"She'll Grow Out of It" and Other Unfortunate Myths about Overweight Kids

Daniel S. Kirschenbaum, Ph.D., ABPP
Professor of Psychiatry & Behavioral Sciences,
Northwestern University Medical School

"You said your daughter is 10 years old, 4'11", and weighs 203 pounds, right?"
"Yes, but her pediatrician says she'll grow out of it."

This exchange actually happened twenty-five years ago, and while it might be an extreme example, something like it continues to happen every day in the USA. That ten year old girl was certainly among the most overweight ten year olds in the country at that time. Today, we have about three times as many overweight and obese young people compared to 25 years ago. Yet, parents still hear that kind of message from some health care providers, grandparents, aunts and uncles, and friends and neighbors. Parents with overweight children and teens are told:

  • Overweight kids will grow out of it
  • Focusing too much on weight causes eating disorders
  • If you deprive your child of certain foods, he'll want it ten time more
  • You'll ruin her self-esteem if you focus on her weight
The result of these messages undoubtedly contributed to a rather startling finding obtained in a 2007 national poll conducted by researchers at the University of Michigan. These researchers found that more than 40% of parents of obese children described their children as "about the right weight" and less than 10% of these parents said that they were "very concerned" about their child's weight 1.

None of us likes to cause conflict in the home or risk focusing on a problem and making it worse. That's understandable. However, parents and health care providers now have the tools to focus on this epidemic of childhood obesity in a very constructive way. The purpose of this article is to debunk some outdated mythology about overweight kids and show you some steps you can take that can do nothing but help your child and your family.

Debunking the Myths
Based on the author's 35 years of experience helping people lose weight and the research that has guided that work, here are some truths to remember:

Overweight kids won't grow out of it. Studies abound that show that ten to twenty times more overweight children become obese adults compared to their leaner peers. They rarely grow out of it. Not only that, obese children are far more likely than their lean peers to develop such serious and life threatening conditions as diabetes, cancer and heart disease. For example, a study published very recently by researchers from Denmark in the New England Journal of Medicine2 found that a 13 year old boy who was 5'1" and weighed 132 lbs had a 51% higher risk of developing heart disease as an adult compared to a boy of the same age and height who was at normal weight. Fortunately, if that overweight boy lost weight, the research suggests that he could reduce this risk very substantially.

Overweight kids won't develop anorexia. Excess weight comes from very active tissues, adipose cells, not from a big empty warehouse full of lifeless fat. Fat cells and related hormones combine to resist weight loss mightily 3. This makes it quite challenging to lose weight and keep it off, but it also makes it especially challenging to become a super slim anorexic. Obese kids just have a biology that resists weight loss too much for them to get to 25% below normal weight (the definition of anorexia).

Finding lovable foods that love you back. This author's books emphasize that you can, indeed, "find lovable foods that love you back"3,4. Weight control programs that produce among the best results in the long run use this principle.

For families this means:

  • Replace high fat chips with baked chips and fat free pretzels.
  • Order pizzas without cheese and then add fat free cheese and re-heat.
  • Turkey dogs instead of high fat hot dogs.
  • Lean bison burgers instead of high fat beef burgers.
  • Baked fries instead of fried fries.
  • Fat free frozen yogurt, fat free brownies, fruit, angel food cake and other goodies instead of their high fat versions
  • Everyone follows this program both at home and when going out to eat.
If you work at it a little, you can find foods that taste and look great - and work for healthy living. Consistency of this approach, however, makes a big difference. Why celebrate a special occasion by doing something self-destructive? Can't a fat free angel food cake (chocolate, vanilla, or pumpkin flavored) with fat free whipped cream and berries feel like a celebration? Would an alcoholic celebrate a birthday with a martini?

Losing weight usually makes overweight kids feel great. Finally, research after World War II included studies in hospitals in which young veterans agreed to stay in locked wards for many weeks at a time. In some of these studies, these men were fed very little. They became very cranky, even delusional5. These findings led many people to believe, mistakenly, that weight loss causes extremely negative psychological consequences. Actually, when people lose weight following a scientifically based program they almost always increase their moods dramatically6. Remember, weight controllers want to lose weight; they often hate they way they look and feel and have been frustrated by previous failures to lose weight. The soldiers in the post-WWII studies volunteered only to make some money. They were forced to lose weight even though they weren't overweight when they signed up. Wouldn't you get cranky under those conditions?

What to Do with Your Overweight Child
The American Medical Association and some governmental agencies convened a group of experts who published a 33-page treatise on this topic on 11/30/07 (online; print version to appear soon) 7. This set of recommendations, considered the most thorough and aggressive guidelines ever created by a group like this, calls for at least annual checks of weights relative to norms, counseling about weight for every family regardless of the weight status of the children, and a four-stage treatment plan. The following review of these guidelines is supplemented based on the author's view of the science of treating this challenging problem.

Checking Weight Status
To find out if your child's weight is OK, go to: http://www.wellspringcamps.com/calc.asp. This website provides a very easy way to plug in your child's current age, gender, height and weight and then to see where the weight falls - from in the normal range to obese. The standards for this assessment come from many years of nationally representative samples of data that were gathered before the obesity epidemic took hold of this country. If your child's weight in the 85th percentile or above, the time to take some action is now.

Steps to Consider
The new guidelines recommend working with your pediatrician for several sessions of education and consistent weigh-ins. They also note that such an approach has no evidence to support its usefulness. Education rarely leads to lasting changes in lifestyle and weight status, although it certainly doesn't hurt and perhaps for some families it can do some good 4. So, consider the following three alternatives that have science behind them, showing some positive and potentially lasting benefits.

  1. Outpatient Cognitive-Behavior Therapy - Identified in the guidelines as a form of structured weight management, this approach involves working with healthcare professionals (primarily psychologists, counselors, and social workers) who have established expertise in treating obesity. Families generally work together, meet once a week in groups, and systematically record their eating and exercising behaviors (self-monitor), learn about nutrition for weight loss, set goals to increase activities and modify eating patterns, and learn how to handle stress and other concerns effectively. This approach produces better outcomes than education alone, but many people discontinue this treatment too soon. Also, rarely do overweight young people in this treatment improve dramatically.
  2. Immersion Programs - Therapeutic weight loss camps and boarding schools use some of the same tools as outpatient cognitive-behavior therapy clinics. However, these programs also remove overweight young people from their obesogenic environments, surround them with staff which model effective weight controlling behaviors, and rely on the support of many peers struggling with related concerns. Several studies show benefits that may well exceed those obtained in outpatient settings, especially the two published reports of longer term interventions in a boarding school and a similar specialty in-patient clinic 8.
  3. Medication and Surgery - This final stage mentioned in the new guidelines has produced some dramatic results. However, surgery for overweight young people is still rarely performed because relatively few children and teens qualify by weight and other standards (e.g., morbid obesity is required, usually with other conditions like high blood pressure or diabetes). Also, some clinical trials reported some troubling complications.
Only two FDA approved medications are available, one of which becomes superfluous if a very low fat diet is followed at home (Orlistat). The second, Meridia, can help decrease appetite, but doesn't work well unless the child/family participates in a cognitive-behavior therapy program concurrently.

Conclusion
If you're currently concerned about your child's weight, you're already a couple of giant steps ahead of most parents who have overweight children. We're in the midst of a worldwide epidemic of childhood obesity. Lack of good, useful, scientifically based direction for parents has fueled the fire ignited by our obesogenic culture. Technological advances have contributed to making destructive food abundant and cheap, as well as creating incredibly appealing forms of entertainment that engender sedentary living. In this paper, you've seen an example of science beginning to provide some answers by debunking myths and suggesting useful steps to take. If necessary, please consider taking those steps with conviction and dedication for the good of your family - and to help transform the obesogenic culture into a healthy living community.

REFERENCES

  1. C.S. Mott Children's Hospital National Poll in Children's Health. 12-14-07 internet search: www.chear.umich.edu.
  2. Baker, J.L., Olsen, L.W., & Sorensen, T.I. (2007). Childhood body-mass index and the risk of coronary heart disease in adulthood. New England Journal of Medicine, 357, 2329-2337.
  3. Kirschenbaum, D.S. (2005). The healthy obsession program: Smart weight loss instead of low carb lunacy. Dallas, TX: BenBella Books.
  4. Kirschenbaum, D.S., Craig, R., & Tjelmeland, L. (2007). The Sierras weight loss solution for teens and kids: A scientifically based program from the highly acclaimed weight-loss school. New York: Penguin.
  5. Keys, A. et al. (1950). The biology of starvation (Vol.1). Minneapolis, MN: U Minnesota Press.
  6. Wadden, T.A., Womble, L.G., Stunkard, A.J. & Anderson, D.A. (2002). Psychosocial consequences of obesity and weight loss. In T.A. Wadden & A.J. Stunkard (Eds.) Handbook of obesity treatment. NY: Guilford Press.
  7. Spear, B.A. et al. (2007) Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics, 120, S254-S288.
  8. Kirschenbaum, D.S., Craig, R.D., Kelly, K.P., & Germann, J.N. (2007, December, in press). Immersion programs for treating pediatric obesity: Follow-up evaluations of Wellspring Camps and Academy of the Sierras - a Boarding School for Overweight Teenagers. Obesity Management, 3.
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