Here’s the transcript from our info-packed Dec. 9 2011 interview with Dr. Kerri Boutelle about the 10 worst things parents unknowingly do to their overweight kids and tips for what does work. Just in time for your New Year resolutions!
Host Linda Frankenbach: Hello everyone, and welcome to fitsmiForMoms Radio. I’m Linda Frankenbach, the founder of fitsmiForMoms, which is an online community for parents of overweight kids. At fitsmiForMoms parents can find support and professional help, education, and particularly help around knowing what to do and what to say to your overweight children. fitsmiForMoms has a great companion site for overweight teen girls that’s called fitsmi.com. And at fitsmi teen girls find a supportive community of other girls like them. They also get professional advice, help about feeling better about themselves and looking good, and easy tools to use to help them get healthy.
Today on our show we are delighted to have with us Dr. Kerri Boutelle. Kerri is a psychologist at UC San Diego, she is an associate professor of pediatrics and psychiatry. She is an adjunct professor of pediatrics and epidemiology at the University of Minnesota, and Kerri, at UC San Diego, is involved in a number of things, and she has a practice in which she works with overweight children and their families. Kerri, lucky for us, has also been working with us on fitsmi and fitsmiForMoms, and she has appeared on the Dr. Oz show, and is really just a wonderful person, involved and dedicated to the issues—to helping overweight kids and their parents. And today Kerri’s going to draw from her experiences, share her thoughts on kind of New Year’s resolutions, best and worst things parents can do to help their kids, and we’re delighted to have her with us. Welcome Kerri.
Kerri Boutelle: Thank you very much.
LF: Before we get started, I love to ask the question, Kerri, what drew you to this field of work?
KB: I have an undergraduate degree in food science and nutrition, and have always been interested in food and how nutrition is developed, and how it affects the body. Over the years, as I went into clinical psychology, it became more and more interesting to me how nutrition and psychology interplay, and it was obvious to me that working in obesity was the best fit. I have done a series of adult trials and have now worked my way down to working with parents and kids.
LF: Terrific. And I’m sure with both your research studies and your work with parents and kids, you have a pretty rich understanding of a lot of the issues that both are faced with. We know that you have some really great and helpful thoughts on the kinds of things that parents should and should not do, and I think many parents are really quite confused about what those kinds of things are. So maybe we can get right to that, and start with the ten worst things that you’ve seen parents do, and, if you will, as parents listen to this, they can think about turning these around and doing the best things, which I hope you’ll get to. So, start us off. What are the worst things that you’ve seen parents do in your practice?
KB: So, and Linda, may I say first of all, that all of these things are terribly normal. Parents want to work with their kids. They want to try to help them. I mean, it’s that inherent parenting urge to have a better life for their children than they had for themselves, in so many words. And so when they see their adolescent gaining weight they automatically want to try to intervene. However, it often comes out in ways that, we know from behavioral psychology, don’t really work that well.
So the first thing that I work with families on, when I work with parents and overweight teens, is for parents to work on the level of, you know, I guess reminding kids, or kids would call it nagging. All parents worry about their overweight teens and they think about it all the time, a lot of parents worry about it at night, and so when they see their teen eating they automatically want to say something. Unfortunately what happens in that situation is that the child could develop some negative feelings, either low self esteem, or anger at the parent or other family members. And so I often tell parents that when they are having those worries and they want to say something, they need to stop and go do something else. Just break the cycle of stating their worries when they come to their mind, but present them to their teen at another time when both of them are more calm and can listen. And that’s the other trick, is when parents say something when it hits their brain, it is often not timed well. But if the same thing was timed well, it can be done very compassionately. So that is the number one thing that we tell parents to try to work on. And parents say to me, well what am I supposed to do? So we are going to talk a little bit more about that.
Another pattern that we see, and this is not all parents, again, as I make these comments, these are not all parents, but most parents have a few of these. Another thing that parents do is they try to ignore it. They think, if I don’t say anything then it’ll work itself out. Or, I don’t want to upset my child, or, I don’t want to talk to them about their weight because I don’t want it to impact their self esteem.
KB: Usually hoping—there’s actually been a number of papers recently that have shown that kids really don’t grow out of their weight. So in generations past they thought, oh, a chubby baby is healthy, and then they grow into a healthy adult. Nowadays chubby babies grow into chubby adults. And so ignoring it is not necessarily the best path either. Do you want me to go on?
LF: Please, please. Yes.
KB: Okay. Parents also try to use a lot of different ways of helping their children and motivating them. Sometimes they use guilt, and I don’t think that they mean to use guilt, but sometimes they do anyway. They try to get their child to do it for them, or do it for a variety of other reasons that the child feels guilty, and unfortunately guilt is usually not productive and it leads to negative feelings. And so if the teen feels sad or has low self esteem, then they’re more likely to overeat.
The other thing is that parents sometimes, parents will try a lot of different things. They’ll try offering money or prizes. I had one family who told their child that they’d fly them to New York if the child lost ten pounds, you know, and those kinds of things, although they sound motivating, are not motivating in the long term. All of the adult studies show that if you pay people to lose weight they only lose weight as long as you pay them. So I tell parents that, unless they’re planning on paying their teen for the rest of their lives, don’t pay them to lose weight. Find other ways to motivate them, which we will talk about at the end of this.
Other things that parents do is, when they get anxious or they worry about their kids’ weight, they say something to their teen in the midst of an eating episode. So just say your kid’s at a buffet or they’re at a birthday party, or they’re at Christmas or Hanukkah dinner. That is not the right time to remind them to eat less. In fact, research shows that when people’s emotions are high, that they cannot hear comments like that as well. And so one of the things I tell parents to do is to talk to their child again when the child is calm and when the parent is calm. A lot of times when parents are worried, they’re also not very calm and words come out sometimes more harsh than they meant them.
KB: Another thing—as the holidays come up this is interesting, that we probably need to talk about—is don’t talk to your teen about their weight in front of other family members. You know, and parents don’t mean to do this, but sometimes it happens, and again that leads to negative feelings, which needs to emotional overeating. I have had parents also ask other people to talk to their teen about their weight, so the grandmother, or the cousin, or the teacher. You know, it may work sometimes, most likely it doesn’t, but then the kid might end up resenting the involvement of other people.
LF: Can I stop you on that one for a second?
KB: Yes, please do.
LF: And ask, you’re a counselor to kids. So in a way, if the parent talks to the child and wants to introduce the child to you and to a program, that’s sort of bringing someone else in. Is there a good way to do that?
KB: Usually I talk to parents, and I was going to cover this at the end, but we can start now. I talk to them about how to talk to their kid about weight, and how to motivate their child. So this list that we’re going through right now, Linda, are all things that really don’t motivate kids. In fact they demotivate them, or lead to emotional berating. So at the end we’ll talk about how to talk to children and teens in an open and supportive manner, and then how to use that conversation constructively. Does that make sense?
LF: Okay, good. Great.
KB: Okay, let’s see. Sometimes, for teens in particular, as their brain develops there are certain times that they can tolerate direct, face-to-face confrontation, and then there are other times where parents tell me things like, I get more information out of my kid in the car than I do when I talk to them at dinner.
KB: So it’s very possible that bringing weight issues up, again when everybody’s calm, in small little bursts, instead of, your father and I or the family and I want to sit down and talk to you about your weight, might be a better way for adolescents to learn.
Let’s see, other things that we’ve seen parents do—I talk to parents about not wanting to be the food police—so the person who is monitoring the kid’s food. You may think that it’s important that the parent counts how many calories they’re eating, or that they should be overseeing the adolescent’s entire eating. Problems with that are that adolescents are starting to separate themselves from their families, and although this method works pretty well with younger children, with kids that are twelve and older, you know, especially as you get into the later teenage years, their job during those years is to learn to start to manage these things on their own. So instead of parents becoming the food police and over-managing everything for teenagers, we try to help them work collaboratively as a team.
Last, but not least, parents often say, I don’t want to talk to my kid about their weight because I’m worried that it’ll impact their self esteem. That makes total sense to me, however the majority of kids know that they’re overweight. I just think that not talking about it can almost be like the elephant in the room in so many words, and the majority of teenagers want to lose weight, they just don’t have the right skills or the ability to do it. And that’s where the parents come in.
LF: Right. Interesting. So now we step back and need to ask, so what are the best things that a parent can do to help their teen manage their weight?
KB: Exactly. And I think this is going to be the most useful part for parents.
LF: Well, it’s good to set up the problem, right? I have a feeling many parents will find themselves in something you just said.
KB: First of all, the number one thing that parents can do, as you’ve heard me say a number of times, is to talk to children when it is not emotionally charged, and not to bring it up the other 24 hours a day. You know, so don’t remind the kid about being overweight and don’t remind the kid about overeating all day, but set aside a time when the teenager is calm and when the parent is calm, maybe before they go to bed, or right after school, or in the car on the way to school, to talk about the child’s weight, and the parent’s worries about the child’s long term health. It’s a good time to try to get the teen to talk about whether they’re worried about their weight. I have had teenagers say, I’m not worried about it, I don’t know why my mom’s talking about it. And then I have other kids who say, of course I’m worried about it. You know, and all variations in between. It’s important to try to understand why their teenager is worried about it.
So parents sometimes think that teenagers are worried about the same things we are so, diabetes risk, long term health risk. That means close to nothing to teenagers. Things that mean things to teenagers are more immediate. So being able to wear clothes that other kids wear, being able to sit on the chairs at school like other kids do. Not being teased. Being able to run at gym without being winded. Those are the kinds of things that mean more to teenagers than long term health risks. And I often tell parents that if your kid comes in and talks about how I’m worried about if I’m going to get cancer when I’m forty, they’re probably just parroting back what providers and parents have said to them. To the majority of kids that’s so far away that they can’t understand it. Getting your teenager to talk about which pieces of this are important related to their weight is really, really important for helping motivate them. Go ahead, sorry Linda.
LF: Terrific point. A lot of entities, people who are trying to help kids, want to stay away from always talking about weight, and they want to use words like, get fit, get healthy. What do those words mean to teens? Do they have an impact in this context?
KB: Well, I think it’s tricky because again, healthy and fit are long term goals for teenagers, whereas overweight is something more immediate.
KB: And I think if you talk to kids—I think in general public health intervention. So where they’re going into the schools and they’re doing more media campaigns. Those should be the softer language, the get fit, get healthy kind of stuff. When parents are talking to their kids directly, it’s okay to use that language, but it’s also totally okay to say, I’m also worried about your weight. What are you worried about for your weight? You know, if you talk to kids, what are you worried about with not being healthy? You know, again that’s an abstract concept to them. You need something that’s more concrete.
LF: Right, yes.
KB: So, like when I talk to kids I say, you know, what is it about your weight that bothers you? And many times they can tell me stories and almost every teen, every overweight teen I have ever seen has talked about being teased. And so getting rid of some of those negative feelings at school, being able to wear the clothes that the other girls or boys wear, being able to keep up on the basketball court. Those are things that are more immediate to teenagers than these other pieces. I’m certainly not opposed to it, and there have been a couple papers recently that have said that parents like that language better than they like talking about their child’s overweight, but when you’re dealing with kids directly you have to use something that will motivate them in the current moment.
LF: Right, understood. Good points.
KB: In terms of—to keep talking about the positive things that parents can do. You know, identifying the few things that impact the child today in terms of their weight is key to helping motivate them to change. So, as I mentioned, parents try to motivate teens in a lot of different ways. They use guilt, they use money, they use prizes, they use all those kinds of things, but really all the research on what’s called motivational interviewing shows that you need to use things that are important to the teenager or, you know, if you were doing it with a parent, with a parent. You know, so that’s why it’s important to have that conversation about how their weight is impacting them today.
Parents need to do it in a supportive manner. You know, being overweight is not the kid’s fault. There is a lot of, lot of data that suggests that there is a huge genetic biological component. And so I often tell kids that, that look, you know, it’s almost like managing another chronic disease, like diabetes. If a kid got diabetes, or a teen got diabetes, you wouldn’t blame the child for having diabetes. In no way should the child feel blamed about being overweight. Now it’s one of these chronic problems that needs to be managed behaviorally, so the answer is still behavioral even though there’s a biological component, the answer is still behavioral, however you want to kind of alleviate some of that guilt. It doesn’t give someone the okay to go free-for-all, but it says look, you’ve got this body, you gain weight like this, and so we need to come up with some strategies to help you manage that so that long term it doesn’t impact your health.
LF: Might I stay on this biological component for a moment. In a world now where 40% of kids, approximately, are overweight, obese, are we looking at biological components in all of those kids?
KB: Can you be a bit more specific? There’s a lot of research about the biological component.
LF: I guess, let me put it another way. We have such large numbers of kids and large numbers of adults now—much larger than we had 30, 40 years ago—who are overweight or obese. And I know years ago people used to say, gee, I have a glandular problem and that’s why I’m overweight. And that may have applied to some. But with the large numbers we have now? Is it biology that you’re saying is very important in all those cases? Or just some?
KB: Well, I would say that it’s not a yes or no question, but a continuum. So biology plays a role in all of the cases, but for some it probably plays a much stronger role, and for others it plays a lower level role. So, you know, if you talk to people in public health they would say, you know, genetics can’t change as quickly as we’ve seen the obesity epidemic rise. So, you know, 40 years ago when I was in grade school—I’ll just tell you—there were one, maybe two obese kids. Now it’s 30 to 40%. So what has changed? Right?
KB: Our genetics probably haven’t changed, but all of the things we’ve been exposed to in our environment has certainly changed, as has the food supply and our access to physical activity. And so, you know, unfortunately this is one of the complex problems that there is no one answer. So people often hope that I’m going to give them the magic pill. You know, oh, if you eat this diet, then that’s going to work for you, or oh, if you do this level of physical activity it’s going to work for you. And today, I mean in the last couple years there’s been a lot more research in this area of how these things fit for certain people, and that there may be subgroups of overweight kids. You know, kids who put on weight because of X. Kids who gain weight because of Y. You know, some of these are definitely psychological, but there are also biological components. Does that answer your question?
LF: Okay, so back to your list. That’s helpful, thank you.
KB: Okay, so other things that parents can do, again, is to identify these specific reasons why kids are motivated to manage their weight, and then try to tie that to how they can change it. And the concept is to try to make it a team based approach. A way that parents and teenagers can talk directly to each other about this and work towards it. Kind of like they do with homework. You know, if the child is getting lower grades than they did before, the parent and child might sit down with a counselor or they might sit down alone, and say, here’s our plan to change it. So the same thing should be done here. You know, the teen’s overweight, they want to change it because they want to be more like other kids, they want to not be teased, they want to date. Let’s figure out what we need to do. And so there are kind of a series of intervention points that parents can do.
The number one thing that parents should do is get the majority of high calorie, calorically dense food out of the home. Not entirely, but all those kind of snacky kind of foods. It is not fair to ask the overweight teen not to eat the brownies that are sitting on the table. You know, parents just have to not have them be there. If they’re going to eat those kind of tempting, really yummy foods in the house, then they should keep them up on a high shelf, but have fruits and vegetables out on the table, have fruits and vegetables available in the refrigerator at eye level, you know, and make all those home environmental changes. I have had a lot of parents who say that that’s really hard for them because my spouse, or because my other child who doesn’t have a weight problem can still eat cookies. And I remind them that cookies aren’t good for anybody no matter what their weight is. It’s a treat and there’s nothing wrong with it, but even your thin child shouldn’t be eating a box of Oreos every day.
KB: You know, so setting up a healthy home environment that’s focused on cooking meals, cooking more meals together as a family is another thing that parents can do, and eating less fast food, and eating less in restaurants. Plating up food before they go to the table and eating as a family there, and trying to encourage the whole family, not just the overweight kid, to have less seconds. Those are some things that parents can do at home that are pretty simple.
Other things, you know, if we want to talk about physical activity, there are ways that parents can help kids get more physical activity. You can make it a tradition to go for a family walk with the dog after dinner. You can make Thanksgiving traditions being walking and playing football instead of watching it on the television. There are all these things that parents can be responsible for, and the best part about this is you don’t have to tell the teen you’re doing them. You can just do them.
KB: They might notice.
LF: Hopefully they do.
KB: Yes, but it’s something that parents can do without having to engage their teen to help them. I’m not saying that all things should be like that, but these are some things that they could do.
The other big thing, especially as the holidays come up, is that people, parents and teens, should think about pre-planning. And I believe that the majority of families that do well in terms of managing holidays and tricky situations like birthday parties, are the ones that plan ahead. Okay, so Mary and her daughter Sally are here, right? And Mary says to Sally, “I know we have this big Christmas party this weekend, or Hanukkah party, or whatever it is. Let’s talk about how we can eat healthy there without completely blowing everything we’re trying to do at home.” That kind of pre-planning and conversation ahead of time, even if it doesn’t work out, is worth doing, and it also trains the child in what’s called self-regulation. Like planning ahead, being able to manage impulses, those kinds of things. And so I often think that families that manage the holidays well, or actually manage to lose weight together, are families that can do that well together.
LF: Good. That’s a list.
KB: I know, I know.
LF: I was just going to say, that’s a list, and if—I hope our parents got it down, but I think we will put this up on a blog so that they can see it again—but I would suspect even if you did half of those things you’d be well on your way. It’s true.
KB: I have two more things.
LF: Two more, here we go.
KB: Things that parents and teens can do together is check their weight. I tell families to check their weight on Mondays and Fridays because on Mondays you can catch what happened over the weekend, and there’s a good amount of data that checking their weight keeps people regulating their eating behavior better than if they don’t check it. So teens will go into the doctor and they’ll be a bit surprised, you know, oh, I gained ten pounds. Really? And if they’re checking their weight they know that their weight is going up and they can adjust what they’re eating or physical activity accordingly. You know, not to stick your head in the sand, but to just pay attention to the data.
And then there’s one more thing that we prescribe as part of treatment programs that I think the majority of parents probably know about, but we ask parents and kids to track everything they eat. Right? I had a parent in clinic last week who said, “Nothing passes these lips until it gets on the paper or on the phone first.” And what is that about? It’s not because we’re interested in counting every single calorie that you eat. It’s about paying attention, and the trick with regulating weight for overweight teens and their parents, is to be able to pay attention very closely to what they’re doing. It’s almost like training for sports, right? If a professional basketball star was going to play basketball and he wanted to practice shooting baskets. He would pay attention to how his wrist is angled, he would pay attention to how high his elbow is, or whether or not he is tensing his shoulder. That kind of intensive paying attention brings what we call self-regulatory training. It’s the same thing for weight. You have to pay specific attention to the behaviors that could result in weight gain.
So those are the things that I would recommend, especially with the holidays coming up.
LF: Terrific. Now you run an adolescent weight program in a clinical environment. Can you tell our listeners a little bit about what happens in those kinds of programs, and who are they for?
KB: We run a series of research and clinical programs. Our program here at UCSD, we run a series of research trials where we get money outside to kind of test one thing versus the other. For our clinical program we provide those to anybody who calls in so that they have that option. And also for the families who don’t fit into our research programs for whatever reason. We want to be able to provide services to anybody who comes in. We have programs specifically for teens that are individual, for the teen and parent only—you never work with just the teen alone because they live in a house with other people—engaging the parents at whatever level is necessary. We also do some psychological counseling about the other issues that go along with being overweight, like depression, anxiety, sadness, anger, those kinds of things.
But our programs, we also have group-based programs, and for teens in particular it provides a community, like fitsmi does, in where kids can talk to each other about what they’re facing and what they’re struggling with. And so our group-based programs, they’re pretty structured, they’re almost like classes where we teach kids about emotional eating, we teach them about writing their food down, you know, and we really play the role of keeping people on task, because without someone helping someone stay on task, it is very easy to slip.
So those are the kinds of things. And then for our parenting group, when we have our teen groups, our parenting groups focus specifically on positive parenting techniques, and how to implement praise and reinforcement, and to help your child talk to you about their weight.
LF: That is very helpful. I think it’s great for parents to understand what goes on in those kinds of programs. They are all over the country. We will have more on our website about that. And that’s actually a good segue for me to just mention that Dr. Boutelle is right now working with us on offering online a variety of different kinds of coaching services for those who would like to do a little bit more than what we do on fitsmi right now.
Dr. Boutelle, thank you so much. Those were great pieces of advice. I hope parents got them. We’re going to put them up on the website and we hope that they will form the basis of some terrific New Year’s resolutions. Thank you so much for your time, and happy holidays.
KB: Thank you for your time and attention. Happy holidays to you.
LF: Thank you. Bye-bye now.
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