We all want our children to be healthy and to love their bodies — how can parents help them if they need to lose weight? TODAY Parents experts weigh in on how to talk to kids about their weight without having them hate you, or themselves.
Nearly one in five U.S. children are "obese," according to a 2016 report from the National Center for Health Statistics, as defined as having a Body Mass Index (BMI) at or above the 95th percentile.
Though some professionals differ as to how much obesity directly affects health, the Center for Disease Control lists high blood pressure and cholesterol, type 2 diabetes, asthma, sleep apnea, joint problems, and fatty liver disease as some of the possible complications of childhood obesity. The CDC also warns that obese children face a greater risk of anxiety and depression, low self-esteem, and bullying.
Now, there is also evidence that obesity can make the complications of COVID-19 more severe — even in young people.
How can parents address obesity in a child without causing them to feel ashamed or embarrassed?
What is obesity in children?
The American Academy of Pediatrics defines children with BMIs between the 85th and 95th percentile are considered "overweight." Those with BMIs over the 95th percentile are defined as "obese."
Children with BMIs between the 5th and 85th percentiles are generally considered to be at a "healthy" weight, and experts do not recommend talking about weight specifically with them. Instead, make a point to talk generally about health, physical fitness, and nutrition, parenting and child development expert Dr. Deborah Gilboa told TODAY Parents.
"You want to talk about food and fitness just like you teach your kids about allowance and chores and money — things they're going to need to know as adults," she said. "We should do that no matter what their weight is."
Gilboa said it is important for all kids to be aware of how much of what she called "tushie time" they have in their lives — which includes not just time spent sedentary while on screens, but also "puzzles and books and just sitting around."
What does BMI mean for children?
Pediatrician Dr. Tobi Amosun, medical director of Nashville's Academy Children's Clinic, acknowledged that BMI is an imperfect measurement of overall health and physical fitness; many factors go into obesity, including a family's structure and socioeconomic status, depression and anxiety, and even whether a family lives in a neighborhood where children can walk to and from school.
Depending on your family's race and ethnicity, Amosun said, a "healthy" BMI range might be higher or lower, and if your child is very active and athletic or has a larger frame, they might have a higher BMI but be very healthy.
If your child's BMI is over the 85th percentile, first take family history, where they are in their growth, and their physical activity into account. Then, if you determine that a change needs to be made in your home and lifestyle, follow these guidelines:
How to talk about kids' weight, ages 3-10
If you have an obese child in preschool or elementary school, you can naturally limit their food choices by limiting what you buy and make available to them in your home. Instead of talking about the number on the scale, talk about the content and quality of their food choices and their activity level without any sense of value judgment or shame, Gilboa said.
"Focus on wanting their bodies to work well without getting tired or wearing out, to keep up their energy," she said.
New York City-based dietician and intuitive eating expert Shana Spence told TODAY Parents she doesn't believe it's ever a good idea to label foods as "good" or "bad," especially to children. "They can take that kind of message into adulthood," she said, and it sets them up for a problematic relationship with food.
Instead, she advocates teaching children mindful or intuitive eating practices, which adults can role model as soon as children begin eating solid foods.
"What I recommend to parents first is sitting down to have meals," said Spence. "I don't think we realize how much we rely on grab-and-go food in this country. I know we're all running around, so sometimes we have to, but especially with kids it's super important to get them to start really thinking about what they're eating."
When you sit down and make yourself focus and be present in the moment while eating a meal or snack — without phones or other gadgets nearby, Spence advised — you more naturally ask yourself, Do I really want this?
"A lot of time, we eat just because it's convenient. We're not really thinking about what we're putting in our body," said Spence. "For instance, potato chips are delicious and are fine as a snack, but if you aren't thinking about it, you are probably eating more than you normally would."
Mindful eating, whether for children or adults, is about really figuring out the foods that work for our bodies and being aware of how they make us feel, Spence said. For example, if your child plays sports, teach them to think about how what they eat before practice or a game affects how their bodies feel and perform.
"Don't teach kids to 'diet,'" Spence said. "Replace that word with the idea of 'mindful eating' instead."
How to talk about kids' weight, ages 11-17
Mindful eating is even more important to reinforce in older children and teenagers who are more likely to want to eat while playing video games or on their computers instead of sitting down at a table for every snack or meal.
Spence recommended continuing to encourage older kids to focus and be present when they are eating, and she suggested distinguishing foods as "nutrient-dense" or not instead of "good" or "bad."
In older children, the way you talk about obesity matters, and it's important to know your own child and how they receive information surrounding weight and body size, said Amosun.
When she approaches a conversation about weight with a teenager, she begins by asking questions like, "How do you feel about your body size or shape?" This helps her keep the conversation neutral and non-judgmental. Sometimes, she said, teens will answer with frustrations not about their weight at all, but about their height or their proportions.
"I think the main thing is to know how to frame things in a way that's not about the child as much as it is about looking at their health," Amosun said.
With younger children, the conversation can focus on feeding their bodies to be able to keep up with their friends on the playground, but in teenagers, it can be more nuanced.
Amosun said she emphasizes that the goal is to feel good about their bodies, no matter what they look like. "Everybody looks different; all bodies look differently," she said. "I tell my patients, 'I want you to feel strong and confident in your body — not just physically strong, but mentally and emotionally too.
"I have plenty of girls who are round and curvy, and they love their bodies," Amosun said. "They're healthy, and I tell them, you know what? Great. Make sure you exercise and eat a good diet."