Making Life Work
By David J. Craig
Feeling socially stigmatized is painful for a child no matter what the cause. But recent studies show that the psychological effects of being obese are particularly damaging — one such study indicates that obese children disproportionately feel socially isolated and depressed, have poor self-esteem, and are at high risk for developing a drinking problem.
“The psychological ramifications of obesity among children and adolescents is just amazing, and much more dramatic than for adults,” says Caroline Apovian, a MED associate professor and director of nutrition support services at Boston Medical Center. “They turn inward, they hardly speak, and some develop cognitive issues — they're so traumatized that they can't concentrate in school.”
Boston University's Faculty and Staff Assistance Office often helps adults struggling with issues involving their children, issues such as their health or their being picked on in school. The office provides BU employees with short-term counseling and referral services that are free and confidential; the problems can be personal, family-related, or work-related. “Parents get very anxious, depressed, and preoccupied when they're worried about their kids, and that can very easily intrude on work,” says Bonnie Teitleman, who directs the office. “They may miss work because they need to take their child to appointments, and some may simply be ashamed of or embarrassed about their child, which in turn can increase their own social isolation.”
Recently, the office counseled a BU employee who didn't know how to change his obese child's eating habits. He told counselors that in addition to overeating and being uninterested in physical activities, his young son was using his size to bully schoolmates. Exacerbating the situation, he felt, was his wife's lack of concern about their child's weight problem. Teitleman's staff provided basic information about childhood nutrition and eventually referred him to a family therapist. “The issue had also become a marital issue,” says Teitleman, who is a licensed independent clinical social worker, “because one parent saw the problem as being more serious than the other, which is common.”
It also is common for parents to have difficulty discussing sensitive topics, such as obesity, with their children, even when a child is obviously troubled, says Thiery Guedj, a senior psychologist recently hired at the Faculty and Staff Assistance Office. “One strategy I've found helpful in dealing with my own children's psychosocial challenges is to simply tell them what I have noticed and wonder aloud how they feel about it,” says Guedj, who has expertise in children's mental and behavioral health issues. “Many children will readily tell their parents that they don't feel good about being labeled fat, and may even say that they do not like their body because ‘I can't run well' or ‘I get tired very quickly.' This is usually a good beginning for a conversation about whether the child would like to get help with the problem. But even when a child says no, it is often because he or she feels powerless to change anything.”
If a child is being teased regularly in school, whether for being overweight, having a learning disability or a speech impediment, or for being different in any other way, Guedj says, parents should consult the child's teacher or school guidance counselor. “While many parents encourage their children to ‘take care of things' by defending themselves and striking back, in many cases it makes things a lot worse for the ostracized child,” he says. “In addition to being teased, he or she may be entirely rejected if they begin striking out against others.”
Being overweight tends to be more traumatic for girls than boys, even at a very young age, adds Apovian, who currently heads a study examining whether moderate use of meal replacements, such as diet shakes, are a healthful way for adolescents to lose weight.
“There are growth charts available on many Internet pediatric Web sites,” Guedj says, “and if your child is in the top range of the charts with regard to weight in relationship to height, it certainly makes sense to consult with a pediatrician. Similarly, if your child expresses concern about his or her weight, or his or her peers' perception of it, that should be sufficient to seek a consultation.”
“Making Life Work” is sponsored by the Faculty/Staff Assistance Office, directed by Bonnie Teitleman, and the Office of Family Resources and Boston University Children's Center, directed by Nikki Sibley. To propose topics for future articles or to express your opinion about this piece, e-mail firstname.lastname@example.org or email@example.com.