A surprising answer to slimming down our kids

What if the real answer to the childhood obesity epidemic isn't just diet and exercise? Two research studies done years and an ocean apart suggest that three family routines -- setting limits on TV, having family meals together and getting the kids to bed on time – could reduce kids' risk for obesity by 40%, while food choices and exercise alone have proven less successful.

Could strengthening these routines at your house help prevent or reverse weight gain in your kids and teens?  Maybe.  There's enough evidence to give it a try. There's also plenty of evidence that just being told that we eat too much, eat the wrong things and don't exercise enough isn't working.

The problem: Having more information isn't the same as making healthy behavior changes at home. As a clinical health psychologist I have seen quite a few kids with medical conditions that require families to monitor what (and how much) they eat – and to balance that with exercise. These include children with Type I diabetes (non-obesity related) and children with food allergies and gastrointestinal problems.  Like families with an overweight or obese child, these families get lots of information on their child's condition -- then go home and try to sort it all out, determine what is most important, and get on with their lives.  It's a big, overwhelming job. Some succeed, some have difficulty, and they all struggle.

Too often, healthcare practitioners (and the media) throw more and more information at concerned parents, confusing facts with behavior change. My experience has been that information overload doesn't help.  Often patients and their families with the most information do the worst.  The information doesn't hurt them, it just gets laid on them every time they fail to progress.   So we wind up with very knowledgeable families who do not improve and are often frustrated in their efforts to try and change their lives.

This happens in families dealing with childhood overweight, too. One nutrition expert I know talked one day at great, complicated length on all the different fats in foods and insisted that mothers needed to know all this information to feed their children properly.  In general, getting kids to a healthy weight via more and more information about food and exercise produces only "minimal change", to quote a comprehensive review by the Endocrine Society in 2008.

What may work: Healthy family routines. Two studies show that routines make a difference.  In the United Kingdom, a long-running study of over 14,000 school children found in 2005 that 17 variables – including food and breast-feeding as babies – didn't seem connected with which kids became overweight. What was: The amount of sleep kids got each night, the amount of TV they watched, and whether their parents were obese.

In the US the Early Childhood Longitudinal Study of about 8000 children is getting similar results.  When researchers looked at the household routines of a group of 4-year-olds from the study, they found three variables that were related to obesity. Obesity rates were much lower in families that simply set an average 2-hour limit on TV and other 'screen time', had meals together at least five nights a week and got kids to bed early enough that they slept an average of 10 ½ hours per night (a healthy sleep number for 4-year-olds). Just 14% of kids whose families practiced all three routines were obese, compared to 24% of kids whose families didn't follow any of them.

To be sure, food and exercise are still important part. What the research is telling us is that without consistent healthy routines at home and warm supportive parents who can set limits as needed, that information on food and exercise is not going to help.  We need to do more than simply talk about food and diet.  Healthy routines are the keys to healthy development and healthy weight, not putting kids on treadmills or overanalyzing their food intake.

The message is clear, obesity is not a simple problem, it is both complex and a symptom of how we are raising our children and perhaps it is a symptom that we are not giving kids what they need.  They need good nutrition, warm supportive parents who can set limits and safe environments to expend energy.  Without all three, they cannot develop well.  The problem is not just our food supply and lack of exercise, it is how we are raising our children, and not understanding and giving them what they need.

W. Douglas Tynan, Ph.D. is the director for program development and implementation at Nemours Health & Prevention Services, an associate professor of pediatrics at Jefferson Medical College and a senior fellow in the Thomas Jefferson University School of Population Health.