Overweight: Nutritional Guidance for Overweight Children

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Overweight: Nutritional Guidance for Overweight Children




Guest:  Katherine Nashatker – Dietetic Services

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Katherine Nashatker who is a pediatric dietician here at the Children’s Hospital at MUSC, with a specialty in pediatric endocrinology.  Katherine, I bet, all the time, everyday, you must talk with parents of children who have difficulty with being overweight.  Is that one of the major things you do?


Katherine Nashatker:  Absolutely.


Dr. Linda Austin:  How do you start?  How do you think about the first steps in having that conversation?  I’m sure there’s so much embarrassment and maybe even shame that goes into that from the parent’s side.


Katherine Nashatker:  I think really establishing some comfort level with the parents and the child and focusing on one thing, either a behavior change or a diet modification, because there are so many facets that are contributing to the problem.


Dr. Linda Austin:  How do you decide what the one thing is?


Katherine Nashatker:  I usually go about, first, talking about a typical day and walking it through with the child, understanding what type of lifestyle they lead, time commitments and dietary preferences, because I’m catering to their needs, obviously.  I think once I can troubleshoot, for instance, is it a behavior problem that is leading to the food choice, or is the food choice and the food offering, maybe, from Mom and Dad and not so much the behavior?  So, I try to pinpoint which one takes precedence.


Dr. Linda Austin:  Now, children, of course, have the advantage that they are growing still.  In mild cases of overweight [children], do you ever find yourself saying, well, let’s just keep your weight where it is, let’s get you moving more, and let your [continuing] growth take care of the problem?


Katherine Nashatker:  Yes.  We always advocate a steady weight and not dramatic weight loss.  We never restrict a lot of calories from a child’s diet, regardless of their obesity.  I feel the need to just make better choices, maybe redistribute calories, but never to say to a child, you need to be on a very restricted calorie limit.  I think it’s unhealthy for the child. 


Dr. Linda Austin:  I have seen situations, more often, I think, between mothers and daughters than other pairs where the daughter may have a weight problem and the mother may get seemingly, to me at least, terribly invested in having the daughter lose weight.  I worry, at times, that it may backfire, that, sometimes, the more attention you call to it, the more there’s a psychological issue created within the child.  Is that a realistic concern?


Katherine Nashatker:  Absolutely.  I encounter that as well.  Usually, I try to speak, first, to the child and then address that with the parent, and, maybe, reflect some of their comments to them in a different way and let them see how they’re perceived.  Oftentimes, the parents aren’t really hearing themselves and don’t realize [the impact of] their word choices, for instance, saying that you’re really ashamed that your child is having to go through this problem, or saying words like that.  I’ve heard terminology like that from parents, and the child hearing that interprets it as, I’m bad or I’ve done something wrong for having the issue that I have.


Dr. Linda Austin:  I think with children, also, sometimes a little goes a long way, that those words can be very hurtful.  What are some better words that a parent can use in talking about weight issues with a child?


Katherine Nashatker:  I think parents, and I try to stress this especially when a child is trying to make a modification, should stress the good things and emphasize their better choices, not use words like good foods or bad foods, fattening and less fattening, but say things like, this is a healthy balanced meal, this is why I’m choosing salad instead of chicken nuggets at the fast food restaurant, I’m doing this because it’s a healthy choice, not because it’s got, you know, this low fat, low cal whatever.  I think when parents reward their own behavior with healthy nonfood rewards, they’re modeling good behavior for their children.  For instance, if it’s the end of the week and the child has come home with good reports, why not just take the child to the park or a movie rather than buy them pizza or coke or candy? 

When they grow, maybe when they, you know, get a promotion, they’re going to do the same thing.  So, I think modeling behavior is a big part. 


Dr. Linda Austin:  How about just not going for fast food?  I mean, it’s very hard to go into a fast food place and come out without 500, 600, 700, or more, calories.


Katherine Nashatker:  Being aware of what you’re eating, absolutely, is part of the battle.  I try to keep resources available for my patients.  I have a fast food guide in my office and it [lists] all the fast food restaurants and nutrients of everything that’s served.  I try to open their eyes to the fact that they just ate a meal that constitutes their total recommended calories for the entire day.  Sometimes just making them aware of that really catches their attention.


Dr. Linda Austin:  Do you know what the single highest calorie food is in a fast food place?  What’s the highest you’ve seen?


Katherine Nashatker:  The highest I’ve seen is the Hardee’s morning breakfast sandwich.  I think it’s called the Big, something, Breakfast Sandwich.  It has two patties of sausage, eggs, bacon, cheese, and it’s over 1200 calories, I believe. 


Dr. Linda Austin:  Oh my gosh, for breakfast!


Katherine Nashatker:  Yeah.


Dr. Linda Austin:  So, that’s almost a whole day’s calorie supply.


Katherine Nashatker:  If not, two day’s worth of meat and fat.


Dr. Linda Austin:  Oh my goodness.  How about the timing and spacing of meals for kids?  I know after school can be a very challenging time.  It’s sort of a psychological letdown time and people are naturally hungry then. 


Katherine Nashatker:  I think establishing routines and taking away distractions, we’re living in such a fast paced society.  So often, I walk into my own friend’s houses and hear them tell me, we don’t use our dinette, we don’t use our kitchen table.  People are eating while they’re standing and moving and driving.  If you sit down to a meal, you take your 20 minutes to seriously enjoy, chew your food and consume your meal, you’re not going to be as hungry.  A child who is learning to eat in front of a TV is so distracted by what’s going on, they’re probably not going to tune into their own internal hunger cues and recognize fullness.


Dr. Linda Austin:  Let’s talk, now, about exercise, if we could, Katherine.  What are some of the points you make to parents about that?


Katherine Nashatker:  It is equally important that a child gets daily exercise.  Too many children are suffering from all kinds of issues, diabetes, obesity.  A lot of it stems from too much intake versus too little output.  If a child can get used to playing everyday, getting sweaty, getting that heart rate up, younger, then they’re going to continue those behaviors later on.  It’s extremely important that time be set aside, and not pushed aside, and they need to be turning off the television.  Mom and Dad need to make that priority.


Dr. Linda Austin:  How about modeling behaviors for children?


Katherine Nashatker:  Absolutely.  Mom and Dad can get involved.  Parents and families should be playing together.  They should be outside when it’s sunny.  It should be a group effort, definitely.


Dr. Linda Austin:  Katherine, thank you so much for talking with us.


Katherine Nashatker:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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