Talking with Your Children About Weight and Health

Transcripción

Talking with Your Children
About Weight
and Health
Discussion ToolKit
Weigh In
Facilitator Handbook
Table of Contents
Purpose ................................................................................................................................................................... 2
What’s Inside? ......................................................................................................................................................... 3
Getting Started & Tips for Hosting a Discussion ..................................................................................................... 4
Your “Weigh In” Discussion Timeline ...................................................................................................................... 5
Additional Questions ............................................................................................................................................. 10
Need Your Feedback!! ........................................................................................................................................... 10
Purpose
The materials included in this kit have been created to help you host a
discussion with parents on how to talk with their children about weight
and health. The goal is to prepare parents to share important health
information with their children and to address questions their children
may ask.
2
What’s Inside?
Inside this kit:
RESOURCES
Weigh In: Talking to Your Children about Weight + Health
We’ve provided one printed copy of this free guide in both Spanish and English.
Electronic versions are saved on the enclosed USB flash drive and also are
available online at www.weighinonobesity.org.
PowerPoint slide presentation, Talking with your Children about Weight
+ Health
We’ve developed an easy to follow presentation to guide your discussion along
with slide-by-slide notes that are included in the “Your Weigh In Discussion”
section below. An electronic version is saved on the enclosed USB flash drive
and also is available online at www.weighinonobesity.org.
HANDOUTS
Weigh In Postcards
20 postcards with Weigh In guide details and website address to hand out at
your meeting.
Act Locally: A Guide to Philadelphia Resources for Families
You can make copies of this printed guide for your meeting guests. An
electronic version is saved on the enclosed USB flash drive and also is available
online at www.weighinonobesity.org.
TECHNOLOGY
A USB flash drive with all of the above materials.
3
Getting Started & Tips for Hosting a Discussion
Get the word out. Send an email or invitation to a group of people (friends, neighbors or people
you know from a community center, worksite, place of worship or your child’s school). We
suggest that you keep the group to no more than 15 people, so everyone can have a chance to
speak.
Set the date and time. Choose a convenient time and location. There may be space at a local
school, library, rec center, place of worship or company. If your group is small, a local coffee
house might be a good spot to meet. Note that the Weigh In discussion is designed to be a onehour long meeting.
Prepare for the talk. Read through the materials and review the slides so you will feel confident
and prepared to lead the discussion.
Everyone gets a turn. One of the most important parts of the meeting is to make sure everyone
can contribute. Make sure all the parents have a chance to talk. And feel free to share your own
experiences if and when it is appropriate.
Have fun! The topic is serious, but it is best if parents leave feeling positive and supported with
information. Keep things upbeat, smile and have fun!
4
Your “Weigh In” Discussion Timeline
Below are slide-by-slide guidelines that coordinate with the PowerPoint presentation.
Also provided is a recommended amount of time you might spend on each slide. You
know your audience best, so trust your own judgment about how to pace your
discussion.
The bolded bullet points below match the headlines on each slide.
5 MINUTES
Before We Get Started
A good start is to have an “ice breaker” question to help people get to know one another. Ask each person to
share:
His/her name
What was your favorite childhood game to play?
2 MINUTES
What We’ll Discuss Today
This slide will establish what you intend to cover. The talk is broken up into 6 areas:
The Challenges of Talking with Children About Weight and Health
A New Guide That’s Here to Help
Tips for Talking With Children about Weight and Health
Let’s Talk – What Would You Say?
Local Places Where We Can Take Action
The KEY to a Good Talk
5 MINUTES
What do you think parents say is the most difficult conversation to have with their child?
This question is meant for the meeting attendees to provide their thoughts.
1 MINUTE
Believe It Or Not…
This slide reveals what may be the unexpected answer that:
A WebMD Health survey found that parents of teens find it more difficult to
talk about weight with their child than talking about sex, drugs, alcohol
or smoking!
5
3 MINUTES Why do you think parents find it so hard to talk with children about weight?
This provides an opportunity for parents in room to talk provide their thoughts on why it’s so hard to discuss weight.
You will want to listen carefully to the group’s responses, and even write down what people say on a flip chart or white
board if there is one in the room.
5 MINUTES Some Reasons Parents Give for Not Wanting to Answer a Child’s Question About Weight
This is a list of what researchers have found to be common reasons parents say talking about weight with their child
is difficult.
Read aloud some of the common reasons (listed on the slide):
– “I don’t know what normal weight is.”
– “I don’t think my child has obesity. I think she/he is beautiful.”
– “If I talk with my child about weight, he/she may develop an eating disorder.”
– “I have tried, but nothing works.”
– “I am tired of being the food police”
Feel free to pause here and have some further discussion about how the parents in the room feel about these reasons.
Can they relate to these responses?
2 MINUTES True or False and Answers – You Are Not Alone
The next two slides help show that parents may or may not have the right answers, but they’re not alone.
True or False – You can do a show of hands for true/false for each statement:
– There are many guides and resources available for parents who need help talking with their children about weight.
– Most parents do not know what to say to their child about weight or how weight can affect their health.
– Only 1 in 100 children in America are overweight or obese.
Answers – You Are Not Alone – this reveals the answers:
– There are many guides and resources available for parents who need help talking with their children about weight.
ANSWER: False - VERY FEW guides exist to help parents.
– Most parents do not know what to say to their child about weight or how weight can affect their health.
ANSWER: True - Most parents struggle with what to say and how to say it. And they don’t know where to turn
for help.
– Only 1 in 100 children in America are overweight or obese.
ANSWER: False - ONE in EVERY THREE children in America are overweight or obese.
1 MINUTE
A New, Free Guide Helps Parents Answer Tough Questions About Weight
This slide allows you to introduce the Weigh In guide to the parents. You can briefly highlight the guide as:
A free, online conversation guide geared to parents of children ages 7-11.
A tool that offers practical information on how to compassionately respond to real-world scenarios about weight and
health including:
– BMI Confusion
– Weight Bias
– Cultural Differences
– Inter-family Weight Differences
– Body Image
– Parental Obesity
– Bullying
If appropriate, you can also note that the guide is also available in Spanish.
6
2 MINUTES
Tips for Talking to Your Kids About Weight
This slide provides some helpful ways for parents to have a productive and engaging conversation with their
children about weight. If possible, you may want to ask different participants to read the tips, one at a time:
Be Positive and Supportive. – Supporting a child helps him/her to build confidence and self-esteem, no matter what
the situation.
Be Realistic and Specific. – Taking small steps helps make any goal – whether health or otherwise – seem possible.
And it’s important for parents to be specific about what to do. After all, the more specific you are with your child, the
more things are likely to get done. For example it’s like the difference between telling your child, “Your room is a
mess. Clean it up.” versus, “Your room is a mess. Please put your shoes in the closet and make your bed.”
Keep the Conversation Open. – Parents should ask open-ended questions and ask kids how they feel. It may help
children feel that it’s ok to speak openly.
Highlight Health. – Perhaps one of the biggest lessons that a parent can learn is that weight is an issue of health, not
how a person looks. Talking about extra weight should be no different than talking to your kids about other health
issues kids may have, like asthma or ADHD.
5 MINUTES
So, Let’s Talk
This slide is a question to ask the meeting attendees to get their first reaction on how they would react to a difficult
situation. You will read the text on the slide to set up the topic of discussion for the group:
What would you say if: Your child is behaving badly, acting withdrawn and says he doesn’t want to go to school. When
you ask why, he says that a bunch of kids have been teasing him and calling him fat and ugly.
Gather responses from the group.
1 MINUTE
A Little Bit About Bullying
This slide is meant to provide some brief facts on bullying including:
Bullying has gotten worse over the years.
A main reason for bullying at school is weight. Weight teasing is more common than teasing for sexual orientation,
race/ethnicity, physical disability or religion.
Bullying is not just about letting kids be kids. The consequences of bullying can
follow a child into adulthood.
There are MANY resources available to help guide parents on ways to help a
child who is being teased
7
10 MINUTES “Weigh In” Talking Tips (Slides 14-19)
These slides include suggested talking points that parents may use if they believe their children are being bullied
about their weight. You’ll notice that the points follow the Tips from the previous slides. You can have members of
the group take turns reading the points on a given slide, or read them aloud yourself. Please let parents know that
these points are not meant to serve as a script, but rather ideas for how to use the tips in guiding what to say.
First, Be Positive and Supportive
– I’m so sorry this is happening and I’m really glad you told me. Teasing is not fair and is wrong. It really can hurt
your feelings.
– One of the hardest things about teasing is that they are talking about your weight in terms of how you look. They
are making you feel like how much you weigh is a measure of who you are as a person.
– And it is not.
– You are…
(List some positive things about your child, like, caring, a good friend, smart, a hard worker…)
Second, Highlight Health
– Weight is a measure of your health and carrying extra weight can hurt your health.
– I love you and I don’t have a problem with how you look, but as your parent, I’m concerned that you are carrying
around extra weight and this can hurt your health. It can also mean that you don’t have as much energy or get to
do the things that you really like to do.
– Carrying extra weight means your body has to work harder than it needs to. Just like when you don’t like it when
your teacher gives you extra homework, your body doesn’t like to do more work than it has to.
– If we can help your body stop overworking, we can make sure you have enough energy to do things that you like
to do and what makes you happy like (ideas here).
Third, Keep the Conversation Open
– How do you feel about your weight?
– Remember, when you’re carrying around extra weight, it’s not about how you look; it’s about how you feel.
– Let’s talk about how we might get to a weight that’s healthiest for you and helps make it easier to do the things
you want to do.
Fourth, Be Realistic
– Losing extra weight is not easy for anyone, especially for someone your age. It’s also very hard to do alone. There
are a lot of things that can get in the way of healthy eating and getting enough physical activity every day.
– Ask for examples specific to your community, home or family routine that might present a problem.
– But, it’s really important, so let’s work on it together.
Be Specific
– What are some things that we can do together to get healthy? Let’s pick a couple…
Do you think we could increase the number of minutes we are active every day?
Could we play more together and play more outside?
How about shopping for healthy foods as a family?
Do you think we could increase the numbers of fruits and vegetables we eat?
Would you like to help me cook dinner a couple of nights a week?
8
5 MINUTES Healthy Places to Go, Things to Do in Philly
This slide introduces the Act Locally guide that is included in your Toolkit and is available online. The guide lists just
some of the ways to get healthy in the area and includes the ideas listed on the slide:
Increase the number of minutes of physical activity in a day
– Check out the Schuylkill River Trail, a bike path with an eight-mile loop between Center City and East Falls. From
Schuylkill Banks to East Falls, the trail is a wide paved surface suitable for rollerblading, walking, running and
cycling.
Create family play time and increase outdoor play time
– Head to Fairmount Park to access its many biking and walking trails.
Shop for or find healthy meals as a family
– Find out whether there is a Philadelphia Healthy Corner Store near you. Food stamps/SNAP are accepted at over
350 healthy corner stores.
Increase fruit and vegetable consumption
– Shop at farmers markets like those organized by “Farm to City.” See a map of Philadelphia Farmer’s Markets here.
Prepare Family Meals Together
– Sign up for Sunday Suppers, an innovative family-oriented meal program in West Kensington sponsored by the
nonprofit SHARE Food Program.
– In partnership with West Kensington Ministry, Sunday Suppers provides healthy shared dinners, increased access
to fresh local food and other food related support to families in the Norris Square area of Philadelphia.
Note: Feel free to pause here to discuss some other resources available in the area that may be suggested by the group. If
people have additions they would like to make to the guide, they can email them to [email protected].
2 MINUTES
Final Thoughts and Reminder KEY
This slide is meant to sum up your talk. Be sure to thank everyone for participating. Ask parents to remember this
KEY when talking with their child about weight and health:
KEEP in mind that weight is about your child’s health not how he/she looks, and tell your child that often
EXCITE your child about getting healthy, even though it’s going to take some changes and hard work
YOU are going to be there for your child, working together since he/she will need your help. A child can’t do
this alone.
1 MINUTE
www.WeighInOnObesity.org
This slide just provides the final closing with the website where the guide can be found online.
9
Additional Questions
The below questions can be used if you’ve gotten through all the material on the
slides and want to talk some more with your group:
1. What do you think are other health problems that can come along with having too much weight?
2. Are you surprised that weight teasing is more common than teasing over race/ethnicity, sexual
orientation or religion? Why or Why not?
3. A child with obesity is 10 times more likely to become an adult with obesity? Do you think this
matters? Why or Why not?
Need Your Feedback!!
Hearing from you is the most important way to help us continue to make a
difference. Email us at [email protected] and let us know what worked
and what didn’t. We’ll use your feedback to make improvements.
10
1
What was your favorite
childhood game to play?
2
I.
The Challenges of Talking with Children
About Weight and Health
II.
A New Guide That’s Here to Help
III.
Tips for Talking With Children about Weight
and Health
IV. Let’s Talk – What Would you Say?
V.
Local Places Where We Can Take Action
VI. The KEY to a Good Talk
3
4
A recent survey said parents
of teens find it more difficult
to talk about WEIGHT with
their child than:
• Sex
• Alcohol
• Drugs
• Smoking
5
6
“I don’t know what normal weight is.”
“I don’t think my child has obesity. I think he/she is beautiful.”
“If I talk with my child about weight, he/she may develop
an eating disorder.”
“I have tried, but nothing works.”
“I am tired of being the food police.”
?
What do you think?
Can you relate to any of these responses?
7
1. There are many guides and
resources available for parents
who need help talking with their
children about weight.
2. Most parents do not know what to
say to their child about weight or
how weight can affect their health.
3. Only 1 in 100 children in America
are overweight or obese.
8
1. There are many guides and resources
VERY FEW guides exist to help
FALSE
available for parents who need help
parents.
talking with their children about
weight.
2. Most parents do not know what to
say to their child about weight or
how weight can affect their health.
Most parents struggle with what to
TRUE say and how to say it. And they
don’t know where to turn for help.
3. Only 1 in 100 children in America are
overweight or obese.
FALSE
ONE in EVERY THREE children in
America are overweight or obese.
9
“Weigh In – Talking to your children
about weight + health”
•
Conversation guide geared to parents and
caregivers
•
Offers practical information on how to
compassionately respond to real-world scenarios
about weight and health including:
– BMI Confusion
– Weight Bias
– Cultural Differences – Inter-family Weight
Differences
– Body Image
– Bullying
•
– Parental Obesity
Get guide for free at www.WeighInOnObesity.org
10
Be Positive
and
Supportive
Supporting a child helps him/her to build confidence and self esteem,
no matter what the situation.
Be Realistic
and
Specific
Taking small steps helps make any goal – whether health or otherwise –
seem possible. And it’s important for parents to be specific about what to
do. After all, the more specific you are with your child, the more things
are likely to get done. For example it’s like the difference between telling
your child, “Your room is a mess. Clean it up.” versus, “Your room is a
mess. Please put your shoes in the closet and make your bed.”
Keep the
Conversation
Open
Highlight
Health
Parents should ask open-ended questions and ask kids how they feel. It
may help children feel that it’s ok to speak openly.
Perhaps one of the biggest lessons that a parent can learn is that
weight is an issue of health, not how a person looks. Talking about
extra weight should be no different than talking to your kids about
other health issues kids may have, like asthma or ADHD.
11
What would you say if…
Your child is behaving badly or
acting withdrawn and says he
doesn’t want to go to school.
When you ask why, he says that a
bunch of kids have been teasing
him and calling him fat and ugly.
12
• Bullying has gotten worse over the years.
• A main reason for bullying at school is
weight. Weight teasing is more common
than teasing for sexual orientation,
race/ethnicity, physical disability or
religion.
• Bullying is not just about letting kids be
kids. The consequences of bullying can
follow a child into adulthood.
• There are MANY resources available to
help guide parents on ways to help a
child who is being teased.
13
Now, let’s take a look at how a parent might respond to the
bullying situation with the “Weigh In” Tips.
Be Positive
and
Supportive
Be Realistic
and
Specific
Keep the
Conversation
Open
Highlight
Health
14
Be Positive
and
Supportive
• I’m so sorry this is happening and I’m really glad you
told me. Teasing is not fair and is wrong. It really can
hurt your feelings.
• One of the hardest things about teasing is that they
are talking about your weight in terms of how you
look. They are making you feel like how much you
weigh is a measure of who you are as a person.
• And it is not.
• You are…
– (list some positive things about your child, like,
caring, a good friend, smart, a hard worker…)
15
• Weight is a measure of your health and carrying extra
weight can hurt your health.
Highlight
Health
• I love you and I don’t have a problem with how you
look, but as your parent, I’m concerned that you are
carrying around extra weight and this can hurt your
health. It can also mean that you don’t have as much
energy or get to do the things that you really like to do.
• Carrying extra weight means your body has to work
harder than it needs to. Just like when you don’t like it
when your teacher gives you extra homework, your
body doesn’t like to do more work than it has to.
• If we can help your body stop overworking, we can
make sure you have enough energy to do things that
you like to do and what makes you happy like (ideas
here).
16
Keep the
Conversation
Open
• How do you feel about your weight?
• Remember, when you’re carrying around extra weight,
it’s not about how you look, it’s about how you feel.
• Let’s talk about how we might get to a weight that’s
healthiest for you and helps make it easier to do the
things you want to do.
17
Be
Realistic
• Losing extra weight is not easy for anyone, especially
for someone your age. It’s also very hard to do alone.
There are a lot of things that can get in the way of
healthy eating and getting enough physical activity
every day.
– Ask for examples specific to your community,
home or family routine that might present a
problem.
• But, it’s really important, so let’s work on it together.
18
Be
Specific
What are some things that we can do together to get
healthy? Let’s pick a couple…
Do you think we could increase the number of minutes
we are active every day?
Could we play more together and play more outside?
How about shopping for healthy foods as a family?
Do you think we could increase the numbers of fruits
and vegetables we eat?
Would you like to help me cook dinner a couple of
nights a week?
19
Taken from a Local Guide Created Just for You
Increase the number of minutes of physical activity
in a day
• Check out the Schuylkill River Trail, a bike path
with an eight-mile loop between Center City and
East Falls. From Schuylkill Banks to East Falls, the
trail is a wide paved surface suitable for
rollerblading, walking, running and cycling.
Create family play time and increase outdoor play
time
• Head to Fairmount Park to access its many
biking and walking trails.
• Find out whether there is a Philadelphia Healthy
Corner Store near you. Food stamps/SNAP are
accepted at over 350 healthy corner stores.
• Shop at farmers markets like those
organized by “Farm to City.” See a map of
Philadelphia Farmer’s Markets here.
• Sign up for Sunday Suppers, an innovative
family-oriented meal program in West
Kensington sponsored by the nonprofit
SHARE Food Program.
• In partnership with West Kensington
Ministry, Sunday Suppers provides healthy
shared dinners, increased access to fresh
local food and other food related support to
families in the Norris Square area of
Philadelphia.
20
Remember this simple KEY when talking
with your child about weight and health
K
KEEP in mind that weight is about your
child’s health not how he/she looks, and
tell your child that often
E
EXCITE your child about getting healthy,
even though it’s going to take some
changes and hard work
Y
YOU are going to be there for your child,
working together since he/she will need
your help. A child can’t do this alone.
21
“Weigh In – Talking to your children
about weight + health”
22
weigh in
Talking to your
children about
weight + health
A conversation guide for parents + adult caregivers of children.
Ages 7-11 years old
Welcome
“You know your child best and that makes
you the most valuable asset in communicating
with your child about weight.”
welcome | 3
Every day, parents and caregivers of children are confronted
with challenging questions and situations for which they
are unprepared.
For many, questions about a child’s weight are particularly difficult for an
adult caregiver to answer since feelings about overweight and obesity are
often complicated by both personal issues and the conflicting messages
communicated about weight through media and society at large. In fact,
a WebMD/Sanford Health survey found that parents of teens find it more
difficult to talk about weight with their child than talking about sex, drugs,
alcohol or smoking!
welcome
getting
started
talking to
your children
resources
But awkwardness won’t stop the questions from coming. As America’s
childhood obesity crisis continues, we can expect that the questions will
surface more frequently – and at almost any time:
• In the car driving to an activity
• While watching TV
• On the way to school
• At church
• Around the dinner table
• The list goes on and on…
A parent who searches online or in a local library or who asks a medical
professional can readily find several guides for talking with a child about
“tough” topics like sex or drinking. If those same parents looked for information
on how to address a child’s weight however, they will be unable to find much
that is useful or that goes beyond basic information we have heard for years –
like, just eat less and move more.
This void isn’t just another gap in the world of “DIY parenting.” It’s a pressing
health concern facing millions of families, and precisely the reason this
conversation guide is needed.
We hope the information provided here will help you navigate the important
and challenging task of talking with your child about overweight and obesity
in ways that are factual, practical and caring.
Here’s to your family’s health,
Scott Kahan, MD, MPH,
Ginny Ehrlich, DEd, MPH
Director, STOP Obesity Alliance
CEO, Alliance for a Healthier Generation
appendix
Getting started
Why a guide is needed –
and a few disclaimers, too
“With societal attention
on weight, children
may reach out to
the adult in their lives
with questions about
whether or not they
are “fat”, and what
they can do about it.”
Many factors have led to a nation where one in three children
is affected by overweight or obesity. This guide is not provided
to get to the root of the issue, point fingers or lay blame.
This guide is intended to help parents and caregivers talk with their children
about weight and health in ways that are factual, practical and sensitive to
the many different emotions that can come with the complex issues
surrounding weight.
Of course, even with the important information provided, the conversation can
still feel uncomfortable. That’s ok. Sometimes, we just have to be the “grown up
in the room” to help our children. Rest assured – you are not alone.
Understand that:
1
2
3
If a parent or adult caregiver wanted to start a conversation with
a child about overweight or obesity, there are few constructive
resources to guide the way
With societal attention on weight, children may reach out to the
adult in their lives with questions about whether or not they are
“fat,” and what they can do about it
There is a very strong likelihood that a parent – no matter what
they weigh – has his or her own biases about weight, which can
get in the way of constructive conversations with a child.
In short, this conversation is going to come up. Chances are it will be initiated
by your child. And you are going to want to be prepared. What’s most
important to know is that your child is not alone and neither are you. Parents
just like you are struggling with what to say to their children about weight.
Be positive! You know your child best and that makes you the most valuable
asset in communicating with your child about weight.
getting started | 5
A common barrier –
our own issues about weight
Weight is an issue that we all think about, and potentially
struggle with, in different ways. This is true for all parents,
wherever they fall on the spectrum of weight – from
underweight to normal weight to obesity. Recognizing
our biases is essential. But simply knowing we have
them is not an excuse to ignore a child’s questions.
There is no separating the role of the parent and a child’s ability to
overcome a weight problem. Children look up to their parents and
much of what they learn is based on modeling a parent or caregiver’s
behaviors. They can’t do it alone.
Some may wonder whether this isn’t just another parenting topic that
is getting too much attention...that the problem may not be as serious
as some make it out to be. But a lot has changed since the time when
YOU were a kid. We know significantly more today about the life-long
connections between weight and health – and those connections are
enough to warrant serious attention.
Today, we now know that:
Obesity is a matter
of health and is a
gateway to many
chronic diseases
and conditions.1
Heart disease, type 2 diabetes, high blood pressure, stroke, liver
and gallbladder disease, sleep apnea and respiratory problems,
bone and joint disorders including osteoarthritis, and some
cancers, among others.2,3
Adults with obesity may have been bullied as kids and may carry
memories from those experiences into conversations with a child.
Bullying has
gotten worse.
A child with
obesity is much
more likely to
become an adult
with obesity.
A main reason for teasing and bullying at school is weight
– weight teasing is more common than teasing for sexual
orientation, race/ethnicity, physical disability or religion.4
A child with overweight or obesity is up to 10 times more likely to
become an adult with overweight or obesity.5
welcome
getting
started
talking to
your children
resources
appendix
6 | getting started
What else is standing in the way –
if the issue was easy, we wouldn’t need a guide
There are many reasons a parent or caregiver might give
for not wanting to answer a child’s questions about weight.
We’ve listed below some of the more common reasons
because sometimes acknowledging the barriers is the first
step to overcoming them.
1
I don’t know what “success” is…normal weight? What is
normal weight anyway?
There are limited resources available for parents looking to help their child
to achieve a healthy weight.
“Being consistent is
key and a good
way to overcome
feeling like you are
“nagging” your child
to eat healthy.”
Unlike with adults, experts don’t yet know how much weight loss is
necessary in kids to start showing improvements in their health. But experts
do know that children who enter adulthood overweight or with obesity are
much more likely to remain overweight or have obesity as adults. Therefore,
experts agree that the goal for kids is to exit their teen years at a healthy
weight (or as your child’s pediatrician may tell you, this means below the
85th percentile on the BMI-for-age growth charts, which will be explained in
greater detail later in the guide).6,7
2
Isn’t losing weight just a matter of will power?
No, obesity results from a complex combination of genetics, environment
and health behaviors, including dietary intake and physical activity.8
3
What some call obese, I call beautiful.
Even though extra weight might be accepted and admired in a particular
culture, it doesn’t protect a child from possible health consequences or bullying.
welcome
4
If I talk to my child about weight, he/she may develop an
eating disorder.
Parents who approach weight in non-productive ways, such as teasing,
put their children at a higher risk for developing disordered eating
behaviors such as anorexia, bulimia and binge eating.9 There’s no
evidence that discussing weight as a matter of health, in a motivating and
caring way, results in psychological harm. This guide was designed to
encourage healthy, non-harmful ways to approach weight-related issues.
5
talking to
your children
resources
I’ve tried to help, but nothing works.
Many parents want their child to lose weight and feel frustrated when
nothing seems to work. They often blame themselves, which can turn
into negative criticism for their child.
What’s important is that there are lots of ways to improve health. Steps
like increasing physical activity or improving nutrition can help.
6
getting
started
I’m tired of feeling like the “food police.”
It is common for parents to feel like they are in a constant power struggle
with their kids in trying to get them to eat healthy. What’s most important
is for you and your family to determine your own rules for healthy eating
and occasional treats – and stick with it.
Being consistent is key and a good way to overcome feeling like you are
“nagging” your child to eat healthy.
Even when you come up with your family’s “healthy eating do’s and
don’ts” however, there are many times when you can’t be around to
help make the healthy choice. Being consistent with rules at home is a
good place to start and there are resources to help a child make difficult
decisions outside the home.
appendix
Talking to your
children about
weight and health
Likely situations and suggestions for how
to respond
Note: As children develop and mature at varying rates
throughout childhood, generalizing advice is not advised. With
that in mind, this guide is specifically created for parents with
children who are 7-11 years old.
Secrets to a successful talk –
a quick roadmap to the situations and responses
Below is a list of seven real-world situations that a parent
or other adult caregiver is likely to face when it comes to
questions about weight and/or obesity from a child. For
each, you will find educational information for you and then
suggestions for how you might respond. The tips encourage
you to:
Acknowledge the situation and thank your child for sharing his/her feelings
with you to build confidence and security.
Ask your child open-ended questions so he/she can express
their feelings.
Identify that weight is a matter of health, not how you look. (Note: You’ll
see this point emphasized and repeated throughout the tips. That’s
because it may be the most important point you can make!)
Let your child know the challenges to being healthy, but also be sure to
emphasize the benefits of better health.
“Whether your child is
dealing with a bully or
struggling with body
image, supporting your
child wil go a long way
to building confidence
and self-esteem.”
Offer to work together – working toward the promise of being healthier
together creates a supportive environment for your child.
talking to your children | 9
Before we get to WHAT to say, here are some things to keep in mind
about HOW to say it:
Be positive and
supportive.
Whether your child is dealing with a bully or
struggling with body image, supporting your
child will go a long way to building confidence
and self-esteem.
Be realistic.
Focusing on small, specific steps makes
achieving a healthy goal seem possible. It’s
like the difference between telling your child,
“Your room is a mess. Clean it up.” versus, “Your
room is a mess. Please put your shoes in the
closet and make your bed.” The more specific
instructions are more likely to get done.
Keep the
conversation open.
Asking children how they feel may help them
to feel that they can speak openly.
Normalize
the issue.
Communicating about obesity as a health
concern keeps it in the context of other health
issues that children may face, like asthma or
ADHD. And remember, everyone is different.
For example, children in the same family may
have different sizes, just like they may have
different eye color, hair colors, heights
and temperaments.
the situations
1
2
3
4
BMI Confusion
Body Image
Bullying
Cultural Differences
5
6
7
Inter-family
Weight Differences
Parental Obesity
Weight Bias
welcome
getting
started
talking to
your children
resources
appendix
10 | talking to your children
“Some schools use
BMI scorecards to
inform parents of their
child’s weight so that
parents and health
care professionals
can be proactive
in addressing any
weight-related issues.”
Situation One: BMI Confusion
Your school district now performs annual BMI screenings.
Your child brings home a BMI report card which shows that
your child has obesity. The child asks what this means.
What do you say?
What a parent needs to know:
What is BMI?
BMI stands for “Body Mass Index” and is an indirect measure of health risk of
weight. It is calculated using a person’s height, weight, age and gender.
Child/adolescent BMI is a good predictor of health risk into adulthood. So if
your child has obesity, he/she has a much higher risk for continuing to have
weight problems into adulthood.10
What is a BMI scorecard?
Some schools use BMI scorecards to inform parents of their child’s weight so
that parents and health care professionals can be proactive in addressing any
weight-related issues. BMI scorecards typically use BMI-for-age which differs
from what most adults think of when they think of BMI.
BMI-for-age is a measure of weight compared to growth and, in children, is
more accurate than BMI alone. After BMI is calculated for children and teens,
the BMI number is plotted on a growth chart (for either girls or boys) to obtain
a percentile ranking. Percentiles are the most commonly used indicator
to assess the size and growth patterns of individual children in the United
States. The percentile indicates the relative position of the child’s BMI number
among children of the same sex and age. The growth charts show the weight
status categories used with children and teens (underweight, healthy weight,
overweight and obese).11
getting
started
BMI-for-age is typically measured as a percentile score in the
following manner:
≤ 5% Underweight
95th Percentile
weight "
5%–84% Healthy Weight
85th Percentile
welcome
talking to
your children
85%–95% Overweight
≥ 95% Obese12
resources
5th Percentile
appendix
age "
Although the BMI number is calculated the same way for children and adults,
the criteria used to interpret the meaning of the BMI number for children
and teens are different from those used for adults. For children and teens,
BMI age- and sex- specific percentiles are used for two reasons. First, the
amount of body fat changes with age. Second, the amount of body fat
differs between girls and boys.13
continued on next page
BMI Confusion continued
“Some kids have
other health
issues like
asthma or trouble
concentrating.
Carrying around
too much weight
can hurt your
health too.”
Tips for what a parent might say:
I’m glad you shared this with me. BMI is not just confusing for you; it can
be pretty confusing for a lot of moms and dads. What’s most important
to understand is that this is a way of measuring your health. It tells your
teachers, your doctors and your family how you’re growing, just like when
we see the doctor for a checkup and they listen to your heart and measure
your height. Some kids have other health issues like asthma or trouble
concentrating. Carrying around too much weight can hurt your health too.
What your report says is that you may be carrying more weight
than is healthy for a girl/boy of your age and size. Having extra
weight means your body may have to work harder than it needs to.
Just like when you don’t like it when your teacher gives you extra
homework, your body doesn’t like to do more work than it has to. If
we can help your body stop overworking, we can make sure you have
enough energy to do things that you like to do and what makes you
happy like (FILL IN).
How do you feel about your weight?
• First things first, weight is not who YOU are.
• Remember, when you’re carrying around extra weight, it’s not
about how you look, but how you feel.
Losing extra weight is not easy for anyone, especially for someone your
age. It’s also very hard to do alone. There are a lot of things that can get in
the way of healthy eating and getting enough physical activity every day.
(Ask your child for examples specific to your community, home or family
routine that might present a problem.) But, it’s really important, so
let’s work on it together.
Why don’t we come up with some things we can do to get
healthy? (Here are some suggestions that you and your child can
talk about. NOTE: They are focused on specific actions that are easy
to monitor and measure.)
Increasing the number
of minutes of being active
in a day
Limiting the number of
sweets (foods and beverages)
you eat a week
welcome
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started
talking to
your children
resources
Increasing amount of
outdoor play time and
limiting screen time
Increasing the number of
meals that the family sits
down and eats together
Creating family play time
Shopping for healthy
foods together
Increasing the amount of
fruits and vegetables you eat
“Weight is not who YOU are.”
appendix
“Parents who
encourage their
children to diet may
actually undermine
their own intent.
Often children wil
develop unhealthful
dieting that can
lead to increased
risk of obesity.”
Situation Two: Body Image
Your child asks, “Am I fat?” and says she wants to go on a diet.
She is emotional because she says she looks different than the
other girls in her class. What do you say?
Dieting is not uncommon among children – studies have shown that
approximately half of 9-11 year olds were “sometimes” or “very often”
on a diet.18
Diets are often not healthy and can be counterproductive, even
resulting in dangerous disordered eating behaviors, such as binge
eating, anorexia, bulimia, etc.19
20
Parents who encourage their children to diet may actually undermine
their own intent. Often children will develop unhealthful dieting that
can lead to increased risk of obesity.20
If your child wants to lose weight, diet is only one aspect
affecting weight.
Children are more successful when parents and/or the family attempt
weight loss and healthier lifestyles together.21
welcome
getting
started
I’m so sorry you’re feeling this way and I’m really glad you
told me.
talking to
your children
Look, we all are different shapes, sizes and colors.
So, don’t worry about being different.
resources
As your parent, I am concerned that you are carrying
around extra weight because this can hurt your health.
appendix
It’s important for you to know that how much you weigh is not
a measure of who you are as a person. Weight is not who YOU are.
You are (FILL IN with positive attributes, e.g., caring, a good friend,
smart, a hard worker).
Body Image continued
“Weight is a
measure of
your health and
carrying extra
weight can hurt
your health
because your
body has to work
harder than it
needs to.”
Weight is a measure of your health and carrying extra weight can hurt
your health because your body has to work harder than it needs to.
Just like when you don’t like it when your teacher gives you
extra homework, your body doesn’t like to do more work than
it has to. If we can help your body stop overworking, we can make
sure you have enough energy to do things that you like to do and
what makes you happy like (FILL IN).
Some kids may have other health issues, like asthma or
trouble concentrating.
Losing extra weight is not easy for anyone, especially for someone your
age. It’s also very hard to do alone.
I understand that you want to take steps to get healthier, so tell me
what you mean by going on a diet.
I think we should really focus on eating more healthfully and
thinking about other things we can all do as a family to get
healthier. (Here are some suggestions that you and your child can
in a day
you eat a week
foods together
“The more we can work these
things into our daily routine,
the healthier we’ll be and
it may also increase your
confidence in how you
feel about yourself.”
welcome
getting
started
talking to
your children
resources
appendix
Situation Three: Bullying
Your child is behaving badly or acting withdrawn and says he
doesn’t want to go to school. When you ask why, he says that
a bunch of kids have been teasing him and calling him fat and
ugly. What do you say?
A main reason for teasing at school is weight. Weight bullying is more
common than teasing for sexual orientation, race/ethnicity, physical
disability or religion.22
Children with obesity are often bullied because peers see them
as different and/or undesirable. This often means that children are
not invited to social activities like parties or are excluded from
certain groups.23
Bullying can lead to depression, anxiety, increased feelings of sadness
and loneliness, changes in sleep and eating patterns, loss of interest
in activities that your child used to enjoy and may even impede
academic development.24
“Bullying can lead to
depression, anxiety,
increased feelings of
sadness and loneliness,
changes in sleep and
eating patterns, loss
of interest in activities
that your child used
to enjoy and may even
impede academic
development.”
24
Bullying is not just letting kids be kids – the consequences of bullying
extend into adulthood.25
Weight stigmatization often leads to increased food consumption as a
coping strategy among adolescents.26
Weight teasing is associated with higher rates of disordered binge
eating behaviors among both boys and girls when compared to
overweight children who were not teased.27
Losing weight should not be the solution to address bullying.
Parents also have a role in helping their child address bullying. There
are resources available that can guide a parent on ways to intervene,
help their child create a safety plan and talk to school staff.
welcome
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started
I’m so sorry this is happening and I’m really glad you told me. Teasing
is not fair and is wrong. It really can hurt your feelings.
talking to
your children
One of the hardest things about teasing is that they are
talking about your weight in terms of how you look.
resources
They are making you feel like how much you weigh is a measure of
who you are as a person. And it is not. You are (FILL IN with positive
attributes, e.g., caring, a good friend, smart, a hard worker).
Weight is a measure of your health and carrying extra weight can
hurt your health.
I love you and I don’t have a problem with how you look, but as your
parent, I’m concerned that you are carrying around extra weight and
this can hurt your health. It can also mean that you don’t have as much
energy or get to do the things that you really like to do.
appendix
Bullying continued
“I love you and
I don’t have a
problem with how
you look, but as
your parent, I’m
concerned that
you are carrying
around extra weight
and this can hurt
your health. It can
also mean that you
don’t have as much
energy or get to do
the things that you
really like to do.”
Carrying extra weight around means your body has to work
harder than it needs to. Just like when you don’t like it when
your teacher gives you extra homework, your body doesn’t like
to do more work than it has to. If we can help your body stop
overworking, we can make sure you have enough energy to do
things that you like to do and what makes you happy like (FILL IN).
Some kids have other health issues, like asthma or
trouble concentrating.
How do you feel about your weight? Remember, when you’re
carrying around extra weight, it’s not about how you look, but
how you feel. Let’s talk about how we might achieve a weight that’s
healthiest for you and helps make it easier to do the things you
want to do.
Losing extra weight is not easy for anyone, especially for
someone your age. It’s also very hard to do alone. There are a lot of
things that can get in the way of healthy eating and getting enough
physical activity every day. (Ask your child for examples specific to your
community, home or family routine that might present a problem.)
But, it’s really important, so let’s work on it together.
So, let’s come up with some things we can do to get healthy.
(Here are some suggestions that you and your child can talk about.
NOTE: They are focused on specific actions that are easy to monitor
and measure.)
in a day
you eat a week
welcome
getting
started
talking to
your children
resources
foods together
“Let’s talk about how we
might achieve a weight
that’s healthiest for you
and helps make it easier
to do the things you
want to do.”
appendix
“Even if your
culture sees extra
weight as positive,
obesity has serious
health and social
consequences
on your child’s
wellbeing.”
Situation Four: Cultural Differences
Your racial and/or ethnic heritage traditionally finds having
extra weight as attractive or something to be admired, rather
than viewing it as a health concern. When your child comes
home having been told by classmates and teachers that he is
“fat,” he is confused and hurt. What do you say?
Even if your culture sees extra weight as positive, obesity has serious health
and social consequences on your child’s wellbeing. And it doesn’t stop there
– a child with obesity is much more likely to become an adult with obesity.
In fact, a child with overweight or obesity is up to 10 times more likely
to become an adult with overweight or obesity.14 This could translate into
a lifetime of battling serious chronic diseases including type 2 diabetes, high
blood pressure and heart disease.
Minority populations, including African Americans and Asians, are
significantly more likely to live in multigenerational family households,
where grandparents have significant influences on children’s eating
habits from early childhood into late adolescence.15
There is a significant relationship between grandparent and grandchild
BMI, physical activity and television viewing.16,17
welcome
getting
started
Thank you for sharing what happened with me. I’m so sorry that your
feelings were hurt by what your friends/teacher said. Weight is not who
YOU are. You are (FILL IN with positive attributes, e.g., caring, a good
friend, smart, a hard worker).
talking to
your children
Our culture has seen weight as a sign of success, happiness and
wealth. And in our family, we’ve celebrated our size and often mark
happy occasions with food.
resources
But, the more doctors learn about weight, it’s becoming
clearer that carrying extra weight can hurt your health. So,
let’s talk about that.
appendix
Carrying extra weight around means your body may have to work
harder than it needs to. Just like when you don’t like it when your
teacher gives you extra homework, your body doesn’t like to do more
work than it has to. If we can help your body stop overworking, we can
make sure you have enough energy to do things that you like to do and
what makes you happy like (FILL IN).
Cultural Differences continued
“One thing we can
do as a family is
find other things
we can point to as
signs of success
and happiness –
like good grades,
having close
friends and
participating in
your favorite
activities.”
Some kids have other health issues, like asthma or trouble
concentrating. Having too much weight can hurt your health too.
How do you feel about your weight? Remember, when you’re
carrying around extra weight, it’s not about how you look, but
how you feel.
someone your age. It’s also very hard to do alone. There are a lot of
things that can get in the way of healthy eating and getting enough
physical activity every day. (Ask your child for examples specific to your
One thing we can do as a family is find other things we can point to as
signs of success and happiness – like good grades, having close friends
and participating in your favorite activities (FILL IN).
Why don’t we also create things we can do to get healthy
together? (Here are some suggestions that you and your child can
in a day
you eat a week
welcome
getting
started
talking to
your children
resources
foods together
“The more we can
work these things into
our daily routine, the
healthier we’ll be and it
may also increase your
confidence in how you
feel about yourself.”
appendix
“One of the hardest
things about this
is that most people
don’t understand that
carrying extra weight
is an issue of health
and they might
tease her about how
she looks, which is
really unfair.”
Situation Five: Inter-family
Weight Differences
Your son, who is of average weight, pokes fun of your
daughter and calls her “fat.” What do you say?
Weight-based teasing by family members is extremely common, nearly
half of females affected by overweight and a third of males affected by
overweight report experiencing weight-based teasing by family members.32
Nearly half of mothers and a third of fathers have been reported to
show weight bias.33
Weight teasing among family members isn’t harmless – family
teasing is associated with higher BMI in the long-term.34
Responsibility, guilt and pressure felt by parents of children with obesity
for not being able to help their child lose weight can also lead to
parental frustration and anger, which can be taken out on the child, but
further research is required.35
welcome
getting
started
I don’t know if you know this, but your sister is dealing with a
health issue.
Like some of your friends who may have asthma or trouble
concentrating, your sister carries around too much weight and
that can hurt her health too.
Struggling with extra weight is really hard to manage. As a
family, we need to be supportive.
One of the hardest things about this is that most people don’t
understand that carrying extra weight is an issue of health and they
might tease her about how she looks, which is really unfair.
talking to
your children
resources
appendix
Inter-family Weight Differences continued
“What’s most
important for us
as her family is
that how much
she weighs is not
a measure of
who she is as
a person.”
What’s most important for us as her family is that how much she weighs
is not a measure of who she is as a person. Because we know she is (FILL
IN with positive attributes, e.g., caring, a good friend, smart, a hard worker).
When a person is carrying extra weight, it means their body is
working harder than it needs to. Just like when you don’t like it when
your teacher gives you extra homework, your body doesn’t like to do
more work than it has to. If we can help your sister manage her weight,
we can make sure her body has enough energy to do things that she
likes to do and what makes her happy like (FILL IN).
someone your sister’s age. And it’s really hard to do alone. There
are a lot of things that can get in the way of healthy eating and getting
enough physical activity every day. (Ask for examples specific to your
Can you think of some ideas that we can do as a family to get
healthier? (Here are some suggestions that you and your child can
Preparing family
meals together
in a day
you eat a week
welcome
getting
started
talking to
your children
resources
appendix
foods together
“When a person is carrying
extra weight, it means their
body is working harder
than it needs to. Just
like when you don’t like it
when your teacher gives
you extra homework, your
body doesn’t like to do
more work than it has to.”
“Yes, I do struggle
with carrying
extra weight, but
that doesn’t
mean that it is
right for anyone,
particularly a
stranger, to make
a comment about
how I look.”
Situation Six: Parental Obesity
You are an adult affected by obesity who is out in public with
your child. Another adult calls you “fat.” Your child asks why.
What do you say?
You are not alone. Two-thirds of the population has overweight
or obesity.
Although many people treat obesity as a failure of personal responsibility
and will tease others about weight, obesity is a complex condition.
Parental obesity is a significant predictor of your child’s weight,
particularly among 7-15 year olds.36
welcome
getting
started
Yes, I do struggle with carrying extra weight, but that doesn’t
mean that it is right for anyone, particularly a stranger, to
make a comment about how I look. In fact, it hurts my feelings
and I hope it hasn’t hurt yours.
I’m going to let you in on a little secret. The extra weight
I’m carrying around is a lot more important to my health than
it is to how I look to other people.
Most people who don’t struggle with their weight have
no idea how hard it is to lose weight.
But I know that it’s important because my extra weight is
making my body work harder than it has to. Just like when you
don’t like it when your teacher gives you extra homework, my body
doesn’t like to do more work than it has to.
talking to
your children
resources
appendix
Parental Obesity continued
“Parents aren’t
perfect. I have to
tell you, of all the
things I’ve had
to deal with like
going to school,
raising a family,
working, this has
been the hardest
thing to manage.”
Are you uncomfortable about my weight? Do you understand what
this means?
Parents aren’t perfect. I have to tell you, of all the things I’ve had to deal
with like going to school, raising a family, working, this has been the hardest
thing to manage.
One of the reasons why it’s been so hard is that for a long time
I thought my extra weight made me a bad person. And it made
me forget all the things that I like about me including (FILL IN with
positive attributes, e.g., being a good mom, being a good cook,
being a great teacher).
Today, I know better. I also know that it takes many steps to get healthier.
I’m working on it and I’m hoping you will help me.
Can you think of some things we can do as a family to help us
all get healthier? (Here are some suggestions that you and your
child can talk about. NOTE: They are focused on specific actions
that are easy to monitor and measure.)
in a day
you eat a week
welcome
getting
started
talking to
your children
resources
foods together
“One of the reasons why
it’s been so hard is that for
a long time I thought my
extra weight made me
a bad person. And it
made me forget all
the things that I like
about me.”
appendix
“Children and
adolescents with
overweight/obesity
experience stigma
and bias from
peers. Parents
and teachers also
demonstrate weight
bias toward children.”
Situation Seven: Weight Bias
A parent or teacher who doesn’t know you or your family well
questions you about whether your child who has obesity is
allowed to have a birthday cupcake or participate in an athletic
activity. What do you say?
Children who are stigmatized due to their weight experience negative
outcomes, including psychological damage, unhealthy eating behaviors and
averting physical activity.
28
Stigma can include the words used to describe a child’s weight. Parents
have reported that “weight” and “unhealthy weight” were preferable
to “obese,” “extremely obese,” or “fat” when speaking with their child’s
doctor.
Children and adolescents with overweight/obesity experience stigma
and bias from peers, but parents and teachers also demonstrate weight
bias toward children.28
Parents often feel stigmatized or blamed for their child’s weight,
which can then impact how they treat their child.29
News media also contributes to stereotypes and misperceptions about
obesity by emphasizing personal responsibility without acknowledging
the roles of the government, industry or media itself. A study of the
viewers of the reality television show The Biggest Loser indicated that
the show promoted the perception that individuals are in total control
of their weight gain and weight loss and by extension increases
obesity stigma.31
welcome
getting
started
Why do you ask that?
You know, my child struggles with carrying extra weight
and it’s a really hard issue to address. It makes it even
harder when I get questions from people who may not
understand the chronic nature of the condition and what
we’re doing as a family to try and help.
We joke about not having a parenting handbook, and I have to
tell you, of all the things I’ve had to deal as a parent (like talking
about job changes, sex, drugs, etc.), this has been the hardest issue
to address.
One of the reasons why it’s been so hard is that I didn’t know
what to say and I didn’t know where to turn for help. As a parent, I
also felt personally responsible which made it that much harder.
But today, we understand that this is a health problem and that
is how we are addressing it.
We’re trying to tackle it as a family because as a young child,
he/she is going to need the support of family and friends.
And we’re trying to establish goals to all become healthier.
Because at the end of the day, that’s what this is about.
talking to
your children
resources
appendix
Resources guide
Bam!
Be Well – Alliance for a Healthier Generation
Be A Healthy Role Model – MyPlate.gov
BodyWorks – Department of Health & Human Services’ Office of
Women’s Health
Childhood Obesity: It’s Everyone’s Business – National Business Group
on Health
Circulation: Evaluating Parents and Adult Caregivers as “Agents of
Change” for Treating Obese Children – American Heart Association
Fit for Parents – WebMD/Sanford Health Systems
FitKids
Healthy Youth: Obesity Facts
How to Talk to Your Kids About Weight Bias – Yale Rudd Center
Is Your Child a Target of Weight Bias? – Yale Rudd Center
Kid’s Corner – Obesity Action Coalition
Let’s Move!
New Moves: Evidence-based Physical Education Program for Girls –
University of Minnesota
Parents: About Weight Bias – Yale Rudd Center
StopBullying.gov – Department of Health & Human Services
Talking to Your Kids about Weight – Yale Rudd Center
Weight: A Big Issue? – Yale Rudd Center
Weight Bias: Important Information for Parents – Yale Rudd Center
Weight Control Information Network
resources guide | 37
Credits & Acknowledgements
This guide was developed in partnership between the obesity
research team at The George Washington University School of
Public Health & Health Services and the STOP Obesity Alliance
communications team at Chandler Chicco Agency:
• Stephanie David, JD, MPH
George Washington University
• Gina Mangiaracina,
Chandler Chicco Agency
• Lucas Divine
• Allison May Rosen,
welcome
getting
started
talking to
your children
resources
• Christine Ferguson, JD
The STOP Obesity Alliance and Alliance for a Healthier
Generation would like to thank and acknowledge the
following individual experts and organizations for reviewing
and providing input into the conversation guide.
American Heart Association
Scientific Advisory Board
Robyn Osborn,
PhD, Assistant Director, National Center
for Weight & Wellness
Betty Pinkins,
Scotie Connor,
Parent of Youth Advisory Board
member, Alliance for a Healthier
Generation
Oklahoma City, OK, Youth Advisory
Board Alum, Alliance for a Healthier
Generation
Ginny Ehrlich,
Scott Kahan,
DEd, MPH, Chief Executive Officer,
Alliance for a Healthier Generation
MD, MPH, Director, STOP Obesity
Alliance & Director, National Center for
Weight and Wellness
Joseph Nadglowski,
Stephen R. Daniels,
President & CEO, Obesity Action
Coalition
MD, PhD, Professor and Chairman,
Department of Pediatrics; University
of Colorado School of Medicine;
Pediatrician-in-Chief and L. Joseph
Butterfield Chair of Pediatrics, Children’s
Hospital Colorado
Laurie Whitsel,
Director of Policy Research, American
Heart Association
Nazrat Mizra,
MD, Faculty, General and Community
Pediatrics & Obesity Institute, Children’s
National Medical Center
Rebecca Puhl,
Director of Research, Rudd Center for
Food Policy & Obesity at Yale University
STOP Obesity Alliance Steering
Committee
appendix
Appendix
Figure 1:
boys growth chart
appendix | 39
Figure 2:
girls growth chart
welcome
getting
started
talking to
your children
resources
appendix
40 | appendix
1. Lalita Khaodhiar, Karen C. McCowen, George L. Blackburn, Obesity and its comorbid conditions,
Clinical Cornerstone, Volume 2, Issue 3, 1999, Pages 17-31, ISSN 1098-3597, 10.1016/S10983597(99)90002-9.
2. Levi J., Vinter S., Richardson L., Laurent R., St., Segal L. M. (2010). Issue report: F as in Fat: How obesity
threatens America’s future. Trust for America’s Health.
3. NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults.
4. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Weight-based victimization toward overweight and obese
adolescents: Observations and reactions of peers. Journal of School Health, 81, 696-703.
5. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic
review of the literature. Obes Rev. 2008;9:474–488. American Academy of Family Physicians.
Recommendations for clinical preventive services. Available at: www.aafp.org/online/en/home/
clinical/exam/k-o.html.
6. Aucott L., Rothnie H., McIntyre L., Thapa M., Waweru C., Gray D. (2009) Long-term weight loss from
lifestyle intervention benefits blood pressure? A systematic review. Hypertension. Available at http://
hyper.ahajournals.org/cgi/content/abstract/HYPERTENSIONAHA.109.135178v1.
7. Lavie C.J., Milani R.V., Artham S.M., Patel D.A., Ventura H.O. (2009) The obesity paradox, weight loss,
and coronary disease. American Journal of Medicine. Available at: http://www.amjmed.com/article/
S0002-9343 percent2809percent2900500-2/abstract
8. Aronne LJ, Nelinson DS, Lillo JL. Obesity as a disease state: a new paradigm for diagnosis and
treatment Clin Cornerstone. 2009;9(4):9-25; discussion 26-9.
9. Kluck AS. Family influence on disordered eating: The role of body image dissatisfaction. Body Image.
2010;7(1):8-14.
10. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Utility of childhood BMI in the prediction of adulthood
disease: Comparison of national and international references. Obes Res. 2005;13(6):1106-1115.
11. Centers for Disease Control and Prevention. (2011). About BMI for Children and Teens. Available at:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/.
14. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic
review of the literature. Obes Rev. 2008;9:474–488. American Academy of Family Physicians.
Recommendations for clinical preventive services. Available at: www.aafp.org/online/en/home/
clinical/exam/k-o.html.
15. Faith, M.S., Van Horn, L., Appel, L.J., Burke, L.E., Carson, J.S., et al. (2012) Evaluating parents and
adult caregivers as “agents of change” for treating obese children: evidence for parent behavior
change strategies and research gaps: a scientific statement from the American Heart Association.
Circulation. 125(9):1186-207
16. Polley DC, Spicer MT, Knight AP, & Hartley BL. (2005). Intrafamilial correlates of overweight and
obesity in African-American and Native-American grandparents, parents, and children in rural
Oklahoma. J Am Diet Assoc, 105:262–265
17. Faith et al., 2012.
18. Gustafson-Larson AM, Terry RD. Weight-related behaviors and concerns of fourth-grade children. J
Am Diet Assoc. 1992;92(7):818-822.
appendix | 41
19. NEDA. “National Eating Disorders Association Fact Sheet on Eating Disorders July 2010”.
Available at: http://www.nationaleatingdisorders.org/uploads/file/in-the-news/In%20the%20
News%20Fact%20Sheet%20PDF.pdf
welcome
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started
20. Lindsay, A.C., Sussner, K.M., Kim, K., Gortmaker, S. (2006). The role of parents in preventing
childhood obesity. The Future of Children. 16(1), 169-186.
21. Epstein LH, Paluch RA, Roemmich JN, Beecher MD (2007). Family-based obesity treatment,
then and now: twenty-five years of pediatric obesity treatment. Health Psychol. 26(4): 381-391.
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22. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Weight-based victimization toward overweight and
obese adolescents: Observations and reactions of peers. Journal of School Health, 81, 696-703.
23. Robinson, S. (2006). “Victimization of obese adolescents.”. The Journal of school nursing (10598405), 22 (4), 201.
24. Puhl RM, Latner JD. (2007). Stigma, obesity, and the health of the nation’s children. Psychol Bull.
133(4):557-580.
25. US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. (2001).
Addressing the Problem of Juvenile Bullying. OJJDP Fact Sheet #27. Available at: http://www.
ncjrs.gov/pdffiles1/ojjdp/fs200127.pdf
26. Puhl, Rebecca M. (2012). “Weight-Based Victimization Among Adolescents in the School Setting:
Emotional Reactions and Coping Behaviors”. Journal of youth and adolescence. 41 (1): 27.
27. Neumark-Sztainer, D. (2002). “Weight-teasing among adolescents: Correlations with weight
status and disordered eating behaviors”. International journal of obesity and related metabolic
disorders (0307-0565), 26 (1), 123.
28. Schwartz MB, Puhl R. (2003). Childhood obesity: A societal problem to solve. Obesity Reviews.
4(1):57-71.
29. Turner KM, Salisbury C, Shield JPH. Parents’ views and experiences of childhood obesity
management in primary care: A qualitative study. Family Practice. 2011.
30. Atanasova, D. (06/2012). “Obesity in the news: directions for future research Obesity in the
news: directions for future research”. Obesity reviews (1467-7881), 13 (6), 554.
31. Yoo, Jina H (06/28/2012). “No Clear Winner: Effects of The Biggest Loser on the Stigmatization
of Obese Persons”. Health communication (1041-0236)
133(4):557-580.
133(4):557-580.
34. Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA. Shared
risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med.
2007;33(5):359-369. e3.
133(4):557-580.
36. Svensson V, Jacobsson JA, Fredriksson R, et al. Associations between severity of obesity in
childhood and adolescence, obesity onset and parental BMI: a longitudinal cohort study. Int J
Obes. 2011;35(1):46-52.
resources
appendix
We want to hear from you.
Please contact us with your personal story at [email protected].
Hablar con sus hijos
sobre el peso y la salud
Una guía de conversación para padres y adultos que cuidan a niños de
7 a 11 años de edad
Introducción
“Usted es el que mejor conoce a su hijo y eso le
da la mayor ventaja para comunicarse con él/
ella sobre el peso.”
Introducción | 3
Todos los días padres y adultos que cuidan a los niños
enfrentan situaciones y preguntas difíciles para las cuales no
están preparados.
En muchos casos, las preguntas sobre el peso de un niño son particularmente
difíciles de contestar para un adulto porque los sentimientos sobre la obesidad
y el sobrepeso generalmente están influenciados por problemas personales y
mensajes conflictivos sobre el tema comunicados por los medios y la sociedad
en general. Tanto es así que una encuesta de salud de WebMD/Stanford indicó
que para los padres de adolescentes es más fácil hablar con sus hijos sobre
sexo, drogas, alcohol o tabaco que hablar con ellos sobre el peso.
Pero esta dificultad no hará que las preguntas desaparezcan. Mientras la crisis
de la obesidad infantil siga creciendo en Estados Unidos, las preguntas surgirán
con más frecuencia –y casi en todo momento:
• En el auto camino a alguna actividad
• Viendo televisión
• Camino a la escuela
• En la iglesia
• En la mesa durante la cena
• Y la lista sigue…
Un padre que busca información en Internet o en una biblioteca local, o que le
pregunta a un profesional médico, puede encontrar fácilmente muchas guías
para hablar con sus hijos sobre temas “difíciles” como el sexo o el alcohol. En
cambio si buscaran información sobre cómo tratar el tema del peso de sus
hijos, esos mismos padres no podrían encontrar mucha información útil o que
fuera más allá de la información básica que hemos oído durante años –como
simplemente comer menos y moverse más.
La falta de este tipo de información no es sólo un vacío en el mundo de las guías
para padres. Es un problema urgente de salud que enfrentan millones de familias,
y precisamente la razón por la cual esta guía de conversación es necesaria.
Esperamos que la información ofrecida aquí le ayude a navegar la importante
y desafiante tarea de hablar con su hijo sobre la obesidad y el sobrepeso de
manera fáctica, práctica y comprensiva.
Por la salud de su familia,
Scott Kahan, MD, MPH,
Ginny Ehrlich, DEd, MPH
Director, Alianza de Acción Contra la Obesidad
CEO, Alianza para una Generación más Sana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
Comienzo
Por qué hace falta una guía –
y también algunas aclaraciones
“Con la atención social
que hay en torno al
peso, los niños pueden
buscar al adulto en
sus vidas para hacer
preguntas sobre si
son ‘gordos’ y qué
pueden hacer al
respecto”
Muchos factores han llevado a que en una nación uno de
cada tres niños tenga obesidad o sobrepeso. Esta guía no está
diseñada para llegar a la raíz del problema ni para culpar a nadie.
Esta guía tiene como objetivo ayudar a padres y adultos que cuidan a los niños
a hablar con ellos sobre el peso y la salud de manera factual, práctica y sensible
a las muchas emociones que vienen con los complejos temas del peso.
Por supuesto, aún con la importante información ofrecida, la conversación
puede seguir siendo incómoda. Está bien. A veces simplemente tenemos que
ser los “mayores” para ayudar a nuestros hijos. Sepa que no está solo.
Entienda que:
1
2
3
Si un padre o adulto quiere iniciar una conversación con un niño
sobre la obesidad o el sobrepeso, hay una guía con recursos
constructivos;
Con la atención social que hay en torno al peso, los niños pueden
buscar al adulto en sus vidas para hacer preguntas sobre si son
“gordos” y qué pueden hacer al respecto; y
Hay una gran probabilidad de que un padre –
independientemente de su peso—tenga sus propios prejuicios
contra el peso, lo cual puede interferir con conversaciones
constructivas con un niño.
En resumen, esta conversación va a surgir. Y es probable que sea iniciada por
su hijo. Usted querrá estar preparado. Lo que es importante saber es que su
hijo no está solo, y que usted tampoco lo está. Muchos padres como usted
están luchando para saber qué decirles a sus hijos sobre el peso.
¡Sea positivo! Usted es el que mejor conoce a su hijo y eso le da la mayor
ventaja para comunicarse con él/ella sobre el peso.
Comienzo | 5
Un obstáculo común–
Nuestros propios problemas con el peso
El peso es un tema del cual todos hablamos, y con
el cual potencialmente todos luchamos de distintas
maneras. Esto es verdad para todos los padres,
independientemente de su peso –desde aquellos
con peso normal o por debajo de lo normal hasta los
considerados obesos. Reconocer nuestros prejuicios es
esencial. Pero simplemente saber que los tenemos no es
excusa para ignorar las preguntas de nuestros hijos.
No hay separación entre el rol de un padre y la capacidad de un niño
para superar el problema del peso. Los niños admiran a sus padres y
mucho de lo que aprenden se basa en el modelo de conducta de un
padre u otro adulto a cargo. No lo pueden hacer solos.
Algunos pueden preguntarse si éste no es simplemente otro tema
para padres que está recibiendo demasiada atención… y piensan que
el problema puede no ser tan serio como algunos creen. Pero muchas
cosas han cambiado desde que USTED era un niño. Hoy sabemos
mucho más sobre las conexiones entre el peso y la salud –y esas
conexiones son suficientes para tomarse el tema en serio.
Hoy sabemos que:
La obesidad es
una cuestión
de salud y una
puerta a muchas
condiciones y
enfermedades
crónicas.1
La intimidación
o “bullying” ha
empeorado.
Un niño con
obesidad es
mucho más
proclive a ser
obeso de adulto.
Enfermedades cardíacas, diabetes tipo 2, presión arterial alta,
derrames cerebrales, enfermedades del hígado y la vesícula,
apnea del sueño y problemas respiratorios, trastornos de huesos
y articulaciones incluyendo osteoartritis, y algunos cánceres,
entre otras.2,3
Puede ser que los adultos con obesidad hayan sido intimidados
como niños y traigan recuerdos de esas experiencias a la
conversación con un niño.
Una razón principal del bullying y las burlas en la escuela es el
peso –las burlas por el peso son más comunes que las burlas por
orientación sexual, raza/etnicidad, incapacidad física o religión.4
Un niño con sobrepeso u obesidad es 10 veces más proclive a
tener sobrepeso u obesidad de adulto. 5
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
6 | Comienzo
Otros obstáculos –
Si el tema fuera fácil no necesitaríamos una guía
Hay muchas razones por las cuales un padre o un adulto a
cargo pueden no querer contestar las preguntas de un niño
sobre el peso. A continuación hemos incluido una lista de
las razones más comunes, porque a veces reconocer los
obstáculos es el primer paso para superarlos.
1
Yo no sé cómo se define el “éxito”… ¿peso normal?
¿Y qué es peso normal?
Los recursos disponibles para padres que quieren ayudar a sus hijos a lograr
un peso sano son limitados.
Ser consecuente
es esencial y una
buena forma de
no sentir que está
constantemente
‘fastidiando’ a su hijo
para que coma bien
Contrariamente al conocimiento que tienen sobre los adultos, los expertos
todavía no saben cuánto deben bajar de peso los niños para empezar a
mostrar mejoras en su salud. Pero los expertos saben que los niños que
llegan a la adultez con sobrepeso u obesidad son mucho más propensos
a mantener el sobrepeso o la obesidad como adultos. Por lo tanto, los
expertos están de acuerdo en que la meta para los niños es terminar su
adolescencia con un peso sano (o como el pediatra de su hijo le puede decir,
debajo del 85/100 en las tablas de crecimiento del IMC-por-edad, que se
explicará en más detalle más adelante).6,7
2
¿Bajar de peso no es sólo una cuestión de fuerza de voluntad?
No, la obesidad es el resultado de una compleja combinación de genes,
medioambiente y conductas de salud, incluyendo la alimentación y la
actividad física.8
3
Lo que algunos llaman obeso, yo llamo hermoso.
Que el peso extra pueda ser aceptado y admirado en una cultura en particular
no protege al niño contra posibles consecuencias de salud o intimidación.
Introducción
4
Si hablo con mi hijo sobre el peso, él/ella puede
desarrollar un trastorno alimentario.
Los padres que abordan el tema del peso de manera no productiva (por
ejemplo, con burlas) ponen a sus hijos en un riesgo mayor de desarrollar
trastornos alimentarios como la anorexia, la bulimia y el trastorno por
atracón. No hay evidencia de que hablar sobre el peso como una
cuestión de salud, de manera inspiradora y comprensiva, pueda causar
daño psicológico. Esta guía está diseñada para alentar a que los temas
sobre el peso se aborden con un enfoque sano y positivo.
5
Conversación
con sus hijos
Recursos
Yo he tratado de ayudar, pero nada funciona.
Apéndice
Muchos padres quieren que su hijo baje de peso pero se frustran cuando
nada parece funcionar. Generalmente se culpan a sí mismos, lo cual a su
vez puede tornarse en criticismo negativo para su hijo.
Lo que es importante es que hay muchas formas de mejorar la salud.
Por ejemplo, aumentar la actividad física o mejorar la nutrición pueden
ayudar.
6
Comienzo
Estoy cansada de sentirme la “policía de la comida”.
Es común que los padres sientan que están en una lucha constante de
poder con sus hijos para que coman bien. Lo más importante para usted
y su familia es determinar sus propias reglas para comer sano, seguir esas
reglas, y saber cuándo darse con un gusto.
Ser consecuente es esencial y una buena forma de no sentir que está
constantemente “fastidiando” a su hijo para que coma bien.
Aun cuando establezca con su familia “reglas para comer bien”, habrá
momentos en los que no podrá estar ahí para ayudar a que se cumplan.
Ser congruente con las reglas en la casa es una buena forma de empezar
y hay recursos para ayudar a los niños a tomar decisiones difíciles fuera de
la casa.
Hablar con sus
hijos sobre el peso
y la salud
Posibles situaciones y sugerencias para
cómo responder
Nota: Como los niños se desarrollan y maduran con variantes
durante la infancia, no se recomienda generalizar los consejos.
Con eso en mente, esta guía fue específicamente creada para
padres de niños de 7 a 11 años de edad.
Secretos para una conversación exitosa –
Guía rápida para responder a distintas situaciones
A continuación hay una lista de siete situaciones del mundo
real que un padre o adulto a cargo de un niño probablemente
enfrente cuando se trata de preguntas de un niño sobre la
obesidad o el peso. Para cada una encontrará información
educativa y sugerencias sobre cómo responder. Los consejos
le alientan a:
Reconocer la situación y agradecerle a su hijo por compartir sus
sentimientos con usted para crear confianza y seguridad.
Hacer preguntas abiertas a su hijo para que él/ella pueda expresar
sus sentimientos.
“Independientemente
de si su hijo está
enfrentando a alguien
que lo intimida o
luchando con su
imagen corporal,
apoyarlo será esencial
para crear confianza
y autoestima.”
Aclarar que el peso es una cuestión de salud, y no de apariencia.
(Nota: Este punto se enfatiza y se repite a lo largo de estas
sugerencias porque puede ser el punto más importante).
Hablar con su hijo de los retos para tener una buena salud, pero también
asegurarse de enfatizar los beneficios de estar sano.
Ofrecer trabajar juntos –trabajar juntos para estar más sanos crea un
ambiente de apoyo para su hijo.
Conversación con sus hijos | 9
Antes de hablar sobre QUÉ decir, a continuación hay cosas para tener en
mente sobre CÓMO decirlo:
Sea positivo y
ofrezca apoyo.
Sea realista.
.Independientemente de si su hijo está enfrentando a alguien que lo
intimida o luchando con su imagen corporal, apoyarlo será esencial
para crear confianza y autoestima.
Concentrarse en pasos pequeños y específicos hace la meta de una
buena salud más fácil de alcanzar. Es la diferencia entre decirle a un
niño “Tu recámara es un lío; límpiala” versus “Tu recámara es un lío;
por favor guarda tus zapatos y tiende tu cama”. Las instrucciones más
específicas tienen más probabilidad de dar resultado.
Mantenga abierta
la conversación.
Preguntarle a los niños cómo se sienten puede ayudarlos a saber que
pueden hablar abiertamente.
Normalice el tema.
Hablar de la obesidad como un problema de salud mantiene al tema
en el contexto de otros problemas de salud que los niños pueden
enfrentar, como asma o TDAH. Recuerde que todos somos distintos.
Por ejemplo, niños de la misma familia pueden ser de tamaños
distintos, pueden tener distinto color de ojos o de cabello, distinta
altura y temperamentos distintos.
Las Situaciones
1
Confusión
en torno al
IMC
5
Diferencias
de peso en
la familia
2
Imagen
corporal
6
Obesidad de
los padres
3
Intimidación
o “bullying”
7
Prejuicio
contra el
peso
4
Diferencias
culturales
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
10 | Conversación con sus hijos
“Algunas escuelas
tienen tarjetas de
IMC para informar a
los padres sobre el
peso de su hijo de
manera que ellos y los
profesionales de salud
puedan hacer algo
para tratar cualquier
problema al respecto.”
Situación Uno: Confusión en torno al IMC
Su distrito escolar ahora realiza pruebas de IMC anualmente.
Su hijo vuelve a casa con un informe de su IMC que indica que
tiene obesidad. El niño pregunta qué quiere decir.
¿Qué le dice?
Lo que los padres deben saber:
¿Qué es el IMC?
IMC quiere decir “Índice de Masa Corporal” y es una medida indirecta del
riesgo de salud del peso. Se calcula usando la altura, el peso, la edad y el sexo
de la persona. El IMC de un niño/adolescente es un buen indicador del riesgo
de salud en la adultez. Si su hijo tiene obesidad, su riesgo de seguir teniendo
problemas de peso en la adultez es mucho mayor.10
¿Qué es una tarjeta de IMC?
Algunas escuelas tienen tarjetas de IMC para informar a los padres sobre
el peso de su hijo de manera que ellos y los profesionales de salud puedan
hacer algo para tratar cualquier problema al respecto. Las tarjetas de IMC
generalmente usan IMC-por-edad, que difiere de lo que la mayoría de los
adultos entiende por ICM.
El IMC-por-edad es una medida de peso comparada con el crecimiento, y
en los niños es más acertada que el IMC solo. Una vez que se ha calculado el
IMC de los niños y adolescentes, el número de IMC se pone en una tabla de
crecimiento (para niños o niñas) para obtener un rango percentil. Estos rangos
percentiles son el indicador más común que se usa para evaluar los patrones
de medida y crecimiento individuales de los niños en Estados Unidos. El rango
percentil indica la posición relativa del número de IMC del niño entre niños
de la misma edad y el mismo sexo. Los gráficos de crecimiento muestran las
categorías de peso que se usan con niños y adolescentes (peso inferior al
normal, peso sano, sobrepeso y obesidad).11
El IMC-por-edad generalmente se mide como un rango percentil de la
siguiente manera:
≤ 5% Peso inferior al normal
Percentil 95
Peso "
5%–84% Peso sano
Percentil 85
Introducción
Comienzo
Conversación
con sus hijos
85%–95% Sobrepreso
≥ 95% Obesidad12
Recursos
Percentil 5
Apéndice
Edad "
Si bien el IMC se calcula de la misma forma para niños y adultos, el criterio usado
para interpretar el IMC en niños y adolescentes es distinto al que se usa para
adultos. Para los niños los rangos percentiles específicos de IMC-por edad y
sexo se usan por dos razones. Primero, porque la cantidad de grasa en el cuerpo
cambia con la edad; y segundo, porque la cantidad de grasa en el cuerpo varía
entre varones y mujeres. 13
continúa en la próxima página
Confusión en torno al IMC, continuación
“Algunos niños
tienen otros
problemas de
salud como
asma o dificultad
para concentrarse.
Estar excedido
de peso también
puede afectar tu
salud.”
Lo que un padre puede decir:
Me alegro de que hayas compartido esto conmigo. El IMC no sólo es
confuso para ti; también puede ser muy confuso para muchos padres. Lo
más importante de entender es que ésta es una forma de medir tu salud.
Le indica a tus maestros, tus médicos y tu familia cómo estás creciendo, tal
como cuando vamos al doctor para un control y él/ella escucha tu corazón
y mide tu estatura. Algunos niños tienen otros problemas de salud como
asma o dificultad para concentrarse. Estar excedido de peso también puede
afectar tu salud.
Lo que el informe dice es que puedes pesar un poco más de lo que
es saludable para un niño de tu edad y tu tamaño. Estar excedido de
peso significa que tu cuerpo puede tener que trabajar más de lo necesario.
Como a ti no te gusta cuando el maestro/a te da tarea extra, a tu cuerpo
no le gusta tener que trabajar más. Si podemos ayudar a tu cuerpo a que
deje de trabajar tan duro, entonces podemos asegurarnos de que tengas
suficiente energía para hacer las cosas que te gustan y que te hacen feliz
como (completar la oración).
¿Cómo te sientes respecto a tu peso?
• Antes que nada, el peso no determina quién ERES.
• Y recuerda que cuando estás excedido de peso, no se trata de
tu apariencia ni de cómo te ves, sino de cómo te sientes.
Bajar de peso no es fácil para nadie, especialmente para alguien de tu
edad. También es muy difícil hacerlo solo. Hay muchas cosas que pueden
interferir con una dieta sana y con suficiente actividad física diariamente.
. (Pídale a su hijo ejemplos específicos de su comunidad, su hogar y su
rutina familiar que pueden presentar un problema). Pero es realmente
importante, así que lo intentemos juntos.
Pensemos en algunas cosas que podamos hacer juntos para tener una buena
salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar.
NOTA: Estas sugerencias se concentran en acciones específicas que son fáciles de
seguir y de medir).
Aumentar el tiempo durante
el cual se está activo en
un día
Limitar las cosas dulces
(comidas y bebidas) que se
comen en una semana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Aumentar el tiempo de
juegos al aire libre y limitar
el tiempo frente a una
pantalla
Aumentar las comidas con
toda la familia sentada a
la mesa
Crear tiempo de juego
para la familia
Salir juntos a comprar
comidas sanas
Apéndice
Comer más frutas y verduras
Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos
estaremos. Y esto también puede hacerte sentir más seguro de ti mismo.
“El peso no determina
QUIÉN eres”
“Los padres que
alientan a sus hijos
a hacer dieta en
realidad pueden
socavar su propio
intento. Generalmente
los niños pueden
hacer dietas no
sanas que pueden
aumentar su riesgo
de obesidad”
20
Situación Dos: Diferencias culturales
La gente de su grupo racial y/o étnico tradicionalmente ha
considerado que tener peso extra es atractivo o algo digno
de admiración, en lugar de verlo como un problema de salud.
Su hijo vuelve a casa dolido y confundido después de que sus
compañeros de clase y sus maestros lo han llamado “gordo”.
¿Qué le dice?
Si bien en su cultura el peso extra es considerado positivo, la obesidad
tiene consecuencias serias en la salud y vida social de su hijo. Y no se
detiene ahí –un niño con obesidad es mucho más proclive a ser obeso de
adulto. En realidad, un niño con sobrepeso u obesidad tiene 10 veces más
probabilidades de tener sobrepeso u obesidad como adulto.14 Esto puede
resultar en una vida enfrentando enfermedades crónicas serias, incluyendo
diabetes tipo 2, presión alta y enfermedades cardíacas.
Algunos grupos minoritarios, incluyendo los afroamericanos y los
asiáticos, son significativamente más propensos a vivir en casas
multigeneracionales, donde los abuelos tienen una influencia
importante en los hábitos de comida de los niños desde la primera
infancia hasta avanzada la adolescencia.15
Hay una relación significativa entre el IMC, la actividad física y el tiempo
frente al televisor entre abuelos y nietos.16,17
Introducción
Comienzo
Gracias por compartir conmigo lo que pasó. Lamento tanto
que estés dolido por lo que tus amigos/maestros dijeron. El
peso no determina quién ERES. Tú eres (completar esta oración
con atributos positivos, por ejemplo, comprensivo, buen amigo,
inteligente, trabajador).
Nuestra cultura ha visto el peso como un signo de éxito,
felicidad y riqueza. Y en nuestra familia hemos celebrado nuestro
tamaño y muchas veces hemos festejado las ocasiones felices con
comida.
Conversación
con sus hijos
Recursos
Apéndice
Pero mientras más aprenden los médicos sobre el peso, más
claro es que estar excedido de peso puede afectar tu salud.
Hablemos sobre esto.
Estar excedido de peso significa que tu cuerpo puede tener
que trabajar más de lo necesario. Como a ti no te gusta cuando
el maestro/a te da tarea extra, a tu cuerpo no le gusta tener que
trabajar más. Si podemos ayudar a tu cuerpo a que deje de trabajar
tan duro, entonces podemos asegurarnos de que tengas suficiente
energía para hacer las cosas que te gustan y que te hacen feliz como
(completar esta oración).
Imagen Corporal, continuación
“El peso es una
medida de tu
salud y estar
excedido de peso
puede dañar tu
salud porque tu
cuerpo tiene que
trabajar más de lo
necesario.”
Algunos niños tienen otros problemas de salud, como asma o dificultad
para concentrarse. Estar excedido de peso también puede afectar su salud.
¿Cómo te sientes respecto al peso? Recuerda que cuando estás excedido
de peso, no se trata de tu apariencia ni de cómo te ves, sino de cómo te
sientes.
interferir con una dieta sana y suficiente actividad física diariamente. (Pídale
a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar
que pueden presentar un problema).
Pero es realmente importante, así que lo intentemos juntos.
Algo que podemos hacer como familia es identificar otras cosas como signos
de éxito y felicidad –como buenas calificaciones en la escuela, tener amigos
cercanos y participar en tus actividades preferidas (completar esta oración).
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud.
(Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas
sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir).
un día
comen en una semana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
pantalla
la mesa
para la familia
comidas sanas
“Mientras más podamos
incorporar estas cosas en
nuestra rutina diaria, más
sanos estaremos. Y esto
también puede hacerte
sentir más segura de
ti mismo.”
Apéndice
Situación Tres: Imagen corporal
Su hija le pregunta, “¿Estoy gorda?”, y quiere empezar una
dieta. Está sensible porque dice que se ve distinta a las otras
niñas en su clase. ¿Qué le dice?
Hacer dieta no es inusual entre los niños –hay estudios que indican que
aproximadamente la mitad de niños de 9 a 11 años hacen dieta “a veces” o
“muy seguido”. 18
Las dietas generalmente no son buenas para la salud y pueden ser
contraproducentes, incluso provocando conductas peligrosas que
pueden ocasionar trastornos alimentarios como la anorexia, la bulimia
y el trastorno por atracón, entre otros.19
Los padres que alientan a sus hijos a hacer dieta en realidad pueden
socavar su propio intento. Generalmente los niños pueden hacer
dietas no sanas que pueden aumentar su riesgo de obesidad.20
“El bullying puede
provocar depresión,
ansiedad, sentimientos
de tristeza y soledad,
cambios en los patrones
de sueño y alimentación,
pérdida de interés en
actividades que su hijo
solía disfrutar y hasta
puede interferir con el
desarrollo académico.”
24
Si su hijo quiere bajar de peso, la dieta es sólo un aspecto.
Los niños tienen más éxito cuando los padres y/o la familia intentan
bajar de peso juntos, adoptando estilos de vida más sanos en forma
conjunta.21
Introducción
Comienzo
Lamento tanto que te sientas así y me alegro que me lo hayas
contado.
Conversación
con sus hijos
Mira, todos tenemos formas, tamaños y colores distintos.
No te preocupes por ser diferente.
Recursos
Como tu madre, a mí me preocupa que estés excedida de peso
porque esto puede dañar tu salud.
Apéndice
Es importante que sepas que tu peso no es una medida de quién eres
como persona. El peso no determina quién ERES. Tú eres (completar la
oración con atributos positivos; por ejemplo, comprensiva, buena amiga,
inteligente, trabajadora).
El peso es una medida de tu salud y estar excedida de peso puede
dañar tu salud porque tu cuerpo tiene que trabajar más de lo
necesario.
Bullying, continuación
“Yo te quiero y no
tengo problemas
con tu apariencia,
pero como padre,
me preocupa que
tengas sobrepeso
y que esto pueda
dañar tu salud.
También puede
significar que no
tengas suficiente
energía y que no
puedas hacer las
cosas que te gusta
hacer.”
Como a ti no te gusta cuando el maestro/a te da tarea extra, a
tu cuerpo no le gusta tener que trabajar más. Si podemos ayudar
a tu cuerpo a que deje de trabajar tan duro, entonces podemos
asegurarnos de que tengas suficiente energía para hacer las cosas
que te gustan y que te hacen feliz como (completar esta oración)..
para concentrarse.
Bajar de peso no es fácil para nadie, especialmente para alguien
de tu edad. También es muy difícil hacerlo sola.
Entiendo que quieras hacer algo para mejorar tu salud, así que
explícame qué quieres decir cuando dices que quieres hacer dieta.
Lo que debemos hacer es concentrarnos en comer mejor y pensar en cosas que
podemos hacer todos juntos como familia para tener una buena salud. (Aquí hay
algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se
concentran en acciones específicas que son fáciles de seguir y de medir).
un día
comen en una semana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
pantalla
la mesa
para la familia
comidas sanas
Apéndice
Mientras más podamos incorporar estas cosas en nuestra rutina diaria, más sanos estaremos. Y esto
también puede hacerte sentir más seguro de ti mismo.
“Hablemos de cómo
podemos lograr un
peso que sea saludable
para ti y que te permita
hacer las cosas que
quieres hacer.”
“Si bien en
su cultura el
peso extra es
considerado
positivo, la
obesidad tiene
consecuencias
serias en la salud
y vida social de
su hijo.”
Situación Cuatro: Intimidación o
“Bullying” (burla, acoso)
Su hijo se está portando mal, se muestra introvertido y dice
que no quiere ir a la escuela. Cuando usted le pregunta por
qué, le responde que los niños se han estado burlando de él,
llamándolo gordo y feo. ¿Qué le dice?
Una de las razones principales de burla en la escuela es el peso. El bullying
por el peso es más común que la burla por orientación sexual, raza/etnicidad,
discapacidad física o religión.22
Los niños con obesidad generalmente son acosados porque sus pares
los ven como distintos o indeseables. Esto con frecuencia significa
que no son invitados a fiestas u otras actividades sociales o que son
excluidos de ciertos grupos.23
El bullying puede provocar depresión, ansiedad, sentimientos de
tristeza y soledad, cambios en los patrones de sueño y alimentación,
pérdida de interés en actividades que su hijo solía disfrutar y hasta
puede interferir con el desarrollo académico.24
El bullying no es simplemente dejar que los niños sean niños –las
consecuencias del bullying se extienden hasta la adultez.25
Entre los adolescentes, la estigmatización del peso generalmente lleva
a un mayor consumo de comida como estrategia para salir adelante.26
La burla por el peso está asociada con índices más altos de trastorno por
atracón entre varones y mujeres, en comparación con niños excedidos de
peso que no fueron objeto de burlas.27
Bajar de peso no debería ser la solución para tratar el problema del bullying.
Los padres también tienen un rol en ayudar a sus hijos a tratar el bullying.
Hay recursos disponibles que pueden guiar a los padres para saber intervenir,
ayudar a sus hijos a crear un plan de seguridad y hablar con el personal de la
escuela.
Introducción
Comienzo
Lamento que esto esté ocurriendo y me alegra que me lo hayas
contado.
Burlarse está mal y no es justo. Realmente puede herir tus
sentimientos.
Una de las cosas más duras de la burla es que están hablando
de tu peso en términos de tu apariencia.
Te están haciendo sentir que tu peso es una medida de quién eres
como persona. Y no es así. Tú eres (completar con atributos positivos, por
ejemplo, compasivo, buen amigo, inteligente, trabajador).
El peso es una medida de tu salud y estar excedido de peso puede
dañar tu salud.
Yo te quiero y no tengo problemas con tu apariencia, pero como
padre, me preocupa que tengas sobrepeso y que esto pueda dañar tu
salud. También puede significar que no tengas suficiente energía y que
no puedas hacer las cosas que te gusta hacer.
Conversación
con sus hijos
Recursos
Apéndice
Diferencias Culturales, continuación
“Algo que podemos
hacer como familia
es encontrar
otras cosas que
podamos identificar
como signos de
éxito y felicidad
–como buenas
calificaciones en
la escuela, tener
amigos cercanos
y participar en
tus actividades
preferidas.”
Estar excedido de peso significa que tu cuerpo puede tener que
trabajar más duro de lo necesario. Como a ti no te gusta cuando el
maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más.
Si podemos ayudar a tu cuerpo a que deje de trabajar tan duro, entonces
podemos asegurarnos de que tengas suficiente energía para hacer las cosas
que te gustan y que te hacen feliz
como (completar).
Algunos niños tiene otros problemas de salud, como asma o
dificultad para concentrarse. Estar excedido de peso también puede
afectar su salud.
sientes. Hablemos de cómo podemos lograr un peso que sea saludable para
ti y que te permita hacer las cosas que quieres hacer.
interferir con una dieta sana y suficiente actividad física diariamente. (Pídale
a su hijo ejemplos específicos de su comunidad, su hogar y su rutina familiar
que pueden presentar un problema).
Algo que podemos hacer como familia es encontrar otras cosas que
podamos identificar como signos de éxito y felicidad –como buenas
calificaciones en la escuela, tener amigos cercanos y participar en tus
actividades preferidas (completar).
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud. (Aquí hay
algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas sugerencias se concentran
en acciones específicas que son fáciles de seguir y de medir).
un día
comen en una semana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
pantalla
la mesa
para la familia
comidas sanas
“Mientras más podamos
incorporar estas cosas
en nuestra rutina diaria,
más sanos estaremos.
Y esto también puede
hacerte sentir más
seguro de ti mismo.”
Apéndice
“Una de las cosas
más difíciles en esto
es que la mayoría
de las personas no
entiende que estar
excedido de peso
es un problema de
salud y otros pueden
burlarse de ella por su
apariencia, lo cual es
realmente injusto.”
Situación Cinco: El prejuicio sobre el peso
Un padre o maestro que no lo conoce muy bien ni a usted
ni a su familia le pregunta si su hijo que tiene obesidad
tiene permitido comer pastel o participar en una actividad
deportiva. ¿Qué le dice?
Los niños que están estigmatizados por su peso experimentan resultados
negativos, incluyendo daño psicológico, conductas alimentarias que no son
sanas y rechazo a la actividad física.
El estigma puede incluir las palabras usadas para describir el peso del
niño. Los padres han expresado que las palabras “peso” y “peso no
sano” son mejores que “obeso”, “extremadamente obeso” o “gordo” al
hablar con el médico del niño.
Los niños y adolescentes con sobrepeso/obesidad experimentan estigma
y prejuicio de parte de sus pares, pero los padres y los maestros también
demuestran prejuicio sobre el peso de los niños.28
Los padres a veces se sienten estigmatizados por el peso de un hijo, lo
cual luego puede influenciar cómo tratan a su hijo.29
Los medios de comunicación también contribuyen a estereotipos y
percepciones erróneas cuando enfatizan la responsabilidad personal
sin reconocer los roles del gobierno, la industria y los mismos medios.30
Un estudio de televidentes del programa The Biggest Loser indicó
que el show promueve la percepción de que los individuos están en
total control para subir y bajar de peso, y por consiguiente aumenta el
estigma de la obesidad.31
Lo que los padres pueden decir:
Introducción
Comienzo
¿Por qué me hace esa pregunta?
Usted sabe, mi hijo lucha con su sobrepeso y es un tema realmente
difícil de tratar. Es aún más difícil cuando recibo preguntas de gente
que puede no entender la naturaleza crónica del problema y lo que
estamos haciendo como familia para tratar de ayudar.
Nosotros bromeamos sobre no tener un manual de padres,
y tengo que decirle que de todas las cosas que he tenido que
enfrentar como padre (como hablar sobre cambios de trabajo,
sexo, drogas, etc.) éste ha sido el tema más difícil de abordar.
Una de las razones por las cuales ha sido tan difícil es que yo no sabía
qué decir y no sabía a dónde recurrir por ayuda. Como padre, también
me sentí personalmente responsable, lo cual lo hacía mucho más difícil.
Conversación
con sus hijos
Recursos
Apéndice
Diferencias de Peso en la Familia, continuación
“Lo más importante
para nosotros
como familia es
que su peso no es
una medida de
quién es ella
como persona.”
Pero hoy entendemos que éste es un problema de salud y es así como
lo estamos tratando.
Estamos tratando de abordarlo como familia porque como niño,
él/ella va a necesitar el apoyo de familia y amigos.
Y estamos tratando de fijar metas para que todos mejoremos nuestra
salud. Porque al fin de cuentas, de eso se trata.
Pensemos en algunas cosas que podamos hacer juntos para tener una buena salud.
(Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA: Estas
sugerencias se concentran en acciones específicas que son fáciles de seguir y de medir).
Preparar las comidas
juntos, en familia.
un día
el tiempo frente a
una pantalla
para la familia
comen en una semana
la mesa
comidas sanas
“Cuando una persona
está excedida de peso,
su cuerpo puede tener
que trabajar más duro
de lo necesario. Como
a ti no te gusta cuando
el maestro/a te da tarea
extra, a tu cuerpo no
le gusta tener que
trabajar más.”
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
“Sí, yo lucho con
mi peso, pero eso
no quiere decir
que cualquiera,
particularmente
un extraño,
pueda hacer un
comentario sobre
mi apariencia.”
Situación Seis:
Diferencias de peso dentro de la familia
Su hijo, de peso promedio, se burla de su hija y la llama “gorda”.
¿Qué le dice?
Burlarse por el peso entre miembros de la familia es extremadamente
común. Aproximadamente la mitad de las niñas con sobrepeso y un tercio
de los varones con sobrepeso dicen haber sido objeto de burlas por el peso
por miembros de la familia.32
Casi la mitad de las madres y un tercio de los padres muestran tener
prejuicios contra el peso.33
Burlarse por el peso entre miembros de la familia hace daño –esta burla
familiar está asociada a niveles más altos de IMC a largo plazo.34
La responsabilidad, culpa y presión que sienten los padres de los niños con
obesidad por no poder ayudarlos a bajar de peso también puede llevar a que
los padres se sientan frustrados, lo cual puede terminar afectando al niño,
pero se necesita más investigación.35
Yo no sé si lo sabes, pero tu hermana está enfrentando un
problema de salud.
Como algunos de tus amigos pueden tener asma o dificultad
para concentrarse, tu hermana está excedida de peso y eso
también puede dañar su salud.
Luchar con el exceso de peso es realmente difícil. Como
familia, debemos ofrecer apoyo.
Una de las cosas más difíciles en esto es que la mayoría de las
personas no entiende que estar excedido de peso es un problema
de salud y otros pueden burlarse de ella por su apariencia, lo cual es
realmente injusto.
Lo más importante para nosotros como familia es que su peso
no es una medida de quién es ella como persona. Porque
sabemos que ella es (complete con atributos positivos, por
ejemplo, compasiva, buena amiga, inteligente y trabajadora).
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
Obesidad de los Padres, continuación
“Los padres no son
perfectos. Te tengo
que decir que de
todas las cosas
que he tenido
que hacer en mi
vida, como ir a la
escuela, criar una
familia, esto ha
sido lo más difícil.”
Cuando una persona está excedida de peso, su cuerpo puede tener
que trabajar más duro de lo necesario. Como a ti no te gusta cuando el
maestro/a te da tarea extra, a tu cuerpo no le gusta tener que trabajar más.
Si podemos ayudar a tu hermana a controlar su peso, entonces podemos
asegurarnos de que tenga suficiente energía para hacer cosas que le gustan
y que la hacen feliz como (completar).
para concentrarse. Estar excedido de peso también puede afectar la salud.
sientes. Hablemos de cómo podemos lograr un peso que sea saludable para
ti y que te permita hacer las cosas que quieres hacer.
Bajar de peso no es fácil para nadie, especialmente para alguien de
la edad de tu hermana. También es muy difícil hacerlo sola. Hay muchas
cosas que pueden interferir con una dieta sana y suficiente actividad física
diariamente. (Pídale a su hijo ejemplos específicos de su comunidad, su hogar
y su rutina familiar que pueden presentar un problema).
Algo que podemos hacer como familia es encontrar otras cosas que
podamos identificar como signos de éxito y felicidad –como buenas
calificaciones en la escuela, tener amigos cercanos y participar en tus
actividades preferidas (completar).
Pensemos en algunas cosas que podamos hacer juntos para tener una buena
salud. (Aquí hay algunas sugerencias de las que usted y su hijo pueden hablar. NOTA:
Estas sugerencias se concentran en acciones específicas que son fáciles de seguir y
de medir).
un día
comen en una semana
Introducción
Comienzo
Conversación
con sus hijos
Recursos
pantalla
la mesa
para la familia
comidas sanas
Apéndice
“Una de las razones por las
cuales ha sido tan difícil es
porque durante mucho
tiempo pensé que mi
peso de más me hacía
una mala persona. Y
me hizo olvidar todas
las cosas que me
gustan de mí.”
“Los niños y
adolescentes con
sobrepeso/obesidad
experimentan estigma
y prejuicio de parte de
sus pares. Los padres
y los maestros también
demuestran prejuicio
sobre el peso de los
niños.”
28
Situación Siete: Obesidad de los padres
Usted es un adulto con obesidad que está en público con su
hijo. Otro adulto lo llama “gordo”. Su hijo pregunta por qué.
¿Qué le dice?
No está solo. Dos tercios de la población tiene sobrepeso u obesidad.
Aunque algunos traten la obesidad como un fracaso de responsabilidad
personal y se burlen de otros, la obesidad es una condición compleja.
La obesidad de los padres es un indicador significativo del peso de sus hijos,
particularmente entre niños de 7 a 15 años.36
Introducción
Sí, yo lucho con mi peso, pero eso no quiere decir que
cualquiera, particularmente un extraño, pueda hacer
un comentario sobre mi apariencia. En realidad, hiere mis
sentimientos y espero que no haya herido los tuyos.
Comienzo
Conversación
con sus hijos
Te voy a contar un secreto. El peso de más que tengo es mucho
más importante para mi salud que para cómo otra gente me ve.
Recursos
La mayoría de la gente que no tiene problemas con su peso no
tiene idea de cuán difícil es bajar de peso.
Apéndice
Pero sé que eso es importante porque el exceso de peso
está haciendo que mi cuerpo tenga que trabajar más de lo
necesario. Como a ti no te gusta cuando el maestro/a te da
demasiada tarea, a mi cuerpo no le gusta tener que trabajar más de
lo necesario.
¿Te sientes incómodo por mi peso? ¿Entiendes lo que significa?
Los padres no son perfectos. Te tengo que decir que de todas las
cosas que he tenido que hacer en mi vida, como ir a la escuela, criar
una familia, esto ha sido lo más difícil.
Una de las razones por las cuales ha sido tan difícil es porque
durante mucho tiempo pensé que mi peso de más me hacía
una mala persona. Y me hizo olvidar todas las cosas que me
gustan de mí, incluyendo (completar con atributos positivos, por
ejemplo, buena madre, buena cocinera, buena maestra).
Ahora lo entiendo. También sé que hay que dar muchos pasos para
estar más sanos. Estoy trabajando en ello y espero que tú me ayudes.
Recursos
Bam!
Esté Bien – Alianza para una Generación Más Sana
Sea un Ejemplo de Salud – MyPlate.gov
BodyWorks – Oficina de Salud Femenina del Departamento de Salud y
Servicios Humanos
Obesidad Infantil: Es Problema de Todos – Grupo Empresario Nacional
sobre Salud
Circulación: Evaluando a Padres y Adultos como “Agentes de Cambio”
para Tratar la Obesidad Infantil – Asociación Americana del Corazón
Padres en Forma – WebMD/Sistemas de Salud Sanford
Niños en Forma
Juventud Sana: Datos sobre la Obesidad
Cómo Hablar con sus Hijos sobre el Prejuicio contra el Peso –
Yale Rudd Center
¿Es su Hijo Objeto de Prejuicios contra el Peso? – Yale Rudd Center
Rincón de los Niños – Coalición de Acción Contra la Obesidad
¡A moverse!
Nuevos Movimientos: Programa de Educación Física para Niñas Basado
en Evidencia –Universidad de Minnesota
Padres: Sobre el Prejuicio contra el Peso – Yale Rudd Center
Departamento de Salud y Servicios Humanos
Hablar con sus Hijos sobre el Peso – Yale Rudd Center
El peso: ¿es un tema importante?– Yale Rudd Center
Prejuicio Contra el Peso: Información Importante para los Padres –
Yale Rudd Center
Red de Información sobre el Control de Peso
Recursos | 37
Introducción
Créditos & Reconocimientos
Comienzo
Esta guía fue desarrollada por una sociedad entre el equipo de
investigación sobre la obesidad de la Escuela de Salud Pública &
Servicios de Salud de George Washington University y el equipo
de comunicaciones de la Alianza Contra la Obesidad en la Agencia
Chandler Chicco:
Conversación
con sus hijos
• Stephanie David, JD, MPH
• Gina Mangiaracina,
• Lucas Divine
• Allison May Rosen,
Recursos
• Christine Ferguson, JD
La Alianza Contra la Obesidad y la Alianza para una Generación Más
Sana quisieran agradecer y reconocer a las siguientes organizaciones
y los siguientes expertos individuales por revisar y ofrecer ideas para
esta guía de conversación.
Junta de Asesoría Científica de la
Asociación Americana del Corazón
Robyn Osborn,
PhD, directora asistente, Centro Nacional
de Peso y Bienestar
Betty Pinkins,
Scotie Connor,
miembro de la Junta de Asesoría Juvenil de
Padres, Alianza para una Generación Más
Sana
Junta de Asesoría Juvenil, Alianza para una
Generación Más Sana
Ginny Ehrlich,
Scott Kahan,
DEd, MPH, directora ejecutiva, Alianza
para una Generación Más Sana
MD, MPH, Director, Alianza Contra la
Obesidad & director del Centro Nacional
de Peso y Bienestar
Joseph Nadglowski,
Stephen R. Daniels,
presidente, Coalición de Acción contra la
Obesidad
MD, PhD, Profesor y jefe del
Departamento de Pediatría de la Facultad
de Medicina de la Universidad de
Colorado; jefe de pediatría y presidente
L. Joseph Butterfield de Pediatría en el
Hospital de Niños de Colorado
Laurie Whitsel,
directora de Investigación Legislativa,
Asociación Americana del Corazón
Nazrat Mizra,
MD, profesora, Instituto General y de
Pediatría Comunitaria & Obesidad, Centro
Médico Nacional de Niños
Rebecca Puhl,
directora de Investigación, Rudd Center
Para Políticas Alimentarias & Obesidad en la
Universidad de Yale
Comité Directivo de la Alianza Contra
la Obesidad
Apéndice
Apéndice
Figura 1:
Tabla de Crecimiento de Varones
Apéndice | 39
Figura 2:
Tabla de Crecimiento de Mujeres
Introducción
Comienzo
Conversación
con sus hijos
Recursos
Apéndice
40 | Apéndice
1. Lalita Khaodhiar, Karen C. McCowen, George L. Blackburn, La obesidad y sus condiciones
comórbidas, Clinical Cornerstone, Volumen 2, edición 3, 1999, Páginas 17-31, ISSN 1098-3597, 10.1016/
S1098-3597(99)90002-9.
2. Levi J., Vinter S., Richardson L., Laurent R., St., Segal L. M. (2010). Informe: Grasa: Cómo la obesidad
amenaza el futuro de Estados Unidos. Trust for America’s Health.
3. Iniciativa de Educación sobre la Obesidad, NIH, NHLBI. Pautas Clínicas para la Identificación,
Evaluación y Tratamiento de Sobrepeso y Obesidad en Adultos.
4. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Victimización de adolescentes con sobrepeso y obesidad
en base al peso: Observaciones y reacciones de pares. Journal of School Health, 81, 696-703.
5. Singh AS, Mulder C, Twisk JW, et al. Seguimiento del sobrepeso de la infancia a la adultez: revisión
sistemática de la bibliografía. Obes Rev. 2008;9:474–488. Academia Americana de Médicos de
Familia. Recomendaciones para servicios clínicos preventivos. Disponible en: www.aafp.org/online/
en/home/clinical/exam/k-o.html.
6. Aucott L., Rothnie H., McIntyre L., Thapa M., Waweru C., Gray D. (2009) ¿La pérdida de peso
a largo plazo por intervención en el estilo de vida beneficia la presión arterial? Revisión
sistemática. Hipertensión. Disponible en: http://hyper.ahajournals.org/cgi/content/abstract/
HYPERTENSIONAHA.109.135178v1.
7. Lavie C.J., Milani R.V., Artham S.M., Patel D.A., Ventura H.O. (2009) La paradoja de la obesidad,
pérdida de peso y enfermedades coronarias. Revista Americana de Medicina. Disponible en: http://
www.amjmed.com/article/S0002-9343 percent2809percent2900500-2/abstract
8. Aronne LJ, Nelinson DS, Lillo JL. La obesidad como un estado de enfermedad: nuevo paradigma
para diagnóstico y tratamiento. Clinical Cornerstone. 2009;9(4):9-25; discusión 26-9.
9. Kluck AS. Influencia familiar en trastornos alimentarios: El rol de la insatisfacción de la imagen
corporal. Imagen Corporal. 2010;7(1):8-14.
10. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Utilidad del IMC infantil en la predicción de
enfermedades en la adultez: Comparación de referencias nacionales e internacionales. Obes Res.
2005;13(6):1106-1115.
11. Centros para el Control y la Prevención de Enfermedades. (2011). Sobre el IMC para Niños y
Adolescentes. Disponible en: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/
about_childrens_bmi.html/.
14. Singh AS, Mulder C, Twisk JW, et al. Seguimiento del sobrepeso de la infancia a la adultez: revisión
sistemática de la bibliografía. Obes Rev. 2008;9:474–488. Academia Americana de Médicos de
Familia. Recomendaciones para servicios clínicos preventivos. Disponible en: www.aafp.org/online/
en/home/clinical/exam/k-o.html.
15. Faith, M.S., Van Horn, L., Appel, L.J., Burke, L.E., Carson, J.S., et al. (2012) Evaluando a Padres y Adultos
como “Agentes de Cambio” para Tratar la Obesidad Infantil: evidencia para estrategias de cambios
en la conducta de los padres y vacíos de investigación: declaración científica de la Asociación
Americana del Corazón. Circulación. 125(9):1186-207
16. Polley DC, Spicer MT, Knight AP, & Hartley BL. (2005). Correlaciones intrafamiliares de sobrepeso
y obesidad en abuelos, padres y niños afroamericanos y nativo-americanos en zonas rurales de
Oklahoma. Asociación Dietética Americana, 105:262–265
17. Faith et al., 2012.
Apéndice | 41
18. Gustafson-Larson AM, Terry RD. Preocupaciones y conductas relacionadas al peso en niños de
cuarto grado. Asociación Dietética Americana 1992;92(7):818-822.
Introducción
Comienzo
19. NEDA. “Asociación Nacional de Trastornos Alimentarios, Datos sobre Trastornos Alimentarios
Julio 2010”. Disponible en: http://www.nationaleatingdisorders.org/uploads/file/in-the-news/
In%20the%20News%20Fact%20Sheet%20PDF.pdf
20. Lindsay, A.C., Sussner, K.M., Kim, K., Gortmaker, S. (2006). El rol de los padres en la prevención de
la obesidad infantil. El Futuro de los Niños. 16(1), 169-186.
21. Epstein LH, Paluch RA, Roemmich JN, Beecher MD (2007). Tratamiento familiar de la obesidad,
antes y ahora: veinticinco años de tratamiento pediátrico de la obesidad. Health Psychol. 26(4):
381-391.
22. Puhl, R.M., Luedicke, J., & Heuer, C. (2011). Victimización de adolescentes con sobrepeso y
obesidad en base al peso: Observaciones y reacciones de pares. Journal of School Health, 81,
696-703.
Conversación
con sus hijos
Recursos
23. Robinson, S. (2006). “Victimización de adolescentes obesos”. Revista de escuela de enfermería
(1059-8405), 22 (4), 201.
24. Puhl RM, Latner JD. (2007). Estigma, obesidad, y la salud de los niños de la nación. Psychol Bull.
133(4):557-580.
25. Oficina de Justicia Juvenil y Prevención de Delitos, Departamento de Justicia de EE.UU. (2001).
Tratando el Problema de la Intimidación (bullying) Juvenil. Hoja de Datos #27. Disponible en:
http://www.ncjrs.gov/pdffiles1/ojjdp/fs200127.pdf
26. Puhl, Rebecca M. (2012). “Victimización por Peso de Adolescentes en la Escuela: Reacciones
Emocionales y Conductas para Enfrentar la Situación”. Revista de juventud y adolescencia. 41 (1):
27.
27. Neumark-Sztainer, D. (2002). “Burlas entre adolescentes por el peso: Correlaciones con estado
del peso y conductas alimentarias anormales”. Revista internacional de obesidad y trastornos
metabólicos asociados. (0307-0565), 26 (1), 123.
28. Schwartz MB, Puhl R. (2003). Obesidad infantil: un problema social para resolver. Obesity
Reviews. 4(1):57-71.
29. Turner KM, Salisbury C, Shield JPH. Opiniones y experiencias de los padres sobre el manejo de la
obesidad infantil en la atención primaria: Estudio cualitativo. Family Practice. 2011.
30. Atanasova, D. (06/2012). “La obesidad en las noticias: instrucciones para investigaciones futuras”.
Obesity reviews (1467-7881), 13 (6), 554.
31. Yoo, Jina H (06/28/2012). “Sin Ganadores: Efectos del Show ‘The Biggest Loser’ en la
Estigmatización de Personas Obesas”. Health communication (1041-0236)
32. Puhl RM, Latner JD. (2007). Estigma, obesidad y la salud de los niños de la nación. Psychol Bull.
133(4):557-580.
133(4):557-580.
34. Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA.
Riesgos compartidos y factores de protección para sobrepeso y trastornos alimentarios en
adolescentes. Am J Prev Med. 2007;33(5):359-369. e3.
133(4):557-580.
36. Svensson V, Jacobsson JA, Fredriksson R, et al. Asociaciones entre severidad de la obesidad en
la infancia y la adolescencia, inicio de la obesidad y el IMC de los padres: estudio longitudinal de
cohortes. Int J Obes. 2011;35(1):46-52.
Apéndice
Queremos sus comentarios.
Contáctenos con su historia personal a [email protected].
Act Locally: A Guide to Philadelphia Resources for Families
Many parents struggle with how to discuss weight and health with their children. “Weigh In: Talking to
Your Children about Weight and Health,” is a free guide developed by the Strategies to Overcome and
Prevent (STOP) Obesity Alliance and the Alliance for a Healthier Generation that offers parents “realworld” situations and plain language responses to questions they may get from their children. You can
view the guide at http://weighinonobesity.org.
While the guide includes recommendations on what to say, this resource is meant to help turn those
recommendations into Philadelphia-specific activities. Below are some suggestions of resources
available to all Philadelphia families. For even more ideas, we suggest visiting Food Fit Philly
(http://foodfitphilly.org) and CAP4Kids (http://www.cap4kids.org/philadelphia) for additional resources.
Have another idea? Email us at [email protected].
Increase the number of minutes of physical activity in a day
Encourage children to participate in physical activity clubs before, during and after school.
Start on-going walking initiatives at your child’s school. Safe Routes Philly outlines several
methods and types of walking activities that students at your school can use for transportation
and fitness.
o Safe Routes Philly: http://saferoutesphilly.org/
Phone: (215) 242-9253 Ext. 309
Check out the Schuylkill River Trail, a bike path with an eight-mile loop between Center City and
East Falls. From Schuylkill Banks to East Falls, the trail is a wide paved surface suitable for
rollerblading, walking, running and cycling.
o Schuylkill River Trail: http://www.schuylkillrivertrail.com/
Phone: (215) 683-0200
Printable map of trails: http://www.schuylkillrivertrail.com/pdfs/Phila_section.pdf
Take the family to Franklin Square, which was recently named one of the top five playgrounds in
the United States by Yahoo.com! Franklin Square features the Philadelphia Park Liberty
Carousel, a Philadelphia-themed miniature golf course and playgrounds centered around the
Franklin Square fountain.
o Franklin Square: http://www.historicphiladelphia.org
Address: 200 N 6th St, Philadelphia, PA 19106
Phone: (215) 629-4026
Try out the renovated Seger Park Playground. The park regularly holds family-friendly
community events and features tennis courts, a dog run, basketball courts and a recreation
center.
o Seger Park Playground: http://friendsofseger.org/
Address: 1020 Lombard Street, Philadelphia, PA 19147
Phone: (267) 507-5558
Create family play time and increase outdoor play time
Head to Fairmount Park to access its many biking and walking trails.
o Fairmont Park: http://www.visitphilly.com/outdoor-activities/philadelphia/fairmountpark/
Published May 15, 2013
Address: 1 Boathouse Row, Philadelphia, PA 19130
Phone: (215) 683-0200
Don’t have access to a bike at home? Rent one from Wheel Fun Rentals at various parks and
locations across the city.
o Wheel Fun Rentals: http://www.wheelfunrentals.com/Locations/Philadelphia
Address: 1 Boathouse Row, Philadelphia, PA 19130
Phone: (215) 232-7778 or (805) 650-7770
Skip the heat in the summer and head to a public swimming pool near you. Philadelphia
swimming pools allow free access to any individual during operating hours in the summer
(Monday through Friday from 11 a.m. until 7 p.m. and Saturdays and Sundays from 12 p.m. until
5 p.m.). The swimming pools offer swimming lessons and family swim.
o City of Philadelphia Pools:
http://www.phila.gov/ParksandRecreation/placestogo/facilities/Pages/SwimmingPools.
aspx
o Find the pool closest to you using this tool:
http://www.phila.gov/parksandrecreation/findafacility/
Take the family to play in the 16,000 square foot (the size of six football fields!) Smith Memorial
Playground & Playhouse, located in East Fairmount Park and was designed solely as a play space
for children. Smith provides opportunities for unstructured creative play for children 10 and
younger. Smith maintains a proud tradition of free family admission. Tuesdays are reserved just
for family fun. Check out other free events at Smith here.
o Smith Memorial Playground & Playhouse: http://smithkidsplayplace.org/
Address: 3500 Reservoir Drive, East Fairmount Park, Philadelphia, PA 19121-1095
Phone: (215) 765-4325
[email protected]
Looking for a fun activity in the winter? Philadelphia Parks & Recreation, in partnership with Ed
Snider Youth Hockey Foundation, owns and operates five ice rinks throughout the city. The ice
rinks are open to the public seven days a week. There is a $3 skate rental fee.
o Philadelphia Ice Rinks:
http://www.phila.gov/ParksandRecreation/placestogo/facilities/Pages/IceRinks.aspx
Blue Cross River Laura Sims
Rizzo Ice Rink Scanlon Ice Rink Simons Ice Rink Tarken Ice Rink
Rink at Penn's
Skate House
1001 South
1099 East Tioga 7200 Woolston 6250 Frontenac
Landing
63rd &Walnut Front Street
Street
Avenue
Street
201 S Columbus
215-685-1995 215-685-1593 215-685-9893
215-685-3551
215-685-1226
Blvd
215-925-7465
Find out whether there is a Philadelphia Healthy Corner Store near you. SNAP are accepted at
over 350 healthy corner stores.
o Food Fit Philly Eat Healthy: http://www.foodfitphilly.org/eat-healthy/
o List of Healthy Corner Stores that accept ACCESS cards/SNAP:
http://www.foodfitphilly.org/FOODFITPHILLY/assets/File/Healthy%20corner%20stores%
20SNAP%207_6_12.pdf
Learn about the Philly Food Bucks program to help you save money on fruits and vegetables.
Philly Food Bucks are accepted at over 25 farmers' markets in low-income communities in
Philadelphia. You must have a current ACCESS card/food stamps to use Philly Foods Bucks.
o
Food Fit Philly - Philly Food Bucks: http://www.foodfitphilly.org/eat-healthy/philly-foodbucks/
Visit Reading Terminal, Philadelphia’s historic farmer’s market, where you can find fresh
vegetables and produce, meats and seafood. The Terminal offers one-stop shopping for healthy
eating there or to take home.
o Learn more here: http://www.readingterminalmarket.org/
Order a box of fresh produce from SHARE Food Program’s Farm to Families initiative from local
farmers at a cost of only $10 or $15. Boxes are brimming with fresh fruits and vegetables, often
valued at double the purchase price. Additional fresh a la carte items including eggs, meat and
seafood are also offered at affordable prices.
o SHARE Food Program’s Farm to Families Program:
http://sharefoodprogram.org/programs/farm-to-families/
Address: 2901 W. Hunting Park Avenue, Philadelphia, PA 19144
Phone: (215) 223-2220
[email protected]
Download the Children’s Hospital of Philadelphia’s free Nutrition in the Kitchen Cookbook and
try out some healthy recipes.
o Children’s Hospital of Philadelphia Nutrition in the Kitchen Cookbook:
http://www.chop.edu/service/healthy-weight-program/cookbook-of-healthyrecipes.html
Download the CAP4Kids fresh food parenting handouts on topics like food and nutrition. Within
each handout, you will find a description of the social service agency, their address, phone
number and website.
o CAP4Kids Parenting Handout on Fresh Food Resources:
http://cap4kids.org/philadelphia/parent-handouts/food-nutrition-breastfeeding/freshfood-resources/
Shop at farmer’s markets that accept access/SNAP.
o You can find a list of those here:
http://www.foodfitphilly.org/FOODFITPHILLY/assets/File/Snap_Access_2012.pdf
Shop at farmers markets like those organized by Farm to City.
o Farm to City: http://www.farmtocity.org/index.asp
Address: 1315 Walnut Street, Suite 1526, Philadelphia PA 19107
Phone: (215) 733-9599 Phone
o Map of Philadelphia Farmer’s Markets: http://batchgeo.com/map/phillyfarmersmarkets
Visit one of the Philadelphia community gardens near you.
o Philadelphia Community Gardens:
http://pennsylvaniahorticulturalsociety.org/phlgreen/current-communitygardens.html
o Address: 100 N. 20th Street - 5th Floor, Philadelphia, PA 19103
Phone: (215) 988-8800
Sign up for SHARE Food Program’s Sunday Suppers, an innovative family-oriented meal program
in West Kensington sponsored by the nonprofit SHARE Food Program. In partnership with West
Kensington Ministry, Sunday Suppers provides healthy shared dinners, increased access to fresh
local food and other food related support to families in the Norris Square area of Philadelphia.
o
SHARE Food Program Sunday Suppers: http://sharefoodprogram.org/programs/sundaysuppers/
Address: 2901 W. Hunting Park Avenue, Philadelphia, PA 19144
Phone: (215) 223-2220
o [email protected]
Check out the healthy family recipes compiled by the Center for Nutrition and Activity
Promotion at Penn State Hershey Children’s Hospital and Kohl’s Department Store as part of
Kohl’s Healthy Choices for Healthy Families initiative.
o Kohl’s Healthy Choices for Healthy Families Healthy Recipes (scroll down to #3):
http://www2.med.psu.edu/cnap/families/kohlshealthyfamilies/
o Plan and track family meals with this chart:
http://www2.med.psu.edu/cnap/files/2012/05/Tracker-3-meals-a-day.pdf
Get involved with the Philly Girls in Motion program, which in addition to offering fitness
activities for girls 9-16 and their families, offers specially designed nutrition lessons. There are
monthly sessions for the whole family on important topics including “Healthy Cooking Tips,”
“Meals on the Go” and “Simple Substitutions.”
o Philly Girls in Motion: http://www.phillygirlsinmotion.org/
o Phone: (610) 357-7446
o [email protected]
How do you respond
when your child:
asks you if you
think he/she is fat?
is being bullied at
school because of
weight?
Weigh In: A conversation guide for parents and adult caregivers of children.
www.WeighInOnObesity.org
Get your free copy of the Weigh In parent conversation
guide at www.WeighInOnObesity.org. It offers practical
information on how to compassionately respond to the
following real-world scenarios about weight and health:
• Cultural Differences
• Weight Bias
• Body Image
• Inter-family Weight Differences
• Bullying
• Parental Obesity
• BMI Confusion

Talking with Your Children About Weight and Health

Transcripción

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