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Friday, 25 May 2012

One Fat Child Inside A Perfect Storm

I write this as a psychologist specialising in obesity, childhood obesity and eating disorders; a member of the National Obesity Forum and an All-Party Parliamentary Obesity Group. I am a spokesperson for the British Psychological Society on all matters relating to eating and obesity, and I am Founder of the National Centre for Eating Disorders.

Every parent dreads getting the dreaded fat letter or a summons from the school. One such parent I know has had such a summons. Healthy schools policies now mean that schools are taking some responsibility for the wellbeing of children, by providing healthy lunches and in some cases banning high fat-sugar snacks. I applaud these policies to some extent. They are also weighing children to alert the parents about potential dangers such as increasing BMI or anorexia in older children. This is controversial and my thoughts about in-school weighing belong elsewhere. However in this case, the child aged 10 looks and is fatter than his classmates. And the parents have been told that Social Services may be invoked.

Even worse, the child himself has been told that his weight is a matter of concern. This the first time that the child has had negative feedback from an adult.

Now where a child’s weight is concerned, some parents are ignorant about what to feed their children and some try hard to feed their child a healthy diet but are thwarted by all that is out there and some parents are too lazy to bother thinking about it all. They say, let children be children and eat what they like.

Some mothers have eating problems and buy food for their children so that they have an excuse to eat it themselves. Some parents have a child who gains weight extremely easily because they were born that way. Most onlookers blame the parents if the child is fat. They think that the parent is over feeding their child.

Or they assume that the children are compulsive overeaters, sneak eaters and so on, that they are unhappy and that their weight gain signifies underlying psychological problems. They might look at the child and discover that the child is eating more than their peers. This would be normal because a fat child needs more calories than a thin child; they have more muscle as well as fat to carry around.

The parent has refused permission for the school to weigh her son. She knew that her child was large, and the diet at home is reasonably sound. I endorse her decision, since the weighing was not routine and the child would have been singled out, a horrible experience for a young person growing his wings. Now she has been told that the school is sending out for counselling for the child. The child will once again be singled out.

First do no harm. Identifying a fat child is one thing, knowing what to do about it is something else, which is why I say the following. By all means weigh children and inspect their size. But be clear that you know what to do about it so that you do not harm the child. Some children will need help and some will not. But in some cases insensitive intervention will create a tragedy. For example, is the next step to put the child on a diet? There is very strong evidence that 99% of children who are put on a diet gain weight excessively afterwards. They develop unreasonable attachments to food which is denied them; they suffer from feeling different from their peers and their self esteem can fall. My eating disorder casebooks are full of people who have been dieted or given pills as children; told that they are unacceptable and thus unlovable.

These are the circumstances for a perfect storm brewing up in which everybody could be hurt. Everyone needs to take a big step back. I would offer the following advice.

1    I would ask the school to wait, do nothing and revisit the situation in a few months time. During that time the professionals involved need to learn more about how to help fat children. They should not just swing into action with panic strategies unless there are other strong reasons for concern. They should liaise with the parents and agree together the best way to proceed.

2     The school must not be led to believe that a fat child is an unhealthy child; this is a myth. While there are health risks associated with being overweight the risks are greater for thin children who do no activity and who eat poorly at home. I would refer to the school to research the HAES research (healthy at any size). The school needs to have a written policy guided by appropriate health professionals for managing children they think have eating or weight problems.

3    The school must immediately remove any pressure on the child that would lead to him feeling different from his peers and must be open to listening to the child if he is being teased.

4   Let the parents, with some help if necessary, take a fearless inventory of the food and eating patterns at home. Even where the parent has expertise and knowledge about healthy nutrition, there are always some small improvements that can be made. This will help the child be more healthy; this will not necessarily result in weight loss. The school must be fully aware of this.

5    Neither the school nor the parents must fall into the trap of insisting that the child do more exercise if he is already doing a reasonable amount. There is no association between insisting on programmed activity that the child does not enjoy and long term weight control. Limiting TV at home is useful but not only for managing weight.

6   At the age of 10, the child is approaching puberty. Children tend to gain weight at this time to provide the energy for a huge amount of pending growth. It is also a time critical for developing self esteem. The parent and the school must do everything possible to support the self esteem of the child and to give them well paced information about nutrition in a sensitive way. This will put the child in a good position to make their own decisions about weight control when they are old enough to be autonomous.

7   Counselling should only be given if the child really wants it and if there are really good reasons for concern - which should be made clear in writing by the school. The parents should be open to giving assistance for weight loss only when the child asks for it. There are good and bad ways to help children lose weight and this needs to be discussed with an expert in the field. Not a doctor and definitely not a school nurse.

If anyone has a problem with a child who is fat, I am willing to act as an advocate for them. It is hard, not a crime, to be the parent of a child who is fat.

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