{Dr. Ivor Is In} Generation XXL: Talking Childhood Obesity With Black Moms

By DR. IVOR HORN

No matter how much I smile, no matter how lighthearted my words, when I bring up weight to the parents of my little patients, the words never sound pretty: Mom, we need to talk about [insert child's name here] weight. Almost always, there's a little dancing a walking of a very fine line when I discuss weight with moms, but those talks become even more tricky when African American parents are involved. Even when I think it's obvious that a child is overweight, the moms I counsel in my Washington, D.C.-based office, most of who are black, might not see it. And almost immediately, the disbelief rears its head: She's just thick, she'll say, or He's like his dad's family they're big boned.

They're not in denial, those moms. When I bring up their child's weight, they meet my assessment almost in the same way they do an old friend who hasn't seen their child in a while like I'm just marveling at how much she's grown. I get that: They're there with their children everyday; the transformation is slow and steady it can go unnoticed. Plus, our community just tends to see weight differently. Studies show that overweight and obese African Americans are more likely than whites to think their weight is about right, and plenty of researchers note that in our community, a little extra meat on our kids' bones may be seen as positive a sign that our kids are healthy.

But it's not. In addition to weight-related issues like sleep apnea and asthma, obesity in children and youth can lead to weight-related, grown-up diseases, such as high cholesterol, high blood pressure, and even Type II diabetes. And though the conversation isn't always easy, it's my job as a pediatrician to help the parents of my patients understand the facts. I start by explaining how we pediatricians track weight. We measure the total body fatness for children ages two and up by checking their Body Mass Index, or BMI a number determined based on a child’s height to weight ratio. The healthy range of BMI for kids varies depending on the child's age. For example, the normal BMI range for a six-year-old is about 13.7 to 17, but for an 11-year-old, it's about 14.2 to 19.4. A child is obese if their BMI falls above the 85^th percentile for their age group.

I show the BMI growth chart to every parent whose child I give check-ups to and explain both where their child falls on the scale and what the healthy range is. And then I remind parents of the importance of not dieting, but eating a healthy diet and developing a healthy lifestyle that will keep their young bodies grow healthy and strong a message that's important for all kids, no matter their weight.

Mind you, it's not just my patients who struggle with finding that balance. I'm a mom, and I struggle with these issues, too, with my two kids. Here, some suggestions I give parents to help them put their children on a road to healthier lifestyles suggestions that I use in my own home with my own family:

Watch what you eat out.

I ask all the families that I see about eating out: How many trips to the drive-thru do you make during a week? How much eating out does your family do at restaurants? In my house, we sometimes eat out once a week, and when it’s a busy time at work, it can be more frequent. To up the quality of food we eat out and keep our budget in tact! we do our best to:

• Make healthy choices from the adult menu and split the meal. Kid's meals at restaurants are often the most unhealthy chicken nuggets and fries anyone? By ordering off the adult menu and splitting two meals between the four of us, we have more healthy options and less calories on our plate.
• We ask for an appetizer or salad plate. This helps with portion control when we split that meal. Or we eat the salad plate portion and take the rest home (separate your meal at the beginning and ask the server to box it up immediately).
• We skip the bread and chips. (Ok, most of the time!) The best way to do this? Don’t even let them bring it to the table.

Watch what your family drinks.

I always ask parents what their children drink, and often, the answer is some combination of juice with a proud statement about water and a little soda. When I explain how many liquid calories juice adds to their child's daily intake, most parents are shocked because they think of juice as a healthy choice. Fruit juice is not a substitute for fresh fruit. I recommend to parents that they substitute the juice with a glass of skim milk at meals, allow no more than four ounces of juice a day, and skip the sodas except on special occasions.

Take control of snack time, especially after school

This one is tough, at least in our house. I don’t know about your kids, but mine come home starving, like I didn’t pack them anything for lunch. When they get home, they make a beeline to the pantry and grab the first thing in sight. I work all day so there is no meal waiting for them when they get home and they generally have to get their homework done, and get to swim practice within about 45 minutes. Dinner is after practice, but they need the fuel to swim their best. And there's the dilemma what's quick and easy for them to fix on their own, but healthy enough to give them energy and nutritional benefit. My kids know that sugar only snacks will not sustain them through 1 “ 1 ½ hours of swimming, but chips with shredded cheese melted on top for protein is not the best choice. While we haven’t mastered the after school snack routine, we do get it right sometimes. Here’s what we do and what I recommend to my patients:

• Keep the unhealthy choices out of the house. This goes especially for kids who get home before their parents. If the unhealthy option is available, they will likely choose it. Until the family is trained to make healthy food choices, sometimes removing the temptation is the best option.
• Make healthy choices easily accessible. If you put a plate of sliced fruit on the table in front of them while they are doing their homework, they will eat it. This one I learned from a friend: Make your own trail mix (banana chips, dried cranberries, your favorite nuts), place it in a big gallon ziploc storage bag in the pantry, and, as the kids walk in the door, put some out in a bowl along with the fresh fruit. That's a great snack! So is the go-to favorite PB&J, on whole wheat bread. Top it with a glass of skim milk and they will be ready to go.

Exercise, exercise, exercise!

Get your family moving. Notice, I didn’t just say get your kids moving. Weight gain at its most basic level is energy (calories) in versus energy (activity) out. The best way for your child to be active is for you to get active. Kids need at least 60 minutes of moderately vigorous activity every day; that means they need to work up a sweat doing something. Play basketball with your son. Go running with your daughter. Get outside and play softball as a family or take a walk in your neighborhood together after dinner. No roof over your head fresh air in your lungs, a breeze against your face. There's no better family time than that!

For great tips on healthy eating and exercise for children, check out Michelle Obama’s Let’s Move campaign.

Ivor Horn is a mom, practicing pediatrician and researcher with several publications in medical journals. She has appeared on the Today show and Good Morning America Health discussing health topics such as childhood obesity, puberty and breastfeeding. She lives in Washington, D.C., with her husband of more than 20 years and their two children. You can follow her on Twitter @DrIvorHorn.

{Read the MyBrownBaby disclosure for Dr. Ivor Is In here.}