Kids have cell phones, CrossFit, and beauty pageants—why not diets, too? Child and adolescent weight loss is the topic of a controversial new book called Maggie Goes on a Diet, due out October 16. Targeting kids ages 4 to 12, the book chronicles—via a series of rhymes—the journey of an overweight and insecure 14-year-old girl as she transforms herself into a normal-size soccer star by eating right and exercising.
While it sounds like a source of sensible advice, the book’s forthcoming release has spawned a frenzy of criticism across news outlets, blogs, and Amazon.com, where commenters are outraged with the notion of familiarizing preschool and elementary-age children with the concept of dieting, and worried that the book will trigger disordered eating among impressionable kids. Eating disorders in children younger than 12 increased by 119% between 2000 and 2011, according to the U.S. Department of Health and Human Services.
Experts have universally condemned the book, arguing that it sends the message that being thin will automatically make you happy, healthy, and popular. Paul M. Kramer, the book’s author, who has no background in medicine or child nutrition, writes, “Losing the weight was not only good for Maggie’s health. Maggie was so much happier and was also very proud of herself.” And later: “More and more people were beginning to know Maggie by name. Playing soccer gave Maggie popularity and fame.”
Kramer defended his work on Good Morning America in August, explaining that the book is about changing kids’ eating and exercise habits, but that the word “diet” was used in the title to make the book more relatable for readers. “If I entitled the book Maggie Eats Healthy, somebody in a bookstore looking at a title Maggie Gets Healthy is really not going to identify with somebody who has been overweight or who has health problems,” Kramer said on the show.
Targeting Childhood Obesity with Tact
When approximately 12.5 million (17%) of children and adolescents ages 2 to 19 are classified as obese, according to the CDC, the epidemic can’t be ignored—but it can be addressed in a manner appropriate to maturing young people who are in the process of developing attitudes about their body image. “Weight—especially excess weight—is a sensitive issue in our society an has to be dealt with carefully in order to avoid damaging a child’s self-esteem,” says Susan J. Woolford, MD, MPH, medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan.
“I think it’s best to stay away from the world ‘diet’ and to actually not engage in dieting,” Woolford says. “Diets are generally thought of as something people do for a temporary period of time until they achieve a certain weight, at which point they’d come off the diet,” she adds, pointing out that yo-yo dieting makes it harder over time to achieve a healthy weight and easier to pack on excess pounds.
In fact, research shows that when healthy foods are the focus, kids tend to weigh less. An Archives of Pediatrics and Adolescent Medicine study tracked 2,327 girls from age 9 to 19. Those who followed the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits and vegetables, lean meats, low-fat dairy, and whole grains without strict portion control, had an average BMI of 24.4, which is considered healthy, while those whose diets least closely resembled the DASH eating plan were classified as overweight, with an average BMI of 26.3.
On the other hand, diet foods and portion control don’t always spell long-term weight loss. In a study of 113 teens conducted by researchers at Children’s Hospital of Philadelphia and published in the journal Obesity, obese adolescents with an average age of 15 drank SlimFast shakes in place of their regular meals. While the study subjects lost weight in the short term, the diet shakes did not help the teens continue or maintain their weight loss until the end of the yearlong study.
Instead of dieting, Woolford advocates lifestyle changes. “For example, if you increase vegetable intake for your family, that’s something you’d want to do indefinitely,” she says. “It’s concerning to have young child focused on weight, diets, and calorie counting; it’s much more advantageous to think about being healthy.” While obesity puts kids at risk for type 2 diabetes, breathing problems such as sleep apnea and asthma, joint and musculoskeletal problems, and social and psychological problems like discrimination and low self-esteem—concepts that kids might not understand—even young children grasp the general idea of being healthy, and parents can make changes geared toward this goal without negatively affecting their child’s self-esteem, Woolford says.
Are Environments to Blame?
Before implementing healthy lifestyle changes, it’s important to understand where unhealthy eating and exercise behaviors originate. Although there are genetic and hormonal reasons for weight gain in kids and teens, at the root of childhood obesity is ultimately eating too many calories while not exercising enough, says Woolford.
Reports suggest that children today are likely to skip breakfast and consume less than the recommended servings of fruit, vegetables, and dairy. They also have easy access to high-sugar and energy-dense foods, while their access to healthy, affordable foods is limited. Like adults, kids are subjected to growing portion sizes, but they’re also the target of marketing campaigns for food that is high in calories, fat, sugar, and sodium, while advertising for healthy foods is scarce.
Environments are also to blame. Kids are bombarded with unhealthy food choices at school, via vending machines, fundraisers, classroom parties, sporting events, and so on. While it’s recommended that children are active for at least 60 minutes each day, many schools don’t offer much opportunity for physical activity. Also, in many urban environments, kids have limited access to safe and appealing places to be active. And today’s tech-savvy kids and teens spend hours engaged with television, video games, computers, and cell phones instead of playing outside.
Getting It Right
Instead of tossing around the d-word, which may be damaging to kids’ self-esteem and perpetuate the insecurities they have about their bodies, here are six suggestions for how to instill lifelong healthy eating and exercise behaviors in your child.
Model healthy behavior. If parents become more active, their children are likely to become more active with them, says Woolford, who suggests creating a home environment that includes activities like family walks or playing basketball in the driveway. The same concept applies to dietary habits. When you eat regular meals, drink water instead of sweetened beverages, and keep slices of fresh fruit and vegetables in the fridge for easy snacking, it’s more likely that your children will adopt these habit as well, says Woolford.
Make it a family affair. When helping younger children develop healthier eating and exercise habits, engage all members of the household. “When we see children who have excess weight, we focus on parents changing [their habits] and the whole family becoming healthy instead of focusing on the child, as this is more effective and helps preserve self-esteem ,” says Woolford.
Avoid eating out. Many fast food and restaurant meals have more calories and fat, and they are served in larger portions than should be regularly consumed as part of a healthy lifestyle. A good way to improve health is to avoid eating out, Woolford advises. Cooking at home allows you to provide nutritious, balanced meals in appropriate portions, and it can be a fun activity for families to do together. (Related: Try these 400-calorie meals your family will love!)
Speak up at school meetings. When many students eat both breakfast and lunch at school and spend the majority of their waking hours inside a school building, the environment should be as healthy as possible. Schools present major opportunities to provide kids with healthy foods, reduce exposure to unhealthy foods, and increase activity through gym classes and recess. The CDC recommends that parents work with schools to limit the sale of unhealthy foods and drinks outside the school lunch program.
Communicate with activity leaders. Don’t just encourage your kids to participate in healthy after-school activities; communicate with organizers in the environments in which children spend large amounts of time to encourage healthier snacks and more activity in those settings. For example, ban together with other concerned parents and encourage schools to change the ways they celebrate birthdays and holidays in the classroom, or suggest healthier options for sporting-event concession stands.
Cut back on computer time. The American Academy of Pediatrics recommends limiting media time for kids to no more than 1 to 2 hours per day, whether at home or with a child care provider.