Question: We b'H have a wonderful almost 10-year-old son; he is a fantastic kid, smart, conscientious, studious, well-behaved. bright, a real baal middos and a budding  talmid chacham. He brings us a tremendous amount of nachas. The problem, he likes to eat and has been steadily gaining since 5 years old. First, it was ten pounds, then 20, and now more each passing year. At almost 10 years old, he is 130 lbs.  As I see it, he is not very athletic, has a big appetite, and won't touch a salad or vegetables. He had been seeing a nutritionist who suggested utilizing punishments or rewards to motivate him. Will that work? Should we punish our wonderful child for gaining too much weight? We have tried rewards with minimal success. Is he just to young to understand the importance of healthy eating and the consequences of unhealthy habits? We would be grateful for any suggestions or advice.

Your situation is increasingly common. The short answer is to a) focus on strategies to motivate him (although I would try to stay away from punishment) and b) structure the home and the family's lifestyle in manner that is conducive to health. Keep in mind that it is important to address this from various angles as research demonstrates that pediatric obesity is best treated with a multidisciplinary approach focusing on healthy eating habits, moderate exercise, and behavioral strategies. I will therefore attempt to elaborate on relevant concepts including appropriate nutrition, physical activity, behavioral strategies, motivational strategies, and stimulus control techniques.

 It is important to obtain good nutritional advice for healthy eating as well as for physical activity. Examples of healthy eating include things like drinking water at mealtime, choosing products low in fat, and giving tasty but healthy snacks. Physical activity refers to a minimum of 30 minutes daily activity such as walking, biking, or swimming. These healthy guidelines should be followed by the whole family, not only the overweight child.  Studies show that at least one parent must participate in the weight loss process for any hope of any long-term success.

Another relevant point to keep in mind is that research demonstrate that all discussion with children on these topics should focus on healthy eating and behaviors rather than discussions about dieting or weight. Even well-intended comments can be perceived as hurtful by children. Weight talk, referring to encouraging children to diet or talking about parent's own dieting, is linked to weight gain as this makes the child increasingly self conscience.  However,  conversations focusing on healthy eating were found to be productive. Goals to work on healthy eating can only work when these goals are both small and practical. In addition, when these small goals are completed, they should be regularly reinforced via praise and small rewards chosen by child.  

It is also important for parents to take a proactive role with children.  Stimulus control techniques involve controlling the environment to encourage healthy eating. For example, nosh can be limited to special occasions (e.g., Shabbos afternoon). In addition, children will likely fill up on healthy foods if the food is presented well and accessible (e.g., placing cut-up fruit around the kitchen). It is also recommended that parents should restrict where children can eat (only at the kitchen table), as well as when to eat (meals and designated snacks). Another role that parents can play is to observe their children's eating patterns and learn how they can teach children better ways to cope with their challenges. These can include how to navigate potentially challenging eating situations (e.g., Kiddushim in Shul) as well as emotional situations (like coping with being bullied). 

There are professionals as well as programs that can assist parents as well as children with implementing these concepts. Hatzlacha!

Originally appeared in Yated Neeman