Is there a right way to talk to children about their weight?
As Weight Watchers launch a new app for children, Suzanne Harrington wonders how parents should broach the subject of weight gain with their kids
So, your child is fat. Is it puppy fat, gained as they navigate the hormonal seas of puberty, or are they actually fat-fat?
Are they growing widthways faster than they are growing tall? And how do you intervene, without shattering their confidence and giving them lifelong food issues?
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What if you don't intervene, and instead they become diabetic, breathless, bullied? Do you cross your fingers and hope they'll eventually stretch into a healthy weight, all the while ignoring the recent Oxford University study, which found that overweight children are at greater risk of heart attack and stroke, even if they lose weight as adults?
Or do you get militant on their weight management without alienating them and making them feel bad about themselves?
It's a minefield. Yet it's more urgent than ever. The latest Growing Up In Ireland report, published by the Economic and Social Research Institute, found that 20pc of 13-year-olds are overweight and 6pc are obese, with girls more likely than boys to be overweight or obese (30pc compared with 24pc).
Yet the perception amongst more than a fifth of overweight Irish 13-year-olds is that they are not overweight at all; 21pc of those who are clinically obese ticked the 'just the right size' box. Some of the obese teens regarded themselves as 'a bit skinny' or 'very skinny.' Do we really need to undermine them by telling them that no, actually, they are too fat? Is it neglectful not to?
The findings were based on a study of 7,400 teens, which would suggest a widespread misconception around obesity - like anorexia in reverse, where an overweight person looks in the mirror and sees a thin person. Such is the prevalence and normalisation of overweight and obese bodies in our society that we quite literally no longer see ourselves as fat.
So what do parents do? Last month Weight Watchers - now rebranded as WW - launched an app in the US marketed at eight- to 17-year-olds called Kurbo. (In the US, 17pc of children and young people aged two to 19 are obese, the figure rising to 23pc in poorer families.)
Using the traffic light system of categorising food into green, yellow and red groups, developed in the 1980s by psychologist Leonard Epstein and Stanford University, the app focuses not on counting calories, but on eating more healthy foods (fruit, veg, wholefoods) and less unhealthy food (processed, sugar-laden, nutritionally poor).
Thea Runyan, the founder of Kurbo Health, wrote in the American Association of Paediatrics: "Rather than focus on calorie counting, which is neither safe nor effective for kids, the Kurbo system is based on teaching users to understand their food choices and gradually decrease the number of reds (unhealthy foods) over time." As well as using the traffic light system, which is free, app users can pay for weekly coaching sessions.
Cue outrage. Not just at the monetisation of childhood obesity (caused, arguably, by the consumption of hyper-processed foods churned out by a profit-driven food industry), but at the idea of making kids dangerously conscious of their weight and body shape before they have the maturity to cope with potential related fall out.
Nearly 107,000 people have already signed a petition calling on WW to withdraw the app immediately before it causes a tsunami of eating disorders amongst impressionable teens and pre-teens.
Model-turned-wellness advocate Roz Purcell took to Instagram to criticise the app: "Are you really giving a child any time to develop their own relationship with food?" she asked.
Actor Jameela Jamil tweeted: "Breeding obsession with weight and calories and food at the age of 8? I was 11 when my obsession started, due to being put on a diet for being the heaviest girl in the class. I became afraid of food. It ruined my teens and twenties."
Diets never work long-term. We all know this, because so many of us have tried them at some point - diets are a big fat business which make big fat profits, and are so persuasively marketed that we have long tended to believe in their efficacy.
However, Kurbo is not marketed as a diet, but as a lifestyle app; it says it's about making healthy changes, exercising more, better nutrition. Meanwhile, Elsie Taveras, a professor of nutrition at Harvard Medical School, in an essay titled 'Let's Just Not Dismiss The Kurbo App', writes how "mounting evidence suggests that obesity prevention and management interventions that included health coaching delivered by community health workers, health coaches, or promotors are effective".
There are broadly two official approaches when it comes to tackling weight issues in teens and pre-teens: ground up, or top down. Top-down initiatives include sugar taxes, advertising restrictions, media campaigns, the banning of fast food outlets near schools; these are shouty and immediate, but perhaps not as effective as ground up initiatives, such as a recent Barcelona public health initiative, which went into schools and worked with 1,500 children aged 9 to 10, in a programme that lasted 12 months.
Its key phases involved tutoring students individually about nutrition, exercise, and body image; the promotion of fitness, via two hours' daily physical activity, and the involvement of the whole family in learning about nutrition, exercise and healthy living. The result was a 40pc reduction in obesity in students who actively took part. So, why aren't more of these types of initiatives in place, rather than corporate profit-driven apps?
Obesity in families is an intricate, prickly, complicated business - it's about a lot more than sitting in front of the telly eating takeaways. It's about feelings, relationships, comfort, denial. I have been obese for years, despite being long-term vegan and teetotal; one of my children gained weight in childhood after a traumatic bereavement. I eventually dealt with my own obesity via weight loss surgery, while my daughter Lola, now aged 18, is a healthy, beautiful size 14-16. Her T-shirt reads 'Riots Not Diets'.
She is currently part of a community interest company which works with teenagers, focusing on issues connected with self-esteem, body image, eating disorders, and self-acceptance. "Parents are totally in charge of what younger kids eat," she says. "What your kids put in their mouths is what you have put in the fridge. It's that simple. Teach kids to cook, and where food comes from."
Older children, however, have more autonomy over their food. "Health has to be a group thing," she says. "Never pressure them to eat differently from the rest of the family. Do exercise together as a group. Make it fun, and never make them feel embarrassed or uncomfortable or less than. That just makes people shut down, and maybe reach for even more food."
Clinical psychologist Dr Malie Coyne agrees. "The most important thing is to talk about health, not weight," she says.
"If children are young enough, it may not be necessary to say anything at all, but instead to make lifestyle changes. Model good eating and sleeping habits, more exercise and reduced screen time. A lot of weight issues are not just about food, but about not enough sleep and too much screen time."
Dr Coyne, herself a recovering anorexic with two young daughters, is wary of pushing ideas of food and weight onto children, rather than teaching them healthy habits by example.
"Children learn by observation," she says. "So starting good habits early is key. Make treats a treat, rather than an everyday thing. "With older children and teenagers, asking them how they feel is often a good place to start," she says. "Be direct but don't criticise or become obsessed with weight and food. Instead, use positive encouragement and praise."
"The goal is to be as healthy as you can be for your body," she adds. "However, if a child is obese, parents may need help, rather than trying to manage it themselves.
"Body shaming children, or talking ad nauseam about food and calories, does not work and can have long-term negative effects on them in adulthood."