March’s Web Content Theme is Mental Health Awareness
The author spoke with Dr. Stephen Pont, head of the Texas Center for the Prevention and Treatment of Childhood Obesity, about strategies for treating kids with obesity. While the path towards obesity may be set by an early age for most people, there are treatments available to help maintain health and longevity that have been proven effective for all children who are overweight.
Dr. Stephen Pont, head of the Texas Center for the Prevention and Treatment of Childhood Obesity, spoke as we did a lap around the Dell Children’s Medical Center in Austin, Texas. He tweeted a few weeks ago that he had done his first walking meeting; and now, this was his first walking media interview. During our interview, he said:
“How you talk to the parents of children challenged with obesity is critical. They have all kinds of signals telling them that ‘You are not good parents,’ and they just tune out. We have to empower families and set goals. As healthcare providers, we also have to be very careful not to use guilt or blame or to show any signs of weight bias when we work with parents and their children. We should present a menu of options and ask questions such as ‘Which one would you like to work on now?’ And then they choose the one that is most achievable. Positivity is critical to success.” We had just gone past what Dr. Pont called the Healing Garden—the indoor one. He explained it had levels that corresponded to the specific climates of Texas: the bottom had a fountain that looked like a bend in a river with coins for stones representing east Texas; the middle represented north Texas with flat, wide, green spaces such as found on the prairie with a lot of playground equipment there. (You need to make your own fun where it is flat.) The part most like Austin, which is semi-arid with tenacious grasses, was up to the left. We finally found the outside door and walked a bit in the cold wind when Dr. Pont turned his head to the left and said, “That’s the outside Healing Garden.”
Dr. Pont is on the front lines of a difficult fight: According to the Centers for Disease Control and Prevention, obesity has more than doubled in children and tripled in adolescents in the past 30 years. Non-Hispanic blacks have the highest age-adjusted rates of obesity (49.5%) compared with Mexican Americans (40.4%), all Hispanics (39.1%), and non-Hispanic whites (34.3%). A 2012 study found that per capita medical spending was $2,741 higher for individuals with obesity than for individuals who were not obese.
Obesity is correlated with both Type 2 diabetes and high blood pressure. Paired with high blood pressure or high cholesterol, Type 2 diabetes can change the brain's structure and increase a person's risk of developing dementia or other forms of cognitive impairment. This includes memory skills, processing speeds, and control of cognitive functions.
I spoke with Dr. Pont about recent research published in the New England Journal of Medicine that revealed kids who are obese by the time they reach kindergarten are likely to stay that way for life. He said that the earlier a child is challenged by obesity, the more difficult it can be to make changes later—but also it is never too late to make a healthy change, regardless of your age or weight. Dr. Pont added, “We want to try to work with kids as early as possible, but we’re not going to give up on older kids, or even adults.”
While there are significant differences between the prevalence of obesity in minority populations
(as statistics cited above confirm), Dr. Pont believes the differences had little to do with genetics and more to do with issues of poverty, and sometimes acculturation. Some families eat out more due to both parents working full-time jobs. He added:
“People get fast food and eat like they think they are supposed to, but eating food you prepare yourself is healthier. And sometimes parents are concerned about kids playing outside because of the neighborhood when kids really need to get outside and run around.”Dr. Pont talked about how they work with kids who come to the Texas Center. He stressed:
“First, we make it clear there are no judgments. Families often come here after experiencing a lot of guilt, blame, and weight bias. Some have been told by others that they are overweight because they are lazy. Both parents and patients have this experience and the defense walls are high. But we try to create a safe, non-judgmental environment where we can work as a team to develop a plan to help children move to a healthier weight. We let them know that making changes can be tough, and there are many strong reasons for why we do what we do each day. We also let them know that setbacks are part of the process. We work on making small changes because often making big changes doesn’t last. Another important thing is that real changes have to happen as a family. Parents are the leaders, but even brothers and sisters are part of it; and the healthy changes that we try to make are healthy for everyone, regardless of weight. We encourage everyone to set a family goal—e.g., eat together, walk together, or turn off the TV. At meal times, we encourage age appropriate behavioral division of responsibility. The parent provides the food choices and the child decides what they want to eat. We try to always keep it positive and tell people to avoid negative reinforcement. For example, we’d prefer parents to not say things like, ‘don’t eat that because you’ll gain weight.’ Rather they could ask, ‘what would be a healthy choice that you could make?’ Additionally, we screen for other psychological conditions, as there is a strong correlation between obesity, depression, and anxiety.”Good nutrition depends on a synchronicity between parent and child. Registered Dietician and Family Therapist Ellyn Satter underscores parental concerns in preventing obesity in her article for the Journal of the American Dietetic Association. In a positive feeding relationship, both parent and child ease into a rhythm where roles are clearly defined, trust can be established, and food interactions support developmental tasks. Parental pressure (even when well meaning) has the potential to affect the child’s acceptance of food as they grow and mature.
Dr. Pont pointed to a corner of the outdoor Healing Garden as we walked past saying, “We are starting to grow some of our own vegetables.” There were several raised beds with Texas winter garden veggies such as kale, broccoli, and chard poking out. The Center’s approach is like gardening: it is a process, not an event; droughts happen, freezes happen, floods happen, and the gardener nurtures the plants through each one. As long as there is sunshine, water, nutrients, and encouragement, the garden will grow.
Source: Satter, E. (1986). The Feeding Relationship. Journal of the American Dietetic Association, 86(3), 352-356.
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