Book Reviews

We've all seen the headlines: Obesity and type II diabetes in children are now reaching epidemic proportions. Indeed, surveys by the National Center for Health Statistics indicate that about one in five children in the United States is now overweight.¹ But obesity in children is not just a frightening headline: Obesity is an important chronic disorder associated with many possible long-term complications as well as complex family, social, and psychological issues. Brave is the parent or clinician who dares to assume the task of attempting to rescue a child from the clutches of obesity. Braver yet are the clinician and health writer who would create a guide for such parents.

Judith Levine (a registered dietician and consultant for the American Heart Association) and Linda Bine (a health and medical writer as well as senior editor for Kaiser Permanente in Northern California) have done just that by creating the revised and updated edition of Helping Your Child Lose Weight the Healthy Way.

The authors use a sensitive, well-organized, practical, family-oriented approach to outline a concise plan for helping a child lose weight. More important, they do not address weight loss as the goal but rather describe ways to make slow, incremental changes in food choice and activity. Developing a healthy lifestyle is the goal: "Positive changes in food and fitness should be your goal­-not changes on the bathroom scale."^2:p69 This book is not about putting your child "on a diet."

The authors present a stepwise plan. First, assess the child: Does the child think he (or she) is overweight? Are you the only one who detects a problem? You should select an approach on the basis of answers to these questions.

Next they guide us gently through the process of gathering data. Growth charts for height and weight and calculation of body mass index (BMI) are presented clearly and simply, as are instructions in how to complete a food diary and eating behavior survey as well as how to assess your child's (and your family's) exercise attitudes and behaviors. Having acquired assessment tools, readers are presented with eight substantial chapters on basic principles of nutrition. Among the topics discussed are the food pyramid, how to understand nutrition labels, savvy grocery shopping and planning, how to eat healthfully away from home, and calorie-lowering strategies designed especially for kids. This section of the book serves as great reference material.

The third major section of the book, "Focus on Fitness," starts appropriately with a chapter titled "Off the Couch!": "The widespread use of two modern inventions­-the television and the automobile­-have contributed significantly to the decrease in physical activity among adults and children."^2:p177 In terms of causing epidemic obesity, this decrease in activity is at least as important as overeating. As in the section on making healthy food choices, the "Off the Couch!" section emphasizes ways to make slow, incremental changes in family activity lifestyle. Emphasis is placed on the family being active together--not on the child joining organized sports or exercise regimens. All of the recommendations given in the book meticulously and sensitively avoid singling out one child as needing to lose weight or be more active. This approach not only respects the self-esteem of the child but also recognizes that long-term success can be achieved only if the whole family is involved and if changes are gradual, small, and ongoing. The authors also recognize that children learn best by example.

The last section teaches parents how to facilitate change and how to recognize their own attitudes that might hinder change. The book also contains a section of "kid-friendly" recipes, followed by excellent bibliographic references. The book's recommendations closely follow recommendations of the Expert Committee on Pediatric Obesity convened by the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.³

As a parent and as a pediatrician who is truly frustrated by inadequate skills in treating obesity, I see this book as a ray of light in a dark room. The book uses an excellent stepwise approach that treats obesity simply and logically as a chronic problem and warns against short-term, quick weight loss. The book is helpful not only for parents but also for any clinician who provides medical care to overweight children.

References

1. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995 Oct;149(10):1085-91.
2. Levine J, Bine L. Helping your child lose weight the healthy way: a family approach to weight control. Rev. and updated ed. New York: Citadel Press; 2001.
3. Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics 1998 Sep;102(3):E29. Available on the World Wide Web (accessed September 5, 2002): www.pediatrics.org/cgi/reprint/102/3/e29.pdf

 

Kathleen H Jones, MD, is a general pediatrician at the Otay Mesa Medical Offices in San Diego, CA. Her special interests are adolescent medicine and adolescent and pediatric gynecology.

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