New research presented by the European Society of Cardiology suggests that we have been going about addressing childhood obesity all wrong. Instead of focusing on nutritional knowledge, we should be teaching children self-regulation and emotion management skills.
Consider the following typical scenario: Jason is 10 years old, and in the 90th percentile for weight. His pediatrician has asked his mom, Andrea, to put him on a diet.
“My son can’t plan five minutes ahead!” Andrea exclaims. “How is he supposed to relate to the concept of “eat healthy now, so you won’t die of a heart attack in ten years?” Sarah chimes in: “My son is so impulsive. He sees something he wants, it’s in his mouth. Instant gratification is pretty much the hallmark of my son’s ADHD profile. And he’s so resistant to change! How do I get him to taste a vegetable, let alone make them the majority part of his diet? It breaks my heart to see him pause for breath halfway up the steps, but realistically, how do I help him change?”
Andrea and Sarah are not alone. The CDC estimated the prevalence of obesity at 18.5% among young people in 2015-2016, affecting about 13.7 million children and young adults.
The correlation between ADHD and obesity is somewhat controversial. But despite the stereotype of ADHD children as skinny, hyperactive, always-on-the-go bundles of energy, many children with ADHD are overweight. With the sophistication of today’s gaming systems, it’s possible to be hyperactive without ever leaving the comfort of your chair, or your snacks! In my Targeted Parenting: The Distractible Child classes, parents frequently ask about how to help ADHD children remain committed to goals like healthy eating when their neurology doesn’t support it.
Recently, Weight Watchers (WW) launched an app called Kurbo, aimed at helping children lose weight. The reaction came fast and furious, from advocacy groups, physicians, and therapists. An online petition calling on WW to withdraw the app quickly garnered 87,000 signatures. The app was accused of promoting unhealthy eating behaviors and possibly fostering eating disorders. A particular problem was the app’s categorization of foods using a classic “traffic light system.” Green means “Go, eat more of this!” Yellow means “Go slow – eat in moderation” and red means “Stop or limit to occasional treats.”
The concept of “sinful” or “bad” food is one that many researchers point to as problematic. So many teenagers or adults will talk about “badness” and “goodness” in terms of diet. “Today I was bad, I need to run an extra mile tomorrow,” or ascribe a sense of virtue to being “good” on their diet. With orthorexia on the rise, this can be a problem.
Is Nutrition Education Sufficient To Cause Behavior Change?
There’s another problem with Kurbo that most have not picked up on. Knowing which are the “good” and “bad” foods doesn’t actually help children make healthier choices. Research recently published by the European Study of Cardiology suggests that simply teaching children about nutrition is an ineffective means of changing behavior.
The Happy Life, Healthy Heart Program randomly allocated 10 public schools in Brazil to either an intervention or control group. The control group schools simply used a standard nutrition and health curriculum.
The researchers added an interesting component to the intervention group – they trained teachers to teach nutrition and physical activity, but also taught them how to teach concepts such as habit change, stress management, emotional health, and how to manage quality of life.
Prior to the study, in both control and intervention groups, all participants – both students and teachers – were assessed for baseline data, including weight, height, physical activity, and food intake. Students, but not teachers, were also assessed for prior knowledge of nutrition and healthy practices.
The teachers in the intervention group were encouraged to modify the material and make it their own, and could incorporate the lessons in their own way. To encourage greater participation, the teachers were invited to a social media network to share ideas and communicate with the researchers.
Social and Emotional Learning Added Significant Benefit:
In both control and intervention groups, the students learned a lot about nutrition and health. However, only the intervention group changed their behavior. In the intervention group, the proportion of students following the recommendation to avoid fast-food increased by 15%, and the proportion of students following the recommendation to avoid sugary soft drinks increased by 20%. In addition, there was a 28% increase in teacher physical activity.
To Change Behavior, Look at Why:
In behavior therapy, we look at the function of the behavior, in order to create lasting behavior change. Who hasn’t eaten their way out of a bad mood at some point in their life? Kids are just like adults – food can be a potent self-soother. It’s no accident that most “comfort foods” like chocolate or ice cream (or chocolate ice cream!) are loaded with carbs – they tend to raise our serotonin levels when we’re feeling down.
By attending to the function of food as a self-soother, the Happy Life, Healthy Hearts program offers an exciting new take on curbing the obesity problem. Let’s teach children adaptive self-soothing skills and teach them the soothing powers of physical activity.
Gamifying Weight Loss:
Those who demonize the Kurbo app are looking at all children as monolithic. But there’s no such thing as an “average child,” there’s only a specific child with specific neurobiology. In my classes, where parents learn about how to parent-specific profiles of children, one of the thorniest problems is health and eating behavior. Andrea and Sarah are typical of the mothers who attend my classes for parenting the Distractible Child, all of whom are struggling with helping their diagnosed children learn to develop healthy eating habits.
We have found that gamifying behaviors like activity and step counts for a day works very well. Using simple fitness trackers, available at any drugstore, works well. If we set a goal – a certain number of steps per hour, per day, and a certain period of aerobic activity – and set up both virtual rewards (badges, stars, emailed congratulations) as well as behavioral reinforcers, Distractible Children will comply. Kurbo seems to be an attempt to gamify healthy eating behaviors.
In our classes, we also learn about how to help children attain stress management, emotion regulation, and self-acceptance skills. While these skills are taught as life skills, the Happy Life, Healthy Heart program demonstrates that they can also be weight-management tools.
Before demonizing the app, consider those children who lack the capacity to plan for the future, and who can’t relate to the “nutrition now, health later” argument. Instead, let’s be pragmatic and learn from a variety of sources. Let’s teach children emotion regulation. Let’s gamify nutrition and physical activity. Let’s use every resource at our disposal, instead of scorning potential tools out of hand.