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to their long-term health, wellness and
productivity. We also know that many of the
long-term health risks as adults are largely
determined by the age of 20, so promoting
health and wellness in the early years is
going to translate to a healthier adult.
At what point should parents seek help
for their children?
It depends on the age. Before the child is
2 years of age, there are no body mass index
standards, so we use height vs. weight. If
they’re at the 95th percentile or quickly
jumping up percentiles in terms of weight,
that would be a red flag. You need to be
looking at what the child is eating or drinking
— usually it’s sugared drinks or juices that are
the biggest culprits. After age 2, we have the
BMI standard: If you’re between the 85th and
94th percentile you’re considered overweight,
and at the 95th percentile or above you’re
considered obese. When I am talking with
a parent of a young child in that situation,
I explain that we need to be mindful of what
might be going on and what we can work
on to make a difference. We do what’s called
1 in 3 children
obese or overweight
Preventive Measures : What can you do at home?
Plan family activities that involve exercise.
Instead of watching TV, go hiking or biking,
wash the car or walk around the mall.
Establish a regular bedtime and wake-up time.
Healthy Meals and Snacks
Replace sugary drinks with healthy natural
bevarages, such as juice and water. Avoid eating
processed food and prepare more fresh meals.
motivational interviewing, which explores the
family’s confidence about what they can do to
change, and ask them to make choices within
the context of their lives. It is a family centered
approach to behavior change. The family has
to not only care about making changes, but
has to embrace them.
What are some of the front-line strategies
for addressing the problem, or preventing
a problem from occurring?
One of the tenets of a healthy lifestyle is
having routines. That includes eating three
meals a day and snacks, so that you’re not
going to be so hungry that you overeat. It
means incorporating physical activity in
your daily life, ideally totaling at least an
hour a day. Among the most important from
a dietary perspective is avoiding sugary
drinks. You want it to be difficult to access
unhealthy foods, so that healthy foods are the
default. We also believe that being mindful of
what you eat and when you eat is important.
Family meals in the evening may be healthier
than eating out.
Children know if they are overweight and don’t
need to be reminded or singled out. Don’t
use food as a reward or punishment. Children
should not be placed on restrictive diets unless
done so by a doctor.
What is the basis for your program’s
approach? We have a psychologist, a dietitian and myself
seeing children and families monthly, and it’s
very individualized. We spend time addressing
not just the mental health of the patient but
the mental health and well-being of the family,
particularly the parents. If they’re not on
board and not taking care of themselves, the
children will have a harder time addressing
their own nutritional and psychological needs.
As far as diet, we are very specific about what
needs to be changed and we work on small,
To view a video about
Wendy Slusser, MD
Vital Signs Winter 2014 Vol. 61