Joey Skelton was training in pediatrics in Wisconsin when he was assigned a young patient with several weight-related health issues.
"And we had no resources," Skelton recalled.
He set about to learn more about how he could help his young patient, studying gastro enterology and nutrition before joining the staff at Atrium Wake Forest Baptist Health. Skelton started the Brenner FIT (Families in Training) program, a family-oriented approach to helping children with obesity.
The program follows a model developed in the 1980s that looks beyond restricting calories when it comes to helping children lead healthy lives.
"You can't just give out a diet plan. You have to change behaviors, and you have to include the family," said Skelton, a board-certified pediatrician and obesity medicine specialist.
Skelton has put what he has learned about this approach in a new book, "Your Child is Not Their Weight: Parenting in a Size-Obsessed World," co-written with his colleagues, Dara Garner-Edwards, an associate director and family counselor at Wake Forest University Health Sciences, and Melissa Moses, the lead dietitian and manager of the Brenner FIT kitchen. The book will soon be available at Bookmarks and on Amazon.
Published by the American Academy of Pediatrics, the book is meant to help parents navigate the sensitive, complex terrain of childhood obesity.
"It's genetic. It's environmental. It's personal," Skelton said of childhood obesity. "And for me, it all started with helping a patient who had no resources."
We've heard about soaring childhood obesity rates for years. Where is that now trending?
It's probably slightly leveled out, but there's asterisks to that. We did see during COVID a big spike, as we did with all people being homebound. And it wasn't just with weight but with a lot of health-related issues, like Type Two diabetes. With the new medicines that are coming out, we're finally recognizing just how complex this really is, and I get so sick of saying the word 'complex.' There's this general idea that it's something that you chose, and it's all related to how much you eat and how much you exercise. We're still fighting the public narrative that it's a lifestyle issue.
Having new medications come out, it gave people the message that this is such a tough problem that you need medications for it. That's a lot of what this book is about.
Weight is a difficult subject for parents to approach with their child. How can parents do a better job? What are the pitfalls?
We always think of eating disorders in thin teenage girls. Actually, we've found in the past 5 to 10 years that children in bigger bodies have two to three times higher prevalence of eating disorders than a child at a regular weight.
So, it's tough. How do we focus on the health of kids with a group of kids with higher rates of eating disorders? My field has really been walloped by this. We recognize that we have to be very careful to talk about it in a way that does no harm.
One of the first things we talk to families about is how not to talk about weight. We need to take the focus off weight. That can set kids up for eating disorders.
There's weight teasing. How much of our own family members tease about weight? And with dieting, doing very overt changes in order to lose weight, like giving up whole food groups and counting calories, all that is setting up for an eating disorder.
A lot of parents ask us, 'Why aren't you weighing more often? Why aren't we removing carbs?'
How did the book come about?
It's an opportunity to get the message out there. I could have never done the book without Dara and Melissa because of the approach we have, of 'How can we improve family behaviors?' We've been focused on this for years. A lot of colleagues knew our approach was a little different.
There was interest from the American Academy of Pediatrics on this approach. And they said, 'Hey, you would be willing to speak on this at a conference?'
It was set up like a Ted Talk, and it was horrible. All the other speakers were funny, and I remember thinking, 'Oh, an epidemiologist is up. She'll be boring. She was great, and I was like, 'Oh, jeez.' So, I had to rewrite a bunch of jokes. I gave my talk there and someone from the Academy was touched by it, and she approached me about a book. It was such an opportunity to talk to families who may never get access to programs like ours.
It's why we dedicated the book to parents who grew up in a diet-obsessed world, hated their bodies and wanted to raise their kids in a different way.
What are your thoughts on the latest effort from the federal government to improve eating?
These sort of public health campaigns, they just sort of tell you what you need to do. They tend not to make that much of a difference. Obesity affects people from under-resourced backgrounds at a greater rate. There are other ways to make families healthy, like increasing access to healthy food, universal free lunch at schools, safer neighborhoods. There are a lot of public health and societal chances to do that. Just telling people to eat healthy is not enough.
So many families know what they need to do, what exercises to do. The book shows you how to do it, how to put these things in place in your home.
When it comes to the government, telling people what to do isn't enough. We have to make health easy. That's access to food, supporting parents. A friend of mine who is a communications professor at Wake Forest says that effective public health campaigns don't cause fear. They give you solutions.
What are some tips for families who want to introduce or maintain healthy eating?
The basis for a lot of it is having some structure. That makes it easier to put in changes you want to see. Structure and schedules first.
You don't have to be military about it. Kids like to know what to expect. It makes them feel secure. They know dinner is about this time, and we sit at the table together. This is when electronics are off. This is when we prepare for bed. That's the scaffolding in which you'll build other habits.
If you have general rules — no electronics at the dinner table, you're only preparing one meal for the entire family, planning ahead on when you get takeout so kids aren't talking to you about going to a drive-thru — it allows you to build healthy habits. If you say, 'We're going to have a vegetarian meal on Mondays and not eat out like we usually do,' it's going to be stressful. Kids respond well to knowing what to expect. Then, it's not so hard to put a little change into that.
Pull out that old family calendar, and in the end, it will relieve a lot of stress. From that, build in changes.
lodonnell@wsjournal.com 336-727-7420 @lisaodonnellWsJ
