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TOOLS TO HELP HEAVYSET TEENS & CHILDREN
The following is an excerpt from "Friendly Mirrors and Contented Closets"
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What to Do for Children Whose BMI Falls at or Above the 85th Percentile. Because these
children are at risk of being overweight into adulthood, it is important to encourage these
children to both increase their activity and to limit calorie-dense foods such as peanut butter,
eggs, butter, candy, and soda. It is important to educate these children about the importance
of increasing their body's fuel requirement and the health benefits of getting regular exercise.
Regarding food intake, I typically discourage the elimination of certain foods from a child's
repertoire, and encourage that these foods be limited. Educating this child about calories
and how to make better food choices will eventually translate into a weight change. Refer
to Appendix F in order to be sure that your child consumes sufficient calories to maintain
growth, immunity, and sexual development. Rather than encourage the child to focus on
counting calories, try to help them keep a food journal that you review each night. If you
estimate the calories consumed, you and the child can monitor progress together. Further,
as the adult counts the calories, the child is encouraged to listen to their hunger and fullness
cues. Together you can both explore whether or not the child's hunger and fullness cues are
calibrated correctly. Vegetables are emphasized as healthy, filling, and low in calories. Try to
avoid words such as "too big" or "fat." It is important to emphasize to these children that exercise
will help their blood circulate more and will help their heart muscle strengthen. Emphasize
to them that exercise will help them become healthier, stronger and also that if they eat too
many calories, their body will store extra fat, which could lead to health problems much later in
life. You don't want to alarm a child and cause them to worry about their current health status.
Rather, you want to emphasize that accumulated fat storage over the course of a lifetime can
lead to medical problems later. The most reasonable and realistic goal is for these children to try
and limit further weight gain as they grow taller. This, in and of itself, will help their BMI stabilize
as they age. Encourage these children to listen to their hunger and fullness cues and avoid
eating if they are not hungry. The Levels of Discomfort Scale in Chapter Two can help the child
eat only when they feel certain levels of hunger and to stop eating just prior to feeling full.
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What to Do for Children Whose BMI Falls Between the 75th and 85th Percentile. For this
group of children it is best to only encourage them to exercise regularly. Dietary restrictions
are not recommended in order to minimize shame and binge eating. The importance of
eating fruits and vegetables needs to be emphasized. Low calorie fruits and vegetables need
to be balanced with high calorie health foods like peanut butter, cheese, and eggs. Refer to
Appendix F in order to be sure that your child consumes sufficient calories to maintain growth,
immunity, and sexual development. If a child continues to gain weight, then physicians need
to consider that the child's parents need to be more involved to get the child more active.
It is important for this age group to not become preoccupied with avoiding or eliminating
any foods from their diet so that they don't become overly obsessed and anxious about their
eating habits. To encourage these children to avoid or eliminate foods could potentially result
in an eating disorder at some point. Try to avoid words such as "too big" or "fat." It is important
to emphasize to these children that exercise will help their blood circulate more and will help
their heart muscle strengthen. Similar to the above, the most reasonable and realistic goal is
for these children to try and limit further weight gain, as they grow taller. This, in and of itself,
will help their BMI stabilize as they age. Encourage these children to listen to their hunger and
fullness cues and avoid eating if they are not hungry. The Levels of Discomfort Scale in Chapter
Two can help the child eat only when they feel certain levels of hunger and to stop eating just
prior to feeling full.
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