. Perhaps my friends understand the concept of personal responsibility and instilling healthy behaviors to their children.

In addition to the Happy Meal, McDonald’s has many other healthy alternatives for adults as well. For example, they now offer oatmeal, a food choice that wouldn’t have been seen in the store even five years ago. They also have some of the best salads that fast-food chains offer, including the Asian chicken salad, grilled chicken salad, and side salad. Yes, many of the salads are topped with fried chicken, which is not the healthiest selection; however, my point is that there are options besides ordering high-fat foods. Furthermore, they even have a snack-size fruit and walnut salad.

At McDonald’s competition – Burger King, Wendy’s and Taco Bell – there are few, if any, options for children. Burger King does have apple slices, but doesn’t market them as part of their kid’s meals like McDonald’s has been doing. Burger King also only serves 3 different salads, unlike McDonald’s selection of 10. Wendy’s also has a limited menu for the health-conscious diner. Included on what they coin as their nutritious offerings are apple slices, four salad choices, a plain baked potato and a small chili. Taco Bell has no low-fat food choices as all of their salads are served in deep-fried taco shells, and they offer no fruit option. Probably the healthiest thing on the menu is the salsa...if eaten by itself!

The list of fast food restaurants seems endless, but the choice to dine at any of them comes down to personal responsibility. Although I seem to be defending it with great force in this column, I confess that I’m not a huge fan of McDonald’s and generally do not eat there...but that’s my personal choice. If I were taken to there, though, I know I would at least be able to find something relatively low-fat to eat.

According to the Wall Street Journal article I mentioned earlier, fast food restaurants as well as other food makers are routinely attacked for marketing to children. In response, federal standards have been posted by the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the U.S. Department of Agriculture. These guidelines suggest (not require) that marketers push their healthier items to limit children’s attraction to high-fat, high-sodium, high-sugar, and high-caloric foods.

Still, is it really the government’s responsibility to tell your child what to eat? I don’t think so. It comes down to parents teaching their children, it comes down to personal responsibility for your own health and the health of your family. If you choose to go to McDonald’s, that’s fine. Eat what you wish...but don’t blame the restaurant for your poor health because no one held a gun to your head for you to eat a Quarter Pounder with cheese for a whopping 740 calories, 42 grams of fat, and 1380 mg of sodium topped off with a side of fries (380 calories) and chased down by a large cola (210 calories).

References:

Burger King. (2011). Retrieved June 20, 2011 from http://www.bk.com.

Jargon, J. (2011). McDonald’s under pressure to fire Ronald. Retrieved June 20, 2011 from http://online.wsj.com/article/SB10001424052748703509104576329610340358394.html

McDonald’s Corporation. (2011). Retrieved June 20, 2011 from http://www.mcdonalds.com/us/en/home.html

Taco Bell. (2011). Retrieved June 20, 2011 from http://www.tacobell.com/.

Pennsylvania’s Unique Approach to Combating Childhood Obesity

The lack of access to healthy foods is directly linked to health in both positive and negative ways. Research has shown that supermarkets and grocery stores that offer fresh fruits and vegetables helps the community residents maintain healthy weights, which in turn wards off heart disease, diabetes, and other weight-related illnesses.

In Pennsylvania, a new initiative began a few years ago to provide low-income and rural communities with local grocery stores. Known as Pennsylvania Fresh Food Financing Initiative (FFFI), the program provides statewide financing designed to attract supermarkets and grocery stores to underserved urban and rural communities.

It has five key objectives:

1. Reduce the high incidence of food-related diseases
2. Stimulate investment in low-income communities
3. Remove financing obstacles to strengthen supermarkets in poor communities
4. Create living wage jobs
5. Prepare and retain a qualified workforce

By June 2010, the state had approved 93 applications out of 206 for financing under the FFFI. What resulted were numerous new grocery stores in underserved urban areas as well as many family-owned supermarkets for rural communities. The closest community store to us cropped up in Warren County. More specifically, Polly’s ShurSave opened in Tidioute in 2009 and has been successful for the community in providing new jobs and access to fresh produce. It’s too early to determine the store’s impact on overweight and obesity rates as well as other food-related disorders.

While prior studies have shown that access to healthy foods is tied to obesity, it stands to reason that Polly’s ShurSave and other stores funded through this initiative could be helpful for Pennsylvania’s residents. Furthermore, this type of project also points to the benefit of eating fresh foods from local farmers. Toward that end, it may be beneficial for you to seek out locally grown foods, many of which are offered at local Farmer’s markets as well as the Market House. All summer long, fresh produce can be purchased at lower rates than some larger chain grocers can offer.

While the FFFI has not provided any direct assistance to Crawford County, the very reason for its existence can be duplicated in our own shopping actions. Remember, think fresh and think local. Not only will you be helping yourself to maintain a healthy body weight, you will be supporting the local economy.

Reference

The Reinvestment Fund. (2010). Pennsylvania Fresh Food Financing Initiative. Retrieved May 8, 2011, from http://www.trfund.com/resource/downloads/Fresh_Food_Financing_Initiative_Comprehensive.pdf.

Superpages.com. (2011). Polly’s ShurSave. Retrieved May 8, 2011, from http://www.superpages.com/bp/Tidioute-PA/Pollys-Shursave-L0003490872.htm.

The Food Trust (2004). Supermarket campaign. Improving access to supermarkets in underserved communities. Retrieved May 8, 2011, from http://www.thefoodtrust.org/php/programs/super.market.campaign.php#FFFIcreation.

Warren Times Observer. (2009). A successful first year for Warren County Main Street. Retrieved May 8, 2011, from http://www.timesobserver.com/page/content.detail/id/515156.html?nav=5109.