Question 3
How would you approach a counseling session with an overweight child? What advice would you give to their caregivers in terms of monitoring and/or controlling diet and activity levels?
posted by karlie @ 2:26 PM
12 comments
12 Comments:
It would first be very important to build good rapport with the child to develop a sense of trust. Asking the child what foods or beverages they like and why they like them might help in getting to the root of the problem. Suggesting small changes in their dietary "problem areas" would not only help reach bigger goals over time, but would hopefully not overwhelm the child. I would also ask what types of activities they like doing and encourage them to do that more often. As for the parent/caregiver, I would emphasize that children tend to "inherit" their parents' eating/physical activity habits (you can't tell your child to eat a certain way or to be physically active when you aren't doing the same) and they are critical in making changes especially since they are in charge of cooking or purchasing food. I would encourage them to avoid using the TV/computer as a babysitter and instead have family activity time and also allow their child to play with friends or siblings in ways that don’t involve just sitting inside. Explaining health consequences their child may suffer if changes aren't made might help them in committing to the change.
This is a really tricky subject because you do not want to damage the child's self esteem. Kids are so vulnerable to criticism and it can become a very damaging area of their childhood memories. I would probably first discuss the issue with the parents who would hopefully be helpful rather than defensive in this situation. I would ask the parent for insight into how their child is... example, if they are sensitive to this subject, if they can handle a conversation at a semi-adult level or if I need to bring the conversation down to a lower level. I would hope that this would help me to get an idea for how the child may react so I could be as gentle as possible. From there I think you would have to start from the beginning, like Vanessa said, by creating a sense of trust with the child and a good rapport. If the child does not trust you then they are never going to get anything out of your conversations with them.
This is a very difficult situation as you really don't want to make a child feel badly about themselves and you especially do not want to create an obsessive association with food in the child that will lead to negative behaviors like eating disorders. I think I would first work on counseling the parents. I believe it is their responsibility to feed the child healthy foods.
When actually talking to the child I would focus on telling them the health benefits of fruits and vegetables and whole grains and not discuss losing weight at all. If they increase their intake of healthy foods and decrease fatty foods then the weight loss will occur on it's own. I would also talk to the child about activities they enjoy and try to encourage the parents to enroll their child in a sport or activity that will get them active and help build their self-esteem.
Vanessa,
I really liked your suggestions for the parents to not use tv as a babysitter and to target them for making better cooking/food purchasing decisions. Would you actually encourage children to try and lose weight or when you say "problem areas" are you meaning suggest trying to avoid foods that are their weakness?
If I was counseling an overweight child and their family I would lay out what a good/healthy diet was and be sure to explain portion sizes and estimated energy needs. I would suggest smaller plates/bowls, measuring food and placing it on the plates, and I would also suggest to not have the leftovers on the table or in sight. You would also have to address proper beverage choices and the importance of activity and ways in which the child could become more active.
As Vanessa stated I would begin by building a good rapport with the child and make sure that they are able to trust me. I would also ask what the child likes to eat on most days or get an estimated 24 hr. Dietary Recall. I would ask about beverages they consume and how much water they consume, specifically. I would explain portion sizes to the parent and child as well as the importance of the food guide pyramid in growth and development. Maybe to keep the child's attention, I would incorporate an activity into the lesson. I would discuss the importance of physical activity in correlation with diet. As far as monitoring the diet and physical activity, I would tell the parent to make sure that the child is making healthy choices in the beginning and advance to more in depth skills from there. I would also suggest setting some time aside each day for some 'mandatory outside play time' for the child.
Shanell...
That is a good idea to suggest to the parents that they set aside time for their children to play outside each day. It is also a good idea to ask the child what they like to eat and go from there, if they don't like the food you suggest the child will more than likely not change their habits at all!
In any counseling session dealing with children (whether the child is overweight or not), it does take certain precautions. There has to be a certain sensitivity factor that comes into play. Start the session as any other session, establishing report and assessing daily food/beverage intake. Assess where the child is and where to make improvements. These “improvements” would have to be realistic and easy attainable for the child. Instead of making the session about being overweight and losing weight; attempt a different angle of trying to be healthier. Perhaps the child has a goal in mind that they would like to work towards. Emphasize how important eating better will make the child feel better (increase self esteem etc). Encourage the family to sit down together for meals. Encourage the parent to have fruits and vegetables available, empower the children to decide how much to eat without pressure from the parents. Limit tv/video games to certain times during the day.
Annie-
I completely agree that this is a difficult subject since you don't want the child to feel bad about themself and obsess over food as a result. It would definitely be better to focus on the positive (the healtheir food options) rather than focus on the negative (what they can't or shouldn't have) which they may take the wrong way and go to the extreme of banning that food and/or binging on it later.
Steph,
I really like your strategy of teaching the whole family about appropriate portion sizes. Just taking care of that issue alone may really make a difference in someone's weight issue. I also liked your comment relating to Shanell's idea of setting aside time each day for the family to devote to activities outside. If the whole family is involved it will be much easier for the child to adapt to the new activity level.
Counseling an overweight child is a touchy subject because the child may or may not realize that they are overweight. Because of this, the topic should be addressed lightly, but in a manner that will open their eyes to healthier eating habits (so also somewhat stearn). After getting a 24 hr recall, the dietitian should be able to determine the cause(s) of the problem. Since the child is younger and you do not want to make food look like an enemy, I would suggest making small chances. I would not tell the child that they cannot have something, but rather I would suggest controlling portion sizes of the problematic foods. If I noticed that beverages tended to be making up a lot of extra calories in the childs diet, I would suggest drink water between meals instead of fluids that contained higher amounts of calories/sugars! I would suggest activity levels by having the child participate in outside activities (bike riding, walking with neighborhood friend) or extracurricular activities (softball/baseball, soccer, cheerleading, football). I would recommend to limit time using electronic devices (TV/computer/videogames) and encourage more play time where the child would be moving. I would want their parents to monitor this activity time just like they would for their diet habits. A good way to keep exact track of activity and diet would be writing it down in a notebook. This will also help the child to get into a habit of be consciencious of what they eat and do as far as activity!
Steph,
I like your idea to control portion sizing by using smaller plates/bowls. I think that many times, our society believes that we need to fill our plates. Well, when the plates have become as large as they are today, this tends to lead to overeating. I believe that using smaller dishes is a great way to recognize that your plate can be full, also filling you up, but not being as large of portions as it would be on a larger plate!
Post a Comment
<< Home