Tips to help kids eat healthy, and have a positive self-image

Even well-intended comments about weight, weight loss and dieting can actually harm children with overweight and obesity. Instead, experts say one way to help is to model healthy behavior for your kids and don't single out any of your children. — Janice Chang for NPR

Dale Knuth, now 58, says that in childhood her weight was a source of anguish — largely because of how her family treated her. "I had a brother who tormented me constantly," she says. "If I came home from school and was hungry and ate an apple, I'd be called a cow, or a pig or whatever."

Her parents, she says, did nothing to stop her brother "except to say, 'Yeah, you're getting fat.' " She had no physical outlet for her frustration — she wanted to play softball, but her mother wouldn't allow it.

Decades later, Knuth is much happier. She has an active life that includes riding bikes and playing racquetball. Her husband tells her he loves her at any size and always will. But she still thinks about how her life could have turned out without so much shaming in childhood.

"Had it not been pointed out at every meal, at every point, had I been given more support to play in sports," she says, perhaps she could have formed healthier habits and a more positive relationship with her body.

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According to Marlene Schwartz, a psychologist and the director of the Rudd Center for Food Policy and Obesity, a child's immediate family can be a common source of fat shaming, or commenting negatively on the child's weight.

"I think sometimes parents misguidedly think that if they tease the child, that it will motivate them to try harder to lose weight," she says. "But there's virtually no evidence that that works. And in fact, there's evidence that it causes harm."

For instance, studies have shown that children subjected to weight-based teasing gain more weight than other children. And even less overtly cruel tactics, like advising your child to lose weight or encouraging your child to go on a diet, can often backfire, causing lasting physical and psychological harm. A 2016 report by the American Academy of Pediatrics warned parents and doctors against prescribing or discussing weight loss to kids and teens, because such behavior could increase their risk of weight gain and disordered eating.

Still, parents can help kids with overweight or obesity eat more healthfully, stay active and maintain positive attitudes about their bodies. Here's advice about the best ways to communicate with children about weight and support their health.

Don't tease — and try to put a stop to others' teasing

It's worth reiterating: Never, ever make fun of your child for their weight.

And parents can go further than that, Schwartz says, by watching what relatives say to their kids. "I think it's perfectly appropriate if a parent feels like someone in the family is likely to say something upsetting, talk to them ahead of time. Say, 'Look, we know our child is overweight. We're working on developing healthy habits. Please don't say anything to him or her about their weight.' "

And if someone does say something, intervene, she suggests. Shift the focus; talk about your kid's role in an upcoming play, for example, or ask the relative a question about themselves. "You want the child to feel safe around their own family," she says.

Promote positive self-image, instead of focusing on weight

Even practical comments focused on your child's weight can backfire, Schwartz says: "Even 'gentle prodding' about weight isn't a good idea, in my opinion." Research backs this up: In one 2017 study in the journal Eating and Weight Disorders, researchers found that women who remembered their parents commenting about their weight in childhood reported greater dissatisfaction with their bodies well into adulthood — regardless of their actual body mass index.

Instead, help your child feel comfortable in their body, no matter the size. For example: "If you're going clothes shopping with your child, don't make comments [like], 'That makes you look slimmer' or 'That is too tight,' " she says. "Focus on finding clothes that the child feels comfortable with, and be generous with your praise when your child finds an outfit."

Don't put your child on a diet

Is it OK to put your child on a diet? The recent introduction of Kurbo, a weight-loss app for children as young as 8 by WW (formerly Weight Watchers), has raised this question among parents and health care professionals.

Denise Wilfley, director of the Center for Healthy Weight and Wellness at Washington University in St. Louis, doesn't recommend Kurbo, writing in an email that "it is not an evidence-based program." In fact, she doesn't recommend diets for kids at all; instead she suggests evidence-based programs that focus on "modifying the entire family environment to support the child."

Schwartz adds that the concept of a diet for kids tends to be counterproductive because it emphasizes a short-term period of deprivation. "The term 'putting a kid on a diet' is problematic, because it implies you are doing something different for a specific period of time, and when you are done the child will go back to his/her regular way of eating," she said via email. "That is not the point."

Instead, choose, as a family, to eat healthfully year-round

The solution, Wilfley says, is to make your entire household a healthy environment "where the child is exposed to high-quality nutrition and prompts for physical activity."

"It's OK to have sugar-sweetened beverages and snack foods in the home, but that should be a small proportion compared to fruits, vegetables, lean meats," she says. But the whole family has to do it — don't single out one child. She says she has seen cases in which parents will have one lean child whom they allow to have fried foods and sugary drinks and one child with obesity, whom they put on a strict diet — "an all health-oriented plan, lots of fruits and vegetables and water, low-fat milk."

"We recommend strongly against this approach," she says. "You can't have Dad coming in with a burger and fries and expect the child to not feel deprived," she says. "It's that deprivation that fuels binge eating."

Focus on behaviors, not body size

You may need to check your own biases, says Wilfley. "Most parents have internalized a culture's view and negative attitudes about shape and weight. Either they themselves have been ashamed of their bodies or they're worried about [their kids] getting stigmatized," she says. But reflecting back these negative attitudes will only harm your kid's self-image and may even promote weight gain. Instead, she says, you need to help your child understand that "having [a] wider range of body types is OK."

"Shape and weight is largely under genetic control. There's a lot of genetic variation," Wilfley says. "So, some kids will [naturally] be leaner than other kids."

And once you've shifted focus away from your child's size, reward your child for healthy behavior. Praise your child for playing soccer or for having a nutritious breakfast. Overall, "focus on creating the healthiest environment for the entire family," Schwartz says.

Many kids with overweight or obesity are interested in getting active and eating healthy. It's up to you to help them.

Model healthy behavior of your own

If you're a parent, you know your kids often do what they see you do. Wilfley often works with entire families to develop healthy eating and exercise habits.

"A parent might eat only one meal a day and model that for their child," Wilfley says. "We know, optimally, kids eat three meals a day with one to two planned snacks." Wilfley advocates that parents establish their own regular eating, sleeping and exercise routines so their child can follow suit.