Younger children, say, up through elementary school, are so much at the mercy of their environment that it's not practical -- or even fair -- to make them the focus of the weight-loss effort, even in those unusual cases where they're the only one overweight.
Imagine that such a child -- call him Joey -- goes to dinner with his family and everyone orders their usual favorites. But Joey, overweight and "dieting," has to have some "lite" selection while everyone around him indulges without limitation. How fun is that?
But that's often precisely what happens, to the point of utter frustration for both parent and child. I often see families who want us to "fix" an overweight child after they've failed with various approaches, from cajolery to punishment to outright policing the pantry.
The candid response? That isn't going to work. Joey can't function in isolation from the rest of his familial structure, so if the weight problem is going to change, the structure has to change, and that means it changes for the parents as well.
Little kids, little roles
One of the big breakthroughs families must make is in determining the roles and responsibilities of each family member, relative to the child's weight loss, and that varies with the age of the child. Since we're discussing younger children here, the parents' role is much larger.
As with the research study, parents in our program learn -- often for the first time -- about important fundamentals of nutrition. They also learn about behavior modification, problem solving and other skills. And they get specific guidance and support about family roles and limits of responsibility.
For instance, most parents worry about ongoing conflicts with their children over what to eat. And sure, when snack time comes, if you have a box of chocolatey-gooey marshmallow cookies and a box of crispy, fat-free rye crackers, most kids are going for the goo.
But this is where parental responsibility looms large, and parents' decisions about the home environment are so significant. Children ought to be given some choice in what they want to eat, but by having only good options at hand, parents set them up for success.
If the available snack choices are fresh fruits, maybe vegetables and dip, even low-fat or low calorie munchables like pretzels or popcorn, kids will choose from those.
If parents don't buy the gooey gunk and bring it home, then kids don't see it, don't ask for it, and don't feel deprived when they're told no. Mom and Dad won't have to play the heavy because these passive controls minimize the risk of conflict for everyone.
Of course, sometimes, less choice is better. If there's a box of fat-free ice cream bars in the freezer, that's a treat, and at dessert time, it's an acceptable indulgence that a child will welcome with delight. A 7- or 8-year-old isn't going to turn up his nose at a 90-calorie Healthy Choice dessert pop and go on strike until someone produces a Twinkie.
Play together, weigh together
Other recent research on children and body weight shows a direct correlation between kids' weight and the amount of time they spent in recreational physical activity, not with friends or peers, but with their families.
We see much in the media about the loss of physical education programs in schools, but these opportunities for exercise and activity don't appear to have as strong a correlation with kids' weight as what they do with their parents.
That could be because we learn our values from our families, typically, not our schools. Even if kids sit around in school all day, the ones who go home to enjoy a bike ride with the family or to play a little flag football with Dad are far more likely to consider themselves as active.
It's a question of lifestyle and self-image. Children who engage in physical pursuits with their parents are statistically far more likely to have a positive attitude about physical recreation and exercise, and to participate in it outside the family setting.
Parents basically have all the power in a small child's life. If healthy changes are introduced with some finesse, no issue need even be made of them. The new standards just become the standards. We only eat dessert twice a week. We don't drive if we can walk. We eat vegetables every day. We don't drink soda with dinner. That's just the way it is.
It doesn't mean children won't ever try a challenge. In fact, count on it that they will. One of my daughters recently produced a piece of candy first thing in the morning and sweetly asked if she could eat it, though she undoubtedly knew the answer already.
We don't have candy for breakfast. That's just the way it is.
Through Thick & Thin
Parents are usually aware that their own dietary habits are relevant to their child's weight, but they often want to compartmentalize, saying they're not concerned about their own weight, only worried about their child. They just want to help fix him. But a child needs a solution where he's not considered the problem.
Caroline J. Cederquist, MD is the author of Helping Your Overweight Child -- A Family Guide, which is available at DrCederquist.com, Amazon.com, or by calling toll-free 800-431-1579.