Episode 88 : Supporting overweight children with their health

Episode 88 : Supporting overweight children with their health

In this episode, I'm talking about supporting an overweight child without making food a battleground or creating a difficult relationship with their body in the process.

As a Paediatric Dietitian with 25 years of clinical experience in children's nutrition, I know how much parents worry about getting this wrong. The guilt, the confusion, the fear of saying something that tips their child into disordered eating , it's real, and it matters.

So I'm walking you through exactly how I approach this in consultations. My approach, what i do and what I definitely don't do!!

Links:
https://nourishwithkarina.com/feedingbabies
https://nourishwithkarina.com/membership

Highlights:

My Child Can’t Stop Eating… What Do I Do? | Episode Introduction & Welcome (00:00.552)

Why Parents Are Worried About Overweight Children (02:22.102)
Why Restriction Makes Children Want Food Even More (04:34.274)
Why Calorie Counting Doesn’t Work for Children (06:53.408)
How Dietitians Assess a Child’s Weight Holistically (09:10.230)
Understanding Eating Patterns, Timing & Metabolic Risk (11:19.936)
Behavioral Triggers: Emotional Eating, Sleep & Environment (13:37.664)
Family Approach: Avoiding Singling Out the Child (15:59.360)
Building a Balanced Plate & Managing Carbohydrates (18:11.532)
Teaching Kids Mindful Eating & Hunger Awareness (20:40.428)
Long-Term Benefits of Healthy Habits (Without Restriction) (22:59.288)
Parental Influence, Body Image & Final Advice + Next Steps (25:23.358)

Show notes

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Show Notes

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My Child Can’t Stop Eating… What Do I Do (00:00.552)
You're listening to the Easy Feed Podcast, episode number 88, supporting overweight children with their health. Hi there, I'm Carina Savage and with over 20 years experience feeding children, including my own, I've learnt all the secrets that busy mums need to get their children eating better and actually enjoying healthy foods. So a huge welcome to the Easy Feed Podcast.

Hello, welcome back to another episode of the easy feed. Today I am talking about overweight children and how I work with their parents specifically to support children who are carrying a bit too much because many parents come to me feeling worried and guilty and you know, wanting to do the right thing by their child, but not really knowing what to do.

because they see their child is carrying more weight than is healthy for their body. It might be that their child is being teased. It might be that the child is calling them self fat. It might be that the parent sees their child snacking lots or emotional eating or sneaking food, finding wrappers everywhere in their bedroom, behind cupboards, under beds. It might be that they eat really fast. It might be that they

They just have no off switch. Or I remember one, a mom of a three year old telling me that she went to the playground and her little one didn't really want to play on the play equipment. She just wanted to sit down and eat everything in her lunchbox. And then when that was empty, other kids in the playground were eating their morning tea. And so then she wanted to join in and eat all of theirs, not all of theirs, but she wanted to join in the, the food feast there as well. So some kids are just really food obsessed.

So parents want to support their child. They want them to be healthy. They want them to eat the right foods in the right amounts, but they're also terrified of saying the wrong thing and creating an eating disorder or creating a problem around food because it's with girls and boys that disordered eating can happen. And certainly I've seen it all into the spectrum in my 25 years as a clinical pediatric dietician. It's really...

Why Parents Are Worried About Overweight Children (02:22.102)
important and it is valid that parents want to get it right and talk to their children about food and body image the right way so that they're setting their child up to have the healthiest future possible, but also the healthiest relationship with food and their bodies possible. Because children don't need to feel restricted. They don't deserve, you know, the shame and the teasing. and we don't want them to feel like

Their body is a problem. Their body is disgusting. They just need a clear plan and structure around eating and messaging around food and bodies because that's really going to support them long-term. And as parents, it's really crucial that we approach it the right way because otherwise it can spiral off into all sorts of different eating behaviors and patterns that

aren't going to set that child up for lifelong health. And sometimes we need to look at ourselves in the mirror too. And as parents go, well, you know what, do I have the right eating behaviors that I'm role modeling for my child? Is my child starting to mirror me or my husband or wife or partner or whoever, whoever is the other parent in the house? Because as parents, we role model, you know, everything. And sometimes we don't even realize that our children are absorbing

verbal and nonverbal behaviors cues information messages from us all of the time. So we need to be really mindful about how we are behaving as well. And that's exactly how I help families in my online consultations. I had an online consultation only two days ago, very, very similar scenario. It was a young boy who was being teased at school and he was overweight. In fact, he was obese.

And parents were wanting to set up a plan to support him so that he can grow into his weight. And that's a really important point sometimes, you know, like the doctor had told him he needs to lose 10 kilos and sure, if he could lose a few kilos or 10 kilos, it would help him metabolically. But the most important thing is that first of all, we stop.

Why Restriction Makes Children Want Food Even More (04:34.274)
that trajectory of weight gain. And that's always the first goal whenever I work with families in online consultations, it's like, well, the first goal for your child is to not gain any more weight in the next few years so that they can grow into their current weight or their existing weight. But ideally if they are obese, yes, so we can drop a few kilos, amazing. But really when parents come to me, there are all different stages of this journey.

Sometimes there has been conversations around the child's weight, the child's eating. Quite often though, there hasn't been any conversation, which is actually better if that's the case, because you really want to be armed with the right information to know exactly what to say, to know exactly what to do so that we set your child up for success. Because as soon as a child feels restricted,

It's like that with any of us, right? It's human nature. As soon as you feel like you're being deprived or restricted, you want more of it. It's just, you know, scarcity, right? That's what they use, you know, all the time in marketing techniques. As soon as something is scarce or you can't get it, you're going to want it. Of course you are. So as soon as something is restricted and you know, this goes for anyone who's trying to perhaps eat healthier, but they really love something and they're going, no, I'm going to restrict myself. I'm going to stop myself from eating that. You don't want it even more.

So you really need to be smart and intentional. I'm not saying you're not being smart by trying to stop eating chocolate or maybe stop drinking wine. You know, just have to go about it in a way that's going to work for your psyche and your child's psyche because it's really important to understand that whole psychological impact of food restriction or deprivation of anything and how it makes us want it more. So when I work with families, there's things that I absolutely do not do. I do not.

calories, I do not like talking about calories. In fact, I hate talking about calories full stop. You know why? Because of all the years that people have counted calories on MyFitnessPal and all of those calorie counting apps, it certainly helped people lose weight, I'm sure. But a calorie is not a calorie. A calorie from a nut, a peanut or an almond, which is rich in fiber and healthy fats and takes a lot more for the body to actually digest.

Why Calorie Counting Doesn’t Work for Children (06:53.408)
is going to be very different to a calorie from a French fry or a calorie from, you know, a potato crisp. So a calorie is not a calorie. So just putting calories into a calorie counting app, and I'm certainly not going to shame my fitness path because I'm sure it's helped so many millions of people, you know, become healthier versions of themselves, but calories, hate talking about calories and I will never talk about calories in front of a child.

I will never talk about weighing a child in front of a child unless it's really, really medically important, meaning they are severely obese or severely underweight. That's the only time when I would clinically say, look, we actually have to weigh you here for a medical purpose. But other than that, do not talk about weight hate scales, which all the scales in the world were burnt. There is no need for them. I don't believe.

I don't put children on calorie restricted diets where we are counting things and adding things up. I don't remove all treats and I don't single them out from the rest of the family. And there's a reason why I'm really firm on all of these things because these things mess with your head. Wang yourself, labeling things as bad or fattening, removing all treats. None of that is going to work. And certainly maybe

No, not even earlier in my career. I don't think I would have done any of those, but these things are commonly used as tools for weight loss in the general public. And there's a reason why they don't work because it just messes with your head and it puts you into that deprived state. So if you're listening to this about you've tried to lose weight and it hasn't worked, perhaps have a think about what approach you've taken and whether you agree with any of what I've just said.

So when a family comes to me, I'm not just asking what does the child weigh? And I certainly do get their weight and height and parents will get that across to me prior to the session. So ideally we're not discussing it in front of the child. To be honest with you, unless the child is above the age of really 12, I don't want the child in the session. I just want the parents. So we can talk about the weight, we can talk about the height, we can talk about the BMI, we can talk about how the child is feeling.

How Dietitians Assess a Child’s Weight Holistically (09:10.23)
We can talk about an approach that's going to be best for the child. The child doesn't need to be there for any of it. It's the parent's responsibility. It's how we set things up for them that's really going to make or break how they go. Sure. When they're 16, 17, 18, it's different, but when they're little, often parents will come to me actually between the ages of nine and 11 where they've just got that excess.

Supposed to be called puppy fat, they think, maybe the puppy fat should have gone by now, but they're sort of pre-pubertal. And so they've got this excess around that, stomach, excess adipose tissue around the belly. And parents are worried that that's going to hang around and increase problems later on. And so that's often when I will see parents, sometimes older, but that's a common age when parents are concerned for their child.

weight and health. So when I see a parent in the consultation or parents, I will look at the child's food diary. I will look at their weight and height. I will plot out their BMI and I will look at their history, their weight history. So where has it been tracking? Have they always been really high or has it really crept up significantly in the past few years? And if so, what is that linked to? Has anything significant happened in the last few years that

potentially has caused that child to gain weight. Perhaps it's a separation or a divorce from the parents. Perhaps it's changing school. Perhaps it's starting a medication. So it's really important to look at the child holistically and look at patterns and trying to understand links and causes that aren't just food, because we really have to look at the whole child and everything related to their life.

And another name for this could be the child's feeding ecosystem, which is a concept that I've created and talked to a lot in relation to fussy eating, but it absolutely applies to all children because it really has to do with not just, you know, the way that the child eats, but it's why the child eats, it's where the child eats, it's how the child eats. Understanding more than the amount and type of food going in their mouth is really important.

Understanding Eating Patterns, Timing & Metabolic Risk (11:19.936)
Often children that I work with in this space or the parents, they don't eat much for breakfast. And we know that people that are overweight or obese can consume, you know, a good 60 to 70 % of their daily intake from the afternoon onwards. And certainly adults will consume a lot in the evening. So if a child is overweight or obese and they're not eating breakfast, the chances are they are simply not hungry because they're backending the day.

with too much food, which is just sitting in their gut overnight and could be driving that whole metabolic syndrome as well. So when you have overweight or especially obese people, then they do have an increased propensity to move towards conditions like insulin resistance, type two diabetes and cardiovascular problems as

adults because it starts early. It can start in the teens. So I look at their food diary. I look at the rhythm of their eating. So are they eating meals and snacks? Are they skipping? Are they front-ending the day? Are they back-ending the day? And then I look at the type of food they're eating, especially the macronutrients. So things like protein, carbohydrates, fat. What types of protein are they eating? What types of carbohydrates are they eating? And this is crucial because if they're filling up on all the

Fast sugars, fast sugars are not satiating. They are not satisfying. You get a quick hit and then it's gone again and then you want more. And then it just reinforces this whole obesity problem because it just eating and eating and eating and getting fast hits and then being hungry again and then getting another fast hit and then being hungry again. And that's terrible for not only appetite control, but also mood regulation and concentration and focus. Often we have constipation that also comes.

because they're not eating enough fruit and vegetables and loading up on more of the unhealthy foods. Although this doesn't always happen, but can go with children who are a bit heavier. And I'm also on the lookout for ultra processed foods and foods that are potentially causing addiction, which is working against the child. And I hate that we have to scan for these ultra processed addictive foods to support our children. Because really at the end of the day, if we were

Behavioral Triggers: Emotional Eating, Sleep & Environment (13:37.664)
doing the right thing by our kids. These foods would not be available to us. The government would step in and go, you know what, these are really not healthy for our children or us. So they're not allowed to be sold. But sadly, the food company dollars means that this whole ecosystem continues. I'll talk to parents about appetite and fullness and whether their child actually gets hungry, whether they get full, whether they can recognize hunger and fullness.

The speed at which they eat, do they eat really quickly? Do they stop when they're full or if they like it, do they keep going? Do they ever leave food on their plate? I'll ask about emotional eating and whether they eat when they're bored or stressed or do they eat more when they're sitting on the couch? So looking at behavioural patterns there and also emotional patterns there. It's also important to factor in general lifestyle behaviours. So screens, sleep, because there's been

Lots of studies that have shown that shift workers or people that do not get enough sleep. So they've actually sleep deprived people in these studies. And the more sleep deprived you are, the more you are likely to go for those really high sugar, high fat foods because you just need a quick hit. So if children aren't getting enough sleep, that can also drive more unhealthy eating habits.

The family environment is another one to factor in and often parents will say to me, yeah, but they've got a sibling who has the opposite problem, hollow legs and we can't get enough into them. And it's really tricky because the sibling needs to eat more. But then the child that you're talking to the parents about in the consultation needs to eat less. And sometimes that dynamic can be really tricky to manage because you don't want the heavy child to feel restricted.

But at the same time, they may have different requirements and it is an important one to navigate well so that the heavy child doesn't feel hard done by. really like it when parents come to me and they say, look, we've already started to make some changes and we're making the changes as a family because we don't want, you know, little Johnny to feel like he's being singled out. And I think this is really valuable so that.

Family Approach: Avoiding Singling Out the Child (15:59.36)
Little Johnny doesn't feel like he's being singled out and these healthy changes are made by the entire family. So the whole family has more structure and the whole family makes these positive changes. The child should never feel like they're the only one who has to make a change. And really when I'm doing my job properly, the child doesn't actually even really notice that anything's changed. And that's my biggest goal when I'm working with parents is how do I looking at

All of the food diary data, listening to everything they've told me about the child, personality, where things have come from, what's happening now. My job as a dietitian is to create a plan that supports the child's long-term health outcomes and goals, but doesn't make them feel deprived at all. And that's my role and skills as a dietitian to give them more options than I'm taking so that the child never feels deprived. And really that's...

A good quality dietician will always give the patient more tips than they will remove in terms of, know, if you've got a restrictor diet for whatever reason. But really I hate that word because as soon as you start restricting, then it messes with your brain. So it's really important to provide plenty of options. So the child feels like they've got plenty of food to eat.

And with the patient that I saw the other day, he did love vegetables, which was brilliant. So we were able to pad out his meals a lot more with vegetables that he loved. Having structure is really important with kids because they really thrive on routine and when they're sport on or other commitments, but at the same time, trying to have some consistency around meals and snacks will help. What will also help though is to make sure that you have a good

balance of healthy foods on the plate though. And look, we have heaps of fussy eaters and I talk a lot about fussy eating in terms of having no test foods next to the safe foods. But in terms of a child and what we should be aiming for for dinner, we should be aiming roughly for a third protein, a third carbohydrate and a third veggies or salad plant foods. Okay.

Building a Balanced Plate & Managing Carbohydrates (18:11.532)
That's really ideally what we're aiming for. If you can get some healthy fats in there, amazing. So if there's fish in there, if there's olives in there, if there's avocado in there, then amazing. And that's a really important ratio to aim for about a third, a third, a third. If you have a really, really overweight or obese child, then we do need to pay attention to carbohydrates. And sometimes I will say we need less carbohydrates, especially if they are big rice eaters, because rice is very carb dense.

So if we have a really big rice eater who is obese, I will say to the parents, we need to cut this down. But so the child doesn't feel deprived, we need to pad it out with something else. Ideally not protein, because they probably don't need any more meat either. But vegetables is a great one. Or we find salad options that are also another option for them. With protein, generally they need about the size of the palm of their hand, whatever that may be. Whether it's meat, whether it's fish, whether it's chicken. If it's tofu or plant based, it could be a bit more, but

Those foods are very high in protein as well and great substitutes. So usually children will get enough protein, but it's definitely the carbohydrates that I will often be talking to parents about reducing and swapping out. So putting more veggies on the plate than, than there was the carbohydrates, mostly rice and pasta, so that the child is not feeling deprived. And when I caught up this family, so I've seen them twice now, saw them once four weeks ago, and I saw them for a second time this week at our review.

And he was not feeling at all deprived. Parents said there was no pushback because he was eating good amounts of vegetables and also still his favourite foods. But his parents said he'd already started to really change the way that he looked just in four weeks. They could already see that he was slimmer in the face and his body was starting to change just from simple changes that we made to his day. Whilst still giving him plenty of healthy food.

whilst still allowing him to have treats so that he didn't feel deprived. Do we worry about, you know, once a week, McDonald's or pizza? Probably not. It's the foods that they are consuming daily. They're the ones that we need to be focusing on. They're the lowest hanging fruit, so to speak. What do we say when children are wanting more food, but having the conversation around the fact that it takes time for the food to reach the tummy. One of my patients once on a review appointment told me that

Teaching Kids Mindful Eating & Hunger Awareness (20:40.428)
her son had said, yeah, mommy, it takes 20 minutes for my tummy to send the email back to my brain to tell me that it's full. I was like, that's really cute. So it's, it's trying to explain to them in very simple terms that it takes a while. Certainly drinking a good amount of water as well can be an effective way for them to feel a bit fuller at dinner time. If you've got a child that really

is just, you know, eating you out of house and home and just wants more and more food. But really planting the seeds of mindful eating is, really valuable. And this can start really at any age that you are identifying a problem with your child. In the earliest age groups, you know, I've had a mum who has worked with her child and she actually did this all on her own. She just told me about it afterwards. She said, you know, she knocks on her tummy to see whether it's hungry or full.

as, you know, basic mindful eating concept. And then, you know, if the child's like nine or 10, then it's talking to them about head hunger versus tummy hunger and how sometimes we eat when we're not at all hungry, but our head tells us we're hungry versus when our tummy is hungry, then we are feeling our tummy rumble. We might feel a bit nauseous, you know, trying to explain the symptoms of tummy hunger, genuine hunger.

versus head hunger. And that's really as simple as it needs to be. Just keep it as simple as that. We do not need to go into any more detail. So it's eating to what you need, head hunger versus tummy hunger. It takes 20 minutes for the food to get to the tummy, send the message back to the brain. So all of those key messages are really valuable for a child who is overweight. It's not going to change their weight today or this week, but it will make a difference over time. And it's really a

trying to plant seeds that will grow and that will help the child to eat to what they need so that they're not overeating and eat the right foods. And that's why I provide specific dietary changes and a plan to people that I have consultations with online that's personalized for that child and that will work for that child. So I'm always saying to parents, do you think that will work? Do you think you'd get pushback? Because the plan has to be doable for that child and that family.

Long-Term Benefits of Healthy Habits (Without Restriction) (22:59.288)
But a really overarching theme is that the child doesn't feel deprived. The child can still have treats, but the treats need to fit. The treats are sometimes foods. They're not four times a day foods. And that's how we explain that to the child and the messaging around that that's really valuable. So the child doesn't feel deprived. They understand how treats fit into healthy balance living. And when we get it right, parents often notice changes quite quickly. As I said, within weeks.

Not always on the scales because we don't want to be weighing our children, but definitely at home in the way the child's eating, in the way the child's looking. There's less of these constant food seeking. There's improved snacks. There's improved bowel actions as well, because generally they're eating more fiber. There's usually a better breakfast intake because we're balancing out the day better. They have more stable mood and energy.

They reduce their risk of developing complications later on in life because of overweight or obesity. So we're actually improving their metabolic profile. And this is something you can't see by just looking at anybody. You can't see their cholesterol levels. You can't see their insulin levels. You can't see their risk of developing heart disease later on, but certainly making healthy changes now for a child will reduce their risk of.

lifestyle related diseases later on in life. And that's one of the best things that you can do for your child. Now, before I wrap it up, I do want to make a special mention about us as parents in terms of how we talk about bodies, our own bodies, other people's bodies, because children are sponges and they absorb all of that. They hear what we say. They hear if we judge someone who's walking past on the street, that's maybe a bit larger or a bit smaller.

They hear all of that. They hear how we talk about our own bodies or they hear us tell ourselves off for eating another piece of cheesecake because it shouldn't have done that. It was naughty. They hear all of that. So just be really mindful about your behaviour around food, your body, how you eat, because all of those things are being observed with whether you realise it or not. The best thing that we can do for our children so that they have a positive body image.

Parental Influence, Body Image & Final Advice + Next Steps (25:23.358)
is to love our own bodies, all the jiggly wiggly bits, all of it. Because if they see us loving our bodies, they're going to learn to love their bodies more. Bodies are strong. Bodies are powerful. They do amazing things. Trying not to talk about bodies being fat, being skinny, food being good, food being bad. I mean, look, we all slip up, I'm sure, but that's really how we should be talking about food and our bodies. Because the more of those positive messages we can give our children.

the better it's going to be for them. So look, if any of this has really resonated with you and you would love to talk to me more about your child and really set up a personalised plan for your family, for your child, for their lifelong health, then you can absolutely head to my website, nourishwithcarina.com and click on the consult tab. And then you can make a time so that we can connect.

We'll also try and put a link to the consult tab in the show notes. And there's always reach out to me. Hello at nourishwithcarina.com. If you've got any questions, then please leave me a review of this podcast. If this episode has been helpful for you and I can't wait to chat with you again soon. Have a great day. Bye for now.