Talking with Your Children About Weight and Health Discussion ToolKit
Weigh In
Facilitator Handbook
Table of Contents Purpose ................................................................................................................................................................... 2 What’s Inside? ......................................................................................................................................................... 3 Getting Started & Tips for Hosting a Discussion ..................................................................................................... 4 Your “Weigh In” Discussion Timeline ...................................................................................................................... 5 Additional Questions ............................................................................................................................................. 10 Need Your Feedback!! ........................................................................................................................................... 10
Purpose The materials included in this kit have been created to help you host a discussion with parents on how to talk with their children about weight and health. The goal is to prepare parents to share important health information with their children and to address questions their children may ask.
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What’s Inside? Inside this kit:
RESOURCES
Weigh In: Talking to Your Children about Weight + Health We’ve provided one printed copy of this free guide in both Spanish and English. Electronic versions are saved on the enclosed USB flash drive and also are available online at www.weighinonobesity.org. PowerPoint slide presentation, Talking with your Children about Weight + Health We’ve developed an easy to follow presentation to guide your discussion along with slide-by-slide notes that are included in the “Your Weigh In Discussion” section below. An electronic version is saved on the enclosed USB flash drive and also is available online at www.weighinonobesity.org.
HANDOUTS
Weigh In Postcards 20 postcards with Weigh In guide details and website address to hand out at your meeting. Act Locally: A Guide to Philadelphia Resources for Families You can make copies of this printed guide for your meeting guests. An electronic version is saved on the enclosed USB flash drive and also is available online at www.weighinonobesity.org.
TECHNOLOGY
A USB flash drive with all of the above materials.
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Getting Started & Tips for Hosting a Discussion Get the word out. Send an email or invitation to a group of people (friends, neighbors or people you know from a community center, worksite, place of worship or your child’s school). We suggest that you keep the group to no more than 15 people, so everyone can have a chance to speak. Set the date and time. Choose a convenient time and location. There may be space at a local school, library, rec center, place of worship or company. If your group is small, a local coffee house might be a good spot to meet. Note that the Weigh In discussion is designed to be a onehour long meeting. Prepare for the talk. Read through the materials and review the slides so you will feel confident and prepared to lead the discussion. Everyone gets a turn. One of the most important parts of the meeting is to make sure everyone can contribute. Make sure all the parents have a chance to talk. And feel free to share your own experiences if and when it is appropriate. Have fun! The topic is serious, but it is best if parents leave feeling positive and supported with information. Keep things upbeat, smile and have fun!
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Your “Weigh In” Discussion Timeline Below are slide-by-slide guidelines that coordinate with the PowerPoint presentation. Also provided is a recommended amount of time you might spend on each slide. You know your audience best, so trust your own judgment about how to pace your discussion. The bolded bullet points below match the headlines on each slide. 5 MINUTES
Before We Get Started
A good start is to have an “ice breaker” question to help people get to know one another. Ask each person to share: His/her name What was your favorite childhood game to play?
2 MINUTES
What We’ll Discuss Today
This slide will establish what you intend to cover. The talk is broken up into 6 areas: The Challenges of Talking with Children About Weight and Health A New Guide That’s Here to Help Tips for Talking With Children about Weight and Health Let’s Talk – What Would You Say? Local Places Where We Can Take Action The KEY to a Good Talk
5 MINUTES
What do you think parents say is the most difficult conversation to have with their child?
This question is meant for the meeting attendees to provide their thoughts.
1 MINUTE
Believe It Or Not…
This slide reveals what may be the unexpected answer that: A WebMD Health survey found that parents of teens find it more difficult to talk about weight with their child than talking about sex, drugs, alcohol or smoking!
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3 MINUTES Why do you think parents find it so hard to talk with children about weight? This provides an opportunity for parents in room to talk provide their thoughts on why it’s so hard to discuss weight. You will want to listen carefully to the group’s responses, and even write down what people say on a flip chart or white board if there is one in the room.
5 MINUTES Some Reasons Parents Give for Not Wanting to Answer a Child’s Question About Weight This is a list of what researchers have found to be common reasons parents say talking about weight with their child is difficult. Read aloud some of the common reasons (listed on the slide): – “I don’t know what normal weight is.” – “I don’t think my child has obesity. I think she/he is beautiful.” – “If I talk with my child about weight, he/she may develop an eating disorder.” – “I have tried, but nothing works.” – “I am tired of being the food police” Feel free to pause here and have some further discussion about how the parents in the room feel about these reasons. Can they relate to these responses?
2 MINUTES True or False and Answers – You Are Not Alone The next two slides help show that parents may or may not have the right answers, but they’re not alone. True or False – You can do a show of hands for true/false for each statement: – There are many guides and resources available for parents who need help talking with their children about weight. – Most parents do not know what to say to their child about weight or how weight can affect their health. – Only 1 in 100 children in America are overweight or obese. Answers – You Are Not Alone – this reveals the answers: – There are many guides and resources available for parents who need help talking with their children about weight. ANSWER: False - VERY FEW guides exist to help parents. – Most parents do not know what to say to their child about weight or how weight can affect their health. ANSWER: True - Most parents struggle with what to say and how to say it. And they don’t know where to turn for help. – Only 1 in 100 children in America are overweight or obese. ANSWER: False - ONE in EVERY THREE children in America are overweight or obese.
1 MINUTE
A New, Free Guide Helps Parents Answer Tough Questions About Weight
This slide allows you to introduce the Weigh In guide to the parents. You can briefly highlight the guide as: A free, online conversation guide geared to parents of children ages 7-11. A tool that offers practical information on how to compassionately respond to real-world scenarios about weight and health including: – BMI Confusion
– Weight Bias
– Cultural Differences
– Inter-family Weight Differences
– Body Image
– Parental Obesity
– Bullying If appropriate, you can also note that the guide is also available in Spanish.
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2 MINUTES
Tips for Talking to Your Kids About Weight
This slide provides some helpful ways for parents to have a productive and engaging conversation with their children about weight. If possible, you may want to ask different participants to read the tips, one at a time: Be Positive and Supportive. – Supporting a child helps him/her to build confidence and self-esteem, no matter what the situation. Be Realistic and Specific. – Taking small steps helps make any goal – whether health or otherwise – seem possible. And it’s important for parents to be specific about what to do. After all, the more specific you are with your child, the more things are likely to get done. For example it’s like the difference between telling your child, “Your room is a mess. Clean it up.” versus, “Your room is a mess. Please put your shoes in the closet and make your bed.” Keep the Conversation Open. – Parents should ask open-ended questions and ask kids how they feel. It may help children feel that it’s ok to speak openly. Highlight Health. – Perhaps one of the biggest lessons that a parent can learn is that weight is an issue of health, not how a person looks. Talking about extra weight should be no different than talking to your kids about other health issues kids may have, like asthma or ADHD.
5 MINUTES
So, Let’s Talk
This slide is a question to ask the meeting attendees to get their first reaction on how they would react to a difficult situation. You will read the text on the slide to set up the topic of discussion for the group: What would you say if: Your child is behaving badly, acting withdrawn and says he doesn’t want to go to school. When you ask why, he says that a bunch of kids have been teasing him and calling him fat and ugly. Gather responses from the group.
1 MINUTE
A Little Bit About Bullying
This slide is meant to provide some brief facts on bullying including: Bullying has gotten worse over the years. A main reason for bullying at school is weight. Weight teasing is more common than teasing for sexual orientation, race/ethnicity, physical disability or religion. Bullying is not just about letting kids be kids. The consequences of bullying can follow a child into adulthood. There are MANY resources available to help guide parents on ways to help a child who is being teased
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10 MINUTES “Weigh In” Talking Tips (Slides 14-19) These slides include suggested talking points that parents may use if they believe their children are being bullied about their weight. You’ll notice that the points follow the Tips from the previous slides. You can have members of the group take turns reading the points on a given slide, or read them aloud yourself. Please let parents know that these points are not meant to serve as a script, but rather ideas for how to use the tips in guiding what to say. First, Be Positive and Supportive – I’m so sorry this is happening and I’m really glad you told me. Teasing is not fair and is wrong. It really can hurt your feelings. – One of the hardest things about teasing is that they are talking about your weight in terms of how you look. They are making you feel like how much you weigh is a measure of who you are as a person. – And it is not. – You are… (List some positive things about your child, like, caring, a good friend, smart, a hard worker…)
Second, Highlight Health – Weight is a measure of your health and carrying extra weight can hurt your health. – I love you and I don’t have a problem with how you look, but as your parent, I’m concerned that you are carrying around extra weight and this can hurt your health. It can also mean that you don’t have as much energy or get to do the things that you really like to do. – Carrying extra weight means your body has to work harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. – If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (ideas here). Third, Keep the Conversation Open – How do you feel about your weight? – Remember, when you’re carrying around extra weight, it’s not about how you look; it’s about how you feel. – Let’s talk about how we might get to a weight that’s healthiest for you and helps make it easier to do the things you want to do. Fourth, Be Realistic – Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day. – Ask for examples specific to your community, home or family routine that might present a problem. – But, it’s really important, so let’s work on it together. Be Specific – What are some things that we can do together to get healthy? Let’s pick a couple… Do you think we could increase the number of minutes we are active every day? Could we play more together and play more outside? How about shopping for healthy foods as a family? Do you think we could increase the numbers of fruits and vegetables we eat? Would you like to help me cook dinner a couple of nights a week?
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5 MINUTES Healthy Places to Go, Things to Do in Philly This slide introduces the Act Locally guide that is included in your Toolkit and is available online. The guide lists just some of the ways to get healthy in the area and includes the ideas listed on the slide: Increase the number of minutes of physical activity in a day – Check out the Schuylkill River Trail, a bike path with an eight-mile loop between Center City and East Falls. From Schuylkill Banks to East Falls, the trail is a wide paved surface suitable for rollerblading, walking, running and cycling. Create family play time and increase outdoor play time – Head to Fairmount Park to access its many biking and walking trails. Shop for or find healthy meals as a family – Find out whether there is a Philadelphia Healthy Corner Store near you. Food stamps/SNAP are accepted at over 350 healthy corner stores. Increase fruit and vegetable consumption – Shop at farmers markets like those organized by “Farm to City.” See a map of Philadelphia Farmer’s Markets here. Prepare Family Meals Together – Sign up for Sunday Suppers, an innovative family-oriented meal program in West Kensington sponsored by the nonprofit SHARE Food Program. – In partnership with West Kensington Ministry, Sunday Suppers provides healthy shared dinners, increased access to fresh local food and other food related support to families in the Norris Square area of Philadelphia. Note: Feel free to pause here to discuss some other resources available in the area that may be suggested by the group. If people have additions they would like to make to the guide, they can email them to
[email protected].
2 MINUTES
Final Thoughts and Reminder KEY
This slide is meant to sum up your talk. Be sure to thank everyone for participating. Ask parents to remember this KEY when talking with their child about weight and health: KEEP in mind that weight is about your child’s health not how he/she looks, and tell your child that often EXCITE your child about getting healthy, even though it’s going to take some changes and hard work YOU are going to be there for your child, working together since he/she will need your help. A child can’t do this alone. 1 MINUTE
www.WeighInOnObesity.org
This slide just provides the final closing with the website where the guide can be found online.
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Additional Questions The below questions can be used if you’ve gotten through all the material on the slides and want to talk some more with your group: 1. What do you think are other health problems that can come along with having too much weight? 2. Are you surprised that weight teasing is more common than teasing over race/ethnicity, sexual orientation or religion? Why or Why not? 3. A child with obesity is 10 times more likely to become an adult with obesity? Do you think this matters? Why or Why not?
Need Your Feedback!! Hearing from you is the most important way to help us continue to make a difference. Email us at
[email protected] and let us know what worked and what didn’t. We’ll use your feedback to make improvements.
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1
What was your favorite childhood game to play?
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I.
The Challenges of Talking with Children About Weight and Health
II.
A New Guide That’s Here to Help
III.
Tips for Talking With Children about Weight and Health
IV. Let’s Talk – What Would you Say? V.
Local Places Where We Can Take Action
VI. The KEY to a Good Talk 3
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A recent survey said parents of teens find it more difficult to talk about WEIGHT with their child than: • Sex
• Alcohol
• Drugs
• Smoking
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“I don’t know what normal weight is.”
“I don’t think my child has obesity. I think he/she is beautiful.” “If I talk with my child about weight, he/she may develop an eating disorder.” “I have tried, but nothing works.” “I am tired of being the food police.”
?
What do you think? Can you relate to any of these responses? 7
1. There are many guides and resources available for parents who need help talking with their children about weight. 2. Most parents do not know what to say to their child about weight or how weight can affect their health. 3. Only 1 in 100 children in America are overweight or obese.
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1. There are many guides and resources VERY FEW guides exist to help FALSE available for parents who need help parents. talking with their children about weight.
2. Most parents do not know what to say to their child about weight or how weight can affect their health.
Most parents struggle with what to TRUE say and how to say it. And they don’t know where to turn for help.
3. Only 1 in 100 children in America are overweight or obese.
FALSE
ONE in EVERY THREE children in America are overweight or obese.
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“Weigh In – Talking to your children about weight + health” •
Conversation guide geared to parents and caregivers
•
Offers practical information on how to compassionately respond to real-world scenarios about weight and health including: – BMI Confusion
– Weight Bias
– Cultural Differences – Inter-family Weight Differences – Body Image – Bullying
•
– Parental Obesity
Get guide for free at www.WeighInOnObesity.org 10
Be Positive and Supportive
Supporting a child helps him/her to build confidence and self esteem, no matter what the situation.
Be Realistic and Specific
Taking small steps helps make any goal – whether health or otherwise – seem possible. And it’s important for parents to be specific about what to do. After all, the more specific you are with your child, the more things are likely to get done. For example it’s like the difference between telling your child, “Your room is a mess. Clean it up.” versus, “Your room is a mess. Please put your shoes in the closet and make your bed.”
Keep the Conversation Open
Highlight Health
Parents should ask open-ended questions and ask kids how they feel. It may help children feel that it’s ok to speak openly. Perhaps one of the biggest lessons that a parent can learn is that weight is an issue of health, not how a person looks. Talking about extra weight should be no different than talking to your kids about other health issues kids may have, like asthma or ADHD. 11
What would you say if… Your child is behaving badly or acting withdrawn and says he doesn’t want to go to school. When you ask why, he says that a bunch of kids have been teasing him and calling him fat and ugly.
12
• Bullying has gotten worse over the years. • A main reason for bullying at school is weight. Weight teasing is more common than teasing for sexual orientation, race/ethnicity, physical disability or religion. • Bullying is not just about letting kids be kids. The consequences of bullying can follow a child into adulthood. • There are MANY resources available to help guide parents on ways to help a child who is being teased.
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Now, let’s take a look at how a parent might respond to the bullying situation with the “Weigh In” Tips.
Be Positive and Supportive
Be Realistic and Specific
Keep the Conversation Open
Highlight Health
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Be Positive and Supportive
• I’m so sorry this is happening and I’m really glad you told me. Teasing is not fair and is wrong. It really can hurt your feelings. • One of the hardest things about teasing is that they are talking about your weight in terms of how you look. They are making you feel like how much you weigh is a measure of who you are as a person. • And it is not.
• You are… – (list some positive things about your child, like, caring, a good friend, smart, a hard worker…)
15
• Weight is a measure of your health and carrying extra weight can hurt your health.
Highlight Health
• I love you and I don’t have a problem with how you look, but as your parent, I’m concerned that you are carrying around extra weight and this can hurt your health. It can also mean that you don’t have as much energy or get to do the things that you really like to do. • Carrying extra weight means your body has to work harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. • If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (ideas here). 16
Keep the Conversation Open
• How do you feel about your weight? • Remember, when you’re carrying around extra weight, it’s not about how you look, it’s about how you feel. • Let’s talk about how we might get to a weight that’s healthiest for you and helps make it easier to do the things you want to do.
17
Be Realistic
• Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day.
– Ask for examples specific to your community, home or family routine that might present a problem. • But, it’s really important, so let’s work on it together.
18
Be Specific
What are some things that we can do together to get healthy? Let’s pick a couple… Do you think we could increase the number of minutes we are active every day?
Could we play more together and play more outside? How about shopping for healthy foods as a family? Do you think we could increase the numbers of fruits and vegetables we eat? Would you like to help me cook dinner a couple of nights a week?
19
Taken from a Local Guide Created Just for You Increase the number of minutes of physical activity in a day
• Check out the Schuylkill River Trail, a bike path with an eight-mile loop between Center City and East Falls. From Schuylkill Banks to East Falls, the trail is a wide paved surface suitable for rollerblading, walking, running and cycling. Create family play time and increase outdoor play time • Head to Fairmount Park to access its many biking and walking trails. Shop for or find healthy meals as a family • Find out whether there is a Philadelphia Healthy Corner Store near you. Food stamps/SNAP are accepted at over 350 healthy corner stores.
Increase fruit and vegetable consumption • Shop at farmers markets like those organized by “Farm to City.” See a map of Philadelphia Farmer’s Markets here. Prepare Family Meals Together • Sign up for Sunday Suppers, an innovative family-oriented meal program in West Kensington sponsored by the nonprofit SHARE Food Program. • In partnership with West Kensington Ministry, Sunday Suppers provides healthy shared dinners, increased access to fresh local food and other food related support to families in the Norris Square area of Philadelphia.
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Remember this simple KEY when talking with your child about weight and health
K
KEEP in mind that weight is about your child’s health not how he/she looks, and tell your child that often
E
EXCITE your child about getting healthy, even though it’s going to take some changes and hard work
Y
YOU are going to be there for your child, working together since he/she will need your help. A child can’t do this alone. 21
“Weigh In – Talking to your children about weight + health”
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weigh in Talking to your children about weight + health
A conversation guide for parents + adult caregivers of children.
Ages 7-11 years old
Welcome
“You know your child best and that makes you the most valuable asset in communicating with your child about weight.”
welcome | 3
Every day, parents and caregivers of children are confronted with challenging questions and situations for which they are unprepared. For many, questions about a child’s weight are particularly difficult for an adult caregiver to answer since feelings about overweight and obesity are often complicated by both personal issues and the conflicting messages communicated about weight through media and society at large. In fact, a WebMD/Sanford Health survey found that parents of teens find it more difficult to talk about weight with their child than talking about sex, drugs, alcohol or smoking!
welcome getting started talking to your children resources
But awkwardness won’t stop the questions from coming. As America’s childhood obesity crisis continues, we can expect that the questions will surface more frequently – and at almost any time: • In the car driving to an activity
• While watching TV
• On the way to school
• At church
• Around the dinner table
• The list goes on and on…
A parent who searches online or in a local library or who asks a medical professional can readily find several guides for talking with a child about “tough” topics like sex or drinking. If those same parents looked for information on how to address a child’s weight however, they will be unable to find much that is useful or that goes beyond basic information we have heard for years – like, just eat less and move more. This void isn’t just another gap in the world of “DIY parenting.” It’s a pressing health concern facing millions of families, and precisely the reason this conversation guide is needed. We hope the information provided here will help you navigate the important and challenging task of talking with your child about overweight and obesity in ways that are factual, practical and caring. Here’s to your family’s health,
Scott Kahan, MD, MPH,
Ginny Ehrlich, DEd, MPH
Director, STOP Obesity Alliance
CEO, Alliance for a Healthier Generation
appendix
Getting started Why a guide is needed – and a few disclaimers, too
“With societal attention on weight, children may reach out to the adult in their lives with questions about whether or not they are “fat”, and what they can do about it.”
Many factors have led to a nation where one in three children is affected by overweight or obesity. This guide is not provided to get to the root of the issue, point fingers or lay blame. This guide is intended to help parents and caregivers talk with their children about weight and health in ways that are factual, practical and sensitive to the many different emotions that can come with the complex issues surrounding weight. Of course, even with the important information provided, the conversation can still feel uncomfortable. That’s ok. Sometimes, we just have to be the “grown up in the room” to help our children. Rest assured – you are not alone.
Understand that:
1 2 3
If a parent or adult caregiver wanted to start a conversation with a child about overweight or obesity, there are few constructive resources to guide the way With societal attention on weight, children may reach out to the adult in their lives with questions about whether or not they are “fat,” and what they can do about it There is a very strong likelihood that a parent – no matter what they weigh – has his or her own biases about weight, which can get in the way of constructive conversations with a child.
In short, this conversation is going to come up. Chances are it will be initiated by your child. And you are going to want to be prepared. What’s most important to know is that your child is not alone and neither are you. Parents just like you are struggling with what to say to their children about weight. Be positive! You know your child best and that makes you the most valuable asset in communicating with your child about weight.
getting started | 5
A common barrier – our own issues about weight Weight is an issue that we all think about, and potentially struggle with, in different ways. This is true for all parents, wherever they fall on the spectrum of weight – from underweight to normal weight to obesity. Recognizing our biases is essential. But simply knowing we have them is not an excuse to ignore a child’s questions. There is no separating the role of the parent and a child’s ability to overcome a weight problem. Children look up to their parents and much of what they learn is based on modeling a parent or caregiver’s behaviors. They can’t do it alone. Some may wonder whether this isn’t just another parenting topic that is getting too much attention...that the problem may not be as serious as some make it out to be. But a lot has changed since the time when YOU were a kid. We know significantly more today about the life-long connections between weight and health – and those connections are enough to warrant serious attention.
Today, we now know that: Obesity is a matter of health and is a gateway to many chronic diseases and conditions.1
Heart disease, type 2 diabetes, high blood pressure, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, bone and joint disorders including osteoarthritis, and some cancers, among others.2,3
Adults with obesity may have been bullied as kids and may carry memories from those experiences into conversations with a child.
Bullying has gotten worse.
A child with obesity is much more likely to become an adult with obesity.
A main reason for teasing and bullying at school is weight – weight teasing is more common than teasing for sexual orientation, race/ethnicity, physical disability or religion.4 A child with overweight or obesity is up to 10 times more likely to become an adult with overweight or obesity.5
welcome getting started talking to your children resources
appendix
6 | getting started
What else is standing in the way – if the issue was easy, we wouldn’t need a guide There are many reasons a parent or caregiver might give for not wanting to answer a child’s questions about weight. We’ve listed below some of the more common reasons because sometimes acknowledging the barriers is the first step to overcoming them.
1
I don’t know what “success” is…normal weight? What is normal weight anyway?
There are limited resources available for parents looking to help their child to achieve a healthy weight.
“Being consistent is key and a good way to overcome feeling like you are “nagging” your child to eat healthy.”
Unlike with adults, experts don’t yet know how much weight loss is necessary in kids to start showing improvements in their health. But experts do know that children who enter adulthood overweight or with obesity are much more likely to remain overweight or have obesity as adults. Therefore, experts agree that the goal for kids is to exit their teen years at a healthy weight (or as your child’s pediatrician may tell you, this means below the 85th percentile on the BMI-for-age growth charts, which will be explained in greater detail later in the guide).6,7
2
Isn’t losing weight just a matter of will power?
No, obesity results from a complex combination of genetics, environment and health behaviors, including dietary intake and physical activity.8
3
What some call obese, I call beautiful.
Even though extra weight might be accepted and admired in a particular culture, it doesn’t protect a child from possible health consequences or bullying.
welcome
4
If I talk to my child about weight, he/she may develop an eating disorder.
Parents who approach weight in non-productive ways, such as teasing, put their children at a higher risk for developing disordered eating behaviors such as anorexia, bulimia and binge eating.9 There’s no evidence that discussing weight as a matter of health, in a motivating and caring way, results in psychological harm. This guide was designed to encourage healthy, non-harmful ways to approach weight-related issues.
5
talking to your children resources
I’ve tried to help, but nothing works.
Many parents want their child to lose weight and feel frustrated when nothing seems to work. They often blame themselves, which can turn into negative criticism for their child. What’s important is that there are lots of ways to improve health. Steps like increasing physical activity or improving nutrition can help.
6
getting started
I’m tired of feeling like the “food police.”
It is common for parents to feel like they are in a constant power struggle with their kids in trying to get them to eat healthy. What’s most important is for you and your family to determine your own rules for healthy eating and occasional treats – and stick with it. Being consistent is key and a good way to overcome feeling like you are “nagging” your child to eat healthy. Even when you come up with your family’s “healthy eating do’s and don’ts” however, there are many times when you can’t be around to help make the healthy choice. Being consistent with rules at home is a good place to start and there are resources to help a child make difficult decisions outside the home.
appendix
Talking to your children about weight and health
Likely situations and suggestions for how to respond Note: As children develop and mature at varying rates throughout childhood, generalizing advice is not advised. With that in mind, this guide is specifically created for parents with children who are 7-11 years old.
Secrets to a successful talk – a quick roadmap to the situations and responses Below is a list of seven real-world situations that a parent or other adult caregiver is likely to face when it comes to questions about weight and/or obesity from a child. For each, you will find educational information for you and then suggestions for how you might respond. The tips encourage you to: Acknowledge the situation and thank your child for sharing his/her feelings with you to build confidence and security. Ask your child open-ended questions so he/she can express their feelings. Identify that weight is a matter of health, not how you look. (Note: You’ll see this point emphasized and repeated throughout the tips. That’s because it may be the most important point you can make!) Let your child know the challenges to being healthy, but also be sure to emphasize the benefits of better health.
“Whether your child is dealing with a bully or struggling with body image, supporting your child wil go a long way to building confidence and self-esteem.”
Offer to work together – working toward the promise of being healthier together creates a supportive environment for your child.
talking to your children | 9
Before we get to WHAT to say, here are some things to keep in mind about HOW to say it:
Be positive and supportive.
Whether your child is dealing with a bully or struggling with body image, supporting your child will go a long way to building confidence and self-esteem.
Be realistic.
Focusing on small, specific steps makes achieving a healthy goal seem possible. It’s like the difference between telling your child, “Your room is a mess. Clean it up.” versus, “Your room is a mess. Please put your shoes in the closet and make your bed.” The more specific instructions are more likely to get done.
Keep the conversation open.
Asking children how they feel may help them to feel that they can speak openly.
Normalize the issue.
Communicating about obesity as a health concern keeps it in the context of other health issues that children may face, like asthma or ADHD. And remember, everyone is different. For example, children in the same family may have different sizes, just like they may have different eye color, hair colors, heights and temperaments.
the situations
1 2 3 4
BMI Confusion
Body Image Bullying Cultural Differences
5 6 7
Inter-family Weight Differences Parental Obesity Weight Bias
welcome getting started talking to your children resources
appendix
10 | talking to your children
“Some schools use BMI scorecards to inform parents of their child’s weight so that parents and health care professionals can be proactive in addressing any weight-related issues.”
Situation One: BMI Confusion Your school district now performs annual BMI screenings. Your child brings home a BMI report card which shows that your child has obesity. The child asks what this means. What do you say? What a parent needs to know: What is BMI? BMI stands for “Body Mass Index” and is an indirect measure of health risk of weight. It is calculated using a person’s height, weight, age and gender. Child/adolescent BMI is a good predictor of health risk into adulthood. So if your child has obesity, he/she has a much higher risk for continuing to have weight problems into adulthood.10
What is a BMI scorecard? Some schools use BMI scorecards to inform parents of their child’s weight so that parents and health care professionals can be proactive in addressing any weight-related issues. BMI scorecards typically use BMI-for-age which differs from what most adults think of when they think of BMI. BMI-for-age is a measure of weight compared to growth and, in children, is more accurate than BMI alone. After BMI is calculated for children and teens, the BMI number is plotted on a growth chart (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children in the United States. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, overweight and obese).11
talking to your children | 11
getting started
BMI-for-age is typically measured as a percentile score in the following manner: ≤ 5% Underweight 95th Percentile weight "
5%–84% Healthy Weight 85th Percentile
welcome
talking to your children
85%–95% Overweight ≥ 95% Obese12
resources
5th Percentile
appendix
age "
Although the BMI number is calculated the same way for children and adults, the criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. For children and teens, BMI age- and sex- specific percentiles are used for two reasons. First, the amount of body fat changes with age. Second, the amount of body fat differs between girls and boys.13 continued on next page
12 | talking to your children
BMI Confusion continued
“Some kids have other health issues like asthma or trouble concentrating. Carrying around too much weight can hurt your health too.”
Tips for what a parent might say: I’m glad you shared this with me. BMI is not just confusing for you; it can be pretty confusing for a lot of moms and dads. What’s most important to understand is that this is a way of measuring your health. It tells your teachers, your doctors and your family how you’re growing, just like when we see the doctor for a checkup and they listen to your heart and measure your height. Some kids have other health issues like asthma or trouble concentrating. Carrying around too much weight can hurt your health too.
What your report says is that you may be carrying more weight than is healthy for a girl/boy of your age and size. Having extra weight means your body may have to work harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (FILL IN).
How do you feel about your weight? • First things first, weight is not who YOU are. • Remember, when you’re carrying around extra weight, it’s not about how you look, but how you feel.
Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day. (Ask your child for examples specific to your community, home or family routine that might present a problem.) But, it’s really important, so
let’s work on it together.
talking to your children | 13
Why don’t we come up with some things we can do to get healthy? (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Increasing the number of minutes of being active in a day
Limiting the number of sweets (foods and beverages) you eat a week
welcome getting started talking to your children resources
Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
Increasing the amount of fruits and vegetables you eat
“Weight is not who YOU are.”
appendix
14 | talking to your children
“Parents who encourage their children to diet may actually undermine their own intent. Often children wil develop unhealthful dieting that can lead to increased risk of obesity.”
Situation Two: Body Image Your child asks, “Am I fat?” and says she wants to go on a diet. She is emotional because she says she looks different than the other girls in her class. What do you say? What a parent needs to know: Dieting is not uncommon among children – studies have shown that approximately half of 9-11 year olds were “sometimes” or “very often” on a diet.18
Diets are often not healthy and can be counterproductive, even resulting in dangerous disordered eating behaviors, such as binge eating, anorexia, bulimia, etc.19
20
Parents who encourage their children to diet may actually undermine their own intent. Often children will develop unhealthful dieting that can lead to increased risk of obesity.20 If your child wants to lose weight, diet is only one aspect affecting weight. Children are more successful when parents and/or the family attempt weight loss and healthier lifestyles together.21
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welcome getting started
Tips for what a parent might say: I’m so sorry you’re feeling this way and I’m really glad you told me.
talking to your children
Look, we all are different shapes, sizes and colors. So, don’t worry about being different.
resources As your parent, I am concerned that you are carrying around extra weight because this can hurt your health.
appendix It’s important for you to know that how much you weigh is not a measure of who you are as a person. Weight is not who YOU are. You are (FILL IN with positive attributes, e.g., caring, a good friend, smart, a hard worker). continued on next page
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Body Image continued
“Weight is a measure of your health and carrying extra weight can hurt your health because your body has to work harder than it needs to.”
Tips for what a parent might say: Weight is a measure of your health and carrying extra weight can hurt your health because your body has to work harder than it needs to.
Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (FILL IN).
Some kids may have other health issues, like asthma or trouble concentrating.
Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone.
I understand that you want to take steps to get healthier, so tell me what you mean by going on a diet.
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I think we should really focus on eating more healthfully and thinking about other things we can all do as a family to get healthier. (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Increasing the number of minutes of being active in a day
Limiting the number of sweets (foods and beverages) you eat a week
Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
Increasing the amount of fruits and vegetables you eat
“The more we can work these things into our daily routine, the healthier we’ll be and it may also increase your confidence in how you feel about yourself.”
welcome getting started talking to your children resources
appendix
18 | talking to your children
Situation Three: Bullying Your child is behaving badly or acting withdrawn and says he doesn’t want to go to school. When you ask why, he says that a bunch of kids have been teasing him and calling him fat and ugly. What do you say? What a parent needs to know: A main reason for teasing at school is weight. Weight bullying is more common than teasing for sexual orientation, race/ethnicity, physical disability or religion.22
Children with obesity are often bullied because peers see them as different and/or undesirable. This often means that children are not invited to social activities like parties or are excluded from certain groups.23 Bullying can lead to depression, anxiety, increased feelings of sadness and loneliness, changes in sleep and eating patterns, loss of interest in activities that your child used to enjoy and may even impede academic development.24
“Bullying can lead to depression, anxiety, increased feelings of sadness and loneliness, changes in sleep and eating patterns, loss of interest in activities that your child used to enjoy and may even impede academic development.” 24
Bullying is not just letting kids be kids – the consequences of bullying extend into adulthood.25 Weight stigmatization often leads to increased food consumption as a coping strategy among adolescents.26 Weight teasing is associated with higher rates of disordered binge eating behaviors among both boys and girls when compared to overweight children who were not teased.27 Losing weight should not be the solution to address bullying. Parents also have a role in helping their child address bullying. There are resources available that can guide a parent on ways to intervene, help their child create a safety plan and talk to school staff.
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welcome getting started
Tips for what a parent might say: I’m so sorry this is happening and I’m really glad you told me. Teasing
is not fair and is wrong. It really can hurt your feelings.
talking to your children
One of the hardest things about teasing is that they are talking about your weight in terms of how you look.
resources They are making you feel like how much you weigh is a measure of who you are as a person. And it is not. You are (FILL IN with positive attributes, e.g., caring, a good friend, smart, a hard worker).
Weight is a measure of your health and carrying extra weight can hurt your health.
I love you and I don’t have a problem with how you look, but as your parent, I’m concerned that you are carrying around extra weight and this can hurt your health. It can also mean that you don’t have as much energy or get to do the things that you really like to do. continued on next page
appendix
20 | talking to your children
Bullying continued
“I love you and I don’t have a problem with how you look, but as your parent, I’m concerned that you are carrying around extra weight and this can hurt your health. It can also mean that you don’t have as much energy or get to do the things that you really like to do.”
Tips for what a parent might say: Carrying extra weight around means your body has to work harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (FILL IN).
Some kids have other health issues, like asthma or trouble concentrating.
How do you feel about your weight? Remember, when you’re carrying around extra weight, it’s not about how you look, but how you feel. Let’s talk about how we might achieve a weight that’s healthiest for you and helps make it easier to do the things you want to do.
Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day. (Ask your child for examples specific to your community, home or family routine that might present a problem.) But, it’s really important, so let’s work on it together.
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So, let’s come up with some things we can do to get healthy. (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Increasing the number of minutes of being active in a day
Limiting the number of sweets (foods and beverages) you eat a week
welcome getting started talking to your children resources
Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
Increasing the amount of fruits and vegetables you eat
“Let’s talk about how we might achieve a weight that’s healthiest for you and helps make it easier to do the things you want to do.”
appendix
22 | talking to your children
“Even if your culture sees extra weight as positive, obesity has serious health and social consequences on your child’s wellbeing.”
Situation Four: Cultural Differences Your racial and/or ethnic heritage traditionally finds having extra weight as attractive or something to be admired, rather than viewing it as a health concern. When your child comes home having been told by classmates and teachers that he is “fat,” he is confused and hurt. What do you say? What a parent needs to know: Even if your culture sees extra weight as positive, obesity has serious health and social consequences on your child’s wellbeing. And it doesn’t stop there – a child with obesity is much more likely to become an adult with obesity. In fact, a child with overweight or obesity is up to 10 times more likely to become an adult with overweight or obesity.14 This could translate into a lifetime of battling serious chronic diseases including type 2 diabetes, high blood pressure and heart disease.
Minority populations, including African Americans and Asians, are significantly more likely to live in multigenerational family households, where grandparents have significant influences on children’s eating habits from early childhood into late adolescence.15 There is a significant relationship between grandparent and grandchild BMI, physical activity and television viewing.16,17
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welcome getting started
Tips for what a parent might say: Thank you for sharing what happened with me. I’m so sorry that your feelings were hurt by what your friends/teacher said. Weight is not who YOU are. You are (FILL IN with positive attributes, e.g., caring, a good friend, smart, a hard worker).
talking to your children
Our culture has seen weight as a sign of success, happiness and wealth. And in our family, we’ve celebrated our size and often mark happy occasions with food.
resources
But, the more doctors learn about weight, it’s becoming clearer that carrying extra weight can hurt your health. So, let’s talk about that.
appendix
Carrying extra weight around means your body may have to work harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. If we can help your body stop overworking, we can make sure you have enough energy to do things that you like to do and what makes you happy like (FILL IN). continued on next page
24 | talking to your children
Cultural Differences continued
“One thing we can do as a family is find other things we can point to as signs of success and happiness – like good grades, having close friends and participating in your favorite activities.”
Tips for what a parent might say: Some kids have other health issues, like asthma or trouble concentrating. Having too much weight can hurt your health too.
How do you feel about your weight? Remember, when you’re carrying around extra weight, it’s not about how you look, but how you feel.
Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day. (Ask your child for examples specific to your community, home or family routine that might present a problem.) But, it’s really important, so let’s work on it together.
One thing we can do as a family is find other things we can point to as signs of success and happiness – like good grades, having close friends and participating in your favorite activities (FILL IN).
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Why don’t we also create things we can do to get healthy together? (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Increasing the number of minutes of being active in a day
Limiting the number of sweets (foods and beverages) you eat a week
welcome getting started talking to your children resources
Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
Increasing the amount of fruits and vegetables you eat
“The more we can work these things into our daily routine, the healthier we’ll be and it may also increase your confidence in how you feel about yourself.”
appendix
26 | talking to your children
“One of the hardest things about this is that most people don’t understand that carrying extra weight is an issue of health and they might tease her about how she looks, which is really unfair.”
Situation Five: Inter-family Weight Differences Your son, who is of average weight, pokes fun of your daughter and calls her “fat.” What do you say? What a parent needs to know: Weight-based teasing by family members is extremely common, nearly half of females affected by overweight and a third of males affected by overweight report experiencing weight-based teasing by family members.32
Nearly half of mothers and a third of fathers have been reported to show weight bias.33 Weight teasing among family members isn’t harmless – family teasing is associated with higher BMI in the long-term.34 Responsibility, guilt and pressure felt by parents of children with obesity for not being able to help their child lose weight can also lead to parental frustration and anger, which can be taken out on the child, but further research is required.35
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welcome getting started
Tips for what a parent might say: I don’t know if you know this, but your sister is dealing with a health issue.
Like some of your friends who may have asthma or trouble concentrating, your sister carries around too much weight and that can hurt her health too.
Struggling with extra weight is really hard to manage. As a family, we need to be supportive.
One of the hardest things about this is that most people don’t understand that carrying extra weight is an issue of health and they might tease her about how she looks, which is really unfair. continued on next page
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28 | talking to your children
Inter-family Weight Differences continued
“What’s most important for us as her family is that how much she weighs is not a measure of who she is as a person.”
Tips for what a parent might say: What’s most important for us as her family is that how much she weighs is not a measure of who she is as a person. Because we know she is (FILL IN with positive attributes, e.g., caring, a good friend, smart, a hard worker).
When a person is carrying extra weight, it means their body is working harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to. If we can help your sister manage her weight, we can make sure her body has enough energy to do things that she likes to do and what makes her happy like (FILL IN).
Losing extra weight is not easy for anyone, especially for someone your sister’s age. And it’s really hard to do alone. There are a lot of things that can get in the way of healthy eating and getting enough physical activity every day. (Ask for examples specific to your community, home or family routine that might present a problem.) But, it’s really important, so let’s work on it together.
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Can you think of some ideas that we can do as a family to get healthier? (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Preparing family meals together
Increasing the number of minutes of being active in a day
Increasing the amount of fruits and vegetables you eat
Limiting the number of sweets (foods and beverages) you eat a week
welcome getting started talking to your children resources
appendix Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
“When a person is carrying extra weight, it means their body is working harder than it needs to. Just like when you don’t like it when your teacher gives you extra homework, your body doesn’t like to do more work than it has to.”
30 | talking to your children
“Yes, I do struggle with carrying extra weight, but that doesn’t mean that it is right for anyone, particularly a stranger, to make a comment about how I look.”
Situation Six: Parental Obesity You are an adult affected by obesity who is out in public with your child. Another adult calls you “fat.” Your child asks why. What do you say? What a parent needs to know: You are not alone. Two-thirds of the population has overweight or obesity.
Although many people treat obesity as a failure of personal responsibility and will tease others about weight, obesity is a complex condition. Parental obesity is a significant predictor of your child’s weight, particularly among 7-15 year olds.36
talking to your children | 31
welcome getting started
Tips for what a parent might say: Yes, I do struggle with carrying extra weight, but that doesn’t mean that it is right for anyone, particularly a stranger, to make a comment about how I look. In fact, it hurts my feelings and I hope it hasn’t hurt yours.
I’m going to let you in on a little secret. The extra weight I’m carrying around is a lot more important to my health than it is to how I look to other people.
Most people who don’t struggle with their weight have no idea how hard it is to lose weight.
But I know that it’s important because my extra weight is making my body work harder than it has to. Just like when you don’t like it when your teacher gives you extra homework, my body doesn’t like to do more work than it has to. continued on next page
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32 | talking to your children
Parental Obesity continued
“Parents aren’t perfect. I have to tell you, of all the things I’ve had to deal with like going to school, raising a family, working, this has been the hardest thing to manage.”
Tips for what a parent might say: Are you uncomfortable about my weight? Do you understand what this means?
Parents aren’t perfect. I have to tell you, of all the things I’ve had to deal with like going to school, raising a family, working, this has been the hardest thing to manage.
One of the reasons why it’s been so hard is that for a long time I thought my extra weight made me a bad person. And it made me forget all the things that I like about me including (FILL IN with positive attributes, e.g., being a good mom, being a good cook, being a great teacher).
Today, I know better. I also know that it takes many steps to get healthier. I’m working on it and I’m hoping you will help me.
talking to your children | 33
Can you think of some things we can do as a family to help us all get healthier? (Here are some suggestions that you and your child can talk about. NOTE: They are focused on specific actions that are easy to monitor and measure.) Increasing the number of minutes of being active in a day
Limiting the number of sweets (foods and beverages) you eat a week
welcome getting started talking to your children resources
Increasing amount of outdoor play time and limiting screen time
Increasing the number of meals that the family sits down and eats together
Creating family play time
Shopping for healthy foods together
Increasing the amount of fruits and vegetables you eat
“One of the reasons why it’s been so hard is that for a long time I thought my extra weight made me a bad person. And it made me forget all the things that I like about me.”
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34 | talking to your children
“Children and adolescents with overweight/obesity experience stigma and bias from peers. Parents and teachers also demonstrate weight bias toward children.”
Situation Seven: Weight Bias A parent or teacher who doesn’t know you or your family well questions you about whether your child who has obesity is allowed to have a birthday cupcake or participate in an athletic activity. What do you say? What a parent needs to know: Children who are stigmatized due to their weight experience negative outcomes, including psychological damage, unhealthy eating behaviors and averting physical activity.
28
Stigma can include the words used to describe a child’s weight. Parents have reported that “weight” and “unhealthy weight” were preferable to “obese,” “extremely obese,” or “fat” when speaking with their child’s doctor. Children and adolescents with overweight/obesity experience stigma and bias from peers, but parents and teachers also demonstrate weight bias toward children.28 Parents often feel stigmatized or blamed for their child’s weight, which can then impact how they treat their child.29 News media also contributes to stereotypes and misperceptions about obesity by emphasizing personal responsibility without acknowledging the roles of the government, industry or media itself. A study of the viewers of the reality television show The Biggest Loser indicated that the show promoted the perception that individuals are in total control of their weight gain and weight loss and by extension increases obesity stigma.31
talking to your children | 35
Tips for what a parent might say:
welcome getting started
Why do you ask that?
You know, my child struggles with carrying extra weight and it’s a really hard issue to address. It makes it even harder when I get questions from people who may not understand the chronic nature of the condition and what we’re doing as a family to try and help.
We joke about not having a parenting handbook, and I have to tell you, of all the things I’ve had to deal as a parent (like talking about job changes, sex, drugs, etc.), this has been the hardest issue to address.
One of the reasons why it’s been so hard is that I didn’t know what to say and I didn’t know where to turn for help. As a parent, I also felt personally responsible which made it that much harder.
But today, we understand that this is a health problem and that is how we are addressing it.
We’re trying to tackle it as a family because as a young child, he/she is going to need the support of family and friends.
And we’re trying to establish goals to all become healthier. Because at the end of the day, that’s what this is about.
talking to your children resources
appendix
Resources guide Bam! Be Well – Alliance for a Healthier Generation Be A Healthy Role Model – MyPlate.gov BodyWorks – Department of Health & Human Services’ Office of Women’s Health Childhood Obesity: It’s Everyone’s Business – National Business Group on Health Circulation: Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children – American Heart Association Fit for Parents – WebMD/Sanford Health Systems FitKids Healthy Youth: Obesity Facts How to Talk to Your Kids About Weight Bias – Yale Rudd Center Is Your Child a Target of Weight Bias? – Yale Rudd Center Kid’s Corner – Obesity Action Coalition Let’s Move! New Moves: Evidence-based Physical Education Program for Girls – University of Minnesota Parents: About Weight Bias – Yale Rudd Center StopBullying.gov – Department of Health & Human Services Talking to Your Kids about Weight – Yale Rudd Center Weight: A Big Issue? – Yale Rudd Center Weight Bias: Important Information for Parents – Yale Rudd Center Weight Control Information Network
resources guide | 37
Credits & Acknowledgements This guide was developed in partnership between the obesity research team at The George Washington University School of Public Health & Health Services and the STOP Obesity Alliance communications team at Chandler Chicco Agency: • Stephanie David, JD, MPH George Washington University
• Gina Mangiaracina, Chandler Chicco Agency
• Lucas Divine George Washington University
• Allison May Rosen, Chandler Chicco Agency
welcome getting started talking to your children resources
• Christine Ferguson, JD George Washington University
The STOP Obesity Alliance and Alliance for a Healthier Generation would like to thank and acknowledge the following individual experts and organizations for reviewing and providing input into the conversation guide. American Heart Association Scientific Advisory Board
Robyn Osborn, PhD, Assistant Director, National Center for Weight & Wellness
Betty Pinkins,
Scotie Connor,
Parent of Youth Advisory Board member, Alliance for a Healthier Generation
Oklahoma City, OK, Youth Advisory Board Alum, Alliance for a Healthier Generation
Ginny Ehrlich,
Scott Kahan,
DEd, MPH, Chief Executive Officer, Alliance for a Healthier Generation
MD, MPH, Director, STOP Obesity Alliance & Director, National Center for Weight and Wellness
Joseph Nadglowski,
Stephen R. Daniels,
President & CEO, Obesity Action Coalition
MD, PhD, Professor and Chairman, Department of Pediatrics; University of Colorado School of Medicine; Pediatrician-in-Chief and L. Joseph Butterfield Chair of Pediatrics, Children’s Hospital Colorado
Laurie Whitsel, Director of Policy Research, American Heart Association
Nazrat Mizra, MD, Faculty, General and Community Pediatrics & Obesity Institute, Children’s National Medical Center
Rebecca Puhl, Director of Research, Rudd Center for Food Policy & Obesity at Yale University
STOP Obesity Alliance Steering Committee
appendix
Appendix Figure 1: boys growth chart
appendix | 39
Figure 2: girls growth chart
welcome getting started talking to your children resources
appendix
40 | appendix
1. Lalita Khaodhiar, Karen C. McCowen, George L. Blackburn, Obesity and its comorbid conditions, Clinical Cornerstone, Volume 2, Issue 3, 1999, Pages 17-31, ISSN 1098-3597, 10.1016/S10983597(99)90002-9. 2. Levi J., Vinter S., Richardson L., Laurent R., St., Segal L. M. (2010). Issue report: F as in Fat: How obesity threatens America’s future. Trust for America’s Health. 3. NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 4. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Weight-based victimization toward overweight and obese adolescents: Observations and reactions of peers. Journal of School Health, 81, 696-703. 5. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–488. American Academy of Family Physicians. Recommendations for clinical preventive services. Available at: www.aafp.org/online/en/home/ clinical/exam/k-o.html. 6. Aucott L., Rothnie H., McIntyre L., Thapa M., Waweru C., Gray D. (2009) Long-term weight loss from lifestyle intervention benefits blood pressure? A systematic review. Hypertension. Available at http:// hyper.ahajournals.org/cgi/content/abstract/HYPERTENSIONAHA.109.135178v1. 7. Lavie C.J., Milani R.V., Artham S.M., Patel D.A., Ventura H.O. (2009) The obesity paradox, weight loss, and coronary disease. American Journal of Medicine. Available at: http://www.amjmed.com/article/ S0002-9343 percent2809percent2900500-2/abstract 8. Aronne LJ, Nelinson DS, Lillo JL. Obesity as a disease state: a new paradigm for diagnosis and treatment Clin Cornerstone. 2009;9(4):9-25; discussion 26-9. 9. Kluck AS. Family influence on disordered eating: The role of body image dissatisfaction. Body Image. 2010;7(1):8-14. 10. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Utility of childhood BMI in the prediction of adulthood disease: Comparison of national and international references. Obes Res. 2005;13(6):1106-1115. 11. Centers for Disease Control and Prevention. (2011). About BMI for Children and Teens. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/. 12. Centers for Disease Control and Prevention. (2011). About BMI for Children and Teens. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/. 13. Centers for Disease Control and Prevention. (2011). About BMI for Children and Teens. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/. 14. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–488. American Academy of Family Physicians. Recommendations for clinical preventive services. Available at: www.aafp.org/online/en/home/ clinical/exam/k-o.html. 15. Faith, M.S., Van Horn, L., Appel, L.J., Burke, L.E., Carson, J.S., et al. (2012) Evaluating parents and adult caregivers as “agents of change” for treating obese children: evidence for parent behavior change strategies and research gaps: a scientific statement from the American Heart Association. Circulation. 125(9):1186-207 16. Polley DC, Spicer MT, Knight AP, & Hartley BL. (2005). Intrafamilial correlates of overweight and obesity in African-American and Native-American grandparents, parents, and children in rural Oklahoma. J Am Diet Assoc, 105:262–265 17. Faith et al., 2012. 18. Gustafson-Larson AM, Terry RD. Weight-related behaviors and concerns of fourth-grade children. J Am Diet Assoc. 1992;92(7):818-822.
appendix | 41
19. NEDA. “National Eating Disorders Association Fact Sheet on Eating Disorders July 2010”. Available at: http://www.nationaleatingdisorders.org/uploads/file/in-the-news/In%20the%20 News%20Fact%20Sheet%20PDF.pdf
welcome getting started
20. Lindsay, A.C., Sussner, K.M., Kim, K., Gortmaker, S. (2006). The role of parents in preventing childhood obesity. The Future of Children. 16(1), 169-186. 21. Epstein LH, Paluch RA, Roemmich JN, Beecher MD (2007). Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychol. 26(4): 381-391.
talking to your children
22. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Weight-based victimization toward overweight and obese adolescents: Observations and reactions of peers. Journal of School Health, 81, 696-703. 23. Robinson, S. (2006). “Victimization of obese adolescents.”. The Journal of school nursing (10598405), 22 (4), 201. 24. Puhl RM, Latner JD. (2007). Stigma, obesity, and the health of the nation’s children. Psychol Bull. 133(4):557-580. 25. US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. (2001). Addressing the Problem of Juvenile Bullying. OJJDP Fact Sheet #27. Available at: http://www. ncjrs.gov/pdffiles1/ojjdp/fs200127.pdf 26. Puhl, Rebecca M. (2012). “Weight-Based Victimization Among Adolescents in the School Setting: Emotional Reactions and Coping Behaviors”. Journal of youth and adolescence. 41 (1): 27. 27. Neumark-Sztainer, D. (2002). “Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors”. International journal of obesity and related metabolic disorders (0307-0565), 26 (1), 123. 28. Schwartz MB, Puhl R. (2003). Childhood obesity: A societal problem to solve. Obesity Reviews. 4(1):57-71. 29. Turner KM, Salisbury C, Shield JPH. Parents’ views and experiences of childhood obesity management in primary care: A qualitative study. Family Practice. 2011. 30. Atanasova, D. (06/2012). “Obesity in the news: directions for future research Obesity in the news: directions for future research”. Obesity reviews (1467-7881), 13 (6), 554. 31. Yoo, Jina H (06/28/2012). “No Clear Winner: Effects of The Biggest Loser on the Stigmatization of Obese Persons”. Health communication (1041-0236) 32. Puhl RM, Latner JD. (2007). Stigma, obesity, and the health of the nation’s children. Psychol Bull. 133(4):557-580. 33. Puhl RM, Latner JD. (2007). Stigma, obesity, and the health of the nation’s children. Psychol Bull. 133(4):557-580. 34. Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA. Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med. 2007;33(5):359-369. e3. 35. Puhl RM, Latner JD. (2007). Stigma, obesity, and the health of the nation’s children. Psychol Bull. 133(4):557-580. 36. Svensson V, Jacobsson JA, Fredriksson R, et al. Associations between severity of obesity in childhood and adolescence, obesity onset and parental BMI: a longitudinal cohort study. Int J Obes. 2011;35(1):46-52.
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Hablar con sus hijos sobre el peso y la salud
Una guía de conversación para padres y adultos que cuidan a niños de
7 a 11 años de edad
Introducción
“Usted es el que mejor conoce a su hijo y eso le da la mayor ventaja para comunicarse con él/ ella sobre el peso.”
Introducción | 3
Todos los días padres y adultos que cuidan a los niños enfrentan situaciones y preguntas difíciles para las cuales no están preparados. En muchos casos, las preguntas sobre el peso de un niño son particularmente difíciles de contestar para un adulto porque los sentimientos sobre la obesidad y el sobrepeso generalmente están influenciados por problemas personales y mensajes conflictivos sobre el tema comunicados por los medios y la sociedad en general. Tanto es así que una encuesta de salud de WebMD/Stanford indicó que para los padres de adolescentes es más fácil hablar con sus hijos sobre sexo, drogas, alcohol o tabaco que hablar con ellos sobre el peso. Pero esta dificultad no hará que las preguntas desaparezcan. Mientras la crisis de la obesidad infantil siga creciendo en Estados Unidos, las preguntas surgirán con más frecuencia –y casi en todo momento: • En el auto camino a alguna actividad
• Viendo televisión
• Camino a la escuela
• En la iglesia
• En la mesa durante la cena
• Y la lista sigue…
Un padre que busca información en Internet o en una biblioteca local, o que le pregunta a un profesional médico, puede encontrar fácilmente muchas guías para hablar con sus hijos sobre temas “difíciles” como el sexo o el alcohol. En cambio si buscaran información sobre cómo tratar el tema del peso de sus hijos, esos mismos padres no podrían encontrar mucha información útil o que fuera más allá de la información básica que hemos oído durante años –como simplemente comer menos y moverse más. La falta de este tipo de información no es sólo un vacío en el mundo de las guías para padres. Es un problema urgente de salud que enfrentan millones de familias, y precisamente la razón por la cual esta guía de conversación es necesaria. Esperamos que la información ofrecida aquí le ayude a navegar la importante y desafiante tarea de hablar con su hijo sobre la obesidad y el sobrepeso de manera fáctica, práctica y comprensiva. Por la salud de su familia,
Scott Kahan, MD, MPH,
Ginny Ehrlich, DEd, MPH
Director, Alianza de Acción Contra la Obesidad
CEO, Alianza para una Generación más Sana
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
Comienzo Por qué hace falta una guía – y también algunas aclaraciones
“Con la atención social que hay en torno al peso, los niños pueden buscar al adulto en sus vidas para hacer preguntas sobre si son ‘gordos’ y qué pueden hacer al respecto”
Muchos factores han llevado a que en una nación uno de cada tres niños tenga obesidad o sobrepeso. Esta guía no está diseñada para llegar a la raíz del problema ni para culpar a nadie. Esta guía tiene como objetivo ayudar a padres y adultos que cuidan a los niños a hablar con ellos sobre el peso y la salud de manera factual, práctica y sensible a las muchas emociones que vienen con los complejos temas del peso. Por supuesto, aún con la importante información ofrecida, la conversación puede seguir siendo incómoda. Está bien. A veces simplemente tenemos que ser los “mayores” para ayudar a nuestros hijos. Sepa que no está solo.
Entienda que:
1 2 3
Si un padre o adulto quiere iniciar una conversación con un niño sobre la obesidad o el sobrepeso, hay una guía con recursos constructivos; Con la atención social que hay en torno al peso, los niños pueden buscar al adulto en sus vidas para hacer preguntas sobre si son “gordos” y qué pueden hacer al respecto; y Hay una gran probabilidad de que un padre – independientemente de su peso—tenga sus propios prejuicios contra el peso, lo cual puede interferir con conversaciones constructivas con un niño.
En resumen, esta conversación va a surgir. Y es probable que sea iniciada por su hijo. Usted querrá estar preparado. Lo que es importante saber es que su hijo no está solo, y que usted tampoco lo está. Muchos padres como usted están luchando para saber qué decirles a sus hijos sobre el peso. ¡Sea positivo! Usted es el que mejor conoce a su hijo y eso le da la mayor ventaja para comunicarse con él/ella sobre el peso.
Comienzo | 5
Un obstáculo común– Nuestros propios problemas con el peso El peso es un tema del cual todos hablamos, y con el cual potencialmente todos luchamos de distintas maneras. Esto es verdad para todos los padres, independientemente de su peso –desde aquellos con peso normal o por debajo de lo normal hasta los considerados obesos. Reconocer nuestros prejuicios es esencial. Pero simplemente saber que los tenemos no es excusa para ignorar las preguntas de nuestros hijos. No hay separación entre el rol de un padre y la capacidad de un niño para superar el problema del peso. Los niños admiran a sus padres y mucho de lo que aprenden se basa en el modelo de conducta de un padre u otro adulto a cargo. No lo pueden hacer solos. Algunos pueden preguntarse si éste no es simplemente otro tema para padres que está recibiendo demasiada atención… y piensan que el problema puede no ser tan serio como algunos creen. Pero muchas cosas han cambiado desde que USTED era un niño. Hoy sabemos mucho más sobre las conexiones entre el peso y la salud –y esas conexiones son suficientes para tomarse el tema en serio.
Hoy sabemos que: La obesidad es una cuestión de salud y una puerta a muchas condiciones y enfermedades crónicas.1
La intimidación o “bullying” ha empeorado.
Un niño con obesidad es mucho más proclive a ser obeso de adulto.
Enfermedades cardíacas, diabetes tipo 2, presión arterial alta, derrames cerebrales, enfermedades del hígado y la vesícula, apnea del sueño y problemas respiratorios, trastornos de huesos y articulaciones incluyendo osteoartritis, y algunos cánceres, entre otras.2,3
Puede ser que los adultos con obesidad hayan sido intimidados como niños y traigan recuerdos de esas experiencias a la conversación con un niño. Una razón principal del bullying y las burlas en la escuela es el peso –las burlas por el peso son más comunes que las burlas por orientación sexual, raza/etnicidad, incapacidad física o religión.4 Un niño con sobrepeso u obesidad es 10 veces más proclive a tener sobrepeso u obesidad de adulto. 5
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
6 | Comienzo
Otros obstáculos – Si el tema fuera fácil no necesitaríamos una guía Hay muchas razones por las cuales un padre o un adulto a cargo pueden no querer contestar las preguntas de un niño sobre el peso. A continuación hemos incluido una lista de las razones más comunes, porque a veces reconocer los obstáculos es el primer paso para superarlos.
1
Yo no sé cómo se define el “éxito”… ¿peso normal? ¿Y qué es peso normal?
Los recursos disponibles para padres que quieren ayudar a sus hijos a lograr un peso sano son limitados.
Ser consecuente es esencial y una buena forma de no sentir que está constantemente ‘fastidiando’ a su hijo para que coma bien
Contrariamente al conocimiento que tienen sobre los adultos, los expertos todavía no saben cuánto deben bajar de peso los niños para empezar a mostrar mejoras en su salud. Pero los expertos saben que los niños que llegan a la adultez con sobrepeso u obesidad son mucho más propensos a mantener el sobrepeso o la obesidad como adultos. Por lo tanto, los expertos están de acuerdo en que la meta para los niños es terminar su adolescencia con un peso sano (o como el pediatra de su hijo le puede decir, debajo del 85/100 en las tablas de crecimiento del IMC-por-edad, que se explicará en más detalle más adelante).6,7
2
¿Bajar de peso no es sólo una cuestión de fuerza de voluntad?
No, la obesidad es el resultado de una compleja combinación de genes, medioambiente y conductas de salud, incluyendo la alimentación y la actividad física.8
3
Lo que algunos llaman obeso, yo llamo hermoso.
Que el peso extra pueda ser aceptado y admirado en una cultura en particular no protege al niño contra posibles consecuencias de salud o intimidación.
Introducción
4
Si hablo con mi hijo sobre el peso, él/ella puede desarrollar un trastorno alimentario.
Los padres que abordan el tema del peso de manera no productiva (por ejemplo, con burlas) ponen a sus hijos en un riesgo mayor de desarrollar trastornos alimentarios como la anorexia, la bulimia y el trastorno por atracón. No hay evidencia de que hablar sobre el peso como una cuestión de salud, de manera inspiradora y comprensiva, pueda causar daño psicológico. Esta guía está diseñada para alentar a que los temas sobre el peso se aborden con un enfoque sano y positivo.
5
Conversación con sus hijos Recursos
Yo he tratado de ayudar, pero nada funciona.
Apéndice
Muchos padres quieren que su hijo baje de peso pero se frustran cuando nada parece funcionar. Generalmente se culpan a sí mismos, lo cual a su vez puede tornarse en criticismo negativo para su hijo. Lo que es importante es que hay muchas formas de mejorar la salud. Por ejemplo, aumentar la actividad física o mejorar la nutrición pueden ayudar.
6
Comienzo
Estoy cansada de sentirme la “policía de la comida”.
Es común que los padres sientan que están en una lucha constante de poder con sus hijos para que coman bien. Lo más importante para usted y su familia es determinar sus propias reglas para comer sano, seguir esas reglas, y saber cuándo darse con un gusto. Ser consecuente es esencial y una buena forma de no sentir que está constantemente “fastidiando” a su hijo para que coma bien. Aun cuando establezca con su familia “reglas para comer bien”, habrá momentos en los que no podrá estar ahí para ayudar a que se cumplan. Ser congruente con las reglas en la casa es una buena forma de empezar y hay recursos para ayudar a los niños a tomar decisiones difíciles fuera de la casa.
Hablar con sus hijos sobre el peso y la salud
Posibles situaciones y sugerencias para cómo responder Nota: Como los niños se desarrollan y maduran con variantes durante la infancia, no se recomienda generalizar los consejos. Con eso en mente, esta guía fue específicamente creada para padres de niños de 7 a 11 años de edad.
Secretos para una conversación exitosa – Guía rápida para responder a distintas situaciones A continuación hay una lista de siete situaciones del mundo real que un padre o adulto a cargo de un niño probablemente enfrente cuando se trata de preguntas de un niño sobre la obesidad o el peso. Para cada una encontrará información educativa y sugerencias sobre cómo responder. Los consejos le alientan a: Reconocer la situación y agradecerle a su hijo por compartir sus sentimientos con usted para crear confianza y seguridad. Hacer preguntas abiertas a su hijo para que él/ella pueda expresar sus sentimientos.
“Independientemente de si su hijo está enfrentando a alguien que lo intimida o luchando con su imagen corporal, apoyarlo será esencial para crear confianza y autoestima.”
Aclarar que el peso es una cuestión de salud, y no de apariencia. (Nota: Este punto se enfatiza y se repite a lo largo de estas sugerencias porque puede ser el punto más importante). Hablar con su hijo de los retos para tener una buena salud, pero también asegurarse de enfatizar los beneficios de estar sano. Ofrecer trabajar juntos –trabajar juntos para estar más sanos crea un ambiente de apoyo para su hijo.
Conversación con sus hijos | 9
Antes de hablar sobre QUÉ decir, a continuación hay cosas para tener en mente sobre CÓMO decirlo:
Sea positivo y ofrezca apoyo.
Sea realista.
.Independientemente de si su hijo está enfrentando a alguien que lo intimida o luchando con su imagen corporal, apoyarlo será esencial para crear confianza y autoestima.
Concentrarse en pasos pequeños y específicos hace la meta de una buena salud más fácil de alcanzar. Es la diferencia entre decirle a un niño “Tu recámara es un lío; límpiala” versus “Tu recámara es un lío; por favor guarda tus zapatos y tiende tu cama”. Las instrucciones más específicas tienen más probabilidad de dar resultado.
Mantenga abierta la conversación.
Preguntarle a los niños cómo se sienten puede ayudarlos a saber que pueden hablar abiertamente.
Normalice el tema.
Hablar de la obesidad como un problema de salud mantiene al tema en el contexto de otros problemas de salud que los niños pueden enfrentar, como asma o TDAH. Recuerde que todos somos distintos. Por ejemplo, niños de la misma familia pueden ser de tamaños distintos, pueden tener distinto color de ojos o de cabello, distinta altura y temperamentos distintos.
Las Situaciones
1
Confusión en torno al IMC
5
Diferencias de peso en la familia
2
Imagen corporal
6
Obesidad de los padres
3
Intimidación o “bullying”
7
Prejuicio contra el peso
4
Diferencias culturales
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
10 | Conversación con sus hijos
“Algunas escuelas tienen tarjetas de IMC para informar a los padres sobre el peso de su hijo de manera que ellos y los profesionales de salud puedan hacer algo para tratar cualquier problema al respecto.”
Situación Uno: Confusión en torno al IMC Su distrito escolar ahora realiza pruebas de IMC anualmente. Su hijo vuelve a casa con un informe de su IMC que indica que tiene obesidad. El niño pregunta qué quiere decir. ¿Qué le dice? Lo que los padres deben saber: ¿Qué es el IMC? IMC quiere decir “Índice de Masa Corporal” y es una medida indirecta del riesgo de salud del peso. Se calcula usando la altura, el peso, la edad y el sexo de la persona. El IMC de un niño/adolescente es un buen indicador del riesgo de salud en la adultez. Si su hijo tiene obesidad, su riesgo de seguir teniendo problemas de peso en la adultez es mucho mayor.10
¿Qué es una tarjeta de IMC? Algunas escuelas tienen tarjetas de IMC para informar a los padres sobre el peso de su hijo de manera que ellos y los profesionales de salud puedan hacer algo para tratar cualquier problema al respecto. Las tarjetas de IMC generalmente usan IMC-por-edad, que difiere de lo que la mayoría de los adultos entiende por ICM. El IMC-por-edad es una medida de peso comparada con el crecimiento, y en los niños es más acertada que el IMC solo. Una vez que se ha calculado el IMC de los niños y adolescentes, el número de IMC se pone en una tabla de crecimiento (para niños o niñas) para obtener un rango percentil. Estos rangos percentiles son el indicador más común que se usa para evaluar los patrones de medida y crecimiento individuales de los niños en Estados Unidos. El rango percentil indica la posición relativa del número de IMC del niño entre niños de la misma edad y el mismo sexo. Los gráficos de crecimiento muestran las categorías de peso que se usan con niños y adolescentes (peso inferior al normal, peso sano, sobrepeso y obesidad).11
Conversación con sus hijos | 11
El IMC-por-edad generalmente se mide como un rango percentil de la siguiente manera: ≤ 5% Peso inferior al normal Percentil 95 Peso "
5%–84% Peso sano Percentil 85
Introducción Comienzo Conversación con sus hijos
85%–95% Sobrepreso ≥ 95% Obesidad12
Recursos
Percentil 5
Apéndice
Edad "
Si bien el IMC se calcula de la misma forma para niños y adultos, el criterio usado para interpretar el IMC en niños y adolescentes es distinto al que se usa para adultos. Para los niños los rangos percentiles específicos de IMC-por edad y sexo se usan por dos razones. Primero, porque la cantidad de grasa en el cuerpo cambia con la edad; y segundo, porque la cantidad de grasa en el cuerpo varía entre varones y mujeres. 13 continúa en la próxima página
12 | Conversación con sus hijos
Confusión en torno al IMC, continuación
“Algunos niños tienen otros problemas de salud como asma o dificultad para concentrarse. Estar excedido de peso también puede afectar tu salud.”
Lo que un padre puede decir: Me alegro de que hayas compartido esto conmigo. El IMC no sólo es confuso para ti; también puede ser muy confuso para muchos padres. Lo más importante de entender es que ésta es una forma de medir tu salud. Le indica a tus maestros, tus médicos y tu familia cómo estás creciendo, tal como cuando vamos al doctor para un control y él/ella escucha tu corazón y mide tu estatura. Algunos niños tienen otros problemas de salud como asma o dificultad para concentrarse. Estar excedido de peso también puede afectar tu salud.
Lo que el informe dice es que puedes pesar un poco más de lo que es saludable para un niño de tu edad y tu tamaño. Estar excedido de peso significa que tu cuerpo puede tener que trabajar más de lo necesario. Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar a tu cuerpo a que deje de trabajar tan duro, entonces podemos asegurarnos de que tengas suficiente energía para hacer las cosas que te gustan y que te hacen feliz como (completar la oración).
¿Cómo te sientes respecto a tu peso? • Antes que nada, el peso no determina quién ERES. • Y recuerda que cuando estás excedido de peso, no se trata de tu apariencia ni de cómo te ves, sino de cómo te sientes.
Bajar de peso no es fácil para nadie, especialmente para alguien de tu edad. También es muy difícil hacerlo solo. Hay muchas cosas que pueden interferir con una dieta sana y con suficiente actividad física diariamente. . (Pídale a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar que pueden presentar un problema). Pero es realmente importante, así que lo intentemos juntos.
Conversación con sus hijos | 13
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir). Aumentar el tiempo durante el cual se está activo en un día
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Introducción Comienzo Conversación con sus hijos Recursos
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla
Aumentar las comidas con toda la familia sentada a la mesa
Crear tiempo de juego para la familia
Salir juntos a comprar comidas sanas
Apéndice
Comer más frutas y verduras
Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.
“El peso no determina QUIÉN eres”
14 | Conversación con sus hijos
“Los padres que alientan a sus hijos a hacer dieta en realidad pueden socavar su propio intento. Generalmente los niños pueden hacer dietas no sanas que pueden aumentar su riesgo de obesidad” 20
Situación Dos: Diferencias culturales La gente de su grupo racial y/o étnico tradicionalmente ha considerado que tener peso extra es atractivo o algo digno de admiración, en lugar de verlo como un problema de salud. Su hijo vuelve a casa dolido y confundido después de que sus compañeros de clase y sus maestros lo han llamado “gordo”. ¿Qué le dice? Lo que los padres deben saber: Si bien en su cultura el peso extra es considerado positivo, la obesidad tiene consecuencias serias en la salud y vida social de su hijo. Y no se detiene ahí –un niño con obesidad es mucho más proclive a ser obeso de adulto. En realidad, un niño con sobrepeso u obesidad tiene 10 veces más probabilidades de tener sobrepeso u obesidad como adulto.14 Esto puede resultar en una vida enfrentando enfermedades crónicas serias, incluyendo diabetes tipo 2, presión alta y enfermedades cardíacas.
Algunos grupos minoritarios, incluyendo los afroamericanos y los asiáticos, son significativamente más propensos a vivir en casas multigeneracionales, donde los abuelos tienen una influencia importante en los hábitos de comida de los niños desde la primera infancia hasta avanzada la adolescencia.15 Hay una relación significativa entre el IMC, la actividad física y el tiempo frente al televisor entre abuelos y nietos.16,17
Introducción Lo que un padre puede decir:
Comienzo
Gracias por compartir conmigo lo que pasó. Lamento tanto que estés dolido por lo que tus amigos/maestros dijeron. El peso no determina quién ERES. Tú eres (completar esta oración con atributos positivos, por ejemplo, comprensivo, buen amigo, inteligente, trabajador).
Nuestra cultura ha visto el peso como un signo de éxito, felicidad y riqueza. Y en nuestra familia hemos celebrado nuestro tamaño y muchas veces hemos festejado las ocasiones felices con comida.
Conversación con sus hijos Recursos
Apéndice Pero mientras más aprenden los médicos sobre el peso, más claro es que estar excedido de peso puede afectar tu salud. Hablemos sobre esto.
Estar excedido de peso significa que tu cuerpo puede tener que trabajar más de lo necesario. Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar a tu cuerpo a que deje de trabajar tan duro, entonces podemos asegurarnos de que tengas suficiente energía para hacer las cosas que te gustan y que te hacen feliz como (completar esta oración). continúa en la próxima página
16 | Conversación con sus hijos
Imagen Corporal, continuación
“El peso es una medida de tu salud y estar excedido de peso puede dañar tu salud porque tu cuerpo tiene que trabajar más de lo necesario.”
Lo que un padre puede decir: Algunos niños tienen otros problemas de salud, como asma o dificultad para concentrarse. Estar excedido de peso también puede afectar su salud.
¿Cómo te sientes respecto al peso? Recuerda que cuando estás excedido de peso, no se trata de tu apariencia ni de cómo te ves, sino de cómo te sientes.
Bajar de peso no es fácil para nadie, especialmente para alguien de tu edad. También es muy difícil hacerlo solo. Hay muchas cosas que pueden interferir con una dieta sana y suficiente actividad física diariamente. (Pídale a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar que pueden presentar un problema).
Pero es realmente importante, así que lo intentemos juntos.
Algo que podemos hacer como familia es identificar otras cosas como signos de éxito y felicidad –como buenas calificaciones en la escuela, tener amigos cercanos y participar en tus actividades preferidas (completar esta oración).
Conversación con sus hijos | 17
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir).
Aumentar el tiempo durante el cual se está activo en un día
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Introducción Comienzo Conversación con sus hijos Recursos
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla
Aumentar las comidas con toda la familia sentada a la mesa
Crear tiempo de juego para la familia
Salir juntos a comprar comidas sanas
Comer más frutas y verduras
“Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más segura de ti mismo.”
Apéndice
18 | Conversación con sus hijos
Situación Tres: Imagen corporal Su hija le pregunta, “¿Estoy gorda?”, y quiere empezar una dieta. Está sensible porque dice que se ve distinta a las otras niñas en su clase. ¿Qué le dice? Lo que los padres deben saber: Hacer dieta no es inusual entre los niños –hay estudios que indican que aproximadamente la mitad de niños de 9 a 11 años hacen dieta “a veces” o “muy seguido”. 18
Las dietas generalmente no son buenas para la salud y pueden ser contraproducentes, incluso provocando conductas peligrosas que pueden ocasionar trastornos alimentarios como la anorexia, la bulimia y el trastorno por atracón, entre otros.19 Los padres que alientan a sus hijos a hacer dieta en realidad pueden socavar su propio intento. Generalmente los niños pueden hacer dietas no sanas que pueden aumentar su riesgo de obesidad.20
“El bullying puede provocar depresión, ansiedad, sentimientos de tristeza y soledad, cambios en los patrones de sueño y alimentación, pérdida de interés en actividades que su hijo solía disfrutar y hasta puede interferir con el desarrollo académico.” 24
Si su hijo quiere bajar de peso, la dieta es sólo un aspecto.
Los niños tienen más éxito cuando los padres y/o la familia intentan bajar de peso juntos, adoptando estilos de vida más sanos en forma conjunta.21
Conversación con sus hijos | 19
Lo que un padre puede decir:
Introducción Comienzo
Lamento tanto que te sientas así y me alegro que me lo hayas contado.
Conversación con sus hijos
Mira, todos tenemos formas, tamaños y colores distintos. No te preocupes por ser diferente.
Recursos Como tu madre, a mí me preocupa que estés excedida de peso porque esto puede dañar tu salud.
Apéndice Es importante que sepas que tu peso no es una medida de quién eres como persona. El peso no determina quién ERES. Tú eres (completar la oración con atributos positivos; por ejemplo, comprensiva, buena amiga, inteligente, trabajadora).
El peso es una medida de tu salud y estar excedida de peso puede dañar tu salud porque tu cuerpo tiene que trabajar más de lo necesario. continúa en la próxima página
20 | Conversación con sus hijos
Bullying, continuación
“Yo te quiero y no tengo problemas con tu apariencia, pero como padre, me preocupa que tengas sobrepeso y que esto pueda dañar tu salud. También puede significar que no tengas suficiente energía y que no puedas hacer las cosas que te gusta hacer.”
Lo que un padre puede decir: Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar a tu cuerpo a que deje de trabajar tan duro, entonces podemos asegurarnos de que tengas suficiente energía para hacer las cosas que te gustan y que te hacen feliz como (completar esta oración)..
Algunos niños tienen otros problemas de salud, como asma o dificultad para concentrarse.
Bajar de peso no es fácil para nadie, especialmente para alguien de tu edad. También es muy difícil hacerlo sola.
Entiendo que quieras hacer algo para mejorar tu salud, así que explícame qué quieres decir cuando dices que quieres hacer dieta.
Conversación con sus hijos | 21
Lo que debemos hacer es concentrarnos en comer mejor y pensar en cosas que podemos hacer todos juntos como familia para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir). Aumentar el tiempo durante el cual se está activo en un día
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Introducción Comienzo Conversación con sus hijos Recursos
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla
Aumentar las comidas con toda la familia sentada a la mesa
Crear tiempo de juego para la familia
Salir juntos a comprar comidas sanas
Apéndice
Comer más frutas y verduras
Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.
“Hablemos de cómo podemos lograr un peso que sea saludable para ti y que te permita hacer las cosas que quieres hacer.”
22 | Conversación con sus hijos
“Si bien en su cultura el peso extra es considerado positivo, la obesidad tiene consecuencias serias en la salud y vida social de su hijo.”
Situación Cuatro: Intimidación o “Bullying” (burla, acoso) Su hijo se está portando mal, se muestra introvertido y dice que no quiere ir a la escuela. Cuando usted le pregunta por qué, le responde que los niños se han estado burlando de él, llamándolo gordo y feo. ¿Qué le dice? Lo que los padres deben saber: Una de las razones principales de burla en la escuela es el peso. El bullying por el peso es más común que la burla por orientación sexual, raza/etnicidad, discapacidad física o religión.22
Los niños con obesidad generalmente son acosados porque sus pares los ven como distintos o indeseables. Esto con frecuencia significa que no son invitados a fiestas u otras actividades sociales o que son excluidos de ciertos grupos.23 El bullying puede provocar depresión, ansiedad, sentimientos de tristeza y soledad, cambios en los patrones de sueño y alimentación, pérdida de interés en actividades que su hijo solía disfrutar y hasta puede interferir con el desarrollo académico.24 El bullying no es simplemente dejar que los niños sean niños –las consecuencias del bullying se extienden hasta la adultez.25 Entre los adolescentes, la estigmatización del peso generalmente lleva a un mayor consumo de comida como estrategia para salir adelante.26 La burla por el peso está asociada con índices más altos de trastorno por atracón entre varones y mujeres, en comparación con niños excedidos de peso que no fueron objeto de burlas.27 Bajar de peso no debería ser la solución para tratar el problema del bullying. Los padres también tienen un rol en ayudar a sus hijos a tratar el bullying. Hay recursos disponibles que pueden guiar a los padres para saber intervenir, ayudar a sus hijos a crear un plan de seguridad y hablar con el personal de la escuela.
Conversación con sus hijos | 23
Lo que un padre puede decir:
Introducción Comienzo
Lamento que esto esté ocurriendo y me alegra que me lo hayas contado.
Burlarse está mal y no es justo. Realmente puede herir tus sentimientos.
Una de las cosas más duras de la burla es que están hablando de tu peso en términos de tu apariencia.
Te están haciendo sentir que tu peso es una medida de quién eres como persona. Y no es así. Tú eres (completar con atributos positivos, por ejemplo, compasivo, buen amigo, inteligente, trabajador).
El peso es una medida de tu salud y estar excedido de peso puede dañar tu salud.
Yo te quiero y no tengo problemas con tu apariencia, pero como padre, me preocupa que tengas sobrepeso y que esto pueda dañar tu salud. También puede significar que no tengas suficiente energía y que no puedas hacer las cosas que te gusta hacer. continúa en la próxima página
Conversación con sus hijos Recursos
Apéndice
24 | Conversación con sus hijos
Diferencias Culturales, continuación
“Algo que podemos hacer como familia es encontrar otras cosas que podamos identificar como signos de éxito y felicidad –como buenas calificaciones en la escuela, tener amigos cercanos y participar en tus actividades preferidas.”
Lo que un padre puede decir: Estar excedido de peso significa que tu cuerpo puede tener que trabajar más duro de lo necesario. Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar a tu cuerpo a que deje de trabajar tan duro, entonces podemos asegurarnos de que tengas suficiente energía para hacer las cosas que te gustan y que te hacen feliz como (completar).
Algunos niños tiene otros problemas de salud, como asma o dificultad para concentrarse. Estar excedido de peso también puede afectar su salud.
¿Cómo te sientes respecto al peso? Recuerda que cuando estás excedido de peso, no se trata de tu apariencia ni de cómo te ves, sino de cómo te sientes. Hablemos de cómo podemos lograr un peso que sea saludable para ti y que te permita hacer las cosas que quieres hacer.
Bajar de peso no es fácil para nadie, especialmente para alguien de tu edad. También es muy difícil hacerlo solo. Hay muchas cosas que pueden interferir con una dieta sana y suficiente actividad física diariamente. (Pídale a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar que pueden presentar un problema).
Pero es realmente importante, así que lo intentemos juntos.
Algo que podemos hacer como familia es encontrar otras cosas que podamos identificar como signos de éxito y felicidad –como buenas calificaciones en la escuela, tener amigos cercanos y participar en tus actividades preferidas (completar).
Conversación con sus hijos | 25
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir).
Aumentar el tiempo durante el cual se está activo en un día
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Introducción Comienzo Conversación con sus hijos Recursos
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla
Aumentar las comidas con toda la familia sentada a la mesa
Crear tiempo de juego para la familia
Salir juntos a comprar comidas sanas
Comer más frutas y verduras
“Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.”
Apéndice
26 | Conversación con sus hijos
“Una de las cosas más difíciles en esto es que la mayoría de las personas no entiende que estar excedido de peso es un problema de salud y otros pueden burlarse de ella por su apariencia, lo cual es realmente injusto.”
Situación Cinco: El prejuicio sobre el peso Un padre o maestro que no lo conoce muy bien ni a usted ni a su familia le pregunta si su hijo que tiene obesidad tiene permitido comer pastel o participar en una actividad deportiva. ¿Qué le dice? Lo que los padres deben saber: Los niños que están estigmatizados por su peso experimentan resultados negativos, incluyendo daño psicológico, conductas alimentarias que no son sanas y rechazo a la actividad física.
El estigma puede incluir las palabras usadas para describir el peso del niño. Los padres han expresado que las palabras “peso” y “peso no sano” son mejores que “obeso”, “extremadamente obeso” o “gordo” al hablar con el médico del niño. Los niños y adolescentes con sobrepeso/obesidad experimentan estigma y prejuicio de parte de sus pares, pero los padres y los maestros también demuestran prejuicio sobre el peso de los niños.28
Los padres a veces se sienten estigmatizados por el peso de un hijo, lo cual luego puede influenciar cómo tratan a su hijo.29 Los medios de comunicación también contribuyen a estereotipos y percepciones erróneas cuando enfatizan la responsabilidad personal sin reconocer los roles del gobierno, la industria y los mismos medios.30 Un estudio de televidentes del programa The Biggest Loser indicó que el show promueve la percepción de que los individuos están en total control para subir y bajar de peso, y por consiguiente aumenta el estigma de la obesidad.31
Conversación con sus hijos | 27
Lo que los padres pueden decir:
Introducción Comienzo
¿Por qué me hace esa pregunta?
Usted sabe, mi hijo lucha con su sobrepeso y es un tema realmente difícil de tratar. Es aún más difícil cuando recibo preguntas de gente que puede no entender la naturaleza crónica del problema y lo que estamos haciendo como familia para tratar de ayudar.
Nosotros bromeamos sobre no tener un manual de padres, y tengo que decirle que de todas las cosas que he tenido que enfrentar como padre (como hablar sobre cambios de trabajo, sexo, drogas, etc.) éste ha sido el tema más difícil de abordar.
Una de las razones por las cuales ha sido tan difícil es que yo no sabía qué decir y no sabía a dónde recurrir por ayuda. Como padre, también me sentí personalmente responsable, lo cual lo hacía mucho más difícil. continúa en la próxima página
Conversación con sus hijos Recursos
Apéndice
28 | Conversación con sus hijos
Diferencias de Peso en la Familia, continuación
“Lo más importante para nosotros como familia es que su peso no es una medida de quién es ella como persona.”
Lo que un padre puede decir: Pero hoy entendemos que éste es un problema de salud y es así como lo estamos tratando.
Estamos tratando de abordarlo como familia porque como niño, él/ella va a necesitar el apoyo de familia y amigos.
Y estamos tratando de fijar metas para que todos mejoremos nuestra salud. Porque al fin de cuentas, de eso se trata.
Conversación con sus hijos | 29
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir).
Preparar las comidas juntos, en familia.
Aumentar el tiempo durante el cual se está activo en un día
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla Crear tiempo de juego para la familia
Comer más frutas y verduras
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Aumentar las comidas con toda la familia sentada a la mesa
Salir juntos a comprar comidas sanas
Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.
“Cuando una persona está excedida de peso, su cuerpo puede tener que trabajar más duro de lo necesario. Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más.”
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
30 | Conversación con sus hijos
“Sí, yo lucho con mi peso, pero eso no quiere decir que cualquiera, particularmente un extraño, pueda hacer un comentario sobre mi apariencia.”
Situación Seis: Diferencias de peso dentro de la familia Su hijo, de peso promedio, se burla de su hija y la llama “gorda”. ¿Qué le dice? Lo que los padres deben saber: Burlarse por el peso entre miembros de la familia es extremadamente común. Aproximadamente la mitad de las niñas con sobrepeso y un tercio de los varones con sobrepeso dicen haber sido objeto de burlas por el peso por miembros de la familia.32
Casi la mitad de las madres y un tercio de los padres muestran tener prejuicios contra el peso.33 Burlarse por el peso entre miembros de la familia hace daño –esta burla familiar está asociada a niveles más altos de IMC a largo plazo.34 La responsabilidad, culpa y presión que sienten los padres de los niños con obesidad por no poder ayudarlos a bajar de peso también puede llevar a que los padres se sientan frustrados, lo cual puede terminar afectando al niño, pero se necesita más investigación.35
talking to your children | 31
Lo que los padres pueden decir: Yo no sé si lo sabes, pero tu hermana está enfrentando un problema de salud.
Como algunos de tus amigos pueden tener asma o dificultad para concentrarse, tu hermana está excedida de peso y eso también puede dañar su salud.
Luchar con el exceso de peso es realmente difícil. Como familia, debemos ofrecer apoyo.
Una de las cosas más difíciles en esto es que la mayoría de las personas no entiende que estar excedido de peso es un problema de salud y otros pueden burlarse de ella por su apariencia, lo cual es realmente injusto.
Lo más importante para nosotros como familia es que su peso no es una medida de quién es ella como persona. Porque sabemos que ella es (complete con atributos positivos, por ejemplo, compasiva, buena amiga, inteligente y trabajadora). continúa en la próxima página
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
32 | Conversación con sus hijos
Obesidad de los Padres, continuación
“Los padres no son perfectos. Te tengo que decir que de todas las cosas que he tenido que hacer en mi vida, como ir a la escuela, criar una familia, esto ha sido lo más difícil.”
Lo que un padre puede decir: Cuando una persona está excedida de peso, su cuerpo puede tener que trabajar más duro de lo necesario. Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar a tu hermana a controlar su peso, entonces podemos asegurarnos de que tenga suficiente energía para hacer cosas que le gustan y que la hacen feliz como (completar).
Algunos niños tienen otros problemas de salud, como asma o dificultad para concentrarse. Estar excedido de peso también puede afectar la salud.
¿Cómo te sientes respecto al peso? Recuerda que cuando estás excedido de peso, no se trata de tu apariencia ni de cómo te ves, sino de cómo te sientes. Hablemos de cómo podemos lograr un peso que sea saludable para ti y que te permita hacer las cosas que quieres hacer.
Bajar de peso no es fácil para nadie, especialmente para alguien de la edad de tu hermana. También es muy difícil hacerlo sola. Hay muchas cosas que pueden interferir con una dieta sana y suficiente actividad física diariamente. (Pídale a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar que pueden presentar un problema).
Pero es realmente importante, así que lo intentemos juntos.
Algo que podemos hacer como familia es encontrar otras cosas que podamos identificar como signos de éxito y felicidad –como buenas calificaciones en la escuela, tener amigos cercanos y participar en tus actividades preferidas (completar).
Conversación con sus hijos | 33
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir). Aumentar el tiempo durante el cual se está activo en un día
Limitar las cosas dulces (comidas y bebidas) que se comen en una semana
Introducción Comienzo Conversación con sus hijos Recursos
Aumentar el tiempo de juegos al aire libre y limitar el tiempo frente a una pantalla
Aumentar las comidas con toda la familia sentada a la mesa
Crear tiempo de juego para la familia
Salir juntos a comprar comidas sanas
Apéndice
Comer más frutas y verduras Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.
“Una de las razones por las cuales ha sido tan difícil es porque durante mucho tiempo pensé que mi peso de más me hacía una mala persona. Y me hizo olvidar todas las cosas que me gustan de mí.”
34 | Conversación con sus hijos
“Los niños y adolescentes con sobrepeso/obesidad experimentan estigma y prejuicio de parte de sus pares. Los padres y los maestros también demuestran prejuicio sobre el peso de los niños.” 28
Situación Siete: Obesidad de los padres Usted es un adulto con obesidad que está en público con su hijo. Otro adulto lo llama “gordo”. Su hijo pregunta por qué. ¿Qué le dice? Lo que los padres deben saber: No está solo. Dos tercios de la población tiene sobrepeso u obesidad.
Aunque algunos traten la obesidad como un fracaso de responsabilidad personal y se burlen de otros, la obesidad es una condición compleja. La obesidad de los padres es un indicador significativo del peso de sus hijos, particularmente entre niños de 7 a 15 años.36
Introducción Lo que los padres pueden decir: Sí, yo lucho con mi peso, pero eso no quiere decir que cualquiera, particularmente un extraño, pueda hacer un comentario sobre mi apariencia. En realidad, hiere mis sentimientos y espero que no haya herido los tuyos.
Comienzo Conversación con sus hijos
Te voy a contar un secreto. El peso de más que tengo es mucho más importante para mi salud que para cómo otra gente me ve.
Recursos
La mayoría de la gente que no tiene problemas con su peso no tiene idea de cuán difícil es bajar de peso.
Apéndice
Pero sé que eso es importante porque el exceso de peso está haciendo que mi cuerpo tenga que trabajar más de lo necesario. Como a ti no te gusta cuando el maestro/a te da demasiada tarea, a mi cuerpo no le gusta tener que trabajar más de lo necesario.
¿Te sientes incómodo por mi peso? ¿Entiendes lo que significa?
Los padres no son perfectos. Te tengo que decir que de todas las cosas que he tenido que hacer en mi vida, como ir a la escuela, criar una familia, esto ha sido lo más difícil.
Una de las razones por las cuales ha sido tan difícil es porque durante mucho tiempo pensé que mi peso de más me hacía una mala persona. Y me hizo olvidar todas las cosas que me gustan de mí, incluyendo (completar con atributos positivos, por ejemplo, buena madre, buena cocinera, buena maestra).
Ahora lo entiendo. También sé que hay que dar muchos pasos para estar más sanos. Estoy trabajando en ello y espero que tú me ayudes.
Recursos Bam! Esté Bien – Alianza para una Generación Más Sana Sea un Ejemplo de Salud – MyPlate.gov BodyWorks – Oficina de Salud Femenina del Departamento de Salud y Servicios Humanos Obesidad Infantil: Es Problema de Todos – Grupo Empresario Nacional sobre Salud Circulación: Evaluando a Padres y Adultos como “Agentes de Cambio” para Tratar la Obesidad Infantil – Asociación Americana del Corazón Padres en Forma – WebMD/Sistemas de Salud Sanford Niños en Forma Juventud Sana: Datos sobre la Obesidad Cómo Hablar con sus Hijos sobre el Prejuicio contra el Peso – Yale Rudd Center ¿Es su Hijo Objeto de Prejuicios contra el Peso? – Yale Rudd Center Rincón de los Niños – Coalición de Acción Contra la Obesidad ¡A moverse! Nuevos Movimientos: Programa de Educación Física para Niñas Basado en Evidencia –Universidad de Minnesota Padres: Sobre el Prejuicio contra el Peso – Yale Rudd Center Departamento de Salud y Servicios Humanos Hablar con sus Hijos sobre el Peso – Yale Rudd Center El peso: ¿es un tema importante?– Yale Rudd Center Prejuicio Contra el Peso: Información Importante para los Padres – Yale Rudd Center Red de Información sobre el Control de Peso
Recursos | 37
Introducción
Créditos & Reconocimientos
Comienzo
Esta guía fue desarrollada por una sociedad entre el equipo de investigación sobre la obesidad de la Escuela de Salud Pública & Servicios de Salud de George Washington University y el equipo de comunicaciones de la Alianza Contra la Obesidad en la Agencia Chandler Chicco:
Conversación con sus hijos
• Stephanie David, JD, MPH George Washington University
• Gina Mangiaracina, Chandler Chicco Agency
• Lucas Divine George Washington University
• Allison May Rosen, Chandler Chicco Agency
Recursos
• Christine Ferguson, JD George Washington University
La Alianza Contra la Obesidad y la Alianza para una Generación Más Sana quisieran agradecer y reconocer a las siguientes organizaciones y los siguientes expertos individuales por revisar y ofrecer ideas para esta guía de conversación. Junta de Asesoría Científica de la Asociación Americana del Corazón
Robyn Osborn, PhD, directora asistente, Centro Nacional de Peso y Bienestar
Betty Pinkins,
Scotie Connor,
miembro de la Junta de Asesoría Juvenil de Padres, Alianza para una Generación Más Sana
Junta de Asesoría Juvenil, Alianza para una Generación Más Sana
Ginny Ehrlich,
Scott Kahan,
DEd, MPH, directora ejecutiva, Alianza para una Generación Más Sana
MD, MPH, Director, Alianza Contra la Obesidad & director del Centro Nacional de Peso y Bienestar
Joseph Nadglowski,
Stephen R. Daniels,
presidente, Coalición de Acción contra la Obesidad
MD, PhD, Profesor y jefe del Departamento de Pediatría de la Facultad de Medicina de la Universidad de Colorado; jefe de pediatría y presidente L. Joseph Butterfield de Pediatría en el Hospital de Niños de Colorado
Laurie Whitsel, directora de Investigación Legislativa, Asociación Americana del Corazón
Nazrat Mizra, MD, profesora, Instituto General y de Pediatría Comunitaria & Obesidad, Centro Médico Nacional de Niños
Rebecca Puhl, directora de Investigación, Rudd Center Para Políticas Alimentarias & Obesidad en la Universidad de Yale
Comité Directivo de la Alianza Contra la Obesidad
Apéndice
Apéndice Figura 1: Tabla de Crecimiento de Varones
Apéndice | 39
Figura 2: Tabla de Crecimiento de Mujeres
Introducción Comienzo Conversación con sus hijos Recursos
Apéndice
40 | Apéndice
1. Lalita Khaodhiar, Karen C. McCowen, George L. Blackburn, La obesidad y sus condiciones comórbidas, Clinical Cornerstone, Volumen 2, edición 3, 1999, Páginas 17-31, ISSN 1098-3597, 10.1016/ S1098-3597(99)90002-9. 2. Levi J., Vinter S., Richardson L., Laurent R., St., Segal L. M. (2010). Informe: Grasa: Cómo la obesidad amenaza el futuro de Estados Unidos. Trust for America’s Health. 3. Iniciativa de Educación sobre la Obesidad, NIH, NHLBI. Pautas Clínicas para la Identificación, Evaluación y Tratamiento de Sobrepeso y Obesidad en Adultos. 4. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Victimización de adolescentes con sobrepeso y obesidad en base al peso: Observaciones y reacciones de pares. Journal of School Health, 81, 696-703. 5. Singh AS, Mulder C, Twisk JW, et al. Seguimiento del sobrepeso de la infancia a la adultez: revisión sistemática de la bibliografía. Obes Rev. 2008;9:474–488. Academia Americana de Médicos de Familia. Recomendaciones para servicios clínicos preventivos. Disponible en: www.aafp.org/online/ en/home/clinical/exam/k-o.html. 6. Aucott L., Rothnie H., McIntyre L., Thapa M., Waweru C., Gray D. (2009) ¿La pérdida de peso a largo plazo por intervención en el estilo de vida beneficia la presión arterial? Revisión sistemática. Hipertensión. Disponible en: http://hyper.ahajournals.org/cgi/content/abstract/ HYPERTENSIONAHA.109.135178v1. 7. Lavie C.J., Milani R.V., Artham S.M., Patel D.A., Ventura H.O. (2009) La paradoja de la obesidad, pérdida de peso y enfermedades coronarias. Revista Americana de Medicina. Disponible en: http:// www.amjmed.com/article/S0002-9343 percent2809percent2900500-2/abstract 8. Aronne LJ, Nelinson DS, Lillo JL. La obesidad como un estado de enfermedad: nuevo paradigma para diagnóstico y tratamiento. Clinical Cornerstone. 2009;9(4):9-25; discusión 26-9. 9. Kluck AS. Influencia familiar en trastornos alimentarios: El rol de la insatisfacción de la imagen corporal. Imagen Corporal. 2010;7(1):8-14. 10. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Utilidad del IMC infantil en la predicción de enfermedades en la adultez: Comparación de referencias nacionales e internacionales. Obes Res. 2005;13(6):1106-1115. 11. Centros para el Control y la Prevención de Enfermedades. (2011). Sobre el IMC para Niños y Adolescentes. Disponible en: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/ about_childrens_bmi.html/. 12. Centros para el Control y la Prevención de Enfermedades. (2011). Sobre el IMC para Niños y Adolescentes. Disponible en: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/ about_childrens_bmi.html/. 13. Centros para el Control y la Prevención de Enfermedades. (2011). Sobre el IMC para Niños y Adolescentes. Disponible en: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/ about_childrens_bmi.html/. 14. Singh AS, Mulder C, Twisk JW, et al. Seguimiento del sobrepeso de la infancia a la adultez: revisión sistemática de la bibliografía. Obes Rev. 2008;9:474–488. Academia Americana de Médicos de Familia. Recomendaciones para servicios clínicos preventivos. Disponible en: www.aafp.org/online/ en/home/clinical/exam/k-o.html. 15. Faith, M.S., Van Horn, L., Appel, L.J., Burke, L.E., Carson, J.S., et al. (2012) Evaluando a Padres y Adultos como “Agentes de Cambio” para Tratar la Obesidad Infantil: evidencia para estrategias de cambios en la conducta de los padres y vacíos de investigación: declaración científica de la Asociación Americana del Corazón. Circulación. 125(9):1186-207 16. Polley DC, Spicer MT, Knight AP, & Hartley BL. (2005). Correlaciones intrafamiliares de sobrepeso y obesidad en abuelos, padres y niños afroamericanos y nativo-americanos en zonas rurales de Oklahoma. Asociación Dietética Americana, 105:262–265 17. Faith et al., 2012.
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18. Gustafson-Larson AM, Terry RD. Preocupaciones y conductas relacionadas al peso en niños de cuarto grado. Asociación Dietética Americana 1992;92(7):818-822.
Introducción Comienzo
19. NEDA. “Asociación Nacional de Trastornos Alimentarios, Datos sobre Trastornos Alimentarios Julio 2010”. Disponible en: http://www.nationaleatingdisorders.org/uploads/file/in-the-news/ In%20the%20News%20Fact%20Sheet%20PDF.pdf 20. Lindsay, A.C., Sussner, K.M., Kim, K., Gortmaker, S. (2006). El rol de los padres en la prevención de la obesidad infantil. El Futuro de los Niños. 16(1), 169-186. 21. Epstein LH, Paluch RA, Roemmich JN, Beecher MD (2007). Tratamiento familiar de la obesidad, antes y ahora: veinticinco años de tratamiento pediátrico de la obesidad. Health Psychol. 26(4): 381-391. 22. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Victimización de adolescentes con sobrepeso y obesidad en base al peso: Observaciones y reacciones de pares. Journal of School Health, 81, 696-703.
Conversación con sus hijos Recursos
23. Robinson, S. (2006). “Victimización de adolescentes obesos”. Revista de escuela de enfermería (1059-8405), 22 (4), 201. 24. Puhl RM, Latner JD. (2007). Estigma, obesidad, y la salud de los niños de la nación. Psychol Bull. 133(4):557-580. 25. Oficina de Justicia Juvenil y Prevención de Delitos, Departamento de Justicia de EE.UU. (2001). Tratando el Problema de la Intimidación (bullying) Juvenil. Hoja de Datos #27. Disponible en: http://www.ncjrs.gov/pdffiles1/ojjdp/fs200127.pdf 26. Puhl, Rebecca M. (2012). “Victimización por Peso de Adolescentes en la Escuela: Reacciones Emocionales y Conductas para Enfrentar la Situación”. Revista de juventud y adolescencia. 41 (1): 27. 27. Neumark-Sztainer, D. (2002). “Burlas entre adolescentes por el peso: Correlaciones con estado del peso y conductas alimentarias anormales”. Revista internacional de obesidad y trastornos metabólicos asociados. (0307-0565), 26 (1), 123. 28. Schwartz MB, Puhl R. (2003). Obesidad infantil: un problema social para resolver. Obesity Reviews. 4(1):57-71. 29. Turner KM, Salisbury C, Shield JPH. Opiniones y experiencias de los padres sobre el manejo de la obesidad infantil en la atención primaria: Estudio cualitativo. Family Practice. 2011. 30. Atanasova, D. (06/2012). “La obesidad en las noticias: instrucciones para investigaciones futuras”. Obesity reviews (1467-7881), 13 (6), 554. 31. Yoo, Jina H (06/28/2012). “Sin Ganadores: Efectos del Show ‘The Biggest Loser’ en la Estigmatización de Personas Obesas”. Health communication (1041-0236) 32. Puhl RM, Latner JD. (2007). Estigma, obesidad y la salud de los niños de la nación. Psychol Bull. 133(4):557-580. 33. Puhl RM, Latner JD. (2007). Estigma, obesidad y la salud de los niños de la nación. Psychol Bull. 133(4):557-580. 34. Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA. Riesgos compartidos y factores de protección para sobrepeso y trastornos alimentarios en adolescentes. Am J Prev Med. 2007;33(5):359-369. e3. 35. Puhl RM, Latner JD. (2007). Estigma, obesidad y la salud de los niños de la nación. Psychol Bull. 133(4):557-580. 36. Svensson V, Jacobsson JA, Fredriksson R, et al. Asociaciones entre severidad de la obesidad en la infancia y la adolescencia, inicio de la obesidad y el IMC de los padres: estudio longitudinal de cohortes. Int J Obes. 2011;35(1):46-52.
Apéndice
Queremos sus comentarios. Contáctenos con su historia personal a
[email protected].
Act Locally: A Guide to Philadelphia Resources for Families Many parents struggle with how to discuss weight and health with their children. “Weigh In: Talking to Your Children about Weight and Health,” is a free guide developed by the Strategies to Overcome and Prevent (STOP) Obesity Alliance and the Alliance for a Healthier Generation that offers parents “realworld” situations and plain language responses to questions they may get from their children. You can view the guide at http://weighinonobesity.org. While the guide includes recommendations on what to say, this resource is meant to help turn those recommendations into Philadelphia-specific activities. Below are some suggestions of resources available to all Philadelphia families. For even more ideas, we suggest visiting Food Fit Philly (http://foodfitphilly.org) and CAP4Kids (http://www.cap4kids.org/philadelphia) for additional resources. Have another idea? Email us at
[email protected]. Increase the number of minutes of physical activity in a day Encourage children to participate in physical activity clubs before, during and after school. Start on-going walking initiatives at your child’s school. Safe Routes Philly outlines several methods and types of walking activities that students at your school can use for transportation and fitness. o Safe Routes Philly: http://saferoutesphilly.org/ Phone: (215) 242-9253 Ext. 309 Check out the Schuylkill River Trail, a bike path with an eight-mile loop between Center City and East Falls. From Schuylkill Banks to East Falls, the trail is a wide paved surface suitable for rollerblading, walking, running and cycling. o Schuylkill River Trail: http://www.schuylkillrivertrail.com/ Phone: (215) 683-0200 Printable map of trails: http://www.schuylkillrivertrail.com/pdfs/Phila_section.pdf Take the family to Franklin Square, which was recently named one of the top five playgrounds in the United States by Yahoo.com! Franklin Square features the Philadelphia Park Liberty Carousel, a Philadelphia-themed miniature golf course and playgrounds centered around the Franklin Square fountain. o Franklin Square: http://www.historicphiladelphia.org Address: 200 N 6th St, Philadelphia, PA 19106 Phone: (215) 629-4026 Try out the renovated Seger Park Playground. The park regularly holds family-friendly community events and features tennis courts, a dog run, basketball courts and a recreation center. o Seger Park Playground: http://friendsofseger.org/ Address: 1020 Lombard Street, Philadelphia, PA 19147 Phone: (267) 507-5558 Create family play time and increase outdoor play time Head to Fairmount Park to access its many biking and walking trails. o Fairmont Park: http://www.visitphilly.com/outdoor-activities/philadelphia/fairmountpark/ Published May 15, 2013
Address: 1 Boathouse Row, Philadelphia, PA 19130 Phone: (215) 683-0200 Don’t have access to a bike at home? Rent one from Wheel Fun Rentals at various parks and locations across the city. o Wheel Fun Rentals: http://www.wheelfunrentals.com/Locations/Philadelphia Address: 1 Boathouse Row, Philadelphia, PA 19130 Phone: (215) 232-7778 or (805) 650-7770 Skip the heat in the summer and head to a public swimming pool near you. Philadelphia swimming pools allow free access to any individual during operating hours in the summer (Monday through Friday from 11 a.m. until 7 p.m. and Saturdays and Sundays from 12 p.m. until 5 p.m.). The swimming pools offer swimming lessons and family swim. o City of Philadelphia Pools: http://www.phila.gov/ParksandRecreation/placestogo/facilities/Pages/SwimmingPools. aspx o Find the pool closest to you using this tool: http://www.phila.gov/parksandrecreation/findafacility/ Take the family to play in the 16,000 square foot (the size of six football fields!) Smith Memorial Playground & Playhouse, located in East Fairmount Park and was designed solely as a play space for children. Smith provides opportunities for unstructured creative play for children 10 and younger. Smith maintains a proud tradition of free family admission. Tuesdays are reserved just for family fun. Check out other free events at Smith here. o Smith Memorial Playground & Playhouse: http://smithkidsplayplace.org/ Address: 3500 Reservoir Drive, East Fairmount Park, Philadelphia, PA 19121-1095 Phone: (215) 765-4325
[email protected] Looking for a fun activity in the winter? Philadelphia Parks & Recreation, in partnership with Ed Snider Youth Hockey Foundation, owns and operates five ice rinks throughout the city. The ice rinks are open to the public seven days a week. There is a $3 skate rental fee. o Philadelphia Ice Rinks: http://www.phila.gov/ParksandRecreation/placestogo/facilities/Pages/IceRinks.aspx Blue Cross River Laura Sims Rizzo Ice Rink Scanlon Ice Rink Simons Ice Rink Tarken Ice Rink Rink at Penn's Skate House 1001 South 1099 East Tioga 7200 Woolston 6250 Frontenac Landing 63rd &Walnut Front Street Street Avenue Street 201 S Columbus 215-685-1995 215-685-1593 215-685-9893 215-685-3551 215-685-1226 Blvd 215-925-7465 Shop for or find healthy meals as a family Find out whether there is a Philadelphia Healthy Corner Store near you. SNAP are accepted at over 350 healthy corner stores. o Food Fit Philly Eat Healthy: http://www.foodfitphilly.org/eat-healthy/ o List of Healthy Corner Stores that accept ACCESS cards/SNAP: http://www.foodfitphilly.org/FOODFITPHILLY/assets/File/Healthy%20corner%20stores% 20SNAP%207_6_12.pdf Learn about the Philly Food Bucks program to help you save money on fruits and vegetables. Philly Food Bucks are accepted at over 25 farmers' markets in low-income communities in Philadelphia. You must have a current ACCESS card/food stamps to use Philly Foods Bucks. Published May 15, 2013
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Food Fit Philly - Philly Food Bucks: http://www.foodfitphilly.org/eat-healthy/philly-foodbucks/ Visit Reading Terminal, Philadelphia’s historic farmer’s market, where you can find fresh vegetables and produce, meats and seafood. The Terminal offers one-stop shopping for healthy eating there or to take home. o Learn more here: http://www.readingterminalmarket.org/ Order a box of fresh produce from SHARE Food Program’s Farm to Families initiative from local farmers at a cost of only $10 or $15. Boxes are brimming with fresh fruits and vegetables, often valued at double the purchase price. Additional fresh a la carte items including eggs, meat and seafood are also offered at affordable prices. o SHARE Food Program’s Farm to Families Program: http://sharefoodprogram.org/programs/farm-to-families/ Address: 2901 W. Hunting Park Avenue, Philadelphia, PA 19144 Phone: (215) 223-2220
[email protected] Increase fruit and vegetable consumption Download the Children’s Hospital of Philadelphia’s free Nutrition in the Kitchen Cookbook and try out some healthy recipes. o Children’s Hospital of Philadelphia Nutrition in the Kitchen Cookbook: http://www.chop.edu/service/healthy-weight-program/cookbook-of-healthyrecipes.html Download the CAP4Kids fresh food parenting handouts on topics like food and nutrition. Within each handout, you will find a description of the social service agency, their address, phone number and website. o CAP4Kids Parenting Handout on Fresh Food Resources: http://cap4kids.org/philadelphia/parent-handouts/food-nutrition-breastfeeding/freshfood-resources/ Shop at farmer’s markets that accept access/SNAP. o You can find a list of those here: http://www.foodfitphilly.org/FOODFITPHILLY/assets/File/Snap_Access_2012.pdf Shop at farmers markets like those organized by Farm to City. o Farm to City: http://www.farmtocity.org/index.asp Address: 1315 Walnut Street, Suite 1526, Philadelphia PA 19107 Phone: (215) 733-9599 Phone o Map of Philadelphia Farmer’s Markets: http://batchgeo.com/map/phillyfarmersmarkets Prepare Family Meals Together Visit one of the Philadelphia community gardens near you. o Philadelphia Community Gardens: http://pennsylvaniahorticulturalsociety.org/phlgreen/current-communitygardens.html o Address: 100 N. 20th Street - 5th Floor, Philadelphia, PA 19103 Phone: (215) 988-8800 Sign up for SHARE Food Program’s Sunday Suppers, an innovative family-oriented meal program in West Kensington sponsored by the nonprofit SHARE Food Program. In partnership with West Kensington Ministry, Sunday Suppers provides healthy shared dinners, increased access to fresh local food and other food related support to families in the Norris Square area of Philadelphia. Published May 15, 2013
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SHARE Food Program Sunday Suppers: http://sharefoodprogram.org/programs/sundaysuppers/ Address: 2901 W. Hunting Park Avenue, Philadelphia, PA 19144 Phone: (215) 223-2220 o
[email protected] Check out the healthy family recipes compiled by the Center for Nutrition and Activity Promotion at Penn State Hershey Children’s Hospital and Kohl’s Department Store as part of Kohl’s Healthy Choices for Healthy Families initiative. o Kohl’s Healthy Choices for Healthy Families Healthy Recipes (scroll down to #3): http://www2.med.psu.edu/cnap/families/kohlshealthyfamilies/ o Plan and track family meals with this chart: http://www2.med.psu.edu/cnap/files/2012/05/Tracker-3-meals-a-day.pdf Get involved with the Philly Girls in Motion program, which in addition to offering fitness activities for girls 9-16 and their families, offers specially designed nutrition lessons. There are monthly sessions for the whole family on important topics including “Healthy Cooking Tips,” “Meals on the Go” and “Simple Substitutions.” o Philly Girls in Motion: http://www.phillygirlsinmotion.org/ o Phone: (610) 357-7446 o
[email protected]
Published May 15, 2013
How do you respond when your child:
asks you if you think he/she is fat? is being bullied at school because of weight? Weigh In: A conversation guide for parents and adult caregivers of children. www.WeighInOnObesity.org
Get your free copy of the Weigh In parent conversation guide at www.WeighInOnObesity.org. It offers practical information on how to compassionately respond to the following real-world scenarios about weight and health: • Cultural Differences
• Weight Bias
• Body Image
• Inter-family Weight Differences
• Bullying
• Parental Obesity
• BMI Confusion
