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Weight-loss advice for adolescents

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Evan Nadler
Co-director of the Obesity Institute at Children's National Medical Center
Thursday, June 24, 2010; 12:00 PM

Evan Nadler, co-director of the Obesity Institute at Children's National Medical Center, will discuss the challenges teens face when trying to lose weight and how parents can help them overcome these difficulties.

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He was online Thursday, June 22, at noon ET to take questions.

For more nutrition news, visit the Post's Fitness and Nutrition section.

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Evan Nadler: Hi all. Dr. Evan Nadler here and happy to answer any questions you may have today.

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Anonymous: My son who is 19 has battled with his weight since he was about 10. He isn't interested in joining a gym. We even bought him an in-home gym which he hasn't used in years. I worry about his weight (60 pounds overweight) and I know he isn't happy with his weight. My daughter is always at him to lose weight, go the gym, etc. and I tell her that he has to want to do it himself. Do you have any ideas on how to handle this? Thank you.

Evan Nadler: Thanks for the question. It's not all that uncommon to find a family where one child is overweight and another is not. There are many strategies to handle this situation, but one that I find helpful is to include both kids and their parents in the exercise activities etc., so that it becomes a family affair. If everyone is supportive and included instead of singling out your son, it means the whole family is committed to healthy living.

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Fairfield, Conn.: I have an 11-year-old son who is generally very fit, but he's developing a bit of a paunch. he especially seems to get a bit chubby in the winter when there are fewer opportunities to exercise beyond basketball and PE.

He is ALWAYS hungry and given that he's approaching puberty I really don't want to deny him food because I think boys this age ARE hungry and often just do eat huge amounts of food. He is a huge carb eater, and I do my best to get him to eat fruit, or mix protein (peanut butter, hummus) with his carbs, but I don't want to go overboard and make him self-conscious, or turn this into a battle so that he'll start loading up on real junk at school or elsewhere, or sneak food. I want HIM to make the right choices.

How do I feed a growing boy well and keep him satisfied, but prevent overeating?

Evan Nadler: You want to encourage healthy food choices without making your son too focused on food. If he is generally at a reasonable weight for most of the year, then I wouldn't worry too much. Just make sure healthy foods are available to him, and get the whole family to lead by example.

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Washington, D.C.: My daughter is in a D.C. public high school. What recommendations do you have for healthy choices in the school cafeteria?

Evan Nadler: Cafetierias can be tough, especially with the other kids looking over your shoulder at what you are eating. I'm hopeful that there may be changes in what's available at school cafeterias here with the new Healthy Schools act in D.C. In general, my advice would be the same as at a restaurant where you just have to look a little harder to find the healthy options.

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Arlington, Va.: I pack healthy lunches for my child, but I think he tosses it and eats the lunches in the cafeteria -- pizza, soft drinks. How do I teach my child that what he eats matters?

Evan Nadler: My twins are the same as your child, and likely everyone else's out there. The best we can do is to just keep packing the right things and eventually our children will try them. Leading by example, involving the whole family and making it fun to learn about foods are all ways to encourage a healthy lifestyle.

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Washington, D.C.: Two things: I think people aren't aware how powerful things kids say can be in terms of this issue. I didn't eat for weeks after a kid said I was fat and had to drink medicine to recover then as an adult. When one of my colleagues called me a "fat slob," didn't eat a meal for months, lost 50 pounds and had to be hospitalized. Also, weight loss does affect thinking and judgment. Thanks.

Evan Nadler: No question that the stigma associated with obesity can be crippling for anyone, and especially for adolescents and children. Its important to try to stay positive and find others who can be part of your support system.

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Boston, Mass.: Should young people (people younger than 27-28) take statins to manage their cholesterol?

Evan Nadler: This is best handled as an individual decision between any patient and their doctor. There is no generalized rule, but if the cholesterol level is too high then medications can be useful.

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Washington, D.C.: I was an overweight teen and have struggled with my weight my whole life. I wish my parents would have gotten me into counseling at that age. It was such a hard time for my identity -- having hit puberty before the other girls -- that I was definitely a bit depressed. Mix that with access to junk food, and it's a deadly combo. I would also recommend enrolling kids into more "adult" things like individual sports lessons or cooking classes (to teach healthy options). I would have preferred all of those rather than my mom dragging me to Weight Watchers at age 13.

Evan Nadler: I agree that adolescents need counseling as part of a comprehensive plan for dealing with weight-related issues. It's important to have a multidisciplinary approach that includes physical activity (preferably one that is attractive to the child), education (nutritional and otherwise), as well as the mental health aspect. That's the approach I take with all my patients, and that's what I recommend for anyone who is seeking treatment for their weight.

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Arlington, Va.: I think that parents should work to give their kids the tools they need rather than trying to control their behavior. How about sending a kid to a nutritionist or a cooking class? My kids are little, but I try to have them cook with me so that they learn good skills and appreciate good food.

Evan Nadler: Involving your kids in their food preparation is a great way to educate them, not to mention bond with them. However, there is no one strategy that works for every family just like there is no one simple solution to the obesity epidemic as a whole. There has to be a commitment from all levels, families, communities, schools, policy makers, industry, etc. I'm glad to see that the first lady has taken this approach in her Let's Move campaign, so we're definitley moving in the right direction.

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Rockville, Md.: I have a 4.5-year-old son who has gained about 15lbs in the past year. He is quite tall at 48inches, and he is 68 pounds. Our other children started out on the chubby side and by the time they hit 5 started slimming down and are quite proportionate. No one would look at them and say they were heavy. This is the opposite. They have similar eating patterns and activity levels. We are becoming concerned. I guess my question is: Should we be? And what can we do? He is only 4.5. Thanks so much.

Evan Nadler: The best thing to do is relay your concerns to your pediatrician. He/she can check the growth charts and tell you whether your child's weight is appropriate for his age. If there is a concern, your pediatrician can help you with strategies.

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Roanoke, Va.: At what point should someone consider plastic surgery, like liposuction or something like gastric bypass surgery?

Evan Nadler: Every patient is different, and decisions regarding surgery can be complex. Plastic surgery doesn't usually address the underlying issue and doesn't make patients any healthier. Weight loss surgery comes in many forms, and can be useful for select patients who meet certain criteria. An in-depth discussion with your primary care physician should be a starting place for anyone considering a surgical procedure. And surgery is only the starting point for a complete lifestyle overhaul.

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How easy it is to become overweight: The days of being outside all day are over. Perhaps the biggest changes is HOW and WHERE we eat. We never ate in cars, in front of the TV, etc. The frig was not open 24/7. Dessert and snacks were not a free for all. You never ate while walking on a sidewalk, e.g, soda and coffee, candy, etc. Now we eat EVERYWHERE!!

Evan Nadler: It's true that food is available almost everywhere these days, which makes it all the more important that we educate ourselves and our children about what's in the food we eat. Family mealtime is important and often overlooked in today's busy world. There are actually studies that show the benefits of eating together, so it's a great place to start.

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Alexandria: I found that when I involved my son in grocery shopping and cooking he became more interested in making good food choices. Teach your son or daughter how to make some fun nutritious snacks. My son also found that the girls were very impressed that he could cook.

Evan Nadler: I wooed my wife by cooking a seafood dinner back in 1998, so it definitely can be a hit with the ladies!!

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Herndon, Va.: How do you know how many calories you are supposed to eat each day? Is it possible to work out five days a week and still not lose weight because you aren't actually eating enough of the right calories?

Evan Nadler: Different people process calories in different ways. It's also important that the calories are distributed among protein, carbohydrates and fat to achieve a proper balance. There are ways to vary your workouts that may help you lose weight, and increasing muscle mass can help burn calories. All that being said, if you're working out five days a week you are already doing great.

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Washington, D.C.: How often do you exercise? Did you start that as an adolescent?

Evan Nadler: I started playing competitive soccer at age 8, and continued to play through college. Go USA!! I do believe that sports early in kids' lives can help build a solid foundation for healthy living into adulthood. Now even though it's tough as a surgeon to find the time, I try to exercise at least three times a week. I ran the GW Parkway 10 miler in April, and I find that having goals helps keep me motivated.

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Alexandria, Va.: What's the best way to start healthy habits early in life? My daughter is 2 and already head-and-shoulders above her peers in terms of height and weight. Given that her father and I are both larger people, I worry that she'll be the same, and I don't want her to pick up our bad habits. Any suggestions for healthy eating for toddlers?

Evan Nadler: If you and your husband have bad habits, the best thing you can do for your toddler is change your behavior first. A healthy family environment, especially at an early age, is going to rub off on her before all the outside influences start to creep in.

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Washington, D.C.: How do I find camps like the one mentioned in the article?

Evan Nadler: The American Camp Association accredits camps like the ones mentioned in the article, so their web site might be a good place to start. Just make sure that any camp you might enroll your child in has long-term follow-up available for campers because it takes more than one summer to make sustained changes.

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Arlington, Va.: I would just like to give some tips from my own personal experience, as someone who was a fat kid who turned into a thin early-teen to an obese late-teen, who has now just managed to get her food and exercise in balance.

First, I think parents need to educate themselves about health. My parents knew nothing about eating healthfully; my mom was thin without trying. So I started eating in a very disordered way when I was trying to lose weight. My parents never picked up on it because they were excited about me being thinner. Meanwhile, I was depressed and felt completely alone. Health is more than just weight.

Secondly, and relatedly, parents need to know the warning signs for depression and eating disorders. I had great parents, and they didn't notice that I had both at some points. I'm not saying all "fat kids" are depressed, but they could be.

Third, if you want your kid to exercise, the best way to do it is to join them in activities that are exercises but don't feel like it. Spend time with them. Take them on hikes and listen to them. Ask them how they are doing, and pay attention to the answer without judging.

Just my two cents. I couldn't start losing weight until I loved myself no matter what size I was. My parents, as wonderful as they are, never taught me that.

Evan Nadler: You bring up some excellent points. We've already talked about the importance of family support and the mental health aspects that go with weight issues. You also touch upon the fact that both thin and overweight children can be malnourished, so disorded eating at any weight can be really unhealthy.

With exercise, different types work for different individuals and families. But I agree doing activities as a whole family is best.

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Boulder, Colo.: To the poster in Arlington whose kid throws out the lunch they packed and eats pizza: You might need to make sure the things you are packing are things your teenager actually enjoys eating. If they like pizza you could make a sandwich on a whole grain roll with mozzarella, turkey pepperoni and veggies. Healthy food isn't a punishment and it shouldn't be austere. It should be delicious and appetizing.

Evan Nadler: There are lots of great ways to make healthy food attractive to eat. As we spoke about earlier, preparing your kid's food with them is one way to help them and you find a balance that will keep everyone happy.

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Evan Nadler: Well I hope everyone enjoyed the chat today. It's definitely an important topic and one that needs to stay in the forefront of the nation's mind.

Evan Nadler: There is no quick fix, so we all need to keep working together.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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