Weight Management for Children with CAH

by Michelle May, MD

Hot from the headlines: Obesity has reached epidemic proportions in our society, fast approaching smoking as the leading cause of preventable disease and death. Although this is a frightening statement, obesity can be prevented.

Prevention of obesity and the development of lifetime healthy eating habits begins in childhood. Currently, 15 percent of children and adolescents are overweight or obese, putting them at risk for high cholesterol, high blood pressure, and type 2 diabetes. They may also face social stigmatization, have low self-esteem, and face an increased chance of adult obesity.

Children with CAH are particularly at risk for weight problems due to the body’s reaction to glucocorticoid therapy. Some children complain of increased appetite with medication increases, and oversuppression can cause excess weight gain. Even once the oversuppression is eliminated, excess weight may still continue to be a problem.

So what can you do? Consult your child’s endocrinologist and primary care physician to discuss whether your child is significantly overweight. Then, determine if there are medical issues contributing to their weight problems (such as oversuppression), or if their weight is causing any medical problems. Then together, you can determine the best approach for helping your child reach a healthier weight.

Many overweight children do not actually need to lose weight, but instead, can maintain their weight while they “grow into it.” Even for extremely overweight children, weight loss should be gradual. Since many overweight children are still growing, their diet must be nutritious and their exercise program should be safe and enjoyable.

The strategies below are important for both the prevention and treatment of childhood weight problems:

Build Healthy Attitudes

Demonstrate your unconditional love for your child. Children—especially overweight children—need support, acceptance, and encouragement from their parents.

• Build self-esteem by focusing on all of your child’s positive qualities, unique talents, and individuality. By developing interests and skills that increase their success and pleasure, they will be less likely to turn to food for fulfillment.
• Help your child develop good communication skills, encourage them to express their feelings, and teach them effective coping skills to decrease the chance that food will serve that purpose.
• Emphasize the importance of good health, not ideal weight.
• Never tease or criticize a child or adolescent about their weight. Such comments are hurtful and can stick with a person for a lifetime.
• Be a positive role model. When your child observes you enjoying healthful foods and physical activity, they are more likely to do the same.

Develop Healthy Eating Habits

• Children have the ability to regulate their caloric intake to meet their needs. Respect these internal cues of hunger and satisfaction.
• Do not force children to clean their plates or bribe them with dessert for finishing their meal.
• Never use food as a reward. Reward desired behavior with praise, extra attention, and privileges.
• Do not comfort your child with food.
• Do not impose stringent food rules, since this may lead to rebellious eating when the child is away from parental control.
• Don’t say or imply that some foods are “good” while others are “bad.” Instead, teach children that some foods are healthier than others. This will help them learn to balance eating for health with eating for pleasure.
• Involve children in shopping, meal planning, and preparation. This is a great opportunity to teach them about nutrition—and they will be more likely to try new foods if they helped make them!
• Since children (and adults!) have a natural preference for sweet and high fat foods, it’s reasonable to limit the amount of sugary and fatty foods that are readily available to encourage intake of more nutrient dense foods.
• Provide a variety of delicious healthy choices for snacks and mealtimes. Suggestions include fresh or dried fruits, vegetables with tasty low fat dips, pretzels, reduced fat cheese or peanut butter and crackers, yogurt, fruit smoothies, whole fruit ice pops, granola bars, turkey roll-ups, or snack mixes made of cereal, dried fruit, and nuts.
• A healthy breakfast is a great way to start the day and is important for achieving and maintaining a healthy weight.
• Encourage children to drink water and fat free or low fat milk instead of sugary sodas, fruit drinks, and sports drinks.
• Promote a high fiber diet by giving your child whole wheat breads and pastas, brown rice, and five servings of fruits and vegetables daily. They will prefer these types of foods if that is what they are used to.
• Perhaps most importantly, sit down and eat together as a family. Mealtimes should be a pleasant time to reconnect with one another.

Enjoy an Active Lifestyle

• Help your child build a lifetime exercise habit by making consistent physical activity a high priority in your family.
• For children that have been relatively inactive, an exercise program should be initiated very gradually to avoid injury and discouragement.
• Encourage active play like biking, swimming, and playing ball.
• Participation in individual and team sports can be a great way to build coordination, athletic skills, and self-confidence.
• Reduce the amount of time your family spends in sedentary activities like TV and video games. Instead, plan fun family activities that provide everyone with exercise and enjoyment.

While management of weight problems in childhood can be difficult, the benefits can last a lifetime!

Michelle May, M.D. is a board-certified Family Physician in Phoenix and developed the Changing Weighs Weight Management Program. She speaks widely on the topic of weight management without dieting as explored in her book “Am I Hungry?” To learn more, visit her website.