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