More
Topics |
Childhood Obesity and Type 2 Diabetes
- When diabetes hits home; the family
as patient
- Lifestyle vs. weight management
- Targeting the family and lifestyle
- The power of positive, empowered,
holistic, interdisciplinary thinking
- Theory and practice
Who you are must always be more important
than how much you weigh…or if you
have diabetes
What do adolescents and patients
with type 2 diabetes have in common?
Both grow resistant to insulin
CATCH
- NIH: School based health promotion
study (classroom curricula, food service
modifications, Phys. Ed. Changes, and
family reinforcement)
- Reduce TV watching and video game
playing
Facts
- Restricting food causes children to
eat more
- Children who spend more time with
TV, computers get less exercise and
eat less healthy
- "supersizing" meals the norm
- no "clean plate club" when not hungry
..Aoops…High content fats and
sugar (snack foods and take out) I.e.
"junk foods" or "PC…. food of
lower nutrient density
Focus choice not restriction
- Relationship of restriction to binge
eating
- With restriction..Children worry,
beg others, hide food, eat others leftovers
- Nondiet approach
Obstacles
- Physiology: we are hardwired to eat
fats and carbohydrates (taste buds)
- Socialization
- Eating out of emotions
TACTICS
- 20 minute rule: HALT (hungry, angry,
lonely, tired
- Managing feelings without food (journal
for awareness; forming new habits)
- Challenging sensory memory: neg and
pos
- Make motivation for self not parents,
doctor
- New habits: If you always do what
you always did, you will always get
what you always got
FIRST DIETARY INTERVENTION
- GOD SAID NOT TO EAT THE APPLE
Improved eating,bs,and physical goals…NOT
WEIGHT LOSS
- Accept your innate biology
- Eat 5 food groups (choc, cake, ice
cream candy..)
- Thin people not better..Make comparisons
not judgments
- Find normal body hunger as basic
drive
- Physically fit overweight are healthier
than thin not fit…
Assessment
- Become aware of patterns: eating,
activity, parenting, and family history
of overweight (aunts, uncles) through
monitoring
- Family’s perception of problem
and readiness to change; involve all
family and extended family
- Consider exogenous (depression, anxiety,
abuse)
- Check school performance, body image,
social interaction
assessment
- monitor
- Identify barriers
- Set goals..small (2 or 3-cut high
sugar beverage)
- Family problem solving skills
- Communication skills around monitoring,
medication adherence, discussion and
negotiation of barriers
- Regular visits for assessment and
motivation
Food and activity intake records
- Do you eat enough!!! Of foods your
body needs? Fruit, grain vegetables
(Ikeda and Kater); not talk about sugars,
fats first
- First eat more of what you should
- Believe experiences of children not
eating much (need fewer calories to
maintain weight)
- Portion sizes, liked and dislike
foods, timing, social setting, family
patterns and knowledge
- Past history of intervention
- TV, video habits, and activity awareness
Activity
- Aerobic exercise 20-30 minutes daily
- Family
- Regular timing
- Condition slowly
- Park, community center, trainers,
classes (karate, tae kwon do, soccer)
Parents
- Eating habits, attitudes to self and
children. Beliefs about change and food
- Be aware of excessive control over
food intake (choice not restriction)
- Model behavior
- Sensitive to limiting access to food
(increases appeal and consumption)
- Behavior mod: don’t eat standing
up or in TV room, eat together, keep
healthy snacks ready, portion control
Motivation maintenance
- See patient regularly
- Family system; friend system
- "Walk the walk"; sessions while walking
- Set up competition-collaboration
with matching patient
- Rule out depression and anxiety and
need for medication
- Change association of diabetes with
loss and deprivation to health (consider
Atkins? "Kids food")
- After school exercise or team with
parent
- Self-management skills
REFERRALS
- Therapists: you don’t have to
be crazy to see a therapist
- Children are free when accompanied
by adult at weight watchers
- Consider hypnosis, relaxation training
Preventing burnout
- Use referrals for provider and patient
- Support systems: groups, team approach,
family members, friends
- Buddy systems (ww adopt a kid, mutual
motivation)
- Resiliency: There is only feedback
not failure
- Changing internal dialogue
- Create more positive interactions
- Non- diet approach: awareness and
choice
- Follow-up: phone calls and letters
Patient and provider
Internal dialogue and communication skills
Practice
- I hate the diet
- She always watches me
- Kids tease me
- I can’t do this
- Parents and siblings: why do I have
to suffer too
- Provider: Your patient gained 5 lbs…
Coping for parents
- Playful problem solving
- Seeking social support
- Positive reappraisal (I know how
to be more helpful now)
- Distancing by fathers (include them)
- Inhibition of coping strategies with
boy vs. girl
It takes a village…
- We all own the problem of children
not having healthy lifestyles
- Lobby vending machines in schools,
TV ads, public outcry
- Spread the word that people come
in all shapes and sizes
- As professionals do not deliver guilt
or punitive messages to parents or patients
- Initial goal? slow down weight gain
- Promote body satisfaction, self-esteem,
and positive body image
Professional awareness
- Impact on social and emotional well-being
and not just the physical
- Remember knowledge does not change
behavior
- Remember that all children struggle
with sedentary lifestyle and poor food
choices
- Think lifestyle not obsession
- Consider feast –famine cycle
of poverty level (less money leads to
higher fat foods. time of month.)
How to get your kids and families MOVING…
- Set specific exercise goals (who,
what, when, where, how)
- Begin slowly and live with fatigue
- Create a regular time slot
- 15 minute rule: get started for only
15…
- Have back-up plan
- Make it fun, have right clothes-shoes-equip
CHANGING THOUGHTS
I can’t do karate; I have no time
and I'm too tired.
I can go to karate. I will get in shape.
I can schedule time to go and accept my
slow progress.
Understand lapse, relapse, and collapse
- And plan accordingly…anticipation
USE OF HUMOR in diabetes and children
- Discharge of negative emotions (Freud:
a pleasurable discharge of negative
emotions.)
- Ability to talk about difficult situations
- Provides new perspective
- Social lubricant
- Physical, immune system advantages
(optimism and perceived control
- Combat feelings of inferiority and
vulnerability
- Release stress in acceptable way (Q."Can
you eat that? A.Why, is the cook that
bad?)
HUMOR
- Humor can be learned (Read a joke
book, see a funny movie, watch comedians
and children..)
- Focus on looking for the odd side
of a situation
- Think about "telling" the story later
as stress is happening
- Better to "think funny" than to be
funny
- Use and model humor to patients
- "Now take my diabetes...please."
Brownell’s learn program
- Lifestyle
- Exercise
- Attitude and affect
- nutrition
COPING: THERE ARE BETTER WAYS
- ESCAPE OR AVOIDANCE
- NAMING
- HUMOR
- VENTILLATIONOR STORY TELLING
- SOCIAL SUPPORT
- DISTRACTION
- ALTRUISM
- RATIONAL THOUGHT
- POSITIVE SELF-TALK
- VISUALIZATION
- EMPOWERMENT
- ASSERTIVENESS
- RELAXATION
Parents
- "It’s your life."
- "Explain to me why you don’t
feel like eating."
- "I’ll make you anything you
want; steak, eggs? Or we can go out
if you like. "
- "I’m going to get your father."
- Other
Your child refuses to eat. You say:
Parents
- "It’s your life."
- "Explain to me why you don’t
feel like eating."
- "I’ll make you anything you
want; steak, eggs? Or we can go out
if you like. "
- "I’m going to get your father."
- Other
Sibling without Diabetes
You see your brother who has diabetes
eating a candy bar after school with his
friends.
You;
- Immediately tell your parents; you
can’t stand the guilt
- Immediately tell your patents; let
him get in trouble - he gets too much
attention, anyway.
- Share this with your brother &
discuss with him how it makes you feel
- Go up to him and grab it out of his
hands
- Other
Professionals
The Patient says: "I refuse to test my
blood sugars. I feel fine." You say:
- "It’s your life. I give up."
- "This is not a suggestion."
- "It sounds like you feel you have
good reason not to test."
- "I’m so glad you trusted me
enough to challenge me. I’m very
interested in understanding why you
are hesitating."
Motivation maintenance
- See patient regularly
- Family system
- Mentor
- Competition (big sister)
- Peer counselor
- Change!
|
