The Fat Child

A great deal of concern can be aroused over the child who is labeled “fatty” at school; and the present obsessive, neurotic attitude of adults toward overweight and “dieting,” coupled with teasing, can make a child miserable. A fat girl can become morose, isolate herself from her classmates, grieve because she has no dates, refuse to change her dress for gymnasium activities, and assume a bitter, hostile attitude in all her human relationships. Boys tend to cover up feelings with a laugh or a semblance of good humor. Because of the psychological scars which may occur, a teacher should have an understanding of the physiological basis of obesity (excessive fat deposition).

The three ages in childhood when overweight may be prevalent are: infancy, pre-puberty (ages eight to 11 years), and adolescence. With interval spurts of rapid growth, the child usually gains more normal proportions and at maturity should assume average weight.

In evaluating overweight the following questions may be asked: Is this individual truly fat? Does he have rolls or pads of fat? Or does he have a big bony frame with heavy muscles? Much has been written about the obese adolescent. Obesity may be different to determine. In general, an individual who weighs over 20 percent more than the average for his height, age, and body build is considered overweight or obese.

Very few cases of overweight are caused by endocrine disturbances. Nevertheless, some are. Low thyroid function, diabetes, or pituitary dysfunction can be ruled out by a physician’s examination. Most children are fat because of overeating; more food is ingested than can be burned for energy. The excess is transformed into fat and is deposited in the body, especially under the skin. Fat children tend to grow into fat adults more often than children who have average weights. Those who are relatively inactive because of crippling conditions still have good foods, foods high in calories, and enjoyment of eating. Mother is usually a good cook, and desserts are popular. Fifty percent of fat children have one or both parents who are overweight. The similarity is probably on an environmental basis. Often a change in the entire family’s eating habits is essential for control of the child’s eating habits.

In some cases a more profound and significant explanation of obesity is offered. Unhappy, poorly adjusted youngsters, as well as adults, derive a great deal of satisfaction from eating. A child who feels frustrated, insecure or inadequate in various aspects of his life gets great pleasure from eating or can secure attention from over-eating. A fat girl who feels unattractive seeks refuge in eating as a compensatory gratification, gains more weight, feels more unattractive and eats more; the cycle is vicious. Many people under emotional or mental tension gravitate toward the refrigerator. One must be careful not to place too much emphasis upon the psychological and emotional factors in producing obesity, however, and keep in mind that eating can be a pleasurable experience.

A younger child who is placed under a strict “reducing” dietary regimen has no motivation and may feel deprived. The mother of a second grader was advised at school that her son was overweight, and she proceeded to place him on such a diet. He began to suck his thumb and wet the bed at night, which he had not done since pre-school days. His pediatrician advised that a return be made to the old dietary with a mild restriction in calories but not nutrients. Soon after, the regressive behavior disappeared. Adolescents are interested in grooming and appearance, which should stimulate a positive emotional response. They do need reassurance, particularly the maturing fat boys, that they will be normal. An attempt is made to prevent a gain in pounds and await the natural growth which will permit the growing youth to become better proportioned and assume a more average weight. With extremely excessive weight, of course, a child should be placed under medical supervision.

An unrelenting obsession with overweight is deplorable. The mother who considers giving her child pills to reduce his desire for food, the father who never fails to admonish his son before each meal to take it easy on food, and the parents, relatives, and friends who call attention even in jocular fashion to a child’s overweight are stupidly doing irreparable harm. Consider the emotional damage which has been done a chubby third grader who, with a recently acquired stutter, holds a morsel of food and haltingly asks, “Will this make me fat, Mother, will this make me fat?”

At the same time that a well balanced diet is followed, the home, school, and social contacts should be gratifying and offer security and acceptance. Overprotection and anxiety in the home should be avoided and the teacher’s constant encouragement over the long road back to normal weight builds up the morale of the obese person.

The secret of success in handling obesity of children is not just weight loss. The emotional stability of the child and his home are factors. Reducing weight does not solve a child’s problems. He needs to build up his self-esteem, and to develop independence and a strong sense of identity.

“Since their peer relations are often poor, it is helpful to involve teenagers in school and church activities, encouraging them to participate in clubs, craft classes, volunteer work programs, and service committees. These outlets can provide the means for attaining some degree of success and a feeling of achievement and thereby help to bolster the adolescent’s poor self-image.”

One effective way of helping fat adolescent has been through group projects, supervised by a school nurse or a health or home economics teacher. By discussion of their mutual problems and reactions, a group of girls ceases to be isolated and withdrawn. Studies on nutrition, selection of foods, and meal planning can form the basis for practical application. Selection of clothing and emphasis upon good posture will be other considerations. In order to assure success of a project of this type, the interest and cooperation of the mothers and families concerned must be enlisted. Self-improvement will be a powerful stimulus for more intensive nutrition education. With loss of weight a better figure assures a more attractive appearance. Many psychological and emotional benefits should accrue to the girls who participate in this plan, and those instructors who have attempted such group therapy have found satisfactory rewards.

These weight control group projects are being conducted in some high schools. Since causes of overweight do vary in the participating individuals, and because the supervisor is accepting responsibilities which do have some medical implications, a wise procedure to follow is to require that each person have a physical examination from her physician first. A letter outlining the objectives of the undertaking and the plan to be followed should be taken by her to her physician. His written consent for her to participate should be filed. Such a measure serves several purposes. The physician decides whether his patient really needs to lose weight; possible harm is being anticipated; the individual’s physician is giving approval; and if supplementary medical therapy is indicated, the benefits to the students will be more effective. If girl needs to see her physician at intervals, this must be done. Psychological support may be necessary. When a school system profits from having a school physician, he should be a consultant. 

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Category: School Health Practice