November 2013: Question 1
Q1: A mother and her daughter are referred to you by their
family doctor. The mother was told by the doctor that her daughter is overweight
for her age. You determine that the daughter is above the 95th
percentile and the mother is also falls into the obese category. The mother tells you that she sees no problem
with her daughter’s weight. How would you address this situation? What suggestions could you make?
posted by Erin M. @ 9:35 PM
15 comments
15 Comments:
To answer this questions, it would be extremely important to take into consideration the age of the child. If the child was still being fed by the parent, I would emphasize the importance of recognizing feeding cues to ensure that the child is not being overfed. If the child is older and self-feeding, it would take a little more digging to find out exactly where meals are coming from. Suggestions would include emphasis of a general healthy diet, perhaps the myplate method and portion control. I don't find it to be appropriate to discuss weight loss methods with children especially if the parent does not consider the child's weight an issue.
Weight loss in children is a tricky conversation. I would not put the child on a diet for weight loss, but have her maintain her current weight so that when the child grows, she would drop down into the average percentiles. Instead of discussing weight with the mother, I would learn more about the child's eating and exercise habits and make suggestions based of hat information. Again, instead of discussing weight, I would mention the other health benefits like increased energy and mood, and stronger bones. Depending on her age, I would talk with the child to get her feelings about her weight and how it is effecting her, if it all.
I would begin to address the situation by exploring the reasons why the mother chose to follow through with the referral in the first place and what signs, if any, would indicate that there was a problem with her child's weight. Asking these questions would help me as a practitioner determine the mother's stage of change. If she continued to communicate to me that she is unaware or unwilling to change the problem (i.e., improve she and her child’s eating/physical activity behaviors), than I would focus my intervention mostly on listening to the mother and providing only as much advice as she's willing to hear. Creating a sense of trust and establishing good rapport would be my ultimate goals followed by generating awareness of the importance of maintaining a healthy weight for all ages in addition to highlighting the dangers of not doing so. Finally, I’d provide the mother with some practical tools and resources for taking steps toward behavior modification if she should decide to pursue further information in the future.
Sarah S said...
I would ask the mother what her goals would be for her daughter and try to work on those with her. I most likely would emphasize a generally healthy diet and lifestyle so that the child would be able to maintain weight and learn healthy habits. I would encourage regular physical activity, whether that be going for walks, playing a sport, or just playing outside instead of sitting inside; I would emphasize that this is healthy for the general population regardless of weight status.
Sarah S said...
I really like Lynetta's idea of asking the mother why she decided to follow through with the referral. This would definitely make her think about things more and maybe help her to re-assess her opinion.
I would ask for a typical diet recall at first just to get a feel for what I am working with, then I would probably go into talking about portion control and MyPlate. When I was at Methodist and did obesity consults for a couple of teens on the behavioral health floors, I approached it in the same manner and they seemed to take it well and weren't offended. I would also ask about her daughter's physical activity level since that definitely plays in to it.
Kaiti, very good point about recognizing the child's age before the meeting. It would totally change my direction if I found out it was a 1.5 year old with assisted feedings versus a 8 year old eating on her own. Lynetta also makes a valid point to build trust and rapport during the meeting to increase the likelihood of the client listening to what you have to say and/or maybe having a return visit.
I would not make this a weight issue, and instead focus on being healthy. It is important that the daughter not develop a complex about her weight, therefore I would not focus on what the child weighs. I would talk to the mother about a healthy lifestyle, how it helps to reduce the risk of disease and illness, can improve mental health, and just make you feel better overall. I would also stress that becoming healthier is a lifetime commitment for the entire family. Then, I would ask the mother what about her diet or lifestyle she and her daughter could change. Hopefully I could continue to meet with this family, to encourage small changes towards a healthier lifestyle one step at a time.
I love Lynetta's use of motivational interviewing! I believe this practice is extremely value and reliable.
I think initially I would talk with the mother and daughter and get to know them a little bit. I would want to figure our their usual lifestyle and eating habits. I would try and help them in areas where I feel need some assistance. I do not think that it would be a good idea to bring up the daughters weight, instead educating them on ways improve a healthy lifestyle.
I agree with Carly in that it is important to know what the mother and her child's typical intake is like. Knowing what types of foods they purchase and how they prepare meals would be very helpful. Perhaps having the mother fill out a nutrition assessment would be a good starting point.
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would explain to the mother a little bit about why extra weight in childhood matters, especially how obesity can actually increase the number of fat cells a child has & make it harder for them to maintain a healthy weight when they become adults, & how their dietary habits now will likely follow them into adulthood. I would also explain that their child doesn't necessarily need to lose weight, but maintaining weight as they grow taller is the healthy way to approach childhood obesity. The key to doing this might be as simple as finding ways to incorporate more activity & play into the child's day, if they aren't naturally inclined to activity. The family could even take a walk together after dinner. I might also give them suggestions for healthy snack options while the child is at school, and recommendations for Ellyn Satter's school of thought regarding food autonomy during meals.
Courtney, I like that you are not focusing on the weight issue, but on how they whole family can become more healthy & avoid health issues later in life. If someone is not motivated by weight, then health & well-being might be something that reaches them. Lynetta, you are right in determining the mother's initial motivation & following through with the stages of change theory.
I would address this situation by putting the obesity diagnosis aside and discussing the health and nutrition of the child. I would ask questions of the mother about the child's nutrition and ask if she sees any room for improvement her child's eating habits or physical activity. I would encourage the mother and child to identify any issues to address and set goals for improving their overall health. I think putting a label on a child as obese is a sure way to get both the child and the parent to shut down. It is important to gain the trust of the mother and to assure her your goal is health and you have the best interest of the child and the family in mind when you provide education and weight loss. In my time at Methodist, I was taught the guidelines for child weight loss and the main focus should be on weight maintenance as the child continues to grow (to balance out the BMI into a healthy range).
Emily had an excellent point of discussing likes and dislikes of the child's eating habits and learning more about the child while engaging them into the conversation and letting them be a part of the goal setting and encouraging behaviors to facilitate health and wellness changes.
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