Elizabeth Poskitt, Laurel Edmunds Management of Childhood Obesity (2008)

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.The unhappiness may have very specific andobvious cause.Actual bereavement or apparent parental desertion in afamily break-up underlie the development of obesity in some.Children sdistress may be overlooked in the presence of adult distress such as mayaccompany the death of a grandparent.In circumstances of family break-up,physical disturbances such as moving house may accompany parental emo-tional disturbance.Children s eating can become disturbed with little noticefrom parent or carers when overweight begins to develop.Parent/carer guiltor a new step-parent wanting to develop positive relationships can lead tooverindulgence and consequent obesity for these children.The possibility ofchildhood depression should be considered when there is unhappinesspersisting over months without reasonable cause.Overindulgence or spoilingSome parental practices allow children to eat more or less what they likewhen they like.Overindulgence may not be simply over food.Parents mayoverindulge children by doing things for them when the children couldeasily do these things for themselves and expend energy in the process.Inthese ways children may develop lifestyles of being waited on by parentsso they have little PA, excessive television viewing, uncontrolled snackingand the presumption that what they want, they get.This too easily con-tributes to obesity.For other parents establishing and maintaining noboundaries are difficult with adverse consequences for children s weights.Sometimes giving children opportunities to do things for themselves is amatter of finding time for the slow and initially only partly successfulaction by the children.In the long term, allowing time for children todevelop the ability to look after themselves and to join in family activitiesis time well spent.In many of these situations helping parents and children recognize howchanged intra-family dynamics could create more effective management oftheir children s overweight requires considerable tact.The quality of therelationships between the HCPs and obese children or adolescents andtheir parents is critical to managing the weight problem.Health professionalsoften share the negative attitudes of the rest of society and may not appreciatethe complexity of having an overweight child in the family.Unhelpfulattitudes will come across in non-verbal communication.Findings from an90 How does psychology influence management?interview-based study with parents of overweight children showed a range ofresponses from HCPs.General practitioners and other medically qualifiedpersonnel could be sympathetic, offering tests, referral and general advice butsome blamed mothers, or dismissed self-help attempts to diet or to increasephysical activity, or labelled mothers as making a fuss.Some just showedlack of interest.Health visitors usually offered plenty of practical advice.Paediatric dietitians were child-centred and very supportive but experienceswith community dieticians were less constructive (Edmunds 2005).Thesefindings may or may not reflect others experiences but they demonstrate theimportance of the quality of interaction.They also highlight that parents mayhave had previous negative experiences when engaging with HCPs and effortmay be required to restore confidence in the help offered.Obesity often runs in families.In the UK the association betweenthe prevalence of obesity and low SES seems to vary with the study (Kinraet al.2000; Viner and Cole 2005).However the families of overweight/obesechildren will include some who are unskilled and/or socially disadvantaged.Interventions must relate to what families are likely to be able to achieve intheir homes and communities and with their finances.For the parents, theirown parenting, the demands of their work, their obesogenic lifestyles andperhaps low levels of education may all be factors which complicate theiraspirations to improve their children s weight and lives.Gently introducedsmall changes in family lifestyles may be all that is possible.Yet, without somelifestyle changes involving the family, nothing is likely to be achieved.Sym-pathetic support may improve well-being, in itself a good thing, but may haveno effect on weight.Studies of pre-adolescent children suggest that working with the parents isthe most effective way of managing childhood overweight.This does notmean disregarding the children and their problems and perceptions ofobesity but rather recognizing that effective change for these children isthrough parental action and provision of the environment in which thechild s lifestyle can change.Without this nothing is likely to be achieved.With age and increasing maturity, children and adolescents need to learn toaccept responsibility for their own weight management but to recognize thehelp and support parents and other significant adults can give.For each obese child and family, the advice will be different and themarkers of progress will be individual.Advice may even be the wrongdescription of the help needed.Health care professionals should be guidingthese families to find their own solutions to issues raised in discussion.It isthis which requires delicacy, understanding and tact.Our recommendationsmay be fine in theory but if they are not implementable within the family,they will not be successful.Improving psychological well-being is a necessary adjunct to any successfulweight management strategy, is unlikely to do any harm, and may be protectiveEating disorders 91against unsafe weight management practices in the child/adolescent (O Dea2005) [ Pobierz całość w formacie PDF ]

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