Trying to help someone lose weight? Here’s what not to say

Healthy eating

Ever wanted to talk to your child, partner, or close friend about their weight and size?

Even if our heart is in the right place, it’s exactly what the experts say we should not do. Research has shown that overweight teens whose parents said that they should try “healthy eating” were more likely to engage in unhealthy weight-control methods (e.g., throwing up) than if parents talked about their teen’s size or weight. But other research has also found that girls who were told that they were fat at 10 years of age were more likely to have a BMI above 30 at age 19.

A 2015 study suggested that teenagers may not be aware of their own BMI and as a result not perceive a need to adopt healthy eating habits. But another 2015 study also showed that having accurate self-perceptions (about being overweight) does not necessarily equate to making healthy eating choices. In fact, labelling teenagers as overweight may in fact be counterproductive.

So what can we do instead? Apart from helping your child, partner, and/or close friend make healthy food choices by eating fruits and vegetables with them and cooking healthy meals with them, experts also advise against using food as a reward for good behaviour.

We suggest 8 useful tips which could help your loved one on the path to healthy eating:

1. Get more sleep. Studies show that lack of sleep is a major determining factor of later risk of being overweight. A 2014 study found that young children who slept less than the recommended duration for their age (e.g., less than 12 hours at 2 years or younger; less than 10 hours at 3 or 4 years of age; less than 9 hours at 5 to 7 years of age) were more likely to be overweight and to have more body fat at age 7 years. A separate 2014 study also found that infants who slept less than 10 hours a day at 16 months of age needed more feeds than their peers who slept 13 hours or more. And it’s doesn’t affect just children. Numerous studies link lack of sleep among adults to increased eating and weight gain, making good sleeping habits a priority.

2. Setting boundaries, warmth and affection matter. A 2014 study showed that children whose parents who set rules without engaging their children in dialogue about their rules and who don’t affirm their children with warmth and affection were at a higher risk of having a BMI above 30: Their risk of obesity was found as early as 2 years of age. A separate 2014 study in Australia found that overprotective maternal parenting during the earlier years (e.g., when children were 6 to 9 years of age) was linked to children having a higher BMI when they were 10 to 11 years of age. That’s why it’s important that your loved one should know that you care for them regardless of their shape and size. And these guidelines for what to say and what not to say apply not just to parents, but partners and friends.

3. Don’t talk about making changes. Instead, it’s more effective to get your loved ones involved in cooking healthy meals and visiting a local attraction or festival.

4. Don’t impose a diet on your child or partner or tell them what they cannot eat. Your good intentions will produce better outcomes if you participate in fun and enjoyable physical activities with them.

5. Don’t say “it’s good for you”. Studies with preschoolers show that a more effective way of getting young children to eat vegetables is to say nothing or to tell them that they’re “yummy”. (It helps of course if they really are yummy!)

6. Say “try this”. Telling your loved one what to eat is more effective than telling them what not to eat. Research finds that positive messages which start with “do” are better received than negative messages which are start with “don’t”.

7. Try and try again. A 2015 study found that children were more likely to eat fruits and vegetables if they were introduced to them on repeated occasions and if their parents also ate them with their children.

8. Start a gardening project. There is consistent evidence that children who participate in gardening projects are more likely to eat fruits and vegetables.

 

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Talking about change

Over a decade ago, we used to have a campaign in schools which aimed to help children with unhealthy BMIs reach a more desirable body mass index. It was of course a bad idea. For obvious reasons.

That was eventually replaced with a programme which promotes a healthy lifestyle to all children, not just those with undesirable BMIs. Although children who are overweight are still a target for bullies, at least schools aren’t their bit to add to the stigma of being overweight.

These were lessons not learnt, apparently. Because there was a Childhood Obesity campaign in another part of the world a few years ago, which had children talking about their experiences of being discriminated against for their weight. Yes, more airtime to the stigma of being fat.

And if it’s not obvious why these campaigns are counter-productive, there’s research to suggest that it is so. A 2013 study, which asked 1085 respondents to evaluate a number of existing health campaigns, found that the motivation to adopt healthy lifestyle changes and their confidence about doing so was not greater after viewing a stigmatizing campaign compared to a less stigmatizing campaign.

It also doesn’t help that the American Medical Association now considers obesity to be a disease. A recent study found that for people with a BMI higher than 30, this information made them less concerned about healthy eating and more likely to choose a higher-calorie snack, compared to others who were told that obesity is not a disease or given some other unrelated public health information. Giving obesity the disease label, appears to send home the message, “Don’t bother trying to manage your weight through healthy eating or physical activity”.

Given the fact that younger children have difficulties distinguishing children’s TV programming and advertisements, it’s a good thing that fast food advertising is now a thing of the past here. It will not be possible for ads with foods containing too much salt, sugar, and/or saturated fat to reach children aged 12 years and below (read about those guidelines here). Happy meals might have to turn into healthier meals in order to reach their target audience.

There are however other ways to tackle childhood obesity. Here’s advice from the experts for talking to children and adults:

1. Don’t talk about healthy eating
It seems like a good idea to help by talking about healthy eating than body size or weight. But research suggests the opposite. A 2013 study found that overweight teenagers whose parent(s) talked about healthy eating, were more likely to use unhealthy weight-control methods (e.g., throwing up) and to binge eat, than if their parent(s) had talked about their size or weight. In contrast, those whose parent talked about body size or weight, were likely to “diet”. Instead, it might be good to talk about what foods to eat, not healthy eating.

2. Affirm their feelings and provide emotional support
Having a one-time “You can eat more fruits and vegetables. And why don’t you exercise more?” conversation with someone you care about could instill in them a negative attitude about food and exercise. It could make them conscious about their body shape, size and/or weight. It’s crucial that your children know you love them regardless of their shape, size, and weight. Here’s a list of what to say and what not to say for parents.

And telling them that they’re fat (shock tactics) are likely to backfire. Results from a recent study demonstrate the self-fulfilling prophecy: Girls who were told they were fat when they were 10 years old, were at a much higher risk of having a BMI above 30 nine years later. So don’t threaten, judge, and nag. Ask your teenagers and close friends how you can help.

3. Start with small lifestyle changes
Rather than talk to children and teenagers about healthy eating habits, it’s easier to help them be healthy by walking the talk. Parents can feed their families more fruits and vegetables, and store fewer sugared drinks at home (more tips here). Fruits and veggies don’t need to be eaten plain or raw. There are many food ideas to make fun meals with fruits and veggies: try this website for more ideas. Preparing meals together is a great way to introduce healthy ingredients to loved ones. Getting your kids to try everything (at least once) isn’t easy. But it’s worth the effort.

4. Do it together with them
It’s easier to help children and loved ones adopt healthy eating habits and incorporate physical activity into their regular routine if it’s a collaborative decision. This guide for parents advocates making changes as a family. It’s easier to persuade someone to eat healthy and be active if you’re also doing it together with them. Try shopping together for healthy food options. Make the visit to the Bird Park or River Safari a family day outing (it’s more effective than if you sell it to them as fun rather than a chance to exercise).

5. Assess their readiness for change
Making healthy lifestyle changes isn’t as easy as it sounds. Being ready for change can make things easier. But not everyone is equipped for conversations about the motivation for change and how to make those changes. But there are tools to equip health professionals for such conversations. One such tool is motivational interviewing — a “collaborative conversation for strengthening a person’s own motivation and commitment to change“. And in fact, there’s a free app for practicing such conversations. It’s called Change Talk.

There’s no sugar-coating it

Food is a national pastime.

We all scream for ice cream!

CNN Travel names chicken rice, char kway teow, wantan mee, chai tow kuay, and chill crab as the top 5 foods locals can’t live without (surprisingly, katong laksa didn’t make it to the top 5; it’s listed at #14). According to a 2012 Mastercard survey, locals spend as much as $262 in US dollars dining out each month. There are more local food blogs than supermarkets and more than just a few food apps (e.g., Hungrygowhere, BurpplePicky). With almost every other person a foodie, that’s quite a lot for a place less than half the size of Greater London and nearly double in its population density.

It’s not the problem of junk food here. Rather, if the National Nutrition Survey in 2010 is anything to go by, nearly half the nation dines out at their local friendly hawker centre more than four times a week (up from 40% in 2004: National Nutrition Survey by HPB). In addition to the problem of too much salt from eating out, which increases the risk of high blood pressure and vascular illness, the most recent data reveal a disturbing trend of overeating. As many as 6 in 10 locals consume too many calories, leaving them vulnerable to the risk of obesity and diabetes, and heart disease.

But there’s a bit more to the story than that. In reality, stress has a bit of a starring role, while sugar plays a vital supporting role.

We typically respond to a stressful situation at work with cortisol (since we can neither fight our co-workers nor flee from our emails, much as we try to sometimes), which encourages our appetite and desire for high energy foods — simple carbohydrates (find the science explained herehere and here). We often think of these as just sugar and honey. But in reality, they often wear clever disguises from white rice, breads, cake, muffins, cupcakes, doughnuts, and biscuits, to hot and cold desserts. And an overconsumption of these lovely, fragrant, heart-warming energy-dense foods increases the risk of impaired insulin function (read this to understand the link between overeating and diabetes).

And while prolonged exposure to stress leads to chronic inflammation, it should be recognized that sugar also contributes to inflammation. In fact, it is sugar in all its various nefarious disguises which is responsible for populating the blood stream with small, dense LDL cholesterol particles. And it’s these small, dense LDL particles which raise our risk of coronary heart disease (read this for a full review of the factors for cardiovascular disease).

So yes, stress and sugar are the bad guys (here’s an earlier blog entry on thwarting the ill intentions of sugar). But there is a simple solution. It’s called exercise.

Why we eat what we eat

Recent reports about the increasing number of people with diabetes mellitus in Singapore and who need kidney dialysis (and here’s the science behind it) are a timely reminder about the evils of simple carbohydrates. Like white bread and white rice.

Saturated fat used to be the bad guy. Now we point fingers at sugar. But refined sugar (white or brown, does it matter? it’s still sugar) is not entirely to blame. Rather, simple carbohydrates are the reason why obesity is on the rise. They’re the real villains for specific individuals, such as people who have diabetes (here’s why).

Simple carbs are the bad guy?

But knowing that fries, chips, crisps, cinnamon raisin buns swirled with icing, cupcakes, and chocolate croissants are not what you should eat regularly is one thing. Actually not eating them is quite another.

One would think that if people told you that you were large (for want of a better label: see this article for ideas), you would stop eating things responsible for your size. But in fact, it does the opposite (this Dr Oz episode is a good illustration). It has unintended consequences: We’re motivated to eat more of those sorts of things people keep telling us not to eat (presumably for our own good).

Emotional eating is the tendency for us to overeat when we’re faced with negative emotions. It’s when we eat to make ourselves feel better. Research indicates that we are inclined to eat when we feel sad. But less so when we experience positive emotions such as when we’re being included as part of a social group. Eating is also often a strategy for dealing with stress.

It could be worse. We could have non-hostile acquaintances who sabotage our good intentions not to eat things we’re not allowed to have and who put us down for making an effort (read these articles on how to questionidentify, and fix toxic friendships). So apart from putting to good use your assertive communication skills (i.e., saying no), it can be useful to have these strategies in your pocket:

1. Keep a food diary
Tracking what you eat and how you felt when you ate it, can make you aware of whether you’re guilty of emotional eating. Instead of a pen-and-paper diary, take pictures of your meals and snacks for a blog or daily facebook post to save time and handbag (or trouser pocket) space.

2. Cook your own meals
Research indicates that doing our own cooking encourages healthy dietary habits. Make a batch on the weekend and bring a portion for lunch. Or bring the constituents of a sandwich, assemble it at the office, and stick it in the toaster for a few minutes.

3. Get your RDA of fruits and veggies
Stash crunchy fruits like jambu, guava, and apples on your desk. Snack on Japanese rice crackers instead of biscuits, and stock your desk with only a few at a time. Keep a facebook diary of healthy snacks and meals to inspire others around you.

4. Make instant oats in a cup
Irish and steel-cut oats retain the whole grain benefits of rolled oats but provide a time-saving convenient snack, as long as your office pantry has a microwave. Add honey, dried cranberries, flax seeds, almonds, and normal cornflakes for crunchy texture.

5. Drink water
Buy disposable tea filters from Daiso and make your own tea bags from loose tea. Keep a stack nearby at work so you can add a tea bag to hot water, if you don’t like drinking plain water. It’s a quick fix for the “itchy mouth” syndrome. Get into the habit of saying “o sosong” or homemade barley at the coffee shop. Soon, you can order unsugared hot drinks on autopilot.

6. Sharing is caring
Share your dessert and cake with others, instead of having the whole thing to yourself. Or bring your tupperware so you can keep half of it for another day. Birthday at the office and leftover cake is calling out your name? Box it up and offer it to a colleague with many little ones to feed at home or offer it to another department!

Don’t just stand there gawking at the cake (and eat it). Do something about it!

Why exercise works

We know the health benefits of physical activity. Better BMI, lower levels of LDL and higher levels of HDL, improved blood pressure and heart rate, more efficient cardio functioning, lower risk of cardiovascular diseases and diabetes. In addition, there are psychological benefits from exercising. It’s not only responsible for positive outcomes such as lower levels of stress and better life satisfaction in the general population, it’s also been shown to be effective in helping to improve psychological mood and mental wellbeing among those with depression (Ströhle, [2009] offers a comprehensive literature review on the subject).

And we know the health benefits of eating healthy. Health magazines and newspaper articles extol the virtues of making healthier eating choices, while there’s plenty of research evidence that increasing one’s daily intake of multigrains and/or greens plays a protective role against cancer, cardiovascular diseases, and obesity.

But knowing and doing are two different things. Perhaps it might be helpful to understand why exercise and healthy eating achieves these things. For one thing, it appears that exercise helps the body process fat more efficiently. A recent news article, “Altered states” (Economist, July 2013) highlights the finding that fats cells of people who exercise behave differently from those of people who exercise rarely (Ronn et al., 2013). For another, increased intake of greens appears to increase gut bacteria associated with healthy metabolism and decrease gut bacteria associated with obesity. The recent news article, “Wider understanding” (Economist, September 2014) explains that a high glycaemic diet impairs insulin functioning, unlike a low glycaemic diet (driven by the intake of multigrains) which in turn is protective against obesity.

But knowing the health benefits of exercise and healthy eating is half the equation: you still have to get out there and do it!