Dear DOCTOR Owen:

Our 12-year-old son is very overweight. He is self-conscious and does not to talk to us about a solution. He says he wants to join a diet program that will help him, but doesn’t want his parents to attend. Is there anything I can do?

Left Out

Dear “Lefty”:

Yes. My clinic is participating in a nationwide study of adolescent obesity for 12- to 16-year-olds. The study is designed to take place for one year. One group receives a medication (Meridia®) and attends a behavioral/education class. The other group receives a placebo (sugar pill) and the same behavioral/education class. All participants, including myself, will not know the results. This is called a double-blinded study.

One of my patients was interviewed and hers is the cover story that appeared in Newsweek magazine (July 2000). Her photo was considered for the cover, but she, understandably, was reluctant to pose as the “fat kid.” She is beautiful, extraordinarily bright, self-assured, and self-confident. Yet, the pain and shame of this problem made her want to “lie low.” What a smart kid! Perhaps this prejudice will one day go the way of race, sex, and religion. (But how many people had to die to make a dent in those areas?)

The study is only for seriously obese children. Children and their parents must attend a class once a week and everyone is expected to participate in the routine; parents attend their own classes. This is the type of program you should seek. 

I don’t think medication should be the usual first route of intervention. While I will be looking at differences in results, I am certain that both groups will fare well. Meridia® is released for use in adults. I am currently involved in a five-year study where patients did lose weight, and I will be looking at and evaluating the weight-loss maintenance effects of Meridia®. The purpose of that study is to determine if medication will predict long-term prevention of weight re-gain. 

The most important part of the teen program is the behavioral/education program, which teaches the basics (mathematics) of diet and exercise, and food choice by mathematics: “Is that package of French fries worth 6 miles of walking “payback” or not?” It is important over the long term for teens and adults to remain totally free to choose whatever they want to eat and when. Slavery, whether active (“don’t eat that”) or conditional (“you shouldn’t eat that”), is never pleasant. By using basic and simple “anchor points,” you and your son can be taught how to estimate the calories in any food instantly, without scales or charts. While this skill isn’t rocket science, it does have to be learned and practiced.

At my clinic, we diet and health counselors find that once our patients know the consequences and the payback—and are able to choose what they want to eat without recrimination or guilt—they usually opt for less fattening foods than previously. This education also allows them to select the foods they crave in a more disciplined manner, and eat them at a later time. They learn to eat without self-doubt, self-shame, or guilt. This is a major breakthrough for people who have been told that they have no willpower—and who have been teased, ostracized, left out of group participation, overlooked in the classroom and received poorer grades, and so on—simply because they are fat. 

Long-term diet programs should be structured to keep weight off. Patients need to attend maintenance programs—after their initial weight loss—in order to continue to be taught and practice the skills they have learned during weight loss. This “maintenance” program is vital for long-term success. Problem solving with support and understanding is important to all patients. 

We usually find that the most difficult problem in treating childhood obesity is the parents. They buy the food. They control the spending money. They promote their children’s beliefs, preferences, and attitudes about food, exercise, “willpower,” and discipline. Parents usually have less knowledge and skills than the child and are usually more resistant to change. The fat child is unconsciously placed “outside” of the family box. “We will support you, baby” or “I’m here to help” sound great, but often really mean “You, child, have the problem—not us. We will change because of you.” How do you think that makes a little boy or girl feel?