What to do if my child is overweight? by Mirna Sabbagh, Adult and Child Nutritionist in Dubai

Mirna Sabbagh a dietitian, nutritionist, and lactation consultant sees patients physically in Dubai, and also does online consultations for weight loss for adults and children, pick eating and  other services. In addition, she also has several digital courses: breastfeeding course, starting solids 6-12 months course, child nutrition for all children including picky eaters, and also a weight loss course for adults that you can sign up for from the comfort of your home.

Mirna is an adult and child nutritionist who sees children from birth until the elderly years. She has helped thousands of children with their weight loss journeys. Below Mirna explains her approach with children and weight loss and you will also find below a testimonial by a 9 year old client who has lost 12 kilos with Mirna.

If you would like to listen to a podcast episode, please click this link "What to do and not do when you find out your child is overweight?"

 

Mirna, as a nutritionist and dietitian who sees adults and children, can you tell us how do I know if my child's weight is normal weight or healthy weight?

When it comes down to children, similarly to adults, we need to check their weight in comparison to their height or their BMI.

I will discuss below the cases for children above the age of 2. For children above the age of 2, we need to get the BMI, and then plot it according to their age. This is an additional step to how we do the BMI for adults.

It's very important to note that most pediatric clinics will unfortunately forget to plot the BMI for the child's age. The easiest way to calculate the BMI for age and to know if your child's weight is healthy, overweight, underweight or obese. Is to plug in their data into there CDC calculator.

Mirna, as a nutritionist for children and adults, should the parents be as concerned if their child is overweight as if they were an adult? So what if the child's weight is overweight? Or obese? Don't they just lose the excess weight over time as they grow taller?

Unfortunately, it is a misconception that most kids will lose the excess body weight as they get taller. According to Harvard, Research shows us that overweight children become overweight adults. When a child is consistently taking in higher calories than their body needs, they will continue to do so unless they is intervention during this period.

Mirna, okay, but do you really think a child being overweight is unhealthy as an adult being overweight? We do not see children having heart disease or hypertension or Diabetes as adults?

Unfortunately, I wish this is true. Childhood obesity has risen dramatically in recent years and according to WHO, it is associated directly with premature onset of diseases (early onset), such as diabetes, and heart disease.

I will tell you that in my practice in Dubai the majority of overweight kids had high cholesterol and pre-diabetes blood results and there are MANY kids who suffer from diabetes today. A statistic we never even compared to before. According to The Who, 

High blood pressure, insulin resistance and dyslipidaemia form the key elements of the metabolic syndrome and are increasingly being observed in children (2).

Heart disease or atherosclerosis which is the hardening of the arteries from fat plaques takes time.  This is why we see it in the elderly more. If the body is taking in excess carbohydrates and fats, they will be converted to fat deposits. hose fat deposits over time also toss in fatty acids into the blood stream. So, imagine those fatty acids being tossed into the vessels starting the age of 5 instead of starting at 35. How long before those fatty acids could close up a whole artery?

The narrowing of the arteries due to fatty acids is what causes high cholesterol, hypertension, and strokes.

Similiarly, a body that is fatigued with excess body fat and the constant removal of sugar from the blood stream due to overeating, will eventually wear out. This is why the pancreas of overweight children and adults weakens and stops being able to respond to food coming in (particularly glucose) causing high blood sugar in the blood, insulin resistance and later on, diabetes. 

Childhood obesity is dangerous and should be treated as soon as the parent is aware.

Alright Mirna. It's dangerous. What should a parent of an overweight child do? Ask them to do more physical activity? Isn't this enough

Unfortunately, most parents think that it is enough to ask the child to exercise. They will tell them "You don't move"."Move more"

Unfortunately, exercising 90% of the time does not outweigh the caloric intake of the child. Therefor, the child starts exercising more, way above the average and ends up feeling very frustrated that they did not lose weight and they lose trust in themselves and their parents ability to understand what they need.

Many parents will often sign the child up with a personal trainer and the trainer will suggest strict diets such as eliminating carbohydrates. 

Alright Mirna, then for an overweight child, we should remove carbohydrates from their diet, or put them on a Keto diet right?

Absolutely not. A growing child or teenager is very sensitive to dietary changes. Eliminating carbohydrates can affect their growth, mental capacity, and also may decrease their metabolism.

A growing child needs more calories than adults many times and definitely more carbohydrates. Also a diet that contains now carbohydrates, is hard to stick to. The child often starts sneaking desert or sugar behind his parents back. In addition, a very low carbohydrate diet causes yoyo dieting leaving the child very frustrated with the ups and downs of weight

Ok Mirna, now what? What should I do as a parent if my child is overweight?

Well, what you should do as a parent is understand that there are no quick or easy solutions. Unlearning eating patterns takes time. In addition, even a very well informed parent or a health coach or fitness enthusiast or even personal trainer is not trained to know how to handle childhood obesity. The same way a dietitian can not do what a personal trainer can do or what you do.

In addition, children often need a third party to support them through the weight loss journey. Simply having the pressure on the parent and child causes family tension and also long term psychological damage that may take years to fix, if it's fixed. I have met hundreds of adult patient in my practice in Dubai who are suffering body image issues from their childhood and parents.

What I have learned over the many years as a nutritionist for adults and children in my practice in Dubai, is that parents think they have no role.

Don't get me wrong, you have a HUGE role. Actually the success of the child's weight loss journey can not exist without the parent's support. The parent should:

1. Support the child to be active

2. Cook healthy meals

3. Encourage the child and support him

4. Acknowledge what can be improved in the home environment or with food choices on weekends so it can be changed

but most importantly, they should look for professional help. 

Is it possible that my child will not lose weight with a child nutritionist because they are genetically built like this?

Unless the child has a hormonal disorder, most children will lose weight with the proper enthusiasm and information. There is nothing called a child who won't lose weight. In some cases, the child may not NEED to lose weight but may need to maintain their weight over the next few months until the child grows taller and then their weight for height becomes appropriate. 

This will depend on how overweight the child is, the age, and recommendation of the dietitian.

Do I need to do blood tests for my overweight child?

In my experience in the past 4 years as a dietitian, nutritionist, seeing adults and children I have never asked for blood tests for a child to help with treatment. We may do them to understand the child's current health risk such as cholesterol and sugar levels. However, we do not need to do it for weight loss or treatment.

As an adult and child nutritionist, what would you do for my child?

Well first, we need to do a full assessment for the child. Most parents think their children do not eat "much". In some instances the portion is not big, but the type of food is energy dense. So we do an assesment and in many situations we are able to pinpoint right away the changes that need to be made.

Many times the changes are very small and other times we need a much longer intervention to correct the behaviors. It usually takes us 3-6 months of consultations.

The most important element of the consultations is trust, acceptance to change, and rapport between the child and myself.

At each consultation I provide a presentation to explain the nutrition concepts, we agree on changes to be made, and we set up a follow up. At the follow up we check how the child is doing and then do the necessary adjustments for the next visit.

Most of the time, the parents are happy, the child is happy, and I am super happy.

When are some situations when you did not succeed with an overweight child?

Many times the child's weight is easy to manage but other times it is difficult such as:

1. If the parents are overweight as well and overall we need a full family intervention and not a one person intervention. Many times families sign up together. However it may occur that the father or the mother are overweight and do NOT wish to make changes, and they are whom the child looks up to. If the parent continues to order unhealthy food and junk then it becomes much more difficult for the child to say no.

2. If there are parental difficulties at home. So, if the parents are too pushy, or the child is using food as a way to bother to get back at the parents. These cases may need additional support such as family therapy.

 3. Sometimes a child is not fully ready for big changes. We try for a few weeks and if it doesn't work we take a break and try again.

My success rate has been 90% and I am very proud of the children and their parents.

What do you believe is the reason behind your success?

I am naturally empathetic, I am a mother myself, and I was overweight as well. I know for a fact I do not want anyone talking to my child in a demeaning way, I will not tolerate it. I also know, being overweight is a sensitive topic and should be treated sensitively, and finally, my approach is about having fun and learning together. It's not a fear and shame game that I have felt when I used to go to dietitians.

What people have said about Mirna.

We as a family have a great and very fruitful experience with the adult and child nutritionist Mirna Sabbagh.
Achieving health and fitness targets have always been a struggle over years and we tried almost everything but couldn't see any results. This frustration adds further complication(s) to anxiety level and stress was always at the peak.
Had a really lucky day when we consulted child nutritionist Mirna Sabbagh for my child and spouse obesity concerns and thanks to Ms. Mirna for accepting the challenge of our family health and fitness project.
It's almost 2.5 months and with the guidance and advise of Mirna Sabbagh, all family members have reduced at least 7%-10% of body weight and moving fast from being obese down to normal, In'Sha'ALLAH.

SOHAIL ASIF KHAN

 

nawal lazreq

4 months ago
With the outstanding support of Dr Mirna Sabbagh my nine year old twin daughters have adopted healthy eating habits in no time and are so happy and proud about it ! Dr Mirna have managed to explain to them the power of balance when it comes to food and how we can loose weight and still enjoy birthday cakes and play dates with friends ! The monthly visits are a blast as they get encouragement and motivational discussions but also talk about their experience.
I was informed by the school that my son is overweight. I looked for the best child nutritionist in Dubai and found Mirna's profile. I was pessimistic at first, but she built a great relationship with my son and he started to understand why he is doing what he is doing. Since then we have been going monthly for 9 months and he has lost more than 15 kilos. Mirna is by far the person you want to go for if you're looking for a child nutritionist in Dubai.
Rami Abass