Re: Re: Weight loss for 9 year old

[Guest guest]

Write your book Kim...as you can see you can look at all sides of the

issue. Ellyn Satter's research and books would be the one to consult. In

fact she is the one who discussed watching for big differences in weight and

height early on.

On Thu, Apr 14, 2011 at 8:15 AM, A. Tessmer, RD LD <

kim@...> wrote:

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected

> family physicians. It is the child herself that decided she needed to lose a

> little weight and not her parents. But they support her and tell her on a

> regular basis that she looks fine, etc... Her Mom said one of her biggest

> problems is portion control. She is 9 years old so when she is hungry she

> eats. How do you teach a 9 year old that it is OK to feel hungry at times or

> how do you help them to monitor that? From what she has said her nutritional

> intake isn’t too bad but it is eating too much that seems to be somewhat of

> a problem. As an adult when you are hungry but know you shouldn’t eat you

> can reason with yourself and know it isn’t time to eat, etc... But what do

> you do with a 9 year old in that situation? That is the type of guidance the

> parents are looking for. She did mention that she keeps a food journal and

> gives herself a happy or sad face depending how she does for the day. In

> addition she weighs herself frequently. How do you tell a 9 year old not to

> keep a food journal when she is trying to eat better by paying attention to

> what she is doing? And how do you guide them not to worry about their weight

> when they obviously do? She has sisters who are thinner and wants to look

> better in her summer bating suit. Though she is still eating plenty so she

> isn’t doing anything drastic. I am used to working with adults only so kids

> seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

> doctor and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an author the discussion was more about are there any books out

> there to help and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

>

[Guest guest]

Write your book Kim...as you can see you can look at all sides of the

issue. Ellyn Satter's research and books would be the one to consult. In

fact she is the one who discussed watching for big differences in weight and

height early on.

On Thu, Apr 14, 2011 at 8:15 AM, A. Tessmer, RD LD <

kim@...> wrote:

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected

> family physicians. It is the child herself that decided she needed to lose a

> little weight and not her parents. But they support her and tell her on a

> regular basis that she looks fine, etc... Her Mom said one of her biggest

> problems is portion control. She is 9 years old so when she is hungry she

> eats. How do you teach a 9 year old that it is OK to feel hungry at times or

> how do you help them to monitor that? From what she has said her nutritional

> intake isn’t too bad but it is eating too much that seems to be somewhat of

> a problem. As an adult when you are hungry but know you shouldn’t eat you

> can reason with yourself and know it isn’t time to eat, etc... But what do

> you do with a 9 year old in that situation? That is the type of guidance the

> parents are looking for. She did mention that she keeps a food journal and

> gives herself a happy or sad face depending how she does for the day. In

> addition she weighs herself frequently. How do you tell a 9 year old not to

> keep a food journal when she is trying to eat better by paying attention to

> what she is doing? And how do you guide them not to worry about their weight

> when they obviously do? She has sisters who are thinner and wants to look

> better in her summer bating suit. Though she is still eating plenty so she

> isn’t doing anything drastic. I am used to working with adults only so kids

> seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

> doctor and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an author the discussion was more about are there any books out

> there to help and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

>

[Guest guest]

Write your book Kim...as you can see you can look at all sides of the

issue. Ellyn Satter's research and books would be the one to consult. In

fact she is the one who discussed watching for big differences in weight and

height early on.

On Thu, Apr 14, 2011 at 8:15 AM, A. Tessmer, RD LD <

kim@...> wrote:

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected

> family physicians. It is the child herself that decided she needed to lose a

> little weight and not her parents. But they support her and tell her on a

> regular basis that she looks fine, etc... Her Mom said one of her biggest

> problems is portion control. She is 9 years old so when she is hungry she

> eats. How do you teach a 9 year old that it is OK to feel hungry at times or

> how do you help them to monitor that? From what she has said her nutritional

> intake isn’t too bad but it is eating too much that seems to be somewhat of

> a problem. As an adult when you are hungry but know you shouldn’t eat you

> can reason with yourself and know it isn’t time to eat, etc... But what do

> you do with a 9 year old in that situation? That is the type of guidance the

> parents are looking for. She did mention that she keeps a food journal and

> gives herself a happy or sad face depending how she does for the day. In

> addition she weighs herself frequently. How do you tell a 9 year old not to

> keep a food journal when she is trying to eat better by paying attention to

> what she is doing? And how do you guide them not to worry about their weight

> when they obviously do? She has sisters who are thinner and wants to look

> better in her summer bating suit. Though she is still eating plenty so she

> isn’t doing anything drastic. I am used to working with adults only so kids

> seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

> doctor and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an author the discussion was more about are there any books out

> there to help and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

>

[Guest guest]

Kim,

Just saw your message go by on my Blackberry and haven't followed all the

discussion here, so don't know if this has been mentioned already, but....

Sounds like to me this is an issue of weight bias, and it's not on the part of

the parents but on the part of the child. Which is something that's

unfortunately not at all uncommon these days.

I'd encourage the mom to get a copy of Ellyn Satter's book How to Get Your Child

to Eat But Not Too Much. It would give her a good framework within which to

work to help her daughter.

best,

Marsha

Marsha Hudnall, RD, MS, CD

Green Mountain at Fox Run

www.fitwoman.com

On Apr 14, 2011, at 8:15 AM, A. Tessmer, RD LD wrote:

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

doctor and she just brought it up at my last visit knowing I am an RD. Knowing I

am an author the discussion was more about are there any books out there to help

and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

Kim,

Just saw your message go by on my Blackberry and haven't followed all the

discussion here, so don't know if this has been mentioned already, but....

Sounds like to me this is an issue of weight bias, and it's not on the part of

the parents but on the part of the child. Which is something that's

unfortunately not at all uncommon these days.

I'd encourage the mom to get a copy of Ellyn Satter's book How to Get Your Child

to Eat But Not Too Much. It would give her a good framework within which to

work to help her daughter.

best,

Marsha

Marsha Hudnall, RD, MS, CD

Green Mountain at Fox Run

www.fitwoman.com

On Apr 14, 2011, at 8:15 AM, A. Tessmer, RD LD wrote:

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

doctor and she just brought it up at my last visit knowing I am an RD. Knowing I

am an author the discussion was more about are there any books out there to help

and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

Kim,

Just saw your message go by on my Blackberry and haven't followed all the

discussion here, so don't know if this has been mentioned already, but....

Sounds like to me this is an issue of weight bias, and it's not on the part of

the parents but on the part of the child. Which is something that's

unfortunately not at all uncommon these days.

I'd encourage the mom to get a copy of Ellyn Satter's book How to Get Your Child

to Eat But Not Too Much. It would give her a good framework within which to

work to help her daughter.

best,

Marsha

Marsha Hudnall, RD, MS, CD

Green Mountain at Fox Run

www.fitwoman.com

On Apr 14, 2011, at 8:15 AM, A. Tessmer, RD LD wrote:

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom is my

doctor and she just brought it up at my last visit knowing I am an RD. Knowing I

am an author the discussion was more about are there any books out there to help

and if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

How about using the stoplight plan.  I have used it with great sucess in

families with struggling children about this age.  Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.)  The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits.  The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out.  I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc.  Children seem to " get it, "  there are no " never

never ever again foods, " just different foods fit into the overall diet

differently..  Children like that they can have the control of having

something,

without asking, when they feel hungry.  Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

To: rd-usa

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

 

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

How about using the stoplight plan.  I have used it with great sucess in

families with struggling children about this age.  Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.)  The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits.  The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out.  I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc.  Children seem to " get it, "  there are no " never

never ever again foods, " just different foods fit into the overall diet

differently..  Children like that they can have the control of having

something,

without asking, when they feel hungry.  Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

To: rd-usa

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

 

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

How about using the stoplight plan.  I have used it with great sucess in

families with struggling children about this age.  Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.)  The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits.  The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out.  I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc.  Children seem to " get it, "  there are no " never

never ever again foods, " just different foods fit into the overall diet

differently..  Children like that they can have the control of having

something,

without asking, when they feel hungry.  Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

To: rd-usa

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

 

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

The fact that a 9 year old is " on her own " keeping a food journal

with her feelings is a huge red flag for a developing eating disorder.

I would refer this child and her parents to an RD who is skilled in

evaluation and treatment (if treatment is necessary). Eating disorders

are being diagnosed at younger ages. This sort of preoccupation with

food and feelings is rather odd in a pre-teen.

While as RDs we might applaud a child who is wanting to track intake

and weight, that's because we are RDs and we are used to doing this.

As a pediatric RD, I have to say I've never seen this in a " normal "

child of any weight without there being something behind the behavior.

The fact that the parents are physicians should not imply that there

is nothing else going on. That mom brought it up at a medical

appointment is also to me, odd. It speaks to someone who is wondering

if this is normal behavior.

You can only run into trouble if you attempt to give this mom advice

outside of the client/provider roles. This would be akin to asking the

mom at a cocktail party " could you please tell me if this mole is

troublesome? "

Regards,

pam

Pam Charney, PhD, RD

Pamela Charney and Associates, LLC

consultants in nutrition informatics

Transforming Nutrition Care With Informatics

pcharney@...

http://www.linkedin.com/in/pamcharney

" Those who say it can't be done are usually interrupted by those doing

it. " -- Baldwin

> How about using the stoplight plan. I have used it with great

> sucess in

> families with struggling children about this age. Teach the child

> that there

> are green foods (eat ad lib when hungry), yellow foods (enjoy in

> moderation as

> part of balanced meals) and red foods (save for rare special

> occasions.) The

> green light foods are, obviously, foods high in fiber and water

> content -

> vegetables and fruits. The yellow are the starches (preferablly fiber

> containing) and lean protein foods, and the red - I am sure you can

> figure that

> out. I teach families to have a free snack shelf in the

> refrigerator where

> there are green foods that are up for grabs without asking - precut

> veggies,

> fruits, bottled water, etc. Children seem to " get it, " there are no

> " never

> never ever again foods, " just different foods fit into the overall

> diet

> differently.. Children like that they can have the control of

> having something,

> without asking, when they feel hungry. Have seen this kind of

> thinking bring

> balance and health improvement for the whole family.

>

> ________________________________

>

> To: rd-usa

> Sent: Thu, April 14, 2011 7:15:54 AM

> Subject: Re: Weight loss for 9 year old

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-

> respected family

> physicians. It is the child herself that decided she needed to lose

> a little

> weight and not her parents. But they support her and tell her on a

> regular basis

> that she looks fine, etc... Her Mom said one of her biggest problems

> is portion

> control. She is 9 years old so when she is hungry she eats. How do

> you teach a 9

> year old that it is OK to feel hungry at times or how do you help

> them to

> monitor that? From what she has said her nutritional intake isn’t

> too bad but it

> is eating too much that seems to be somewhat of a problem. As an

> adult when you

> are hungry but know you shouldn’t eat you can reason with yourself

> and know it

> isn’t time to eat, etc... But what do you do with a 9 year old in that

> situation? That is the type of guidance the parents are looking for.

> She did

> mention that she keeps a food journal and gives herself a happy or

> sad face

> depending how she does for the day. In addition she weighs herself

> frequently.

> How do you tell a 9 year old not to keep a food journal when she is

> trying to

> eat better by paying attention to what she is doing? And how do you

> guide them

> not to worry about their weight when they obviously do? She has

> sisters who are

> thinner and wants to look better in her summer bating suit. Though

> she is still

> eating plenty so she isn’t doing anything drastic. I am used to

> working with

> adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom

> is my doctor

> and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an

> author the discussion was more about are there any books out there

> to help and

> if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

The fact that a 9 year old is " on her own " keeping a food journal

with her feelings is a huge red flag for a developing eating disorder.

I would refer this child and her parents to an RD who is skilled in

evaluation and treatment (if treatment is necessary). Eating disorders

are being diagnosed at younger ages. This sort of preoccupation with

food and feelings is rather odd in a pre-teen.

While as RDs we might applaud a child who is wanting to track intake

and weight, that's because we are RDs and we are used to doing this.

As a pediatric RD, I have to say I've never seen this in a " normal "

child of any weight without there being something behind the behavior.

The fact that the parents are physicians should not imply that there

is nothing else going on. That mom brought it up at a medical

appointment is also to me, odd. It speaks to someone who is wondering

if this is normal behavior.

You can only run into trouble if you attempt to give this mom advice

outside of the client/provider roles. This would be akin to asking the

mom at a cocktail party " could you please tell me if this mole is

troublesome? "

Regards,

pam

Pam Charney, PhD, RD

Pamela Charney and Associates, LLC

consultants in nutrition informatics

Transforming Nutrition Care With Informatics

pcharney@...

http://www.linkedin.com/in/pamcharney

" Those who say it can't be done are usually interrupted by those doing

it. " -- Baldwin

> How about using the stoplight plan. I have used it with great

> sucess in

> families with struggling children about this age. Teach the child

> that there

> are green foods (eat ad lib when hungry), yellow foods (enjoy in

> moderation as

> part of balanced meals) and red foods (save for rare special

> occasions.) The

> green light foods are, obviously, foods high in fiber and water

> content -

> vegetables and fruits. The yellow are the starches (preferablly fiber

> containing) and lean protein foods, and the red - I am sure you can

> figure that

> out. I teach families to have a free snack shelf in the

> refrigerator where

> there are green foods that are up for grabs without asking - precut

> veggies,

> fruits, bottled water, etc. Children seem to " get it, " there are no

> " never

> never ever again foods, " just different foods fit into the overall

> diet

> differently.. Children like that they can have the control of

> having something,

> without asking, when they feel hungry. Have seen this kind of

> thinking bring

> balance and health improvement for the whole family.

>

> ________________________________

>

> To: rd-usa

> Sent: Thu, April 14, 2011 7:15:54 AM

> Subject: Re: Weight loss for 9 year old

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-

> respected family

> physicians. It is the child herself that decided she needed to lose

> a little

> weight and not her parents. But they support her and tell her on a

> regular basis

> that she looks fine, etc... Her Mom said one of her biggest problems

> is portion

> control. She is 9 years old so when she is hungry she eats. How do

> you teach a 9

> year old that it is OK to feel hungry at times or how do you help

> them to

> monitor that? From what she has said her nutritional intake isn’t

> too bad but it

> is eating too much that seems to be somewhat of a problem. As an

> adult when you

> are hungry but know you shouldn’t eat you can reason with yourself

> and know it

> isn’t time to eat, etc... But what do you do with a 9 year old in that

> situation? That is the type of guidance the parents are looking for.

> She did

> mention that she keeps a food journal and gives herself a happy or

> sad face

> depending how she does for the day. In addition she weighs herself

> frequently.

> How do you tell a 9 year old not to keep a food journal when she is

> trying to

> eat better by paying attention to what she is doing? And how do you

> guide them

> not to worry about their weight when they obviously do? She has

> sisters who are

> thinner and wants to look better in her summer bating suit. Though

> she is still

> eating plenty so she isn’t doing anything drastic. I am used to

> working with

> adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom

> is my doctor

> and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an

> author the discussion was more about are there any books out there

> to help and

> if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

The fact that a 9 year old is " on her own " keeping a food journal

with her feelings is a huge red flag for a developing eating disorder.

I would refer this child and her parents to an RD who is skilled in

evaluation and treatment (if treatment is necessary). Eating disorders

are being diagnosed at younger ages. This sort of preoccupation with

food and feelings is rather odd in a pre-teen.

While as RDs we might applaud a child who is wanting to track intake

and weight, that's because we are RDs and we are used to doing this.

As a pediatric RD, I have to say I've never seen this in a " normal "

child of any weight without there being something behind the behavior.

The fact that the parents are physicians should not imply that there

is nothing else going on. That mom brought it up at a medical

appointment is also to me, odd. It speaks to someone who is wondering

if this is normal behavior.

You can only run into trouble if you attempt to give this mom advice

outside of the client/provider roles. This would be akin to asking the

mom at a cocktail party " could you please tell me if this mole is

troublesome? "

Regards,

pam

Pam Charney, PhD, RD

Pamela Charney and Associates, LLC

consultants in nutrition informatics

Transforming Nutrition Care With Informatics

pcharney@...

http://www.linkedin.com/in/pamcharney

" Those who say it can't be done are usually interrupted by those doing

it. " -- Baldwin

> How about using the stoplight plan. I have used it with great

> sucess in

> families with struggling children about this age. Teach the child

> that there

> are green foods (eat ad lib when hungry), yellow foods (enjoy in

> moderation as

> part of balanced meals) and red foods (save for rare special

> occasions.) The

> green light foods are, obviously, foods high in fiber and water

> content -

> vegetables and fruits. The yellow are the starches (preferablly fiber

> containing) and lean protein foods, and the red - I am sure you can

> figure that

> out. I teach families to have a free snack shelf in the

> refrigerator where

> there are green foods that are up for grabs without asking - precut

> veggies,

> fruits, bottled water, etc. Children seem to " get it, " there are no

> " never

> never ever again foods, " just different foods fit into the overall

> diet

> differently.. Children like that they can have the control of

> having something,

> without asking, when they feel hungry. Have seen this kind of

> thinking bring

> balance and health improvement for the whole family.

>

> ________________________________

>

> To: rd-usa

> Sent: Thu, April 14, 2011 7:15:54 AM

> Subject: Re: Weight loss for 9 year old

>

>

> Thanks everyone for the GREAT discussion!!

>

> Just a few points is that this child’s parents are BOTH well-

> respected family

> physicians. It is the child herself that decided she needed to lose

> a little

> weight and not her parents. But they support her and tell her on a

> regular basis

> that she looks fine, etc... Her Mom said one of her biggest problems

> is portion

> control. She is 9 years old so when she is hungry she eats. How do

> you teach a 9

> year old that it is OK to feel hungry at times or how do you help

> them to

> monitor that? From what she has said her nutritional intake isn’t

> too bad but it

> is eating too much that seems to be somewhat of a problem. As an

> adult when you

> are hungry but know you shouldn’t eat you can reason with yourself

> and know it

> isn’t time to eat, etc... But what do you do with a 9 year old in that

> situation? That is the type of guidance the parents are looking for.

> She did

> mention that she keeps a food journal and gives herself a happy or

> sad face

> depending how she does for the day. In addition she weighs herself

> frequently.

> How do you tell a 9 year old not to keep a food journal when she is

> trying to

> eat better by paying attention to what she is doing? And how do you

> guide them

> not to worry about their weight when they obviously do? She has

> sisters who are

> thinner and wants to look better in her summer bating suit. Though

> she is still

> eating plenty so she isn’t doing anything drastic. I am used to

> working with

> adults only so kids seem to be a whole different world!!

>

> Again, I am not counseling them! Was not asked to do that. Her Mom

> is my doctor

> and she just brought it up at my last visit knowing I am an RD.

> Knowing I am an

> author the discussion was more about are there any books out there

> to help and

> if not I should think about writing one.

>

> Thanks again!

> Kim Tessmer, RD LD

>

>

[Guest guest]

All I can say Is that you’ve just taught me a hugely important lesson. I’m

so glad to have the list where I can learn new skills daily. This is such a

terrific idea, and such a simple one too.

Thanks!

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of Sandi

Birch

Sent: Thursday, April 14, 2011 8:23 AM

To: rd-usa

Subject: Re: Re: Weight loss for 9 year old

How about using the stoplight plan. I have used it with great sucess in

families with struggling children about this age. Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.) The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits. The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out. I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc. Children seem to " get it, " there are no " never

never ever again foods, " just different foods fit into the overall diet

differently.. Children like that they can have the control of having something,

without asking, when they feel hungry. Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

From: " A. Tessmer, RD LD " <kim@...

<mailto:kim%40nutrifocus.net> >

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

All I can say Is that you’ve just taught me a hugely important lesson. I’m

so glad to have the list where I can learn new skills daily. This is such a

terrific idea, and such a simple one too.

Thanks!

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of Sandi

Birch

Sent: Thursday, April 14, 2011 8:23 AM

To: rd-usa

Subject: Re: Re: Weight loss for 9 year old

How about using the stoplight plan. I have used it with great sucess in

families with struggling children about this age. Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.) The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits. The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out. I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc. Children seem to " get it, " there are no " never

never ever again foods, " just different foods fit into the overall diet

differently.. Children like that they can have the control of having something,

without asking, when they feel hungry. Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

From: " A. Tessmer, RD LD " <kim@...

<mailto:kim%40nutrifocus.net> >

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

All I can say Is that you’ve just taught me a hugely important lesson. I’m

so glad to have the list where I can learn new skills daily. This is such a

terrific idea, and such a simple one too.

Thanks!

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of Sandi

Birch

Sent: Thursday, April 14, 2011 8:23 AM

To: rd-usa

Subject: Re: Re: Weight loss for 9 year old

How about using the stoplight plan. I have used it with great sucess in

families with struggling children about this age. Teach the child that there

are green foods (eat ad lib when hungry), yellow foods (enjoy in moderation as

part of balanced meals) and red foods (save for rare special occasions.) The

green light foods are, obviously, foods high in fiber and water content -

vegetables and fruits. The yellow are the starches (preferablly fiber

containing) and lean protein foods, and the red - I am sure you can figure that

out. I teach families to have a free snack shelf in the refrigerator where

there are green foods that are up for grabs without asking - precut veggies,

fruits, bottled water, etc. Children seem to " get it, " there are no " never

never ever again foods, " just different foods fit into the overall diet

differently.. Children like that they can have the control of having something,

without asking, when they feel hungry. Have seen this kind of thinking bring

balance and health improvement for the whole family.

________________________________

From: " A. Tessmer, RD LD " <kim@...

<mailto:kim%40nutrifocus.net> >

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Sent: Thu, April 14, 2011 7:15:54 AM

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it

is eating too much that seems to be somewhat of a problem. As an adult when you

are hungry but know you shouldn’t eat you can reason with yourself and know it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

Althought I can’t comment globally or in generalizations about weight control

for children, I do want to make a couple of comments about the topic based on

my own experiences:

· Some body structure is stocky with big bones. As dietitians we learn

to take frame and bone size as well as fully developed height into

consideration. It’s difficult w children but growth charts are a useful tool

– if there’s more weight gained than the height may warrant the child may be

gaining weight and not putting the nutrients towards growth in length, so that

warrants investigating at the very least the nutrient density of the diet.

· 2 months ago I visited with a 5 y.o. who was about 3 ft & a couple

inches and 105 lbs. 3 day history confirmed the source and amt of calories

being low in nutrients and fiber, very high in fat and refined CHO. At 5 she

absolutely needed intervention.

· Most babies look chubby – they have larger heads and torsos are

broad compared with older children or adults, arms and legs are very short.

Watching their development and again keeping a growth chart is an important

monitoring and evaluation tool, as is reviewing source of nutrients. A breast

fed infant needs the same monitoring, but unless there is a risk (insufficient

nutrients intake for whatever the reason), then if they get chubby they get

chubby. IMO the weaning process will take care of that, as will normal growth if

kept active and well nourished, and above all, content and secure

· I have never tried to, and never would, but, how do you teach a 9

y.o. it’s OK to feel hungry? Hunger triggers the response to find food –

it’s a very primal response or we never would have made it out of the caves,

dying then of malnutrition. I wouldn’t want to change that response in a young

child. However, stocking the right foods for the family and being able to

provide guidance and training on making the right choices when they’re hungry

is a beneficial approach that will benefit that child through adulthood.

· Positive self-image is important, but the most difficult one to

achieve. Insecure and shy children may have a poor self- image, fewer friends,

compare themselves more with other friends and not be able to be trend-setters.

This is a parental responsibility and some need outside help with it.

· Although both parents are well respected physicians that doesn’t

negate the possibility of family issues, chemistry, problems, or either of them

having influenced the daughter’s self-image. Physicians are like the rest of

us, not better, not worse, and can be just as screwed up as anyone.

· I’ve noticed from my 10 y.o. g/daughter that children these days

are much more conscious of looks and fitting in, and they all want to look like

the Disney channel actors, or like the cute girl in their class. She’s going

to be at least 5’11 (paternal side came from the land of the giants), so her

chubby years were over at age 3) so most probably won’t be having any weight

problems, and as one of the taller girls feels like the leader of the pack.

However, her mother at 5’1†WAS the leader of the pack at school and

socially, and still is. My 10 y.o. g/daughter also eats much more than her mom,

and she should. Her mother is 44, she’s 10 and still growing and developing.

The point is that every individual has complex issues to deal with at an earlier

age now than generations before. How do we acquire the skills to help them? I

sure don’t know. I believe that psychology may be beneficial to include in

the undergrad requirements, or be taught at some point in time during our

training, as we’re no longer dealing with food and nutrition and diet therapy.

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of

A. Tessmer, RD LD

Sent: Thursday, April 14, 2011 5:16 AM

To: rd-usa

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it is eating too much that seems to be somewhat of a problem. As an adult when

you are hungry but know you shouldn’t eat you can reason with yourself and

know it isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

Althought I can’t comment globally or in generalizations about weight control

for children, I do want to make a couple of comments about the topic based on

my own experiences:

· Some body structure is stocky with big bones. As dietitians we learn

to take frame and bone size as well as fully developed height into

consideration. It’s difficult w children but growth charts are a useful tool

– if there’s more weight gained than the height may warrant the child may be

gaining weight and not putting the nutrients towards growth in length, so that

warrants investigating at the very least the nutrient density of the diet.

· 2 months ago I visited with a 5 y.o. who was about 3 ft & a couple

inches and 105 lbs. 3 day history confirmed the source and amt of calories

being low in nutrients and fiber, very high in fat and refined CHO. At 5 she

absolutely needed intervention.

· Most babies look chubby – they have larger heads and torsos are

broad compared with older children or adults, arms and legs are very short.

Watching their development and again keeping a growth chart is an important

monitoring and evaluation tool, as is reviewing source of nutrients. A breast

fed infant needs the same monitoring, but unless there is a risk (insufficient

nutrients intake for whatever the reason), then if they get chubby they get

chubby. IMO the weaning process will take care of that, as will normal growth if

kept active and well nourished, and above all, content and secure

· I have never tried to, and never would, but, how do you teach a 9

y.o. it’s OK to feel hungry? Hunger triggers the response to find food –

it’s a very primal response or we never would have made it out of the caves,

dying then of malnutrition. I wouldn’t want to change that response in a young

child. However, stocking the right foods for the family and being able to

provide guidance and training on making the right choices when they’re hungry

is a beneficial approach that will benefit that child through adulthood.

· Positive self-image is important, but the most difficult one to

achieve. Insecure and shy children may have a poor self- image, fewer friends,

compare themselves more with other friends and not be able to be trend-setters.

This is a parental responsibility and some need outside help with it.

· Although both parents are well respected physicians that doesn’t

negate the possibility of family issues, chemistry, problems, or either of them

having influenced the daughter’s self-image. Physicians are like the rest of

us, not better, not worse, and can be just as screwed up as anyone.

· I’ve noticed from my 10 y.o. g/daughter that children these days

are much more conscious of looks and fitting in, and they all want to look like

the Disney channel actors, or like the cute girl in their class. She’s going

to be at least 5’11 (paternal side came from the land of the giants), so her

chubby years were over at age 3) so most probably won’t be having any weight

problems, and as one of the taller girls feels like the leader of the pack.

However, her mother at 5’1†WAS the leader of the pack at school and

socially, and still is. My 10 y.o. g/daughter also eats much more than her mom,

and she should. Her mother is 44, she’s 10 and still growing and developing.

The point is that every individual has complex issues to deal with at an earlier

age now than generations before. How do we acquire the skills to help them? I

sure don’t know. I believe that psychology may be beneficial to include in

the undergrad requirements, or be taught at some point in time during our

training, as we’re no longer dealing with food and nutrition and diet therapy.

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of

A. Tessmer, RD LD

Sent: Thursday, April 14, 2011 5:16 AM

To: rd-usa

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it is eating too much that seems to be somewhat of a problem. As an adult when

you are hungry but know you shouldn’t eat you can reason with yourself and

know it isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

Althought I can’t comment globally or in generalizations about weight control

for children, I do want to make a couple of comments about the topic based on

my own experiences:

· Some body structure is stocky with big bones. As dietitians we learn

to take frame and bone size as well as fully developed height into

consideration. It’s difficult w children but growth charts are a useful tool

– if there’s more weight gained than the height may warrant the child may be

gaining weight and not putting the nutrients towards growth in length, so that

warrants investigating at the very least the nutrient density of the diet.

· 2 months ago I visited with a 5 y.o. who was about 3 ft & a couple

inches and 105 lbs. 3 day history confirmed the source and amt of calories

being low in nutrients and fiber, very high in fat and refined CHO. At 5 she

absolutely needed intervention.

· Most babies look chubby – they have larger heads and torsos are

broad compared with older children or adults, arms and legs are very short.

Watching their development and again keeping a growth chart is an important

monitoring and evaluation tool, as is reviewing source of nutrients. A breast

fed infant needs the same monitoring, but unless there is a risk (insufficient

nutrients intake for whatever the reason), then if they get chubby they get

chubby. IMO the weaning process will take care of that, as will normal growth if

kept active and well nourished, and above all, content and secure

· I have never tried to, and never would, but, how do you teach a 9

y.o. it’s OK to feel hungry? Hunger triggers the response to find food –

it’s a very primal response or we never would have made it out of the caves,

dying then of malnutrition. I wouldn’t want to change that response in a young

child. However, stocking the right foods for the family and being able to

provide guidance and training on making the right choices when they’re hungry

is a beneficial approach that will benefit that child through adulthood.

· Positive self-image is important, but the most difficult one to

achieve. Insecure and shy children may have a poor self- image, fewer friends,

compare themselves more with other friends and not be able to be trend-setters.

This is a parental responsibility and some need outside help with it.

· Although both parents are well respected physicians that doesn’t

negate the possibility of family issues, chemistry, problems, or either of them

having influenced the daughter’s self-image. Physicians are like the rest of

us, not better, not worse, and can be just as screwed up as anyone.

· I’ve noticed from my 10 y.o. g/daughter that children these days

are much more conscious of looks and fitting in, and they all want to look like

the Disney channel actors, or like the cute girl in their class. She’s going

to be at least 5’11 (paternal side came from the land of the giants), so her

chubby years were over at age 3) so most probably won’t be having any weight

problems, and as one of the taller girls feels like the leader of the pack.

However, her mother at 5’1†WAS the leader of the pack at school and

socially, and still is. My 10 y.o. g/daughter also eats much more than her mom,

and she should. Her mother is 44, she’s 10 and still growing and developing.

The point is that every individual has complex issues to deal with at an earlier

age now than generations before. How do we acquire the skills to help them? I

sure don’t know. I believe that psychology may be beneficial to include in

the undergrad requirements, or be taught at some point in time during our

training, as we’re no longer dealing with food and nutrition and diet therapy.

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of

A. Tessmer, RD LD

Sent: Thursday, April 14, 2011 5:16 AM

To: rd-usa

Subject: Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular basis

that she looks fine, etc... Her Mom said one of her biggest problems is portion

control. She is 9 years old so when she is hungry she eats. How do you teach a 9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad but

it is eating too much that seems to be somewhat of a problem. As an adult when

you are hungry but know you shouldn’t eat you can reason with yourself and

know it isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who are

thinner and wants to look better in her summer bating suit. Though she is still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

Oh, this is beautiful, Sandi. Thanks for sharing!

Diane Preves, M.S., R.D.

N.E.W. LIFE (Nutrition, Exercise, Wellness for LIFE)

www.newlifeforhealth.com

e-mail: newlife4health@..., newlife@...

Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected

family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular

basis

that she looks fine, etc... Her Mom said one of her biggest problems is

portion

control. She is 9 years old so when she is hungry she eats. How do you teach a

9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad

but it

is eating too much that seems to be somewhat of a problem. As an adult when

you

are hungry but know you shouldn’t eat you can reason with yourself and know

it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who

are

thinner and wants to look better in her summer bating suit. Though she is

still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my

doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am

an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

Oh, this is beautiful, Sandi. Thanks for sharing!

Diane Preves, M.S., R.D.

N.E.W. LIFE (Nutrition, Exercise, Wellness for LIFE)

www.newlifeforhealth.com

e-mail: newlife4health@..., newlife@...

Re: Weight loss for 9 year old

Thanks everyone for the GREAT discussion!!

Just a few points is that this child’s parents are BOTH well-respected

family

physicians. It is the child herself that decided she needed to lose a little

weight and not her parents. But they support her and tell her on a regular

basis

that she looks fine, etc... Her Mom said one of her biggest problems is

portion

control. She is 9 years old so when she is hungry she eats. How do you teach a

9

year old that it is OK to feel hungry at times or how do you help them to

monitor that? From what she has said her nutritional intake isn’t too bad

but it

is eating too much that seems to be somewhat of a problem. As an adult when

you

are hungry but know you shouldn’t eat you can reason with yourself and know

it

isn’t time to eat, etc... But what do you do with a 9 year old in that

situation? That is the type of guidance the parents are looking for. She did

mention that she keeps a food journal and gives herself a happy or sad face

depending how she does for the day. In addition she weighs herself frequently.

How do you tell a 9 year old not to keep a food journal when she is trying to

eat better by paying attention to what she is doing? And how do you guide them

not to worry about their weight when they obviously do? She has sisters who

are

thinner and wants to look better in her summer bating suit. Though she is

still

eating plenty so she isn’t doing anything drastic. I am used to working with

adults only so kids seem to be a whole different world!!

Again, I am not counseling them! Was not asked to do that. Her Mom is my

doctor

and she just brought it up at my last visit knowing I am an RD. Knowing I am

an

author the discussion was more about are there any books out there to help and

if not I should think about writing one.

Thanks again!

Kim Tessmer, RD LD

[Guest guest]

My first concern is why does she eat to the point of vomiting????  Wouldn't

bother with a food record yet.  Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

Holly

 ----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa

Sent: Thu, April 14, 2011 12:48:47 PM

Subject: Re: Weight loss for 9 year old

 

I have a similar situation that I am not sure how to deal with. I just received

a call on a 9 year old girl that is 120# and 4'9 " . I am to see her next week.

Spoke with her mother on the phone. Mother stated that the family drinks only

milk and water with limited pop on special occasions, she limits the amount of

meat and potatoes her daughter eats, but allows her to eat as much fruit and

vegetables as she wants. The mother said that the child will eat whatever she

can and often will eat until she throws up because she is so full. TSH and T4

wnl on labs. I already charted her on growthcharts->95%ile for ht, wt, and BMI.

I happen to know the girl and see her riding her bike and playing basketball, so

I know she gets some exercise. I am wondering how to proceed. I question if it

is appropriate to ask for a food diary from the mother on foods served/eaten by

the daughter to help see if there is something blatant. Any ideas?

>

> What are your best recommendations for a parent of a child that is 9 years old

>and just slightly over weight but wanting to take it off.

>

> It isn't the parents that are worried about it but the child. She even on her

>own started a food journal.

> Any good websites, books, etc... that I can refer them to that would be for

>either the parent OR child? This is not a patient or client of mine just

someone

>that asked for a little advice and I am trying to send them in the right

>direction. Her mother is actually a family physician and was wondering what

>might be out there if anything to help them out a bit!

> Thanks,

> Kim Tessmer, RD LD

>

[Guest guest]

My first concern is why does she eat to the point of vomiting????  Wouldn't

bother with a food record yet.  Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

Holly

 ----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa

Sent: Thu, April 14, 2011 12:48:47 PM

Subject: Re: Weight loss for 9 year old

 

I have a similar situation that I am not sure how to deal with. I just received

a call on a 9 year old girl that is 120# and 4'9 " . I am to see her next week.

Spoke with her mother on the phone. Mother stated that the family drinks only

milk and water with limited pop on special occasions, she limits the amount of

meat and potatoes her daughter eats, but allows her to eat as much fruit and

vegetables as she wants. The mother said that the child will eat whatever she

can and often will eat until she throws up because she is so full. TSH and T4

wnl on labs. I already charted her on growthcharts->95%ile for ht, wt, and BMI.

I happen to know the girl and see her riding her bike and playing basketball, so

I know she gets some exercise. I am wondering how to proceed. I question if it

is appropriate to ask for a food diary from the mother on foods served/eaten by

the daughter to help see if there is something blatant. Any ideas?

>

> What are your best recommendations for a parent of a child that is 9 years old

>and just slightly over weight but wanting to take it off.

>

> It isn't the parents that are worried about it but the child. She even on her

>own started a food journal.

> Any good websites, books, etc... that I can refer them to that would be for

>either the parent OR child? This is not a patient or client of mine just

someone

>that asked for a little advice and I am trying to send them in the right

>direction. Her mother is actually a family physician and was wondering what

>might be out there if anything to help them out a bit!

> Thanks,

> Kim Tessmer, RD LD

>

[Guest guest]

My first concern is why does she eat to the point of vomiting???? Wouldn't

bother with a food record yet. Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

I could not agree more with this!

On the discussion of should us dietitians do any type of counseling…

I believe this is where lots of us are lacking. We in school and in our job are

taught to take the scientific approach. The black and white approach, if you

will. Here’s your diet, here’s what you do, let’s weigh you, get your

BMI, get your labs, f/u with results based off of number on scale or lab results

or you get my point. And yes, we should most definitely be doing this.

But my approach has been, let’s look at behavioral issues also that might be

contributing to whatever needs to be addressed. Are you overeating b/c you are

stressed, bored, angry, etc. If the answer is yes, then I very much encourage a

therapist to also get involved in his/her care… but I don’t just stop there.

I give techniques to help with these issues. If you are bored, find something

to do to keep you busy so food isn’t your first thought. If you are stressed

and eat, try to find an alternative to relieving stress (take a bath, read a

book, do your nails, take a walk, find an outlet such as a hobby).

And I could go on and on about the behavioral issues that I attack. My motto

is, “Food is not black and white… let’s find the gray… meaning the

balance.†I have to say that it is working. And I do not feel unethical

about one iota! I am encouraged by the therapist that I work with to do this.

Again, I just don’t think that it’s black and white… we as dietitians

don’t need to absolutely, positively NOT “counsel†our clients. We need

to know our limitations and respect the client’s needs as well as what we are

able to give them. I don’t get into true therapeutic issues – no way, no

how! But I do address the feelings of what is stemming from those issues IF

food is involved.

And I just want to add… teaching any person, young or old to NOT eat when they

are hungry is absolutely setting the person up for failure when it comes to a

healthy diet. Honestly, this should be the absolute BASIS of what we teach…

eat when you’re hungry and stop when you are satisfied.

Just my two cents.

Respectfully,

From: rd-usa [mailto:rd-usa ] On Behalf Of hl

brewer

Sent: Thursday, April 14, 2011 5:02 PM

To: rd-usa

Subject: Re: Re: Weight loss for 9 year old

My first concern is why does she eat to the point of vomiting???? Wouldn't

bother with a food record yet. Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

Holly

----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

From: KristyH <kheussner@...<mailto:kheussner%40yahoo.com>>

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Sent: Thu, April 14, 2011 12:48:47 PM

Subject: Re: Weight loss for 9 year old

I have a similar situation that I am not sure how to deal with. I just received

a call on a 9 year old girl that is 120# and 4'9 " . I am to see her next week.

Spoke with her mother on the phone. Mother stated that the family drinks only

milk and water with limited pop on special occasions, she limits the amount of

meat and potatoes her daughter eats, but allows her to eat as much fruit and

vegetables as she wants. The mother said that the child will eat whatever she

can and often will eat until she throws up because she is so full. TSH and T4

wnl on labs. I already charted her on growthcharts->95%ile for ht, wt, and BMI.

I happen to know the girl and see her riding her bike and playing basketball, so

I know she gets some exercise. I am wondering how to proceed. I question if it

is appropriate to ask for a food diary from the mother on foods served/eaten by

the daughter to help see if there is something blatant. Any ideas?

>

> What are your best recommendations for a parent of a child that is 9 years old

>and just slightly over weight but wanting to take it off.

>

> It isn't the parents that are worried about it but the child. She even on her

>own started a food journal.

> Any good websites, books, etc... that I can refer them to that would be for

>either the parent OR child? This is not a patient or client of mine just

someone

>that asked for a little advice and I am trying to send them in the right

>direction. Her mother is actually a family physician and was wondering what

>might be out there if anything to help them out a bit!

> Thanks,

> Kim Tessmer, RD LD

>

[Guest guest]

Dear Kristy H,

A nine year old girl who is throwing up from overeating - even if fruits and

vegetables - with a mother who is placing food restrictions - is a family who

needs to go straight to a family therapist for counseling and see a dietitian as

well. This poor girl already has disordered eating / an eating disorder. I am

not crying for her but am a little glossy eyed. Restrictions can lead to

feeling deprived which can lead straight to binging and hoarding.

children who were in a food environment that was unstable can have binging and

hoarding problems. Depression and emotional eating of carbohydrates for a

serotonin boost might be a concern.

And I know I probably am typing this for nothing but TSH and T4 tests wnl means

nothing regarding her potential metabolic health or iodine levels. She could

take her Basal Metabolic Temperature - as soon as waking up and before moving,

take temperature immediately three days in a row. If average is below 97/96

degrees, then it is suggestive of hypothyroidism. The other clue would be if the

mother has hypothyroidism then her children probably got a low amount of iodine

prenatally and are susceptible as well.

Kelp can help against radioactivity and obesity . . . ;-) Adequate iodine

levels really can help with overeating and subconscious craving. The Japanese

nuclear accident has reminded us that historically millions of people have

safely taken emergency doses of 130 or 300 mg of iodine a day for several days.

Our RDA, which most people don't even get, is a meager 150 mcg. A kelp

supplement will vary but typically may provide 500 mcg of iodine. The Iodoral

supplement that I have used contains 12.5 mg and half would be fine probably for

a 120# person. Or sea vegetables would probably help and the restrictive mom

might like another form of vegetables to serve. Love can harm when it denies the

need for internal self guidance and control. I still fight " clean plate club "

habits. I found the Health At Every Size approach helpful personally.

http://haescommunity.org/ http://www.lindabacon.org/

If you are uncomfortable bringing this up with the girl's mother than I give my

permission to share this email with her - you didn't break any confidentiality

in what little you revealed about her situation or daughter. I may be totally

off base but disordered eating doesn't get better typically on its own and can

represent hidden issues - she may have a sexual abuser in the background even. -

now I am teary.

A three day food record might be a place to start at least. I would encourage

working on reducing restrictions and feelings of deprivation - trust building -

work on teaching mom and daughter to listen to hunger and fullness cues. - Yes

Virginia - you can binge and get obese on health food alone (and it doesn't make

you super healthier either).

Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa

Sent: Fri, April 15, 2011 8:58:27 AM

Subject: RE: Re: Weight loss for 9 year old

My first concern is why does she eat to the point of vomiting???? Wouldn't

bother with a food record yet. Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

I could not agree more with this!

On the discussion of should us dietitians do any type of counseling…

I believe this is where lots of us are lacking. We in school and in our job are

taught to take the scientific approach. The black and white approach, if you

will. Here’s your diet, here’s what you do, let’s weigh you, get your

BMI, get

your labs, f/u with results based off of number on scale or lab results or you

get my point. And yes, we should most definitely be doing this.

But my approach has been, let’s look at behavioral issues also that might be

contributing to whatever needs to be addressed. Are you overeating b/c you are

stressed, bored, angry, etc. If the answer is yes, then I very much encourage a

therapist to also get involved in his/her care… but I don’t just stop there.

I

give techniques to help with these issues. If you are bored, find something to

do to keep you busy so food isn’t your first thought. If you are stressed and

eat, try to find an alternative to relieving stress (take a bath, read a book,

do your nails, take a walk, find an outlet such as a hobby).

And I could go on and on about the behavioral issues that I attack. My motto

is, “Food is not black and white… let’s find the gray… meaning the

balance.†I

have to say that it is working. And I do not feel unethical about one iota! I

am encouraged by the therapist that I work with to do this.

Again, I just don’t think that it’s black and white… we as dietitians

don’t need

to absolutely, positively NOT “counsel†our clients. We need to know our

limitations and respect the client’s needs as well as what we are able to give

them. I don’t get into true therapeutic issues – no way, no how! But I do

address the feelings of what is stemming from those issues IF food is involved.

And I just want to add… teaching any person, young or old to NOT eat when they

are hungry is absolutely setting the person up for failure when it comes to a

healthy diet. Honestly, this should be the absolute BASIS of what we teach…

eat

when you’re hungry and stop when you are satisfied.

Just my two cents.

Respectfully,

From: rd-usa [mailto:rd-usa ] On Behalf Of hl

brewer

Sent: Thursday, April 14, 2011 5:02 PM

To: rd-usa

Subject: Re: Re: Weight loss for 9 year old

My first concern is why does she eat to the point of vomiting???? Wouldn't

bother with a food record yet. Sounds like something psychological happening

(worried she isn't going to be allowed to eat another meal in the future so

tries to overeat at the current meal) versus physically having no sensation of

satiety?

Holly

----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

From: KristyH <kheussner@...<mailto:kheussner%40yahoo.com>>

To: rd-usa <mailto:rd-usa%40yahoogroups.com>

Sent: Thu, April 14, 2011 12:48:47 PM

Subject: Re: Weight loss for 9 year old

I have a similar situation that I am not sure how to deal with. I just received

a call on a 9 year old girl that is 120# and 4'9 " . I am to see her next week.

Spoke with her mother on the phone. Mother stated that the family drinks only

milk and water with limited pop on special occasions, she limits the amount of

meat and potatoes her daughter eats, but allows her to eat as much fruit and

vegetables as she wants. The mother said that the child will eat whatever she

can and often will eat until she throws up because she is so full. TSH and T4

wnl on labs. I already charted her on growthcharts->95%ile for ht, wt, and BMI.

I happen to know the girl and see her riding her bike and playing basketball, so

I know she gets some exercise. I am wondering how to proceed. I question if it

is appropriate to ask for a food diary from the mother on foods served/eaten by

the daughter to help see if there is something blatant. Any ideas?

>

> What are your best recommendations for a parent of a child that is 9 years old

>and just slightly over weight but wanting to take it off.

>

> It isn't the parents that are worried about it but the child. She even on her

>own started a food journal.

> Any good websites, books, etc... that I can refer them to that would be for

>either the parent OR child? This is not a patient or client of mine just

someone

>that asked for a little advice and I am trying to send them in the right

>direction. Her mother is actually a family physician and was wondering what

>might be out there if anything to help them out a bit!

> Thanks,

> Kim Tessmer, RD LD

>