Parents judge other parents all of the time — it's almost a modern-day sport — but no one may feel judged more than a parent of a child who is overweight.

You don't have to put your overweight child on Maury Povich's daytime talk show to be the recipient of unwelcome attention and unbidden advice. Everyone — not just doctors and school nurses, but also mere acquaintances and even strangers — has something to say to the parent of a child struggling with obesity.

On the question of whether childhood obesity constitutes a public health crisis, there no longer seems to be any debate. Parents, educators and health experts all agree that something has to be done to curb the problem.

But those who are dealing with the crisis firsthand say that talking to children about weight issues is no simple matter. It can be, they say, a minefield.

According to a new report by Trust for America's Health, Pennsylvania has the 29th highest rate of overweight youths in the nation — 13.3 percent of youths, ages 10 to 17, are overweight. One in four adult Pennsylvanians is obese.

Dr. Marsha Novick, a physician with Penn State Hershey Medical Center's Pediatric Multidisciplinary Weight Loss Program, said the consequences of obesity can be devastating.

"It's really frightening the number of kids who are coming in my door, not just a little overweight, but morbidly obese," Novick said, noting that she has 5-year-old patients whom she is treating for weight-related high blood pressure.

If something isn't done, childhood obesity, and its associated health issues —including diabetes and hypertension —"will eventually bankrupt our country," Novick said.

Battle plan
But what to do about the problem? As U.S. News & World Report declared last week, "While eating too much and exercising too little clearly put children's health in jeopardy, so might the methods used to change their behavior. As with any losing war, this one lacks a battle plan that everyone agrees upon."

Pennsylvania schools are attempting to tackle the problem. But, as Novick pointed out, the No Child Left Behind Act has resulted in some schools reducing phys ed and recess, in favor of increased academic instructional time.

Some people think the schools aren't doing enough; others think they are going overboard in the fight against obesity.

The state recently launched a program called "What Moves U?" with the Philadelphia Eagles and Pittsburgh Steelers. The curriculum-based program will help middle-school teachers incorporate physical activity into their lesson plans.

But the Trust for America's Health report suggested that Pennsylvania schools could be doing more.

The report pointed out that Pennsylvania is not one of the 17 states that require school meals and snacks to exceed the nutritional standards set by the U.S. Department of Agriculture. And it is not among the 22 states that have established nutritional standards for the foods sold in school vending machines, school stores, or school bake sales.

Pennsylvania is, however, one of 16 states that screens students' body-mass index, and sends the results home to parents and guardians.

Dr. Richard Levine, director of adolescent medicine and the Eating Disorders Program at Hershey Medical Center, believes the current approach to obesity in schools and in public health campaigns is "somewhat heavy-handed."

Levine worries that the body-mass-index screenings and the steady stream of food-related messages children receive at school will lead some children to develop eating disorders and an unhealthy obsession with weight.

"The approach is too generic and hasn't been researched adequately for every schoolchild in Pennsylvania," Levine said, asserting, "It has the potential for harm."

Kids sometimes get the wrong messages from school and home, "that all fat is bad, and that sometimes, food in general is a danger," Levine said.

These messages can send some —not all, but some — children in the direction of an eating disorder, he said.

There's also a downside to reading food labels, he said. Many kids will learn to look for fat grams and calories, and will be helped by this information, he said, but some will become obsessive, and will decide they cannot have any fat, or any sugar. "Overall, we don't recommend meal plans that do away with one of the food groups," Levine said.

He argues for a more individualized approach — and a more holistic one. Children should be taught to think critically about the way food is marketed to them — and grownups, he said, need to counter the media messages about the necessity of thinness. He doesn't recommend that schools ban treats from school parties, but instead, suggests that they ask parents to send in carrots, perhaps, along with cookies.

"Cookies aren't evil," he said.

But kids, especially very young children, will see foods in absolute terms, if they're taught that certain foods are bad. "We try to have kids not have forbidden foods," he said. "If you forbid a food, then it has power over you."

Role of parents
Dianne Neumark-Sztainer, a professor and researcher at the University of Minnesota, asserted in an article that "parents can play an important role by doing more and saying less."

She recommends that parents provide an environment where healthy eating is possible. She also recommends that parents model healthy eating behaviors.

But talking about weight issues can spell trouble, according to her research, which has found that adolescents who are raised in homes in which there is a lot of talk about weight are more likely to engage in unhealthy weight-control behaviors.

Neumark-Sztainer's research makes it clear that adolescents have enough problems with body image; they are not helped by parents who talk incessantly about their own weight and body issues.

She cautions parents not to allow teasing about weight at home. And, she writes, "when a child comes home upset after being teased about his weight at school, parents need to resist the urge to provide weight loss advice." Instead, she recommends listening to the child, and discussing ways to recognize, resist and recover from such teasing.

Laurel Greberman, clinical supervisor of outpatient programs for the Renfrew Center in Philadelphia, an eating disorder treatment facility, said parents need to focus on health, rather than on size or numbers.

If parents describe their children's bodies using negative terms, they are telling their children that they don't accept them. How then, she mused, are children "going to accept themselves?"

In two-parent homes, she said, it's important that both parents agree on the language they will use. If one parent insists that a child clean his plate, and the other parent argues that a child only should eat until he feels full, the split will be apparent to the child.

She urges parents not to use food as a reward. If parents want to take their kids out for ice cream, that's fine, but emphasize the time being spent together, not the frozen treat, she said.

And sitting down for family meals, on a regular basis, is crucial, she said, noting that numerous studies have shown that families who eat together, at the family table, tend to develop healthier eating habits. When you eat apart, you can feel isolated, she said, and your "relationship becomes with the food, and not with the people."

One Hempfield mom said life during the school year is "just crazy." Fitting in dinner, amid sports, practices and other school commitments, often is just impossible, she said.

This mother, concerned about the privacy of her three children, asked that her name not be used. She has a 15-year-old daughter who recently gained more than 30 pounds, as a result of medications she takes for an abdominal ailment.

"She went from being very tall and thin, to having a weight problem — at a very bad time, when girls are very into their looks, and into wearing size 3 jeans," this mom said.

Her daughter needed a physical, and saw a doctor who was unfamiliar with her health history. The female doctor labeled her daughter obese, and grilled the teen about what she was doing to control her weight.

"My daughter was absolutely devastated," this mom said, noting, "You hear so many stories about anorexia and bulimia. These are the kinds of things that set kids up for (eating disorders)."

Unfortunately, she noted, too many grown-ups seem oblivious to the pitfalls of talking about weight with youngsters. Her eldest daughter once heard a gym teacher tell her class that if they didn't get moving, they would end up looking like a certain girl in their class who was heavy.

Concerned about her own weight —she figures she needs to lose about 30 pounds — this mom decided to join a local branch of Curves, a women's fitness center, with her daughter. The mother and daughter now work out together.

And sometimes, this mother says she feels like she is walking on a tightrope.

When talking to children about weight issues, she said, "I think there's a real fine line where you can do more damage than good."

---

Suzanne Cassidy is a staff writer for the Sunday News. Her e-mail address is scassidy@lnpnews.com.