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Column originally published May 25, 2004

It Is Not Healthy To Be Too Skinny Or To Be Overweight Or Obese

Question: We have two lovely children. Our 14-year-old daughter is a healthy teenager. She is active and fit. But in the last six months, she is saying that she is fat and tries to lose weight. We have seen her skipping breakfast and sometimes even lunch. She would walk our dog for one to two hours each evening. I haven’t seen her throwing up after meals. Our younger son is the opposite. He is nine and he is overweight. In the last two years he is spending more time watching television and playing computer games than going outside. When he sits down, he always has a bag of chips or cookies. He has gained a lot of weight, and our doctor has warned us that if he continues, he is going to develop diabetes and other health problems. We are wondering what should we do? Our overweight son doesn’t want to diet, and our skinny daughter is trying to lose weight. If we encourage our son to lose weight, would we give the wrong message to our daughter? Please give us some advice.


Your family does have a serious dilemma. Your son is overweight and you want to help him to lose weight. On the other hand, you are worried that your daughter may develop a serious eating disorder.

Over my thirty years of medical practice, I have seen the worrisome trend of obesity creeping up in our society. This is not just a Canadian issue; rather, it is a worldwide problem affecting even developing countries like China. With economic development, there is increase in family income and reduction in the number of children per family. As a result, there is more disposable money for many families, and this is often spent on food. Without a doubt, more food means less malnutrition. However, excess food leads to obesity.

Over the last few decades, fast foods industry has blossomed and is present everywhere. Coffee shops and donut stores are selling high calorie snacks and desserts. At the same time, snack foods companies are marketing things that appeal to everybody’s taste buds. These foods contain large amounts of salt and MSG (monosodium glutamate), making them taste good and irresistible. Many restaurants also provide larger servings with very little extra cost. The end result is marked increase in calorie intake for everyone.

Compounding this problem is reduction in physical activity. The majority of Canadians live in cities and towns, and the main transportation is automobiles. Most children don’t walk to school anymore, they either go on school bus or get dropped off by their parents. Many schools have reduced physical education in their curriculum. Although some are involved in after school activities, many are just like your son, sitting in front of television or spending hours on computer games or chatting with friends on computers, tablets and smartphones. The end result is marked decrease in physical activity which can consume some of the calories. The extra calories are piled up in the body as fat.

I have seen many obese children over the years. It is a huge struggle for families to try to help these children. Most of the time, the problem doesn’t happen to one child, rather it is a family problem: one or both parents are also overweight. The calorie intake is greater than the body’s requirement, and frequently they lack exercise which is so important to maintain the physical health of the body.

What I always recommend is for the family to look at what they eat, and be honest with it. At the beginning, many families are defensive and deny overeating. However, they often forget to count the second or third plates and the desserts they eat, as well as the snack foods in between meals.

My first suggestion to these families is to record down everything that they eat, including the amount of each item, for three full days, and have a dietitian do a rough calorie count. One item that is missed easily is milk and juice. Milk has good supply of calcium, but excessive amount of milk can increase the calorie intake significantly. Drinking juice can be healthy, but it also carries a lot of calorie in the form of natural sugars. If a person is already overweight, it makes sense to reduce both milk and juice, but drink water instead.

I do not believe any kind of dieting is good for children. Research has clearly shown, at least in adults, that most diets don’t have lasting effect. Dieting will help people lose weight, sometimes very quickly. The weight that they lose is not only fat, but often muscle. But diets are very hard to stick to for very long. Many people end up gaining back the weight and more when they stop the diet. The recent fad of Atkins diet is more troubling. We really have no idea what is the long term effect of high protein on our body, especially children. Therefore, I do not recommend dieting for children.

What I recommend is sensible eating. If a child drinks lots of milk and juice, reduce them and drink more water instead. If your son eats a lot of carbohydrate like bread, potatoes (including chips and fries), pasta, or a lot of processed food, reduce the amount at each meal. You can increase vegetables and fruits that generally have less calories, and larger volume that can fill the stomach. I recommend significant reduction in snacking on processed foods in between meals. Munching on popcorn without added butter or salt is far more healthy than a bag of chips while watching movies. Fruits can be used as dessert instead of high calorie cakes and ice cream.

The other important aspect of weight reduction is increasing exercise. Physical activity does not always imply organized sports. Of course, sports like soccer, hockey, swimming, gymnastics, etc are excellent for children. However, not everyone is so athletically inclined. Even activities like walking, biking, skateboarding, and rollerblading are good for the body. Children playing hide-and-seek in the backyard is just as good as baseball or softball. The important thing is get them off their behind, get out of the house, and breathe in some fresh air.

In our northern climate, the challenge is to find activities for children in winter. The fact that many schools have cut back on physical education doesn’t help: it gives them the wrong idea that physical activity is not as important as academic success. Being active can help the mind to develop.

In many cities and towns, there are gym facilities for older teenagers and adults. Younger children need to be supervised by their parents. The cost of enrolling in these private gyms is often beyond the financial means of many families. However, school gyms often stay idle after school hours. If they can be used for children and families, especially during our long winter months when it is difficult to have outdoor activities, it will help our children to stay active and healthy. Without a doubt, there are logistical concerns for schools and administration, but the reward this brings to children, families, and communities can be enormous.

By increasing physical activity and reducing calorie intake sensibly, most of the overweight children in my practice are able to lose weight gradually over time. I believe this is a more healthy approach than losing weight quickly by dieting.

I should voice a word of caution here. If a person is extremely obese, it may be caused by a medical condition. This can only be determined by examination and investigation by a physician and the treatment is much more complicated than exercise and reducing calorie.

In your family’s situation, the danger is sending the wrong message to your daughter who is already trim and fit, while at the same time help your son to lose weight. It is a real problem in our society, where girls feel that they have to be like Barbie dolls to be attractive. Many girls (and sometimes boys) develop eating disorder because of this distorted body image. This is a real challenge. You should discuss with your daughter, may be with the help of your physician, that she is not overweight. She should not skip any meal, and she can eat healthy and sensibly with the rest of the family. She should continue regular exercise, and may be the whole family can walk together.

Sometimes it is necessary to seek help from professionals like psychologists, who have the training in talking to children and teenagers, especially in the area of eating disorder. As you already recognized, it is important to watch for more serious problems like vomiting after meals or purging themselves with laxatives. These are serious problems that require professional help.

Good luck.