The Language of Lifestyle Choice

A survey indicates that doctors don't know how to talk to kids and parents about obesity. What can fitness professionals do?

By Joy Keller

How do you tell children and teens that they are overweight or obese? This question is receiving new attention in light of the California Health Interview Survey's recent results. The statewide review found that of 240 physicians, more than 90% admitted they needed to learn more about skills and strategies for communicating with kids and parents about weight issues.

IDEA member Monte Ladner, MD, is a "physician turned personal trainer" who made his career move after repeated frustrations with trying to treat patients he believed suffered primarily from lack of exercise, poor diet and ineffective stress management. He says he is not surprised by the survey findings and believes they signal fitness professionals to fill a need. "Obesity is a complex condition with multiple contributing factors," he says. "However, I think most authorities agree that the biggest issue is one of lifestyle choices. Frankly, many physicians are unaware of the true impact of lifestyle on health outcomes. They have not embraced the notion that food and exercise are real-and powerful-medicine."

Ladner believes that doctors may also have psychological reasons for not speaking up. "They may fear that the family will perceive the message as casting blame," he says. "Doctors fear further stigmatizing children who already have a negative selfimage." Ladner goes on to say that even if a doctor is willing to practice a little wellness coaching, people typically don't make office visits often enough for the message to really sink in. This is where fitness professionals can make inroads.

The Right Words

Fitness professionals may be in a much better position to offer health advice to overweight and obese children and teens, but it's still a touchy subject. Jim Gavin, PhD, professor of applied human sciences and graduate program director at Concordia University in Montreal, says a delicate approach is best. "Obese children stand a good chance of having obese parents, so sensitivity is of the essence," he says. "I think our current politically correct language sometimes goes too far by obscuring the message. Yes, it's wrong to call a kid `fat,' but obesity is a relatively sanitized descriptive term that is used throughout the medical literature. I don't think the issue is [about] avoiding the term obese, but rather [about] how you engage in a dialogue with parents to determine how they perceive matters, how well informed they are and where they stand in terms of commitment to action. Clearly, in dealing with a child, it's a family matter, and the fitness professional needs to consider the client to be the family, rather than the child alone."

IDEA member Karen Jashinsky is the founder and chief executive officer of 02 MAX, a fitness concept exclusively for teens, based in Los Angeles. She agrees that working with a child is a family matter, but she also thinks it's important to relate to the child or teen as an individual and in a way that is motivating and uplifting. "You have to first build trust," she says. "If [kids] don't trust you and feel comfortable, it is going to be a tough battle. They need to feel that you are on their side and you are working for them and with them, not with the parent or for the parent."

The commitment to change varies, however, depending on the context. "Clearly, when parents bring their child to you, getting their personal involvement is easier," says Gavin. "If it is you who brings the `bad news' to the parents, be prepared to meet resistance. I think it's reasonable to ask parents whether they are open to having a conversation about their child's physical status. If they are, and if you present clear indicators of the child's obesity, your best tactic after a brief presentation is to ask, `Does this raise any concerns for you?' If they say yes, I would ask what their concerns were, rather than launch into an informational piece about obesity."

Ladner, who offers a free fitness podcast (www.fitness rocks.org), sees the communication chasm as something that fitness professionals can help bridge. "The ideal scenario is for the medical community and the fitness community to come together and solve this problem," he says. "If physicians and personal trainers worked together to create community programs that promote healthy eating and exercise, I think we could turn the obesity epidemic around."

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