Sudden changes can discourage kids, expert says

Dr. Seth Ammerman, a specialist in adolescent medicine at Lucile Packard Children’s Hospital in Palo Alto, Calif., and an assistant professor at Stanford University who has written extensively about child obesity, answered these questions:

Q: Do incentives work in getting kids to be more active?

A: Obviously, to change the behaviors that are leading to obesity in the first place, you’re asking kids to change significant established habits with eating as well as physical activity.

I think incentives are very helpful in getting and … potentially keeping them motivated as well.

Q: Do they go back to their old ways once incentives are over?

A: As long as it’s clear upfront what the incentives are, I don’t think that’s the problem.

The idea with obesity is for you to change habits. Once you get them into a program where they start learning new ways of behaving, trying out new ways, healthier ways, to eat and getting involved in physical activity, then success breeds success.

Q: We’re talking about kids here, but what about the family?

A: With obesity and youth, you’re also talking about not just the kid who needs help, but also the family. Without the family being involved, it’s often less successful.

Q: Doesn’t obesity have psychological impacts for kids, too?

A: I think it’s a tough thing for kids from a psychological point of view … kids are teased about being fat. They’re often relatively easy targets for that kind of thing.

You get this vicious cycle: They start feeling bad, so they eat more. It can be difficult to get motivated or stay motivated.

Q: Weight is always a touchy subject. How can you talk to a teen about it?

A: A parent could just take their kid to the doctor and have the doctor say, ‘Hey I’m concerned about your weight.’

I think we have to let a kid know that there is a range of healthy weight. Ask them how they feel. Rather than the doctor or parent saying, ‘I think you have a problem,’ ask the kid. Most kids are aware that if they’re fat, it is an issue.

Kids are comparing themselves to their peers constantly. They know they’re overweight.

Q: And how do you talk to kids about exercise?

A: I tend to not even mention the word exercise. I talk physical activity. Exercise has a connotation of being a chore and task and something relatively boring and not fun. The things that kids like are just as good as exercise that they may not like.

Q: What’s important for kids to remember who want to increase their exercise or activity levels?

A: The idea is to start slow and gradually progress to what the kid needs. Let’s say we want a kid to be physically active for a half-hour a day. If the kid is doing nothing and you say you have to do a half-hour a day, the likelihood is it’s not going to happen.

If you start off with five to 10 minutes, see how they feel about that. Once they accomplish a small task, then they’ll be feeling good about taking it further. Small steps can lead to big steps.

You don’t need to start right away with big steps. With kids, interim goals are very helpful.

Q: So they feel a sense of accomplishment?

A: Yes. The same thing with eating, to say all of a sudden you have to totally change your diet, no more junk food, no more sodas, it’s unlikely to work.

Again, it’s a habit, and it takes some time and effort to change habits.

Q: So how can kids cut down on pop?

A: If a kid is chugging a lot of soda … three sodas a day, that could be close to 1,000 calories – half of their (recommended) caloric intake. It depends on the soda.

But if you say to kids cut out sodas totally, not likely.

If you say instead of three a day, can you make it one a day, and then concretely suggest substitutes.

Q: What would you suggest?

A: As an alternative, sparkling water, lime- or orange-flavored water. Even low-fat milk instead of soda would be useful.

Again, small steps first.

But like many other kinds of habit issues, it takes time and stick-to-it-tiveness.

Q: So is it harder at the beginning or sticking with a program?

A: It’s those initial few months where you begin new behaviors that’s the toughest. Typically, even if you get a motivated kid, that motivation only lasts a week or two.

If roadblocks come up, then you can problem solve together about how to get going again.

If they get discouraged … they often feel like they can’t do it, they get into this vicious cycle of, “I can’t do it, so why bother?” They’ll easily slide back.

This is very similar to smoking cessation with kids. In smoking cessation, we make a big effort to say if you slip up or relapse, that’s going to happen. Start over and keep on doing what you did well.

Q: Any other tips for helping kids establish healthy eating patterns?

A: Sometimes kids eat for emotional reasons rather than when they’re really hungry.

Q: So what are some helpful rules for that?

A: Portion size, to make sure that the kid doesn’t need to eat the same amount of food as his father. … One interesting thing that’s come up: It can take 20 to 30 minutes from the start of eating for the brain to recognize that you’re no longer hungry.

Q: So you can really pack it away in that amount of time, can’t you?

A: Yes. What I recommend is if the kid wants seconds, they wait 20 to 30 minutes. Parents should encourage kids to eat more slowly. Often they’ll tell me they see a major difference. The kid might get distracted or start feeling full.

Q: Any final tips to parents?

A: I think with kids … it’s real important to have concrete steps they can do rather than just say you’ve got to eat better and increase activity. It’s important to give concrete suggestions that they can follow or are willing to try.

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