Sunday, December 13, 2009

Nutrition and Physical Activity (not diet and exercise)

One of my aforementioned obese middle-schoolers - I'll call him James - came into my office today.  James spends a good portion of his lunchtime with me everyday.  He sits next to his assistant principal in the cafeteria, eats as fast as possible, and then retreats to the sauna that is my office for the remaining 20 minutes.

I am usually too busy to talk to him for the whole period -  he spends most of the time quietly reading his book - so I know that he's not there for my company.  My suspicion is that he gets teased incessantly if he spends too much unsupervised time with his peers, so he avoids social situations like the plague, especially with anyone under the age of 18.  On this particular day Joe was sitting at the desk next to me when James arrived for his lunchtime visit. 

"Joe, what's the prize for the Best Ornament Competition?" James inquired.

"A big bag of Hot Cheetos and Snickers," Joe replied with a straight face and a glance in my direction.  Unable to summon even a hint of a smile, I glared at him, told James that it was time to head to class, and stormed out of the room.

As I aimlessly wandered the hallways, avoiding my own office, I found solace in the fact that Joe was not going to give anyone Hot Cheetos or Snickers, at least not on my watch.  My efforts earlier this semester had made sure of that.  Joe mentions junk food to me at least once a day, with a sinister chuckle, and it irks me to no end.  But if junk food exists only as part of a gross, seriously unfunny joke, then I can live with that.  Hopefully James didn't hear Joe's joke this afternoon, or at least forgot about it, because offering junk food as an incentive is probably just as bad as actually giving it (minus the calories).  Especially to an obese child!

But the mere absence of junk food is not enough to combat obesity.  I realized that since I have James' undivided attention on most days of the week, I have a great opportunity to discuss diet and exercise with him.  While eating my own lunch at my desk,  I pulled up the old Google standby and began to do some research ...

At first I entered "intervention childhood obesity" and browsed through some dense PDF files about public health interventions, carbonated beverage consumption and the impact of decreased fat and sugar consumption on weight.  The studies that I found were focused on large-scale school interventions, family-based approaches and recommendations for doctors and hospitals.  Blah.  Not what I wanted.

I am not a doctor, I do not have an obese child and I am not running a double-blind randomized control trial with 10 different middle schools.  Realizing that this blog is about my daily interactions and experiences with kids, I took a step back and changed my search words to: "How to talk to an obese child."

BINGO! Hundreds of accessible, parent and mentor-friendly websites about how to talk to obese children about their weight.  Many of the suggestions don't apply to me because I, for the most part, do not have control over choices that are made at home about food or the amount of time James is allowed to spend watching TV.

Here, however, are a few of the tips that I found quite helpful:

- Use the words nutrition and physical activity, instead of diet and exercise.

- Don't use the word obeseOverweight is much more effective and allows for a discussion about weight, without implied judgment.

- According to Scholastic Magazine, the only conclusive indicator of obesity in children is the amount of time spent watching television.  Be sure to include television and the importance of alternative activities in conversations with children about weight!

Some of the suggestions that my readers gave on this topic a few weeks ago were also quite insightful. Like starting a class for the overweight children in my afterschool program, and keeping food logs and feelings journals.  This would be quite an endeavor, however, since I would need to dedicate programming time and prep time to designing and implementing an effective class.  And I'd need the buy-in of my supervisor and my students, which is no easy task.

One of the tips that I found while perusing websites such as and was to bring up the topic of overweight in a natural way.  The example was to gently ask, on the way home from a doctor's appointment, "You heard the doctor say you're gaining weight too quickly. Do you want to talk about what we can do to help?" James' mother does not wash his clothes for him, or even point out the fact that his clothes are filthy.  I don't even know if she takes him to the doctor.  So I am fairly certain that she has not taken the time to discuss his weight with him in a gentle manner.

Starting a conversation about weight is even trickier for a teacher or mentor because there are fewer natural moments, like doctors appointments, to bring it up.  Beginning the conversation is one of the greatest obstacles for me when I think about discussing weight with the kids in my program.

Many web suggestions revolved around doing activities as a family, like taking walks or bikerides together to "get in shape".  Now this seems a little easier.  Perhaps James and I could take a walk together during lunchtime, instead of sitting in my office.  I know I could use the fresh air.  I'll have to ask his assistant principal if it's okay, but since she previously asked me to get James involved in physical activity after school, I'm sure it won't be a problem.  Walks are also a great time time for sensitive conversations.

An article that I came across at said it best:"Obesity needs to be treated like illness it is. Shame, harassment and avoidance are inappropriate and counter-productive. If your child had pneumonia or eczema, you would care for the child and help them cope them heal from the conditions. Obesity is an illness and should be treated as such."

I can't let my own fears or hang-ups prevent me from bringing up such an important topic with a child.  And I hope that others who are teachers and mentors and care givers will consider having the same conservation with the overweight children that they know.  After all, spending a few minutes here and there to encourage better nutrition and more physical activity could save these children a lifetime of medical problems and shame.  Those of us who care deeply about child health and nutrition need to counteract the irresponsible Joes of the world, and step up when parents are absent on the subject of weight.

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