Ask a paediatrician about your child’s overweight

Marketta, you are studying children’s overweight, and as a paediatrician you have also treated overweight children. Why do we need to intervene when a child is overweight? Isn’t it a family matter?

Overweight in children and adolescents has to do with growth. Healthy growth is a great thing. Many parents mark their child’s height on door frames and walls and compare the child’s weight with that of local children and cousins. In the Finnish healthcare system – at child health clinics, school healthcare and other places monitoring children’s health – there has always been a kind of unspoken agreement with families that it is ok to measure their children’s growth. By doing this we are also monitoring their health. Children who are growing steadily in line with Finnish growth charts are already doing well. If the child is not growing as expected, we have to find the reason for it. Is it something worrying, and should we look into it more closely? If we know the reason, we can help the child grow in a healthy way as appropriate for him or her.  This applies to both height and weight. Growth charts help us notice if the child is gaining too much weight. The earlier we notice it, the faster and more easily we can get the child back to a healthy weight.  As a paediatrician, I concentrate on the child’s health and well-being and monitor his or her weight progression objectively and for a good reason. Overweight can mean consequences for the child that we healthcare professionals are able to take into account. In my opinion, a significant health issue like this must be discussed with families.

How can parents best support their child’s healthy growth?

The answer is simple: through food, exercise, fun, boundaries and love. Problems arise when we as parents have to make our own decisions on these things. How much and what kind of food, which boundaries and how much and what kind of exercise? Love knows no boundaries, as long as loving and caring bring the child the feeling of security. In the old days, nature and life itself regulated our most important needs. We would eat when we were hungry, and everyone would be at home at dinner time. We would stop eating when our stomach was full. We would get exercise on our way to school, and after school we would ski and skate. Nights were for sleeping and resting. Life was more natural in many ways. Today, our well-being has brought with it problems which also complicate the task of parenting. Supporting healthy growth means meeting the child’s basic needs, being there for the child, being together, respecting the natural rhythm of the body and coping with daily routines. We humans still have some natural instincts left in us, and we as parents should trust them. We should set our children an example by showing what is enough, what is good enough and what is needed. We should find the answers to our questions and teach our children good values and the things we have learnt.

If the child is already overweight, how will he or she be managed in healthcare? What will happen there? How does one get a referral to specialist healthcare?

In the healthcare system, the child’s overweight is managed together with the family. Sometimes overweight is noticed at home, but more usually in healthcare. In this case the first step is to contact the parents. If the child is becoming overweight, this should be demonstrated and acknowledged. The next step will be to look into the reasons for the child’s weight gain, the child’s current health status, and explain the disadvantages of being overweight both now and in the future. Safe management of overweight is based on lifestyle changes. It is therefore very important to discuss with the family what changes are needed to control weight gain. The strengths of the family that can be used to support weight management will also be looked into. For weight management to succeed, it must be seen as important for health. The recommended lifestyle changes are based on data obtained from studies on healthy eating and exercise habits, limited screen time and sufficient rest. Good planning and setting objectives are important when making changes. Change will be gradual and results will only come little by little; sometimes patience and success only come after several setbacks. Your own public health nurse is a good person to help the family and the child with these issues. The public health nurse will offer instructions as well as good, reliable tips and links to further reliable information. Many public health nurses also use Smart Family as their tool. I would like all families to have the chance to consult a dietician. Some people might also benefit from seeing a physiotherapist, family therapist or psychologist. To what extent children and adolescents become involved in weight management depends on their age and especially their level of development. It is important to acknowledge the situation and, as with any other illnesses, manage the child’s overweight in a friendly way.

In Finland, we have well-defined and appropriate procedures for managing overweight in children based on the Current Care Guideline and local treatment channels. Specialist healthcare shouldn’t be your first choice in weight management. The staff in primary healthcare are well versed in the management of overweight and obesity, so these problems are typically dealt with outside specialist healthcare. Only very severe cases of obesity and those involving significant metabolic changes or where some other disorder is suspected are managed in specialist healthcare. As a paediatrician, I’ve been observing children and adolescents from the vantage point (concretely too, as my hospital is on a hill), and I hope that in the future, fewer and fewer overweight children and adolescents will have to be treated in specialist healthcare.
How often is the child’s overweight caused by an illness?

Considering how common overweight is, it is very rarely caused by some other illness. If height delay, developmental disorders or health problems also occur, overweight may be caused by something other than the usual imbalance between the intake and expenditure of energy.
If parents find that setting boundaries concerning, say, screen time or eating is difficult, what would you suggest to them?

As a parent and a paediatrician I think that love knows no boundaries, but without boundaries you cannot raise children. Setting boundaries is not dictatorship but caring about the child. Parents have to be strict in a good way and hold on to the family rules, which can be drawn up together to apply to everyone. The easiest way is to draw up the rules when the child is young. The wrong option is to start talking about them when the child is an overweight teenager – but better late than never. You should also think how to replace snacking and screen time with something meaningful. Limiting these activities enables children to spend more time outdoors and to build real-life relationships.

Some parents don’t want to talk about overweight in front of their child. What’s your opinion?

As a paediatrician I encounter this occasionally. I would like to talk about it on a more general level and not just from the viewpoint of overweight and obesity. I understand that parents want to protect their child and maybe a little bit of themselves too. In my opinion, saying nothing just creates taboos. And taboos are never good. I feel dishonest with the child if I keep quiet about the problem. The child will anyway hear about their overweight from someone – why couldn’t we talk about it in the safe setting of a doctor’s office? It’s part of my job to talk to children and adolescents according to their age and level of development and without making them feel guilty or hurting them. I know how to split the information to allow them enough time to digest it. Overweight and obesity raise many different emotions in children and families. Only if we accept and deal with these emotions can we go forward in the treatment of overweight in children and adolescents.

The answers were provided by Marketta Dalla Valle, specialist in paediatrics, researcher, North Karelia Central Hospital, University of Eastern Finland.

For more of Marketta’s answers about children’s health and illnesses, watch Akuutti by the Finnish Broadcasting Company (in Finnish).