August 9, 2005
FAMILY MEALS FOCUS #6
Interpreting the news and research about feeding and eating

CHILD OVERWEIGHT: ARE CURRENT GUIDELINES HELPFUL? DO THEY DO HARM?

In the July 2005 Pediatrics, the US Preventive Services Task Force published the daunting conclusion that current policy-driven preventative measures for child overweight do not work. Moreover, the task force concluded that multidisciplinary, behavioral and even family-based approaches in specialized obesity clinics produce modest to no changes in total BMI.(1,2) The highly respected independent panel reached their conclusions after reviewing roughly 2500 journal articles.

The Task Force found no evidence that current policy-drive interventions do harm: screening for children whose BMI exceeds the 85th or 95th BMI percentile, decreasing children's dietary caloric density, limiting food portion sizes and increasing physical activity. However, members neglected to review the behavioral and feeding dynamics research. Children who are labeled overweight, even if they are no heavier than their peers, feel flawed in every way,not smart, not physically capable and not worthy.(3) Nine-year-old girls classified as overweight at age five years showed increased restraint, disinhibition, weight concern, increases in weight status and body dissatisfaction.(4) Restricted preschool and school-age girls given free access to ''forbidden'' food during a sham task ate more than unrestricted girls, felt bad about themselves for doing it and weighed more.(5)

Does this mean that we do nothing at all? Absolutely not! Instead, we can do an excellent job with feeding and raise children to get bodies that are right for them. Instead of applying arbitrary weight cutoffs and counseling parents on calorie restriction we can 1) Emphasize providing, not depriving 2) Assess children for weight acceleration and do problem-solving.

First, to emphasize providing, not depriving, remember children are born wanting to eat, knowing how much to eat, inclined to move and grow in the way that nature intended and feeling good about their bodies. Good parenting with feeding preserves those qualities.(6) Professionals who work with children are in a powerful position to teach and support parents in effective, stage-appropriate feeding and parenting.

Second, we can evaluate each child's longitudinal growth pattern and distinguish consistent from upwardly divergent growth. Growing out of this individual assessment, childhood nutrition and health professionals can help parents of the large, consistently growing child to accept and support that child's growth pattern, even when it is outside statistical cutoff points.(7) In addition, professionals can intervene early in response to a child's growth acceleration, identify feeding distortions, and correct those distortions promptly.(8) With consistent, properly informed early intervention, minor issues can be kept from exacerbating into seriously distorted feeding and weight patterns.

For more about providing, not depriving and assessing children's growth, see Ellyn Satter's Your Child's Weight: Helping Without Harming.

Reference List

1. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force. Pediatrics. 2005;116:e125-144.

2. US Preventive Services Task Force. Screening and Interventions for Overweight in Children and Adolescents: Recommendation Statement. Pediatrics. 2005;116:205-209.

3. Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics. 2001;107:46-53.

4. Shunk JA, Birch LL. Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. Journal of the American Dietetic Association. 2004;104:1120-6.

5. Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger. American Journal of Clinical Nutrition. 2003;78(2):215-220.

6. Satter EM. Internal regulation and the evolution of normal growth as the basis for prevention of obesity in childhood. Journal of the American Dietetic Association. 1996;96:860-864.

7. Satter EM; Chapter 10, Understand Your Child's Growth . Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005:323-380 .

8. Satter EM. Feeding dynamics: Helping children to eat well. Journal of Pediatric Health Care. 1995:178-184.

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