FEATURE: Is it right to put a child on a diet?

WHEN Dara-Lynn Weiss decided to come ‘the heavy’ with her overweight seven-year-old, she couldn’t have imagined the controversy.

The New York writer’s account of putting her daughter, Bea, on a diet and micro-managing everything she ate, even in public, has provoked debate in America, and here, where two in ten Irish children are obese or overweight.

By the age of seven, Bea’s weight was worryingly high. “When we intervened, she was 20lbs above a healthy weight and 30lbs above average,” Weiss says.

Yet Bea did gymnastics and dance and regularly played in the park, and the family diet was healthy and didn’t include junk food.

So what was the problem? Quantity, says Weiss, who has written a book, aptly titled The Heavy.

Since the age of three, Bea, who loved food, had been overweight. Weiss decided to control Bea’s portions — but worried about the implications. “You’d be afraid of giving your child issues. You’d feel nervous about telling her to stop eating. At the same time, I knew she needed limits.”

That first, gentle intervention yielded poor results. “Bea gained 23 pounds in the year I was trying to help her,” Weiss says.

The family saw a paediatric nutritionist. Frightened by the numbers, Weiss decided to act the ‘heavy’. “I was very strict with Bea. This was a medical problem.”

Although the programme was not extreme, Weiss says she was “severe in my implementation,” because her daughter couldn’t fit into kids’ clothes. “She was shopping with me in adult stores. You’re terrified of the health implications, and also that your child’s experience of life is affected by being overweight — overweight children are made to feel bad about their weight. Bea complained and fought.

“We’d have dinner as a family and her brother would eat twice as much as her … but I had to be the enforcer.”

Weiss was tormented by doubts and the disapproval of others. Many people, including Bea’s grandparents, objected to the strict regime, but Weiss refused to yield. “You force your children to brush their teeth until they do it on their own — I felt, when Bea was seven, that I was forcing her to eat the right way.”

Bea is now a healthy weight for a nine-year-old. Yet Weiss is careful about preaching. “This is what I did for my family and it worked for us,” she says. “Every family is different and every child is different. The circumstances are so complicated, and I don’t agree with the one-size-fits-all theory.”

Things are not so different in Ireland, where child obesity is rocketing and, where, like Weiss, parents of overweight children are between a rock and a hard place.

If parents limit treats and portion sizes, they risk damaging their child’s self-confidence. Yet if they don’t, they may be putting their child’s health at risk.

So what to do?

Take control over what your child eats, says obesity expert and Operation Transformation guru, Dr Eva Orsmond. She says Weiss’ approach “sounds fantastic.”

People with normal-weight children may be taken aback by it, Orsmond says, but there’s another side: “I see 14- and 15-year- olds coming in at 115 kilos. About 60% of people in this country are overweight and obese, and we’ve lost our perception of what is normal weight.”

The statistics underline this assertion — in the Growing Up in Ireland Study (2011), 54% of parents of overweight children, and 20% of parents of obese children, reported their children were ‘about the right’ weight for their height.

Yet around 26% of nine-year-olds were either overweight or obese.

Michelle Clarke had a nagging anxiety about her 12-year-old daughter Lauren’s weight.

“I felt she was slightly overweight — but her aunties and her granny had a thyroid problem.”

So when Lauren was eight, Michelle brought her to Temple Street hospital to have her thyroid tested.

The results were clear, but staff suggested Lauren might go on the W82GO programme at Temple Street Children’s University Hospital.

W82GO, a 12-month, family-based obesity treatment programme for children and teenagers, has achieved weight reductions better than in international studies.

Michelle believed quantity was the issue, as Lauren ate a healthy diet with fruit and vegetables.

Michelle started to serve the portions recommended in the programme. “I was shocked when I saw the portions for adults as well as kids — a child was only allowed a tablespoon of spaghetti, for example, or five or six home-made chips.

“The whole family was shocked — the portions were smaller than what we would have eaten, but we ate fruit, so that helped to fill us up.”

They also increased her exercise levels — Lauren did karate, went dancing, and walked. She had two hours of physical exercise a day, six days a week.

Over two years, she lost a stone in weight. “It was a good programme,” says Michelle. “I’d recommend it to anyone.”

Dr Declan Cody, consultant paediatrician at the Weight Management Clinic at Our Lady’s Children’s Hospital, Crumlin, advises parents to practise tough love. “Sometimes, parents will admit they find it hard to say no to their child — they feel as if the child is being deprived,” he says.

“Some parents are unable to place boundaries on children, in terms of insisting that they don’t have regular treats or drink fizzy drinks, and that they be more active.

“Parents fall into the pattern of letting children eat when they want.”

Irish parents, says Orsmond, who is Finnish, aren’t taking responsibility because the concept of monitoring our body-weight has not been inculcated in us from childhood.

“We don’t monitor a child’s weight in Ireland the way we do in Finland. My son spent a year in Finland, in school, and in that time he had two medical check-ups, including weight checks,” she says.

Irish people are embarrassed about weight-gain, she says, adding that GPs have told her they find it difficult to broach the subject because people get so defensive.

Junk food is cheap, accessible and heavily marketed, and while child-obesity programmes like the one at Temple Street, and programmes like the school programme, Food Dudes, can help, what’s really required is a “societal shift.”

This means understanding that what’s needed is “less in, nutrition-wise, and more out, energy-wise. And that has to start at home.”

Obesity is also a class issue, says Dr Sinead Murphy, consultant paediatrician and clinical lead of the W82GO programme at Temple Street Children’s University Hospital.

“There’s a higher incidence of obesity in lower socio-economic groups. There’s no doubt that children who are more able to exercise in a structured format are less likely to be obese,” she says, pointing out that structured sports programmes cost money.

However, she says, any kind of exercise, such as walking, skipping, or cycling, is good for children: “Sometimes, children in lower socio-economic groups have more screen time, because parents are not aware of how deleterious an effect it has on weight and health — TV, computer-gaming, texting.

“We’d see children who spend up to five hours a day on computer games, or on the phone texting — and up to 12 hours a day at weekends.”

It’s also cheaper to eat unhealthy food, she says. “There tend to be a lot of special offers on the more unhealthy foods,” Dr Murphy says.

Once again, the statistics bear it out — the Growing Up in Ireland study found pronounced social-class inequalities in the prevalence of overweight and obesity among nine-year-olds.

The report showed that 19% of boys, and 18% of girls, from professional households were overweight/obese, compared to 29% of boys and 38% of girls from semi- and unskilled social-class households.

“The environment is set up around these kids to ply them with unhealthy choices, and unhealthy choice is often the easier choice to make,” she says.

Dr Murphy worries about the breakdown of traditional meal-time routines.

“Overweight is becoming normal,” she says, as are changing societal trends, “where families don’t eat together, or where children don’t want to eat a traditional dinner”.

Managing a child’s weight must be a family affair, says Dr Cody. At the Weight Management Clinic the aim is to get parents to buy into a “family centred healthy-living approach.”

“One of our biggest challenges is motivating parents to recognise that there’s a problem and encouraging them to make permanent lifestyle changes,” Dr Cody says.

“The problem needs to be addressed at a family level and not just looking at the child in isolation,” he says.

The looming nightmare, says Cody, is the long-term effect on such children — Type 2 diabetes in the late teens or early 20s. “This could be the first generation whose parents outlive the kids because of diabetes.”

Forget dieting — a healthy lifestyle path for the whole family is the answer, says Dr Edna Roche, professor of paediatrics at Tallaght Hospital and University of Dublin: “I don’t agree with children being put on diets, it’s about what everyone is having. I think it’s very important that parents act as positive role models for their children as regards diet and exercise.”


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