At the local ice cream stand, a mother orders chocolate soft serve for her trio of daughters. Small cones with rainbow sprinkles, she tells the clerk. Her oldest daughter howls in protest. "I want hot fudge," says the girl, who is about 10 and round with layers of baby fat. "I want a sundae."
"Not today, honey," says the exasperated mom. "We just had dinner and we shouldn't be hungry for a big sundae. This is just a little dessert." The girl begins to pout and kick at the counter as a teen-age clerk hands her a cone. Her younger sisters, both slender, accept their cones without complaint. The frustrated mom shrugs her shoulders, as if to apologize to the witnesses. "It's soooo tough," she says under her breath.
Indeed, dealing with an overweight child takes a ton of emotional sensitivity and pounds of patience, according to physicians, nutritionists and experts on eating disorders who say the wrong approach can erode a child's self-esteem, setting her up for a lifetime of disordered eating.
"While we have an epidemic of overweight children in this country, I can't help but wonder if the fallout is going to be an even bigger subset of anorexic and bulimic adolescents," says Dr. Diane Mickley, founder and director of the Wilkins Center for Eating Disorders in Greenwich, Conn. "I can't tell you how many teens I work with who were told as kids they were chubby or fat one too many times."
Yet confronting the problem of childhood obesity seems more imperative these days as the nation's youngest citizens tip the scales in each successive year. Children ages 10 and younger are getting fatter by the decade with an estimated 4.7 million of them fitting into the category of severely overweight, according to the American Academy of Pediatrics' latest figures.
"These are not kids who just need to lose five pounds," says Maria Walls, senior nutritionist for Weight Watchers Inc. "They are severely overweight and probably destined to have a problem with obesity as adults if they don't begin to adapt a healthier lifestyle now." The problem, Walls says, is only made more challenging by the prevalence of computers, TVs and VCRs and the trend by food manufacturers to double and triple portion sizes to boost sales.
Yet confronting weight problems in children can have disastrous effects if parents and doctors try to enforce diets, limit food choices or criticize a child's appearance, some experts say.
Indeed, they were hard-pressed to say if the mom at the ice cream stand was helping or hurting her daughter by refusing her demands for a sundae. "She sounds like she was making a good effort at limiting portion size, but not denying a treat," notes Walls. "But you really need to know more about the family and how much they battle over food. If the mother is someone who is weight-obsessed, it may be why her daughter has a problem in the first place. She could be eating to fill a void."
But even the best-intentioned parent can get into a quandary when food and weight become battlefields.
"One of the problems we have in this country is that we haven't come up with a good, healthy way for kids to lose weight," says Dr. Marcie Schneider, director of the new adolescent medicine program at Greenwich Hospital. "There are no guidelines. And it's a problem because it makes it hard to know what the right approach is."
There is some consensus, however, that diets are bad news for any child who has not reached puberty, says Schneider, who has worked extensively with overweight teens, anorexics and bulimics. "Children have huge nutritional requirements, particularly as they approach their teens," notes Schneider. "It's much worse for them to go on a restrictive diet than the average adult. It really can impact their growth and development. I always worry when a kid goes to one of those weight-loss camps and drops 30 pounds in the summer."
Schneider goes on to note that a growing problem with some children involves restrictions imposed by their families in the name of health, such as low-fat diets. Children, she stresses, need more fat in their diets than their parents to absorb vitamins vital to their growth. "A lot of times what gets cut is dairy," she says. "But kids really need the calcium that comes from these foods. When I mention that kids need to be eating foods like yogurt, milk and cheese on pizza, parents look at me sometimes like I'm crazy. But I'm dead serious."
Schneider says her adolescent medicine program soon will include a nutritionist and psychologist because weight and body image are such problems for children making the transition to their teen years. "And when we talk to kids about weight issues, we plan to include parents in some of those sessions," she says, "because often, they are bringing as many issues to the table as the kids."
Even in situations where parents are seriously concerned about an obese child, the scales have to be carefully balanced with the emphasis on lifestyle changes and not dieting, notes Weight Watchers' Walls.
"My first course of action would be to take a good hard look at the child's activity level and find ways to integrate more exercise into their lives," she says. "I think changing lifestyles is probably the most productive way to go with a kid."
Schneider concedes this can be a challenge with a child who is not interested in competitive sports. Westport, Conn.-based parent educator Sheryl Wolf-Kayne says parents do have a right and obligation to set some limits about eating, but the restrictions need to be carefully executed. "There's nothing wrong with saying 'This is dessert,' and serving some fruit or frozen yogurt," says Wolf-Kayne. "But I like to give the kid some choices, too. Maybe you say 'It's a small cone,' but they get to pick the flavor. Or maybe you pick a day when everyone has a special treat together."
Walls advocates the same approach with portion size. "One problem I see a lot with kids is the sheer quantity of food they are getting," she says. "Look at the size of a typical muffin or bagel or bottle of soda you get today. It's way too much. Even for adults."
Parents can start limiting portion size by pouring beverages into small cups or serving halves of large items such as frozen pizzas or deli sandwiches. Walls also encourages parents to limit sodas and other caloric beverages in favor of more satisfying, sustaining foods.
"A lot of these things you can do without ever saying the word 'diet,' " says Walls. "And with kids that may be the best way to go."