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Working With Fat Children

Working With Fat Children

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Published by Christopher DeWitt

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Published by: Christopher DeWitt on Jan 17, 2011
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Working with Fat Childrenhttp://www.radiancemagazine.com/kids_project/working.htm[1/17/2011 12:15:31 AM]
Working with Fat Children in Schools
By Michael I. Loewy, Ph.D.Illustrations by Doug Dworkin
Fall 1998
Sandy McBrayer, the 1995 national Teacher of the Year, tells of visiting anelementary school that was proud of its ethnic diversity and the integrationachieved within the school’s social milieu. The principal walked her to thenewly built multipurpose "cafetorium" and ceremoniously pulled open thedoors to reveal children of all colors eating, talking, and laughing together.As she entered, a contrasting scene near the door caught her eye. Separatedfrom the rest of the student body were two large children who sat at a tableeating their lunches in silence, staring directly ahead. They were not laughing.They were not talking. They were just bringing their forks to their mouths and down again, tryingto be inconspicuous and to finish quickly. This day, they were too slow.
As other children finished their meals and exited the cafetorium, they threw their uneaten food at the two children. The fatchildren appeared oblivious as food hit their table and slid to the floor or hit their hands and fell onto their plates. They just kepteating and staring directly ahead. They behaved as if they did not know what was happening or as if this was a normal occurrenceand they expected nobody to intervene.The ridicule and torment of fat children by others is a story told again and again by fat children and by adults who were fatchildren. What effect does such ridicule—often accepted and endorsed by society—have on its young victims? How caneducators and counselors intervene to support fat children?
Prejudice and Its Effects
The literature on prejudice reveals that fat children are the target of ridicule and disgust both bytheir peers and by the adults in their lives, such as teachers, counselors, and parents. This is nosmall problem in schools: according to the Centers for Disease Control (1994), 21 percent of people ages twelve to nineteen are overweight. As early as preschool age, children have acceptedthe stereotypes about and developed prejudice against fat people. Given the opportunity to playwith fat or thin dolls, all children, even those who could correctly identify that the fat dollslooked more like them, preferred to play with thin dolls (Dyrenforth, Freeman & Wooley, 1978;Rothblum, 1992). Given pictures of children who were in a wheelchair, missing a limb, oncrutches, facially disfigured, or obese, most children said they would least like to play with thefat child (Rothblum, 1993).By elementary school, children describe fat children as lazy, sloppy, dirty, stupid, and ugly (Levine, 1987). Fat children are lesslikely than other children to receive “best friend” ratings from their classmates (Rothblum, 1992). When shown silhouettes of fatand thin males and females, nine-year-old children rated the fat figures as having significantly fewer friends, being less liked by
Working with Fat Childrenhttp://www.radiancemagazine.com/kids_project/working.htm[1/17/2011 12:15:31 AM]
their parents, doing less well at school, being less content with their appearance, and wanting to be thinner (Hill & Silver, 1995).A group of six- to ten-year-old boys rated fat children as most likely to be teased (Staffieri, 1967).By adolescence, the subjective importance of physical appearance is particularly great among girls (Wadden & Stunkard, 1987).A longitudinal study of one thousand high school students revealed that more than 50 percent of the girls wanted smaller hips,thighs, or waists. Of ninth-grade girls, 63 percent wanted to lose weight. This figure rises to 70 percent for tenth- and eleventh-grade girls (Huenemann, Shapiro, Hampton & Mitchell, 1966). Canning and Mayer (1966) found lower acceptance rates intoprestigious colleges for fat high school students, compared with average-weight students, even though the two groups did notdiffer in high school performance, academic qualifications, or application rates to colleges.Teachers and counselors are subject to the same stereotypes and biases as parents and children. In a study of more than twohundred teachers, it was found that for such characteristics as attractiveness, energy level, leadership ability, self-esteem, and theability to be socially outgoing, large children are consistently perceived by teachers more negatively than average-weight children(Schroer, 1985). In another study of education professionals, a picture of an average-size teenage girl received higher ratings onscholarship, while the picture of a fat girl was rated highest on risk for personal problems and recommendation for psychologicalreferral (Quinn, 1987). A study of fifty-two mental health professionals indicated that counselors have the same biases as thegeneral public: they tend to stereotype fat people negatively and thin people positively (Loewy, 1994).Parents have a strong impact on children’s self-image and self-esteem. One study found that girls were less likely to receivesupport from their parents for college education if they were fatter than average (Crandall, 1991). Controlling for income,ethnicity, family size, and number of children attending college did not change the results. Further examination found thatreluctance to pay for large daughters’ educations is a matter of parental choice, not ability (Crandall, 1995).According to a 1994 article by Ronald Kleinman, M.D., chief of the Pediatric Gastroenterology and Nutrition Unit, MassachusettsGeneral Hospital, and associate professor of pediatrics at Harvard Medical School, “Many parents are unnecessarily concernedwith their children’s weight. They badger their high-achieving, happy kids for generally unfounded reasons. We need tocommunicate to parents [and other responsible adults] that a fat child does not have any more medical problems than otherchildren the same age.”Parents and educators often project their dissatisfaction with their own bodies on the children over whom they have influence. Itcannot be stressed enough that adults must deal with their own negative body image and fear, loathing, and disgust of fat beforethey can stop teaching children to hate their bodies.The cultural obsession with thinness and the stigma attached to being fat take a toll on the mental health of large people.Although they show no greater disturbance on conventional measures of psychopathology, many fat people suffer from poor bodyimage (Wadden & Stunkard, 1987). Fat people characteristically view their own bodies as grotesque and loathsome and believethat others view them with hostility and contempt (Stunkard & Mendelson, 1967). Because poor body image is an internalizationof parental and peer criticism (Wadden & Stunkard, 1987), only a cultural shift in parental concern and acceptance of fat childrenby peers and adults can alleviate fat children’s internalized self-hatred.
What Is Wrong with Common Strategies?
Several perceptions encourage well-meaning parents and teachers to be concerned with childhoodobesity. First, it is commonly believed that being fat is a health hazard. Second, it is generallyaccepted that fat children grow into fat adults (Stunkard & Berkowitz, 1990). Third, parents don’twant their children to be the target of oppression and discrimination. Fourth, we know that beingfat during adolescence has important social and economic consequences. For example, largeadolescents and young adults remain single more often and have lower household incomes in earlyadult life than their average-weight counterparts, regardless of their socioeconomic origins andaptitude-test scores (Gortmaker, Must, Perrin, Sobol & Dietz, 1993).As a result of these perceptions and misperceptions, many parents subject their children tocommonly prescribed strategies for weight loss, including caloric restriction, behaviormodification, and commercial weight-loss programs. Most attempts at weight loss will result in short-term success (Bennett &Gurin, 1982). Yet current research demonstrates that for many children, such methods result in increased frustration and lowerself-esteem.What is not generally accepted or understood is that efforts to control or limit the food intake of children and adults through diets(or the euphemistic term
lifestyle change
) do not work in the long run. There is overwhelming evidence that obesity is primarily
Working with Fat Childrenhttp://www.radiancemagazine.com/kids_project/working.htm[1/17/2011 12:15:31 AM]
genetically determined (Price et al., 1990; Stunkard et al., 1986; Stunkard, Harris, Pedersen & McClearn, 1990). In a study of same-sex, identical and nonidentical twins, estimated heritability of obesity was 88 percent (Borjeson, 1976). Price, Cadoret,Stunkard & Troughton (1987) found a strong relationship between body mass index (BMI) of adoptees and their biologicalparents, whereas no relationship was found in the BMI of adoptees and their adoptive parents.Research has shown that metabolic rate has a genetic pattern. The metabolic rate of the four-year-old children of fat parents was10 percent lower than the rate of the four-year-old children of parents who were not fat (Griffiths & Payne, 1976). At threemonths of age, the BMIs of infants of lean and obese mothers were indistinguishable. However, the energy expenditure was morethan 20 percent lower in the infants who later became fat (Roberts, Savage, Coward, Chew & Lucas, 1988). The findings of Ravussin et al. (1988), who studied energy expenditure among Southwest American Indians, indicate that, although there was nodifference between fat and lean children in caloric intake, the children of fat parents became fat later in life.Fat children, as a group, do not eat more than average-size children. Withholding or restricting someone else’s food is the sameas starving that person, and it feels the same: torturous. And when one withholds or restricts one’s own food intake, we call it adiet. In reality, it is self-starvation.Several reviews of behavioral and dietary treatments of obesity have revealed the dismal failure of these methods (Bennett &Gurin, 1982; Garner & Wooley, 1991; Wadden, Stunkard & Liebschutz, 1988). Although almost all weight-loss programs appearto demonstrate moderate success in promoting at least some short-term weight loss, there is virtually no evidence that clinicallysignificant weight loss can be maintained over the long term by the vast majority of people.The most successful weight-loss programs studied have incorporated behavior management techniques, exercise, social influence,longer treatment duration, and continued therapeutic contact after the end of formal treatment. Although these strategies havebeen found to promote greater weight loss and improved maintenance during the first eighteen months after treatment, long-termfollow-up studies (Garner & Wooley, 1991) show that in time, weight is gradually regained, with many participants weighingmore than they did before the programs.For example, in a five-year follow-up study, Stalonas, Perri & Kerzner (1984) reported that the average participant had gained11.9 pounds since the end of treatment, making him or her 1.49 pounds heavier than when treatment began. Researchers studying114 men and 38 women who had successfully completed a fifteen-week behavioral weight-loss program reported that less than 3percent maintained their post-treatment weight loss after four years (Kramer, Jeffery, Forster & Snell, 1989). Weight reboundseems to be almost as reliable a consequence of treatment as initial weight loss (Garner & Wooley, 1991).Not only do such methods fail to produce lasting results, but there is strong evidence that continued attempts at dieting result inincreased biological resistance to weight loss. Young people are often advised to lose weight now because it gets harder to lose asone gets older. However, the earlier one starts this cycle of losing and regaining, the heavier one will be as an adult.Teachers, parents, and other caregivers who lack understanding of the variations in growth patterns that occur during childhoodmay do more harm than good. Poor role modeling and attempts to limit children’s food intake are ineffective and can even beharmful in dealing with children’s body-size issues (Ikeda & Naworski, 1992). The more pressure we put on children andadolescents to conform to the ideal body type, the more we perpetuate the myth that this ideal can be achieved by everyone.Furthermore, we are sending children the message that they are damaged and need to change in order to be acceptable.In reality, it seems that body weight is regulated by physiological mechanisms that oppose the displacement of weight caused byeither over- or underfeeding. This concept, known as “set point,” accounts for the data from human and animal studies showingthat there is a remarkable stability and homeostasis of body weight over time (Bennett & Gurin, 1982). Set point accounts notonly for the difficulty people have in losing weight, but also for the extreme difficulty some people have in gaining weight andmaintaining that weight gain.In essence, as body weight is reduced, the resting metabolic rate is also reduced. Therefore, it takes increased restriction of caloric intake to maintain any weight loss. Furthermore, when food intake is normalized after a period of food restriction, there isa tendency for energy to be redeposited preferentially as body fat (Dulloo & Girardier, 1990).In sum, a small percentage of children will slim down as they physically mature, and for some very few, weight-loss programsmay have long-term benefits. However, the vast majority of children and adolescents who attempt to artificially control theirweight will experience failure and frustration, leading to lower self-esteem.
Recommendations for Supporting Fat Children

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