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Feb 1, 2004

TYPE 2 DIABETES AND CHILDREN Part 2 Weight, Metabolism And Self-Esteem Issues

In our previous segment I discussed the reasons for the staggering increase in Diabetes in children and why the worse is yet to come. Now I am going to help you help your patients understand why this is occurring and how to begin to combat the problem.


However, before I get into the issues of self esteem and metabolism in children, I wanted to follow up on the discussion on fruits and vegetables from last time as there are some pretty interesting statistics to review.

In a study for her book, Food Fight: A Guide to Eating Disorders for Pre-Teens and Their Parents, author Janet Bode issued food diaries to 87 students in three schools on Long Island and one in Brooklyn. The results were eye-opening. On the average, each child consumed 4.7 servings of fruits and vegetables (not including French fries) not a day, but a week! This translates into about half a serving a day, instead of the hoped for five. And, even more startling, was that of the 87 students, 17 ate no fruits or vegetables (except French fries), and often, when they did consume fruit it was in the form of fruit juice, which lacks all-important fiber.

I find that most parents don’t like vegetables, therefore their children don’t like them, so therefore they are not a part of the meal. This is a serious problem. If we don’t teach our children to appreciate vegetables at an early age, it will be increasingly difficult as they get older. We make sacrifices every day for our children, and this should be something we’re prepared to do.

When it comes to adding fruit to a child’s diet, many well-meaning parents have leaped to the mistaken conclusion that substituting fruit juices for soda will help solve the problem. This is a dangerous misconception. After all, sugar behaves in the body the same way, no matter how it’s delivered, so the fact that one is filled with natural sugar and the other is added white cane sugar, is of no difference and ultimately has the same effect on the nutritional status of your child.

Fruit juice is the dietary equivalent of drinking soda. As far as I’m concerned, there is absolutely no nutritional value in fruit juice. The vitamin C you can get from juice is too small an amount to compensate for all the sugar contained in that glass of juice. From a health stand point, neither your overweight nor non-overweight child should be drinking fruit juice because their body will have difficulty metabolizing all the sugar at once. This causes too much insulin to be secreted and may set your child up for a hypoglycemic reaction and food cravings, among other things.

Trick or Treat?

All too often sweets are used as a reward. Who among us can’t remember being coaxed by a parent to make an unpleasant visit, perhaps to a doctor or a dentist, with the promise that, “If you’re good, we’ll stop for ice cream on the way home.” Or, after visiting a doctor, being rewarded with a lollipop for good behavior. And what holiday, whether it be Christmas, Easter, Halloween, or Chanukah isn’t associated with chocolate, candy corn, or jelly beans? Is it any wonder then that sweetness equals reward which translates into feeling good?

This, I feel, is a large part of the problem faced by overweight children and their well-meaning parents. And it’s not only parents who unknowingly create roadblocks to prevent to a child from eating properly. I’ve found that it is often grandparents or other care-givers who create some of these problems as well. With the increase in the number of children who are minded by people other than their parents, and this includes nannies, baby-sitters, and grandparents, it is necessary to explore that person’s feeling concerning sugar too.

Not long ago, I had a young couple bring in Steven, their 4-year old, who was starting to max out on the height and weight charts and since his father had a weight problem and was diabetic, the mother was concerned about preventing this from happening to her son. I told the parents that Steven had to be taken off all sugar and simple carbohydrates. His parents were willing to try but suddenly, his grandmother, who had accompanied them, began to cry. This woman was in tears because she felt as if I were trying to deprive her grandchild of something so special that removing these items from his diet would scar him more seriously then facing a lifetime of obesity, diabetes, and heart disease.

“Mirror, Mirror On the Wall, Who’s The Fattest of Them All?”

This refrain actually went through my head as a child! I felt so hopeless about my situation that I began to conjure up outrageous images, as I peered tentatively toward and then away from my reflection in a full-length mirror. My self-esteem with regard to my appearance was really bad. I was lucky, though, in that I had parents who never criticized my appearance – or the way I ate – and also because I was quite good in school. So there was some balance in my formative years.

But being overweight is far more than just a matter of cosmetics. It can and often does result in potentially serious physical and emotional problems, including grave social ramifications that can result in severe psychosocial stress. I should know. I was the kid who hated to go to school on gym days because I was afraid I would have to take my shirt off in front of the other students. I dreaded basketball season because of the inevitable Shirts vs. Skins competition, afraid that if I were to be chosen for the Skins team, I would have to take off my shirt, exposing myself to ridicule. And, even worse, what if I weren’t chosen because of my enormous size? How embarrassing that would be! If your child is overweight, trust me, he or she will know it without having to be told.

“Who Am I?”

Proper self-image is critical to a child’s development. Think about it. If you were a good athlete as a child, you will probably always think of yourself as being so. And if you did well academically, you will probably always think of yourself as being smart. By the same token, if you were fat as a child, no matter how thin you may be as an adult, you can be sure that the perception you have of yourself is always going to be that you’re fat. I still suffer from the thought that I am overweight, despite the fact that I carry only 165 pounds on my six-foot frame. I look into the mirror and I see the overweight child staring back at me.

Recent studies have shown that children who lose weight gain an enormous amount of self-esteem. They don’t express it the way we would as adults, instead, they say things like, “I want to be just like my best friend,” or, “I want to hang out at the mall like Mike.”

In a survey conducted by the Commonwealth Fund, in which 3,586 girls and 3,162 boys from grades 5 through 12 were interviewed, it was found that there was a marked difference in self esteem between the sexes.

This survey found that young girls entering puberty experience a crisis in confidence that renders them vulnerable to risky healthy behaviors, such as alcohol consumption, drug use, and eating disorders. Dr. Emily Hancock, a psychologist and author of The Girl Within, shows that self-esteem in girls peaks at the age of 9, then begins to plummet. Backing up this contention, the Fund study reports that by high school, only 39% of girls were highly self-confident, and that older girls had less self-confidence than younger girls.

Another interesting finding from this survey is that older boys were more likely to be highly self-confident than younger boys, with more than half of all boys in high school indicating high self-confidence. Something else from this study that caught my eye is that girls were particularly likely to be critical of themselves and 25% of older girls reported that they did not like themselves, whereas only 14% of the boys felt this way.

The Fund survey reported that many 9-year olds are dieting to lose weight. Furthermore, up to 25% of adolescents, many of them girls, regularly purge themselves to control their weight. In fact, nearly 1 in 5 ninth grade girls admitted to having binged and purged, and the incidence of bulimia is twice that amongst high school seniors.

I see these statistics as a cry for help. It is our responsibility as parents and health professional to offer them proper guidance and set good examples, instead of having them turn to the media which often gives them damaging advice. When there is a TV special on models–many of whom are pre-teens themselves–one of the most often asked questions to them is “What do you eat?” Or, “How do you stay so thin?” Do we really want to get our children to get nutritional advice from another adolescent? There are also many programs that deal with eating disorders. When these shows air, many girls report seeing the troubled girls on television as healthy, having desirable weights, and they long to be like them. The only way they know how, however, is to develop an eating disorder themselves.

By losing weight and gaining health, there is no end to the amount of self-esteem that can be gained. They want to know how and are becoming increasingly savvy about fat, carbohydrates and reading food labels. Let’s help them.

Can I Keep a Child on a Diet?

One day, as I sat in my office, I received a call from the mother of one of my young patients named Jason. It seemed that Jason was about to go to his first birthday party as a dieter and his mother was concerned not only about how Jason would deal with his diet in those surroundings, but how his peers would react to his “special diet.” I thought about it for a while and then decided that the best solution would be to have Jason’s mom call the other child’s mother and explain to her that Jason was on a special diet and that she would like to send over something special for him to snack on. Of course, it was fine with the birthday boy’s mother and so I gave Jason’s mom a list of fun foods he could bring with him, so he wouldn’t feel as if he were being left out. In the end, the food I had her prepare was so delicious that all the other kids wanted to eat just what Jason had. Certainly, I can’t guarantee that all life’s difficult situations can be resolved this easily, but I do know that dieting is always more successful when there is some thought involved.

One of the great fears expressed by parents is that they doubt that their child can stay on a diet. “Dr. Pescatore,” they say, “I can’t be with them all the time. How can I make sure that they eat what’s good for them?”

The truth is, children don’t want to be overweight. They want to lose weight so they will feel better, look better, and, most importantly, fit in with their peers. Too many parents underestimate their children. In my experience, children are often more motivated and more disciplined than their parents. A child, for the most part, will do what he or she is told. They generally accept authority and they are looking for structure that only you, as a parent, can provide. They generally accept the dietary limitations placed on them. I can’t say the same for my adult patients, who offer excuse after excuse as to why they can’t stay on their diet.

From my experience, as soon as children begin losing weight on the diet, a natural reinforcement begins to take place. They begin to feel better about themselves. They begin to relate better to their peers. And, in my experience, they often choose to stay on the weight loss part of the diet far longer than they have to. A better self-image is starting to take hold and they are very reluctant to give this up. A positive self-image can be just as self-perpetuating as a negative self-image and often, even more so.

And, in the worst case, if your child eats well only when they are with you, you’ve made excellent progress in controlling what they eat and helping to instill new habits. No one is perfect all the time and we can’t expect our kids to be either. The other important thing to keep in mind is that we control the food that comes into the house. Where does your child get the money to buy their own food? Who goes grocery shopping? Keep this in mind and only buy healthy foods – you’ll feel better too.