The tragedy of the fat child
DOROTHY SANGSTER EXAMINES
Is it wise to insist that your ehild clean up his plate?
You may be condemning; him to the humiliation and loneliness of obesity.
He may be hungering not for food but for love, security or approval
Every body, says the legend, loves a fat man. But nobody — not even his loving parents — pretends to admire a fat child for his growing girth. His playmates tease him about it — then easily outrun him when he reacts in anger. The ball team doesn't want him and his physical education teacher is often unsure whether to press him into activities that are hard for him or leave him standing helplessly at the sidelines.
And, until recently, even many doctors impatiently dismissed his problem with a much-too-simple diagnosis: “He eats too much and exercises too little."
Thus has many a fat child's mental suffering exceeded his physical discomfort, leaving him with psychological scars he may carry the rest of his life and making his problem one of the least understood tragedies of our time.
Today the medical part of that picture has changed. Doctors have found that what they used to call “simple obesity" is anything but simple, but in attempting to find the true causes of overweight in children, they have often left the worried parents more confused than ever. Some medical men emphasize the importance of body metabolism, others the psychological factors. Many explain that overeating is often not a cause hut a symptom, diet alone is not the cure, and exercise is often impractical.
Some doctors even lay such stress on the emotional effects of any "cure" that they tell parents, in effect: "Your child's emotional well-being is more important than his weight. Don't nag him about his eating. Let him stay fat."
These seemingly contradictory opinions are perhaps made more understandable by the pediatrician who said recently: “There arc as many kinds of obesity as there are fat children, and all of them are different."
Most fat children, however, can be classified in one of several general groups:
Some are fat because they come from a family of fat people and inherited their tendency to overeat.
Some children are too fat because they have psychological problems of one kind or another which make them turn to food as solace. Dr. Edward T. Wilkes, an Americontinued on page 35
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“The only glands that make most children fat,” says one specialist, “are the salivary glands”
can pediatrician and author, lists causes of teenage obesity as escape fatness. TV fatness, mother-love fatness, sports shy fatness and family-fatness. Children who feel unloved and unwanted sometimes are driven to eat too much.
Some children are fat because it's light for them to be fat at that particular time. Children entering puberty often gain weight very quickly. A few years later they'll slim down again.
And some (but very few ) children are fat because of faulty glands. A doctor who specializes in glandular disorders recently remarked that a lifetime of working with obese youngsters had convinced him that the only glands involved were the salivary glands, and they were stimulated by bad eating habits right from the cradle.
Different kinds of obesity call for different kinds of therapy, doctors say now. and putting some overweight children on a diet is not only useless hut may be damaging.
A Toronto psychiatrist. Dr. Daniel Cappon. recently suggested that perhaps our exaggerated concern with weight may be a bad thing in itself. "Self-consciousness leads to anxiety, anxiety often leads to overeating, and overeating is the main mechanism of obesity." he explained.
The simplest question of all remains the hardest to answer: When is a child too fat?
"A child is obese if he looks fat and awkward, if he feels uncomfortable, and if he's unable to engage in normal childhood play." one doctor declares. "Those health charts you see giving a child's normal' weight for his age and height mean very little. Ten percent above the tabulated weight, and a child is considered overweight; twenty percent over, and he's supposed to be in a serious condi-
tion. C harts don't take into consideration such things as bone structure, glands, cultural background or the child's own temperament.”
Another physician points out that children grow in spurts, shooting up in the early years, flattening out in middle childhood and usually putting on pounds at the time of puberty. A child of twelve or thirteen who's putting on weight is just doing what's normal, and will probably slim out again.
What of the boys and girls who are recognizably overweight? Contrary to the opinion of many school teachers and parents, it isn't usually a child's glands that are to blame and there's no magic pill or injection that will work a miracle. The endocrinologist who observes that 'only the salivary glands are involved" is right as far as he goes but new medical thinking suggests that he's pointing at the symptom, not the cause of obesity. The fat child eats too much, all right, but the real question is: Why does lie?
It's suspected that there are many contributing factors.
A child's genetic background has a lot to do with whether he's going to be thin or fat. Fat people tend to have fat children and thin people usually have thin progeny. (The phenomenon of the thin member of the fat family is explained by the fact that fat people carry lean genes —factors which determine their physical heritage. Thin people don't carry fat genes. )
A Toronto pediatrician says. "In my thirty years practice I’ve tried with a notable lack of success to make fat youngsters thin and thin youngsters fat. I think it's the body type that determines what a child’s going to be like.
Another pediatrician disagrees. In his opinion, bad food habits in infancy start
a child on the road to obesity. Some families confuse size with excellence. To them the only good baby is a big, fat oversize baby. Hearty eating is a tradition in some families and the child with a small, finicky appetite is teased into second helpings. To parents with a background of poverty and insecurity, abundant food is the finest gift they can give their child. Their motive is good but the results are often confusing. "My mother makes me so mad!” an awkward ten-year-old recently complained. “She keeps saying, 'Eat. eat, eat.’ And now she complains that I'm getting fat.”
Watching the overweight child move lethargically from table to television set and back again, his parents often can’t help but have the conviction that he wouldn't be so fat if he’d exercise more. He's got a bicycle and a baseball mitt— why doesn't he get outside and use them?
A Toronto doctor who has many fat children among his patients says, “There are a few' obese children who are extraordinarily light on their feet and who don’t seem to get winded by hard exercise. But most of them are awkward and clumsy, and lack good muscle co-ordination. Why should this kind of child exhaust himself at games so that the other children can laugh at him? People who suggest that the lack of exercise makes a child fat are putting the horse before the cart. He’s fat: therefore he doesn’t exercise.”
Some medical thought has been given to the possibility that fat children, and adults too, have something wrong with their “appestat”—the automatic mechanism in our brain that’s supposed to tell us when we've eaten enough. Worry over exams, tension at the table or arguments before dinner can trigger off a reduction in appetite. Similarly, psychological fac-
tors may be involved when a child constantly and deliberately overeats. Psychologists believe that some youngsters gorge themselves on rich foods because they feel unloved, unwanted, lonely and bored. Food comforts them.
One physician recalls a twelve-yearold boy who came to him weighing one hundred pounds more than his healthy weight. The boy’s widowed mother had left him in an orphanage for nearly seven years, then remarried and brought him home. He immediately began to overeat, and when his mother had a new child, the boy overate more than ever. "He was obviously trying to catch up on all the love and attention he'd missed most of his life,” the doctor says.
Guilt as a factor
Sometimes parents feel so guilty about what they owe their children that they create a neurotically obese child. One family constantly apologized to their young daughter for not being able to give her all the luxuries of life they (and she) felt she deserved. Her self-pity grew' out of proportion and she turned to food for consolation. When she got horribly fat, she felt it was just one more cruel blow of fate.
Sometimes a boy feels guilty and inadequate because he can’t live up to his parents’ high expectations, and turns to food for consolation. Sometimes a girl is so jealous of her father's attentions to her mother, or to his business, that she settles down to getting fat as a means of provoking some reaction from him— if only disgust.
So say the psychologists, searching their files.
Dr. Hilde Bruch, a New York pediatrician who turned psychiatrist and has
since won international recognition for twenty years’ work and study with fat children, says the obese child is a special kind of personality, somewhat akin to the schizophrenic type. He has a low frustration tolerance—he wants things when he wants them. He reacts angrily to unexpected demands. He has a feeling of helplessness, a conviction that he's not very important, and an all-or-nothing attitude to life. He daydreams of being rich, handsome, famous, much admired —and thin. "When his dreams don't come true, he doesn’t break down like the schizophrenic: he just withdraws,
eats more and gets fatter,” Dr. Bruch says.
Many of the fat children she's known have been curiously dependent, emotionally involved with one or both parents, usually the mother. She considers it significant that seventy percent of the children brought to her office over a period of years turned out to be the only child or the “baby” of the family. Although their mothers had apparently turned to her for help, they showed amazing resistance whenever she advised dieting. Once w'hen she put an eleven-year-old boy who weighed one hundred and seventy pounds on a one-thousand-calorie diet, he managed to lose five pounds. “You’re starving him. I’m taking him off the diet,” his mother telephoned in tears.
As a rule, the obese child’s mother was fiercely overprotective, dressing and undressing ten-year-olds, insisting that the child sit on the only chair in the waiting room w'hile they stood up, answering all questions which the doctor addressed to the child.
At first Dr. Bruch thought all this babying was the mother's fault, but as the years went by she concluded that the child was quite walling to accept the
role for the pleasures and privilege« that went with it.
Often such families refused psychiatric help—or if they accepted it, it provee useless. Then the child grew up, ventar ed out of his mother's sheltering care inte the world, was rebuffed as much for hi' spoiled personality as for his size am promptly withdrew and consoled himsel: with more food.
Being a psychiatrist, Dr. Bruch admit tedly saw some of the more extreme cases of obesity.
What of the non-neurotic, ordinär) child who is perhaps twenty, perhaps forty pounds overweight? Should his obesity be ignored? Should he be taken to the family doctor? What kind of treatment should he get?
There's no simple answer because there are different kinds of fat children and what’s right for one is wrong for the other.
Dr. Arvid Wallgren of Denmark, where there has been considerable study about the fat child, says, “Every child is an individual and it's the state of the w'hole child that must be treated, not just his obesity.”
On the subject of diets, doctors have a great deal to say and some of it is pretty hopeless.
"To begin with,” a Toronto pediatrician says, "many a mother makes the mistake of telling her overweight child, 'I’m taking you to the doctor because you're too fat.’ By attacking the child’s individuality and suggesting there’s something wrong with him the way he is, she has given the child two enemies—herself and the doctor. If the child's hostility is extreme, he may react by eating even more voraciously, whether the parent finds out about it or not.”
Trying to keep a child on a diet against
his will is like beating your head against a stone wall, doctors say. At ten or eleven, a child may be willing to co-operate; at thirteen or fourteen the situation is even better because then the idea of dieting is often the child's own. A Toronto doctor says. "I find I get somewhere with a girl of thirteen or so. when she starts worrying about how' she'll look in a bathing suit. Boys ask for a diet when they discover they're too slow for the high school football team.”
Should a child be put on a greatly reduced diet all at once, or should it be a gradual thing—say twenty percent lower than his present food requirements, to begin with?
Here again there’s a sharp divergence of opinion. Dr. Giorgio Lolli, an American psychiatrist who sees certain similarities in the childhood environment of alcoholics and obese adults, says, "A drastic curtailment of food intake can set up reactions similar to those of a deprived alcoholic.” Dr. Bruch agrees that there are some fat children for whom too sudden a diet may result in severe emotional trauma, now that the mother (hitherto the Great Giver) is withholding what her child thinks he needs.
Pediatricians are apt to snap “Nonsense!” at such psychological twaddle.
"When 1 give a child a diet I don’t make it gradual.” says one. “I tell him This is it and it’s going to be tough'. That w'ay, he knows what he’s up against."
A medically approved diet for the overweight child consists of fifteen to tw'enty percent protein (from meat, fish, eggs, poultry and cheese) and sufficient bulk to give the child a comfortable feeling.
It should include green vegetables and citrus juice and be at least five hundred calories less than what the doctor esti-
mates is necessary for a child to maintain his present weight. Thus an overweight. inactive ten-year-old boy who is eating thirty-five hundred calories a day and still gaining, could maintain his present weight on a diet of three thousand calories. To lose weight, he must go down another five hundred calories. The doctor will therefore prescribe a twenty-fivehundred-calorie diet.
To find out how' many calories their child is getting at the present time, physicians sometimes suggest that parents write down a list of everything the youngster eats and drinks in a forty-eighthour period. This is often an eye-opener to parents who insist that little Susie may be thirty pounds overweight but she hardly eats a thing.
When it comes to putting a child on a diet, some do’s and don't's for parents are in order.
Most important is that you don’t talk about it. Don’t hand your overweight son or daughter a plate of coleslaw and yoghurt w'ith the remark, “This is what you've got to eat because you’re too fat.” You'll only build up his resistance to the whole idea. Try to give him limited amounts of things you know he likes (unless everything he likes is fantastically fattening, like gravy, cake and pie). Serve low calorie foods, especially proteins, and make it as visually attractive as possible. Let the child who’s dieting sit at the table with the family (he’s feeling isolated enough as it is) and, says a Toronto doctor, serve the same kind of food to everyone. He explains, “You can’t expect a child to nibble on grapes when right next to him is his sister gobbling up cocoanut cake. The diet that’s good for the fat child is good for everyone.”
Above all, encourage your child for his efforts instead of blaming him for his
failures. You're asking him to give up something that may not mean much to you. but it obviously means a lot to him.
Some doctors feel it's only right to give a judicious prescription of some "mood drug" like amphetamine to cheer up a child who’s dieting. Other doctors don’t approve. They claim drugs keep some youngsters awake at night and make others irritable. Some doctors prescribe
exercise as part of their treatment; others say that exercise comes later on, when the child's thin enough to enjoy it.
Something that's generally acknowledged is that no matter how' discouraging the doctor finds their progress, he must remain patient and uncritical with his obese young patients.
This isn’t easy, for physicians attest that fat children and their parents are notorious for their poor co - operation. They will go off a diet and insist they've stuck to it manfully, meanwhile gaining a mysterious five pounds. They cancel appointments and they’re overly sensitive to all comments about themselves. A Toronto doctor says, “I’ve got an elevenyear-old girl coming to me and I’ve felt almost from the beginning that psychiatric help is what she needs. But if I were
to broach the subject I’d never see the girl again, nor would the psychiatrist.”
For this kind of problem, diet alone is obviously not the answer. In any case, as Dr. Giorgio Lolli recently declared, "Before we can make a child cut down on his food willingly, we've got to make his life so meaningful that the pleasures of food seem small by comparison."
Until your child is ready and eager to go on a diet, then, take it easy. Don’t hound your boy to get thin or taunt him with the athletic prowess of the skinny lad who lives next door. If your daughter undertakes to diet and fails, try to be understanding; encourage her to try again.If you and your husband are plump, don’t be surprised if your children are fat too. and if they appear happy and well adjusted and healthy, think twice before you hurry to change them.
"The acceptance of a child's individuality reflects a sound emotional attitude on the part of parents and helps a child to grow up normally,” doctors say.
A few' years ago, follow ing up as many of her former young patients as she could locate, psychiatrist Bruch discovered somewhat to her embarrassment that fifteen percent of them had managed to get thin and happily stayed that way; twenty percent stayed fat but had adjusted comfortably to their overweight state; tw'entyfive percent were thin but maladjusted and unhappy; and forty percent were still fat. and still emotionally disturbed.
Parents might take heed from the fact that the “cured" fifteen percent — those who stayed thin and were well adjusted and happy — were young people who had undergone comparatively little doctoring and used no drugs. They had chosen to diet themselves, usually in their teens. And they had one blessing above all others — their parents didn’t nag. ★