Obesity and Kids Have Family Ties : Treatment: Experts at Anaheim conference say that therapy must go beyond the child, into the rest of the home.

When children are obese, it likely is as much a result of what goes into their heads as what goes into their mouths.

In other words, skewed family dynamics can be just as fattening as a double cheese pizza.

“We’re trying to broaden the context of childhood and adolescent obesity to incorporate family therapy,” said Laurel Mellin. “We’re doing more than treating weight when we plunge into the family system. We must treat not just the family lifestyle, but the family context; not just what they do, but how they do it.”

Mellin, the director of the Center for Child and Adolescent Obesity at the UC San Francisco School of Medicine, recently told several hundred participants at the annual meeting and exhibition of the American Dietetic Assn. that “only family-based treatment has shown long-term effectiveness” in treating childhood obesity. “Families have patterns; they’re determinable, and they’re powerful.”

Mellin, who spoke at the Anaheim Convention Center along with John Gray, author of “Men Are From Mars, Women Are From Venus” (HarperCollins, 1992; $22), said that the recognition of the role of the family in pediatric obesity is relatively new and that the problem remains large.

There are more than 10 million obese children in the United States, she said, and roughly one in 250 “severely obese children in California get family-based care.

“Oprah Winfrey probably wouldn’t be obese,” she said, “if family therapy had been available to her.”

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Mellin said she had identified six principal causes of childhood obesity--genetics, medical problems, lifestyle, emotional overeating, the too-comfortable child and the too-uncomfortable child--and added that the last four could be directly attributed to family behavior.

Particularly susceptible to overeating, she said, are children who tend to be sensitive, depressed, passive or withdrawn, and parents can worsen those conditions by becoming too close to their children or by withdrawing from them.

The trick, she said, is to remember who’s the parent and who’s the kid.

Parents must “keep the generations separated,” she said. “They have to treat the child as a child and not as a peer. Children need limits.”

Being too buddy-buddy with a child creates an unnatural comfort zone, said Mellin, who called the condition “parent-child enmeshment.” On the other hand, “parent-child disengagement” can be just as bad, she said.

“Parents can withdraw from an obese child,” she said. “In either case, the problem is not food, the problem is missed communication.”

The parent-child boundary must be absolute, said Gray, a marriage and family counselor who lives in Mill Valley. Above an imaginary psychological line are the parents, below are the children, and neither must cross it. An absence of parental love and attention, or an overabundance of parental control and involvement in children’s lives, upsets the parent-child balance and leads to overeating, Gray said.

“When we eat, we’re in control,” he said. “Eating becomes a love substitute. The hunger for food is really a hunger for love.”

An overeating child may be rebelling against what Gray called “negative punishment”--a blaming, guilty sort of punishment that erodes the child’s confidence and self-esteem rather than helping him to change his behavior. Parents, Gray said, must remember that they’re not dealing with mature, analytical adults. Kids are kids.

“We need to give children permission to have inconvenient feelings, make inconvenient demands,” he said. “Negative punishment is the weakest form of education. It’s the worst form of control.”

Instead, Gray said, parents should try to encourage their children to use what he called “the love letter technique.” If children feel that no one is listening to them or recognizing their true feelings, then they can “listen to their own feelings and write them down. Then they can better express what they want and need and also express any forgiving impulses they have inside.”

Once this is done, he said, the parents’ job is to listen. And, for good measure, admit to their children mistakes they may have made. The result, Gray said, can be better communication, greater trust and more firmly defined parent-child roles.

“It’s a release,” he said, “for children to know their parents make mistakes.”