For overweight youths, teasing at home often hurts the most

No one doubts that classmates can be cruel to their overweight peers. These days, though, with 9 million children nationwide considered heavy -- about 1 in 6 -- they stand out in the classroom far less than they once did. With safety in numbers, the stigma isn't what it used to be.

It's a different story at home. There, some parents and siblings deliver more judgment and hurt than anything dished out in the schoolyard, say professionals who work with overweight youngsters. Consider this recent mother's comments to her teenage daughter during a conversation with a reporter:

"Think about what we ate for dinner tonight, will you? Burgers, right? Why did you slobber yours with mayo? I ate half a bun. I used lettuce for the top half. Why can't you do that?!"

The speaker is a thin, attractive mother in her 40s. She is sitting with her daughter in the dimly lit family room of their home in a western suburb. At first, she agreed to allow their names to be used for this story, but the mother was unprepared for how painful the conversation might be. In the end, she asks that real names not be used. We'll call her Ella, her daughter, Dawn.

Dawn is a pretty 15-year-old who has struggled with her weight since her parents divorced when she was 9. At 5 feet, 165 pounds, she weighs about 35 pounds over a healthy weight. She lost 16 pounds last summer at Kingsmont, a camp in Amherst for youngsters who want to lose weight, but she gained some back. She plans to try again this summer.

During her mother's harangue, Dawn slumps in her chair. A tear rolls down her

face. Ella seems not to notice. This kind of berating has gone on for as long as Dawn can remember. "My weight is a nonissue for my classmates. They never tease me," she says. "It's my family. They're real judgmental, especially my mother and brother." There's a pause. "It eats me up inside," she says, almost in a whisper.

If anything, Ella's criticism of Dawn has increased since last month, when Tommy Thompson, US secretary for health and human services, identified obesity as a serious threat to health in America. "This `epidemic of obesity' stuff makes me crazy," Ella admits. "It makes me more worried than ever about her health." Not without reason. Her husband, Dawn's stepfather, was obese and died of a heart attack.

While no one can deny the importance of making the public aware of the dangers of obesity, it's important for parents not to overreact, use scare tactics, or impose strict, new diets, says Cleveland psychologist and Case University professor Sylvia Rimm. She is author of "Rescuing the Emotional Life of Overweight Children" (Rodale).

Pay attention instead to your family dynamics. That can be the single biggest factor both in a child's ability to gain control of weight and as a predictor of mental health. Research from Rimm and others shows that children who do not feel supported unconditionally at home are much more likely to have low self-esteem and poor interpersonal relationships, which can be both cause and effect of poor eating habits.

"Children are concrete thinkers, and weight loss is a slow process. When they don't see quick results and there's finger-pointing going on at home, they believe it," says Ingrid Hustrulid, a dietician at Children's Hospital whose private practice helps pediatricians identify children at risk for being overweight. She says it leads to hopelessness: " `No matter what I do, it doesn't matter.' So they stay inside and watch TV and play video games instead of going out to play."

Dawn thinks most parents, her mother included, don't realize the power of their words. "If the people who are supposed to love you most make you feel unwanted or uncomfortable, you lose your confidence to do just about anything, including make changes that help lose weight. It's because I love her so much that her words hurt so much," she says of her mom.

Ella can't seem to help herself. "I don't realize I've hurt her until 10 minutes after I've said something," she said.

Children who feel picked on in their families typically have parents who see the problem as the child's alone, says psychologist Myles Faith, a child obesity specialist at the University of Pennsylvania School of Medicine.

This is most common in families where:

One child is overweight, siblings are thin. These parents typically say it's not fair to deprive thin children of food they want. "That creates resentment in the overweight child and gives siblings unspoken permission to be cruel," says clinical psychologist Deborah Vineberg, who runs weight groups for adolescent girls and their parents at Massachusetts General Hospital Weight Center (www.mgh.harvard.edu/weightcenter). In addition, studies show that even if an overweight youngster is able to ignore teasing from peers, he tends to believe it from a sibling.

Dawn says, "My brother is the worst.
He calls me `fathead,' `tubby.' His current favorite is `lardo.' He can make me cry." "Fat" is the one word her brother and mother never use. "They know that's the danger word," she says. "It would kill me." One or two children and one parent are overweight. This can produce unhealthy alliances: Either the heavy child and parent form a tight bond, making fun and sabotaging the thin parent's efforts toward a healthier lifestyle, or the overweight parent is so hard on the heavy child that the thin parent feels the child is being deprived and undermines the effort, sometimes with special foods. Rimm sees this most often in families where a thin mother was overweight as a teen and wants to spare her daughter from going through what she did. Ella was the opposite: As a teen, she suffered severely from an eating disorder. Weight, she says, is always on her mind. Another teenager, a participant in one of Vineberg's groups who we'll call Amy, says her dad is cruel even though he is also overweight. "He polices me," she says. "He'll say, `What did you just put in your mouth?' "

When children live in two households. If one home has junk food and one doesn't, and especially if that parent says things like, "You deserve a break," a child gets mixed messages. Faith says, "He's left wondering, `Who really loves me?' " The best way to help a child of any age is not to isolate her with diets, exercise regimens, or weight monitoring but to change the family's lifestyle. "The whole family needs to adjust, even if no one else is overweight," says Faith.

That prevents the sense of isolation that can lead to a downward, emotional spiral. Besides, notes Vineberg, "What family member can't benefit from more healthy choices?"

Family members are most likely to buy into changes if you make them slowly, says University of North Dakota nutritionist Frances Berg, author of "underage & overweight" (Hatherleigh Press). "Tell siblings, `No matter who has a weight problem in this family, we all need to eat heathfully. We all need to be more active.' " Moderation is key. It's not that there's no ice cream, it's that you go from every night to twice a week, to special occasions.

Ditto for exercise. "For children, physical activity is much more important for weight loss than it is for adults," Berg says. If you introduce it gradually, as a fun, family activity, no one will see it as punishment.

At Amy's house, everyone eats the same healthy food at home, but only she is grilled about her exercise. "My sister can sit on the couch and watch five hours of TV and nobody cares. If I watch five minutes, my mother is all over me. `Did I work out today?' It's extremely annoying."

Those "extremely annoying" comments add up.

Recently, Dawn's room was a mess. "My mother told me, `Get up off your fat butt and burn some calories.' Why did she have to say it like that? Why couldn't she just say, `Clean up your room.'?"

Contact Barbara Meltz at meltz@globe.com.