Book review: Overweight: What Kids Say.

Overweight: What Kids Say. By Ro­bert A. Pretlow, MD. North Charles­ton, SC: eHealth International, Inc., 2nd edition, 2010. ISBN 1-450-534392. Paper, 322 pages. $12.82.

This book is a compilation of 10 years of commentary posted by overweight teens and preteens to an interactive website (www.weigh2rock.com) created by Dr Pretlow in 1999. The site provides information, support, and resources on healthy eating and activity for pre-teens, teens, and their families who are dealing with weight-management issues. The site gives users the opportunity to interact with peers through surveys, chat rooms, and message boards, and health professionals respond to questions posed in the Q&A section.

At publication, the website’s statistics included 134000 users with more than 166000 messages posted.

Despite the numbers involved, the insight gleaned from the messaging has been well organized into a revealing panorama of the life of an overweight child. The anonymity of the website allows for a raw, unfiltered view of their angst, attempts, failures, and successes with food and weight issues. Comments on teasing, bullying, weight loss camps, yo-yo dieting, parents, and health professionals are all part of the conversation. Healthy weight visitors to the site are blocked from posting, so that a child whose weight and height are in the healthy range cannot post claiming that they are overweight.

What does this offer to the health professional?
This book offers an unprecedented opportunity for health professionals to obtain insight and compassion for these children and their day-to-day reality. 

Shame, guilt, loneliness, self-hatred, and secrecy are pervasive themes imbedded in messages related to exercise, healthy eating, weight cycling, comfort eating, overriding satiety, motivation, lack of parental support, and negative health professional interaction. 

The results of the polls and the postings on this website reflect the deep psychological roots of weight and food issues for these children. This insight is invaluable in providing a road map for health professionals to respond with more ap­propriate, compassionate, and effective treatment modalities. 

Some statistics gleaned from site postings and surveys include:
• 45% of children say they have not talked to anyone about their weight, and they struggle alone.
• 68% of children indicated that they were too embarrassed to ask their health care provider for help with their weight.
• 74% said they would like to try losing weight on their own via a website.
• 62% said they would like a weight-loss program at their school. (This attempt was most successful in re­cruitment when it was termed a “Get Fit” class and not a weight-loss program.)

Some cautions
This book reflects an open-access, interactive website that is entirely focused on weight loss. As a result, the “success” stories are celebratory of the amount of the weight lost, regardless of the child’s age and the time frame involved, as seen in the following testimonials:

From age 14, female: “…I was 200 lbs but now I am 112 lbs! WOW. I feel great and you will too if you just try!”

From age 16, female: Start: height: 5'5", 165 lbs (BMI percentile: 95). Today: height: 5'6", 110 lbs (BMI percentile: 11). “At first I was like ‘oh my goodness I have to lose those 50 lbs’ and now I am looking for a way to lose 2 lbs. Good luck to everyone. It’s worth it!”

From age 11, female: Start: height: 4'7", 100 lbs (BMI percentile: 92). Today: height: 4'7", 72 lbs (BMI percentile: 33). “Now I have gotten down to 72 lbs and the calculator says I am close to being underweight! Not that I want to be underweight or anything. I can run, swim, rollerblade so good now. I might even be better than my friends. This website helped me during those hard months of trying to lose weight. If I can do it anyone can! Keep it up!”

Such posts are alarming because of the extreme weight loss and BMI change noted without reference to a time frame. Misinterpretation of this data could impact long-term weight-loss outcomes, creating the potential for eating disorders and relapse. 

Also of concern is that children as young as 9 years old can be found posting messages of desperation re­garding their food/weight issues. Since parents are often unaware of the child’s struggles, a child’s participation in an open forum airing thoughts and opinions requires some vigilance on the part of the health professional to en­sure the health and safety of the participant, in addition to the safeguards in place at the front end of registration to the site, and the availability of crisis prevention numbers for kids who feel suicidal.

Dr Pretlow supports the view that childhood obesity should be approach­ed as an addictive behavior—the de­pendency on comfort foods increases with BMI, eventually affecting brain function. Following this reasoning, a withdrawal period would certainly ensue when changes in lifestyle are implemented. Distraction, positive re­inforcement, improved coping skills, and addressing underlying stressors are recommended approaches to mitigate the withdrawal response.

As well as outlining Dr Pretlow’s premise for the etiology of childhood obesity, this book provides a forum for the voices of the children who are affected. We need to listen with compassion in order to provide the help that they are seeking. 
—Arlene Cristall, MSc, RD
Program Coordinator
Centre for Healthy Weights, BC
BC Children’s Hospital