Childhood obesity: “There is no one correct method”

Do you have a child who suffers from obesity? As a parent, helping your child lose weight can seem difficult. But effective help is available, say researchers at Karolinska Institutet.

Paulina Nowicka. Photo: Mikael Wallerstedt.

Bodies, both large and small, need to exercise and eat nutritious food. But it can be hard to get the entire family to live up to the ideals of health. Around ten per cent of all children of pre-school age are now overweight and around two percent have developed the disease obesity.

“This is a big increase compared with the 1980s. We are seeing the effects of that fact that both sedentary lifestyles and access to calorie-rich food have increased in society,” says docent Paulina Nowicka, who is researching childhood obesity at Karolinska Institutet’s Department of Clinical Science, Intervention and Technology.

If a child is overweight or obese in childhood, there is a greater risk that they will remain overweight as an adult. In the long term, being overweight leads to poorer health, with an increased risk of diseases such as cardiovascular disease and diabetes.

Overweight children usually have a genetic susceptibility that means a calorific diet and sedentary lifestyle have a more detrimental impact on them than on others. It is more difficult for them to burn off an excess of calories than it is for others. According to Paulina Nowicka, the most effective way to achieve a healthy weight is to reduce the energy taken in via the diet, which should be done as soon as possible.

“But food is love; it can be a sensitive area to restrict. Parents are also constantly bombarded with different messages and opinions about how they should take care of their children and many are uncertain about what method is best,” she says.

And when, as a parent, you have decided on tangible goals – such as reducing your child’s sugar and fat intake and giving them more vegetables – there are still many questions that remain. How do I push through changes without ending up in a viscous circle of nagging and arguments? How do I bring the indulgent grandmother on board?

In 2011, with questions such as this in mind, Paulina Nowicka began the “More and Less” study, which compares two different methods for tackling childhood obesity at pre-school age. One is the traditional treatment, which involves children and parents meeting paediatricians and receiving lifestyle advice. The other is based on groups of patents who meet ten times over the course of a year together with two trained supervisors. The parents in these groups discuss their experiences and are presented with themes and exercises that they then implement at home. The idea is to provide not only knowledge and health advice, but also assistance with the tangible challenges of parenthood.

“One basic premise is that there is no method that works for everyone, instead each patent is given help to find what works in their family,” says Paulina Nowicka.

But this does not mean that all methods are equally good. The treatment is based on a range of methods that research has shown to be effective. Paulina Nowicka uses that classic struggle with vegetables as an example.

“One method that has proven effective is to use the attraction of small rewards, for example the child receives a nice sticker if they taste a carrot. The goal is to make something a habit. The majority of children who are tempted into tasting vegetables in this way then continue by themselves,” she says.

However, she advises against using food or treats as a reward.

“It is better to find other positive things that the child can look forward to. You can perhaps go to the swimming pool or go something else that the child likes. The majority of children like doing activities together with their parents,” says Paulina Nowicka.

One common question concerns how to talk to your child about weight. Is there a risk that the child will lose self-confidence, become fixated on their weight and perhaps even develop eating disorders?

“Research shows that treatment of childhood obesity does not lead to eating disorders. Nor is usually necessary for parents to address the subject, but you should know how to answer the question in an appropriate way if the child brings it up themselves,” says Paulina Nowicka.

A tired, hungry four-year old who is craving sugar is not inclined towards change. You have to be clever so as not to stir up bad blood unnecessarily. It is often best to exercise control invisibly and pull strings behind the scenes.

“Prevent power struggles by not buying things you don’t want the child to eat. Be one step ahead and don’t walk past McDonald’s if you know the child likes going there; take another route home,” says Paulina Nowicka.

The list of strategies is long. It is important to do what has been shown to work. The research results that have emerged from the “More and Less” study so far indicate a significant difference in children’s BMI (body mass index) and waist measurements in favour of the parental support therapy, compared with the standard treatment.

“The parent’s also very much appreciate the contact they have with each other; sharing experiences is an important part of the treatment,” says Paulina Nowicka.

She is convinced that the treatment programme is on the right track, but much can still be improved. One area of for development relates to cultural diversity – how is the treatment to take into account the fact that views on food can vary depending on the family’s background? Another relates to the significance of stress.

“How do the often high levels of stress among the parents of young children affect their ability to give the family a healthier lifestyle? More research is needed here,” says Paulina Nowicka.

Paulina Nowicka dismisses six claims about children and food:

  1. My child will grow out of their overweight by themselves. “Unfortunately not. Children who are large at birth often continue to be so. The child needs help to lose weight”.
  2. Artificial sweeteners are harmful. “No, there is no scientific evidence to support this. Products containing artificial sweeteners can be a good transition when reducing sugar”.
  3. Diet X is the solution. “Forget about this and focus on a varied diet, but this shouldn’t be overdone either. It is OK to always make the same five dishes the children like”.
  4. You should not eat in the evening. “No, it depends on the circumstances. For example, a teenager who comes home from playing sports needs to eat, even if it’s late”.
  5. It is important to eat a certain number of meals per day. “Not really. Routines are important, but it is the amount of calories that affect weight, not the number of meals”.
  6. Only bad parents give their children sweets. “No, but it is important to limit sweets. If the child otherwise eats a varied, nutritious diet, there is space for a limited amount of sweet things”.

Text: Ola Danielsson, first published in Medicinsk Vetenskap nr 4 2016