Finding a Balance: Q&A with Stewart Trost

Terra: Sometimes anti-obesity programs are viewed as placing emphasis on children’s weight rather than on their health.

Stewart Trost: Yes, that’s true. Some programs have tried sending home BMI (body mass index) report cards to parents. They’ve had a lot of push-back from parents saying, “You’re telling me my child’s fat.” It’s difficult, because on the one hand we’re trying not to erode self-esteem. We know that overweight and obese kids have lower self-esteem. They get picked last by schoolmates, and later in life, they’re actually less successful making money. They get all sorts of discrimination. Our challenge is how to frame the issue to say, “We believe you have a health problem” without implying, “You’re a bad person.”

Terra: So how do you avoid making kids and parents feel bad while still getting across the message?

Trost: Unfortunately, we tend to err on the side of maintaining the person’s positive self-image. By doing that, we’re failing to reduce their risk for debilitating diseases. We’ve got a large increase in the prevalence of children with Type 2 diabetes – which used to be called adult-onset diabetes, by the way. And the incidence is disproportionate among Hispanic, American Indian and African American kids.

Terra: When encouraging kids to achieve a healthy weight, do we also risk pushing them toward eating disorders?

Trost: We always fight the “you’re going to cause eating disorders” push-back whenever we go into schools to do a program. There’s a real need to avoid sending the wrong message. Teenage girls are already bombarded with unrealistic messages about body image in the media. So we as parents, educators and health-care providers often just bite our lip and allow them to continue on at an unhealthy weight. The research literature shows that there’s a huge amount of health benefit to a fairly modest weight loss. We’re not trying to create Cosmopolitan cover girls-which unfortunately are Photoshopped to look even skinnier. We’re not focused on weight. Our work is always focused on the behaviors. We’re trying to promote healthier choices for food and more activity.