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Why do children gain too much weight?
To view the list of references in this article, click here.
The common conviction that children get too fat because they eat too much and exercise too little mandates that parents and professionals make children eat less and move more. But “overweight” children eat no more than slim children—in fact, they eat less (Rocandio)—and even energetic, multifaceted, weight management interventions are consistently unsuccessful (Epstein, Whitlock). In fact, children who are made to go hungry become preoccupied with food, prone to overeat, and are likely to gain too much weight (see #2 below). To avoid doing more harm than good, grownups must maintain the division of responsibility in feeding, both doing their jobs with feeding and trusting children to do theirs with eating and growing. However, to trust children to eat the right amount to grow appropriately, parents and other care-providers must have a satisfactory answer to a critical question: What undermines children’s ability to grow in a way that is right for them? The primary causes are 1) Misinterpretation of normal growth, 2) Restrained feeding, 3) Poor feeding practices and 4) Stress.
I. Misinterpretation of normal growth.
It is normal for children to grow consistently along a particular percentile on the growth chart, even if that percentile is the 85th or 95th percentile. Most large children gradually slim down as they get older (Serdula, Whitlock). It is only when growth accelerates—diverges consistently and over time from a previously established growth pattern—that it can be defined as abnormal growth. Then, rather than treating the symptom with food restriction, it is essential to answer the fundamental question: What is interfering with this child’s normal ability to eat as much as he or she needs to grow in a consistent fashion?
Consistent growth at the extremes is likely to be normal
Some populations show naturally high consistent BMI
II. Restrained feeding (and circumstances that mimic restrained feeding).
Children whose food intake is restricted become preoccupied with food and prone to overeat when they get the chance. The same holds true for children whose parents don’t or can’t provide regular meals with ample amounts of food. Food-restricted or food-insecure children get fatter, not thinner, over time. Even children on ambitious, multidisciplinary weight reduction regimens do not lose significant amounts of weight.
Parents who restrain themselves have fatter children
III. Poor feeding practices.
Poor feeding practices undermine children’s eating capability and therefore interfere with their ability to regulate their food intake and grow appropriately. Parents’ feeding practices may be poor because don’t know recommended feeding practices and/or are getting inaccurate advice, because they react to a child’s illness and/or poor appetite by urging food, because their own eating capabilities are seriously limited or because they are too controlling or too chaotic to maintain the division of responsibility in feeding. Failure to provide the structure of family meals and sit-down snacks is an increasingly-common and particularly destructive poor feeding practice. Instead, children are allowed unlimited access to food and beverages, which undermines their ability to regulate food intake. Children exposed to poor feeding practices also do poorly with food acceptance, which attracts feeding pressure from parents and further undermines internal regulation of food intake.
- Chatoor – Children who fail to achieve developmental tasks grow poorly.
- Crawford - Children with early feeding problems become fatter as teenagers.
- Klesges – Urged children eat more and weigh more.
- Reilly – Child survivors of leukemia have increased overweight risk, likely related to health-related feeding distortion.
- Stice & Agras - Parents with eating problems raise children with eating problems.
Poor feeding practices are increasingly normative
- Anliker Parents of preschoolers control at meals, give unlimited access to food between times.
- Eisenberg - Family meals decreasing in frequency: 14% have no meals. 18% have >7 per week.
- Jahns – Snacking, grazing on the increase.
- Pelchat – Parents apply too much pressure, offer too little support.
- Skinner – Parents wait for toddler food requests, short-order cook, give alternatives.
IV. Stress.
For stress to cause excess weight gain, children have to first have learned to use food for emotional reasons. Otherwise, they will express their emotional upset in some other way—defiance, inattention, excessive caution, bed-wetting, constipation. Feeding children in a restrained fashion teaches them to use food for emotional reasons. Particularly when children are working on separation-individuation, imposing too much pressure and control on their eating, or providing too little support, makes food and eating an issue all the time and can teach them to use food for emotional reasons. To combat the stresses of everyday living, children who are relatively large, like children with any other unusual characteristic, need particularly good social skills in order to allow them to be successful.
- Birmaher – Child, adolescent depression increasing.
- Davison – Children labeled overweight feel flawed in every way–not smart, not physically capable and not worthy.
- Lissau (1993) - Mothers’ not-knowing re sweets intake, not sweets intake, per se, correlated with overweight.
- Lissau (1994) - Parental neglect correlated with overweight.
- NCCP - >1/3 of US children (~ 27 million children) live in low-income families; 17 % (>11 million) live in poor families. Young children disproportionally affected.
- Roemmich – Restrained children overate when stressed; non-restrained did not.
- Twenge – Child, adolescent anxiety increasing.
- Zlotkin – Profoundly obese preschoolers showed marked behavioral, family problems.
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