Healthy Behaviors in Role Modeling
By: Dr. Steven C. Simper, MD, FACS
“It is the will and ambition of our patients who ultimately make their weight loss possible. Treating the whole person is a critical part of the care given to my patients.”
Childhood weight problems can be treated successfully with sustained weight loss when treatment focused on behavioral changes is family based. Those of you who have undergone weight loss surgery and have sustained significant weight loss know that you maintain your loss by acquiring healthy behavior. These behaviors can impact in a positive manner on your children and other loved ones in the family environment and help them lose weight, if needed, and encourage a lifestyle that is less likely to lead them to obesity.
Articles in the American Academy of Pediatrics looking at childhood obesity, which can be defined as a BMI for age and sex greater than 85th percentile with comorbidities or greater than 95th percentile and also in children who are overweight; that the foremost important factor in helping children lose weight or have normal weight is the family environment. The family must be ready for a change just as the individual undergoing weight loss surgery must commit to a change.
Through parental guidance in setting an example of healthy eating, healthy exercise, and improved lifestyle, these examples for our children will encourage them to do the same thing. The whole family should be involved. Involvement of the entire family and all caregivers will create a new family behavior consistent with the child’s new eating and activity behavior and lead to improved health for everyone. This is also beneficial to the person who has had the weight loss surgery. It is often very difficult for you to maintain your good dietary habits when everyone else in the family is eating as they had before. What is good for you is also good for your family and should be reflected in your planning.
The family should learn to monitor eating and activities. Common problems identified by monitoring include saboteurs. These are people who interfere with the changes the family is making. Many of these saboteurs are innocent. They can be friends and loved ones who, in themselves, have always rewarded themselves and others with food items and have made food the mainstay of their social activities. They can also be an intentional saboteur as many times people, friends, family, and relatives identify the drastic changes that you have made in your life with the benefit realizing that while they should make those same changes, they are not ready emotionally or physically to do so and, therefore, feel that if you failed then they will not be committed to those same changes. It is important to identify saboteurs, and in a positive way, influence them into a positive support for your behavioral patterns; or figure out a way to isolate yourself so they have little or no influence.
Food consumption outside the home should also be limited. It becomes a big problem in the workplace, at school, etc. where every desk has a candy bowl. Oftentimes social activities within the school system for the children are a circle around candy and other high-sweet treats. You get into the church environment and high-calorie, high-carbohydrate refreshments become the mainstay of all activities. You can have a positive influence not only in your family, but in your community by insisting that your children not be exposed to these things, as well as yourself. Make a concerted effort within your workplace to encourage the removal of candy dishes and snack bowls from desks, as well as encourage your teachers in school to come up with other types of rewards besides candy for holidays and other seasonal events. Teach your children that this is not necessary rewards that come; that there are other better rewards for these environments.
There is also a lack in time of physical activity in food preparation. Be sure to take that time and set the example for your family that they need to make that a priority in their lives as well and identify a safe environment for all of these activities.
Never use food for a reward. Instead of food for a reward, point out other things. Oftentimes in the case of children, just simply taking time and spending extra time and activities with your children is adequate reward for their special behavior in school and in the home. For your own personal rewards, oftentimes you can reward yourself with a new book from the bookstore, or even from the library. Finding new clothes items can help reward you. Taking special time for yourself for a massage or some other behavior that you find beneficial but not using food as a reward.
Establish daily family meals and snack items. This helps you monitor what your children are eating and also gets them into a eating behavior that is more consistent and a healthier eating pattern. Stop eating while watching television. Eating in front of the television creates a behavior that any time we sit down to watch television you feel you must have something to eat or can also stimulate the habit of eating during this period. Much of eating behavior and hunger is actually habit.
Parents and caregivers should determine what food is offered to the children. The child should decide whether to eat or not. If the child chooses not to eat, do no force him. If they are not hungry, again forcing the child that is not hungry to eat can create the wrong eating behavior. Again, a child, if they are not hungry, should not eat. I have never seen a child starve to death, but again they learn to eat at specific times. If you allow them to eat at other times, then they are not hungry at mealtimes. They need to have food offered at specific times. If they choose not to eat, then this is okay. If there are options of what to eat, these should only be healthy options. Parents can have a child choose between a carrot and an apple for a snack. Remove the temptations from your children. Get all of the chips and sugary juices, candy, and sodas out of the house. The same thing for the adults, get rid of the high-calorie alcoholic beverages and beer; other high-calorie, high-carbohydrate foods which are tempting to the adults. If they are not in the home, you are not going to go out and get in your car and drive down to the supermarket to get them in a time of weakness. This helps you maintain the control over your diet, and also that of your family’s. If the food is present, it will be eaten.
Parents control the food by what they purchase, and by limiting it to only high-quality foods and eliminating high-carbohydrate, high-fat foods, you can help control your family without depriving them of good nutritious food; which is really the appropriate way of showing your love for them rather than the false sense of giving them sugary or high-carbohydrate treats that are not good for them. Be consistent, do not give in. Occasionally rewarding good behavior with food only encourages temper tantrums and other behavior, where consistency leads to compliance and a much happier, healthy relationship with your loved ones.
One of the most important family activities is not only mealtime but activity. Reduce inactivity, limit television, video games, and computer times to one to two hours per day. It has been shown that Americans, particularly children, spend up to six hours a day in front of the television. This is time that they should be out doing other activities; being physically active and more productive. This helps them to be happier, healthier, and better rounded children. Families should strive for a goal of at least 30 minutes of strenuous physical activity a day. This does not necessarily need to be done in a gymnasium, or heavy weight lifting. This can be playing basketball or some other activities, skiing as a family, playing basketball as a family, going to the park and playing baseball, or other activities. This type of parental example will help your children from a physical standpoint but also help your family from an emotional standpoint.
The bottom line is that for you to succeed you also need to have a family that supports you. For your family to succeed you need to support them. Show your love for your family by setting an excellent example and setting up a quality lifestyle for them as well. It may not be easy initially, just as it is difficult for you to make the decisions to change your life. Oftentimes it is difficult for them, and initially you can be ridden with guilt for withholding food that your family thinks that they are entitled to when really you are showing your family your love by caring for them and ensuring that they are living a healthier lifestyle as well and helping to avoid the problems and the mistakes that you have made that helped lead to your weight problem and your health problems.
This can be difficult. It can lead to significant strife within the family, and if this does indeed occur, then professional help may be needed.
These are appropriate topics to be brought up in support groups and other educational groups here at our wellness center.
In conclusion, a healthy lifestyle for you is a healthy lifestyle for your family as well. Show your family love by encouraging them to a healthier lifestyle as well. Only offer healthy options.
About the Author:
Dr. Steven Simper, MD, FACS, performed his first bariatric procedures in 1984 at Wilford Hall Medical Center, in Texas. Currently, he performs laparoscopic gastric bypass, sleeve gastrectomy, duodenal switch, and revisional surgery. In addition to general surgery procedures. He joined Rocky Mountain Associated Physicians in 2001, and began performing laparoscopic gastric bypass. Since 2008, he has developed his skill and expertise with the powerful biliopancreatic diversion with duodenal switch (DS). He is among a handful of surgeons who perform this procedure. He both proctors other surgeons and is a speaker at bariatric conferences in regards to the duodenal switch procedure. In following his patients, and witnessing results, he has become a strong advocate for this procedure in the select individual who needs a powerful surgery.