Wednesday, June 9, 2010

A Snapshot Of Sad

A few weeks back, both of my girls had late-afternoon soccer practices and, since my wife was an excellent soccer player in her day, she welcomed the opportunity to go with both of them to their practices. Afterwards, their "girls-only" plans were to continue, including pursuits of some dinner, some ice cream and a little shopping. Of course.

Since Cole had his own soccer practice after school and was off from baseball for the night, this also afforded us the opportunity to have our own bonding time. After talking about it, I gave him the option of picking out a restaurant where he and I could grab a bite before going to a local golf driving range and hitting a bucket of balls.

"Should we go to Hoss's or Bob Evan's, Dad?" he asked, a big smile spreading across his face. In our family, it is a running joke about our kids always picking either Bob Evans or Hoss's to eat. Since I don't eat greasy breakfast food often, Bob Evans is my guaranteed ticket for getting an upset stomach. Worth it, though, since I can never say "no" to their big breakfast meal for dinner. Hoss's, on the other hand, is a buffet that is famous for its unlimited salad bar, which includes its choice of four soups (I'm a soup guy here) and, most importantly, a huge dessert line, complete with their own self-serving soft ice cream machine. Twists included. An obvious plus for any kid, probably.

Cole hmm'd and haa'd for a few minutes before deciding. "Hoss's it is, then," he said, adding, "unless you would rather have Bob Evans, Dad." Nope, I assured him, any decision he made would be a good one.

So off we went to Hoss's. Little did I know, though, that this visit would open up an opportunity to talk to Cole about a serious issue.

After driving the ten minutes, we arrived at Hoss's and parked our car in the lot. We hurried to the entrance, eager to dive into the salads, the soups, and the desserts.

We opened the outside double doors to enter the welcoming foyer of the restaurant, only to be greeted by three young kids creating havoc while arguing over the gumball machines. The youngest, about five or so, was on his knees trying to wedge his hand up into the exit slot of one machine. The middle child was at another machine, fumbling to put some coins in and turn the handle. The oldest child, a girl, probably around Cole's age of ten or eleven, stood in front of the second set of entrance doors, blocking our way. She was waiting to step up to the machine the middle child was at. There were no adults around.

Strikingly, and sadly, all three kids were very obese. Most remarkable, though, was the oldest child, the girl, who was around Cole's age. Easily, she must have weighed over two-hundred pounds. She had light brown hair, straight, cut in a bob, which seemed to accentuate her full cheeks and chin. She wore a fashionable short-sleeve t-shirt with a graphic logo on front. Unfortunately, though, it was several sizes too small, revealing her protruding belly from below. Her arms and legs seemed inflated and over-sized, poking out of her summer clothes. She wore thin flip-flops that did little to support her weight or fallen arches. As I took her in, she continued to block the doorway while trying to tug her middle brother away from the gumball machine so she could access it.

Cole looked up at me as if to ask what to do. I winked at him, willing to patiently wait out the arguing.

After thirty seconds or so, the other door that led to the welcoming foyer, an exit door from the inside cashier, opened up and a very obese woman in a flowing, floral-print dress walked out. She was accompanied by an equally obese elderly woman. I assumed it was the children's mother and grandmother.

The mother yelled at her kids. "Hey, you three," she said with a sharp, grating voice, "move and get out of the way. Can't you see you are blocking the door for these people." She lifted up her arm and waved her finger at her kids, who looked up to finally notice us waiting. "It's quite alright, maam," I assured her, "we are in no hurry." She gave me a brief smile. "I don't know where their manners are these days."

The girl my son's age moved to the right of our entrance door and we were able to continue on our way. I noticed my son smile at the girl as we passed. "Have a nice night," I added to the family.

After sitting down and grabbing our plates of food, I decided to question Cole about what we just saw. "Cole," I said, "what did you think of those kids at the gumball machines?"

"What do you mean, Dad?" he asked, pausing with his spoonful of chicken noodle soup in mid-air. "You mean how crazy they were trying to get the gumballs?"

"Yes," I said, "and..." He interrupted me. "And," he continued, "how big they were?" I winced a little, although I was glad he didn't use the other "f" word.

"Yes, that too." I paused to let him talk. "Well," he said, "I think they were acting crazy because their mother wasn't with them. They straightened right up, though, when she came out." He took his spoonful of soup to his mouth and swallowed it before continuing. "And they probably eat too much candy and soda or else don't exercise enough, I guess. Maybe they watch too much TV or play a lot of video games."

He was probably right. "But Cole, why do you think they eat too much candy? Because they are sad? Or bored? Or just like it?"

"Probably bored and they like it, Dad," he said, "but do people really eat because they are sad?" I assured him that they do, sometimes. "Cole, what if she (now focusing on the girl his age to make it personal) doesn't have a father in her life? Or maybe she has a father that yells at her all the time? Or what if the kids at school are mean to her? Maybe she eats candy to feel better about all of it."

"But where would she get all that candy, Dad, or the money to buy it? Do you think her mom buys it for her?" He was thinking hard now, placing his spoon on the table. Again, he hit on something big, as I thought back again to the mother and grandmother as they walked out of the exit door.

"I'm not sure," I told him, trying to lighten it up, "maybe, though, she saves all her Halloween candy through the year like you do!" We both laughed, thinking back to this past Halloween when Cole set a new house-record, bringing in over seven pounds of candy (yes, now the kids weigh it, not count it, it seems).

"Cole," I added, "do you have any classmates like this girl?" He nodded no, continuing to eat his soup. "But if you did," I continued, "you would be nice to her, right? Give her a smile? Say "hello" as you passed her in the hallway?"

"Of course, Dad," he said, not even pausing, as I remembered him smiling at this girl as we walked through the entrance way, "why wouldn't I?"

And that's where our conversation ended about this topic. My son smiling, and me looking at him with some major pride in my eyes. Although he had noticed the children, he didn't judge them or seem affected by them.

After this experience, I did a little research on childhood obesity. The most surprising thing I learned was that I overestimated the number of children who are obese, by definition, because of medical or genetic reasons. It seems that the majority of childhood obesity cases are due to social causes, a reflection of poor choices from the adult-figures in their lives. Poor exercise habits, poor dietary choices, poor discretion of computer and TV use, and the poor decision to use food as a reward or comfort can add up to some very serious issues for children. Even life-threatening. Sometimes, of course, there are some very worthwhile reasons, medical or otherwise, as to why a child is overweight.

It sure doesn't help, though, to live in a society where extreme thinness and waif-skinniness is embraced more than a healthy lifestyle is.

Which leads me to my point. Let's either start, or continue, to make our kids the number one priority in our lives. They are our legacy. They are our future. They are our treasures. Treat them as such. Eat together at meal time. Cook together. Shop together. Pursue fun physical activities as a family. Go for a walk, a hike, or play Frisbee in the yard. Play kickball. Turn off the computers and TVs and video games. Get involved in school and community functions. Read, especially before bedtime. Talk. Be fully aware of your child's life. Don't make excuses. Don't put them on your back burner. Love them.

And teach acceptance, not judgment. Especially when you don't know another's story.

Love. Peace. Harmony.

It was probably another typical evening in Cole's eyes, dinner and some fun afterwards. For me, though, it was a huge reminder of just how many times through a typical day my kids will be bombarded with "life" happenings.

I can only hope that someday our kids will walk confidently into this big, big world of ours. My bigger hope, though, is that every child out there has an adult in their life who also wishes the same for them.

As always, big thanks for reading. I see much of the above at work in the ER, but seeing it through my son's eyes gave me a new, fresh perspective. See you either Friday or Monday. Until then...


Stephany said...

There's also a socio-economic factor that can be playing a role in some of these kids' lives. If a family relies on low income services, such as food banks for their groceries, it often consists of inexpensive high carb foods, pastas, boxed mac and cheese, etc.

For some families produce shopping and having choices for healthier foods is not an option.

I volunteered for many years in a food bank and would sadly have very low-nutrition foods to place in their bags. The produce donated was limited and often non-edible--just something to keep in mind this summer for those who depend on in school lunches, the moms are more pressed to be able to feed their kids.

I'm very glad read how your son wouldn't judge another child due to shape or size.

When my kids were toddlers I would use the analogy of red and green apples while grocery shopping, and show them both apples, and say, "Both are apples, different on the outside, but the same on the inside, just like people".

Proudly, I can say my kids are all compassionate human beings in their 20's now.

While reading this, I wondered after you saw the family, did you sub-consciously eat less from the buffet?

Confessions of a Mother, Lawyer & Crazy Woman said...

I just discovered your blog and love reading it. What a great lesson to teach your son. He sounds like a wonderful child!

Anonymous said...

I remember a little girl who was in my fourth grade class with me. Her name was Debbie, and she was terribly obese, always wore an unfashionable, tent-like dress, and was very shy. On top of that, her family's religion forbade her to say the pledge of allegiance with the rest of us each morning, which earned her no end of harassment on top of her weight.

Debbie was the first person, outside my grandma, I ever knew who was morbidly obese, and of course this was back in the early 60s, when obesity wasn't the epidemic it is now. I remember trying to be friendly to Debbie -- I felt bad about how the other kids treated her -- but she was so shy and repressed we never really became friends. I've thought of her many times over the years, wondering how she is today, and whether she ever overcame her weight problems. I've wondered if her repressive, strict religion just swallowed her up, too. I hope she's still out there somewhere, happy.

Your conversation with your son was touching, Dr. Jim. You've obviously raised him to be open-minded and fair to everyone he meets, regardless of how they look. That's some good parenting. Bravo!

kristi said...

I am trying to lose weight and I am eating healthier and exercising every day. However, I am struggling with my autistic son who only eats certain foods and gags on things I give him to eat...typically causing him to vomit and never eat that food again. Fruits and veggies will not touch his lips. EVER.
I have tried!!
We are active and I encourage him to play outside every day, however his extreme asthma hinders this as well. It is a struggle because he is overweight and I would like to see him lose at least 10 pounds.
I do wish kids and adults were more understanding. I get looks of disgust sometimes and I am fat but I am trying to lose weight, it is hard but it is doable without weight loss surgery.

Jacqueline said...

Love your son's attitude...and the fact that I know he learned that compassion from you and your wife. I couldn't agree more with everything you wrote. Thanks again, Jim, for an uplifting and inspiring post.

Katie said...

I found myself actually nodding all the way through this post, especially when you talked about parents being involve in their children's lives. My friend Melia went to a nursing conference this last spring and discovered that research has been done showing parental influence is a direct link in childhood obesity. She said it basically boiled down to the stricter the parents, the thinner the child. At first, neither one of us really believed it, but then we looked at it in our families. I'm a stick and my parents have always been strict with me (they argue I've always been strict with myself, too). My sister's been shown more leaneance and she's not obese but heavier than I am. She said of course it's not the only factor but still something to ponder. (No, I don't know any of the details of the study)

Enjoy those times with your kids when they're at home! My parents are quickly learning that they get bigger and move out...

<>< Katie

Kate said...

The part that makes me sad is that these kids usually don't know any other way to eat/exercise. And what they know is what they do.

Heather said...

You had me at Hoss's. I absolutely Miss and Miss some more, some Hoss's.
That was the staple of Sunday dinner after church when I grew up.

Bestest ever.

I know this was deeper than that, but I kinda got stuck on Hoss's. ;)

littlepretendnurse said...

BRAVO MOM AND DAD!!!! You have obviously raised some great kids. My heart sang when I read of your son smiling at that girl. Kids can be mean sometimes without meaning to, but you have certainly taught your kids well. Keep it up!!

Gen said...

Just stumbled across your blog and it's wonderful. Thank you for your lovely writing.

Moose said...

Terrific. You've taught your son the fat people stereotype: that fat people are fat because they over eat and eat poorly and never exercise. That fat people eat because they're bored and sad.

Nevermind the ones that eat healthy and exercise regularly.

Nevermind the obvious genetics involved here -- mom and grandma are both fat? You're gonna be fat, too. Unless of course you decide to live your life on a diet, constantly worrying about what you're going to eat, what you're allowed to eat and whether you've exercised enough to have that slice of bread. Hello, my name is eating disorder.

The fat gene(s) seems to be closely tied to the insulin resistance gene, and I don't have to tell you how too much insulin promotes weight gain at even "normal" calorie intakes.

Yes, it is, in a way, sad to see small children be very fat, mostly because they will become the target for bullies. It will be assumed that they cannot ever be fit [because "everyone knows" you can't be fat and fit], and they will be predetermined to be depressed [as a psychiatrist once told me, "You cannot be morbidly obese and not be depressed." (I promptly fired that twit.)].

The statistics about how all the fat children are going to up and die early is manufactured bunk. There is no giant wave of fat diabetic children. They are not all going to live shorter lives because they were fat at age 10. But we're seeing high cholesterol levels in our kids today! [Nobody checked them until recently, plus there's STILL no clear picture that cholesterol is related to heart health, especially for females].

And there are no piles of fat children all fighting to get candy more than the skinny kids do.

I refer you to a blog written by an RN who examines medical articles and studies for what they really say, not what gets reported in the mass media:

here's a good search to start you out:

emmy said...

Several years ago I was watching a Dr. Phil show where he was discussing morbidly obese toddlers. It was a sad, but eye opening show. Everyone was assuming that there was some sort of genetic condition, and a few of the children had been definativel diagnosed with them. But the parents attitude was "I just can't keep them away from the snacks. I hide them, but they find them anyway." And I thought to myself, "They can't find what you don't bring into the house." The next year my ex left me. Suddenly I couldn't be a stay at home mom anymore. I had to go to work which meant that my daughter went to a sliding scale fee day care for before and after school care and during school breaks. The food there as well as school lunches was mostly high carb and high fat. Teachers used candy as rewards for good grades and good behavior. I had to resort to food pantries for staples and as reported above, it was mostly poor quality food. My daughter, who was under stress, began to show signs of Cushings, but the doctors at the clinic looked at me blankly when I pointed out the moon face and the camel hump. I got a better job, and we are now able to choose the foods that we are going to eat. The pediatrician listened to me and we treated the Cushings. In middle school my daughter was able to loose the weight and had a happy and sucessful high school career. I'm glad that you said not to judge because you don't know the story. My daughter and I have felt a lot of that kind of critisim. Not every parent has control over what their children eat. And then I feel bad about complaining about the quality of the food we were give. At least we weren't allowed to starve. The doctors at the clinic didn't want to consider Cushings, but they did treat her ear infections and strep throat. I should be greatful, right? Still, it was a very frustrating time for me as a parent.

Freda said...

So glad to hear of your compassion and your son's attitudes too. Being older now, and not in such good health I am definitely needing to lose some weight. But when I look back to being a child I think of myself as being fat and overweight then - the thing is that I wasn't. Wish I had realised, I think I set up a lifetime's problems with using food for comfort, and now I can't exercise much at all. Won't give up though, thanks to your good sense.

DownDoggin in MN said...

I live by those ideas as well...Love peace, harmony AND compassion. Great post and conversation with you son!

tracy said...

Dr. Jim, You have done such a beautiful job with you son, thank you.

My thoughts...however unfortunate/fortunate..for me...
"Bones are what define us-me-let them show".
i am working on it.

Anonymous said...

well done Doc! you should stand proud knowing you are raising a young man with kindness in his heart.

I totally agree with you about societies preconceived notions about what is "healthy".. seriously, emaciated with bulging clavicles and sunken eyes healthy?? I think not.

Another sad fact especially these days, healthy food is expensive... junk food isnt. A family of 4 can eat for less than $5 at taco bell, but not at the dinner table at home... how sad.

Bob Evans and Hoss' makes me yearn for the restaurants we used to have in PA... OMG do I miss Sheetz! have a good night Doc.

coulrophobic agnostic said...

Wasn't there a study done that tested a bunch of people who claimed to have medical reasons for being overweight, only to find that something like five percent of them did, and the rest just assumed/believed it to be the case when it wasn't?

Genes can only make you gain weight to a point. Biology may load the gun, but behavior pulls the trigger. You can't retain the calories you don't ingest.

Anonymous said...

Nice drive by diagnosis there doc. You have no idea of the health status of those children just by looking at them. Thin =/= healthy.

Tanya said...

Well done-you took an opportunity to teach your son an important lesson. I'm glad he's one of those kids that don't judge; that will serve him well when he becomes an adult. You've done a good job, Dad!

NYCRN said...

Do you have a book out? A work of fiction, perhaps.
let me know, i would love to read it.

SeaSpray said...

As always ..terrific post Jim!

Really need to get some fiction books going ..a series. i will wait until most are out and then I can have the thrill of buying 2 at a time (because God forbid I'd be left hanging!)You'll be so popular'll have to write a prequel. I'm just sayin... :)

You and your wife do an excellent job parenting ..that is certain.

I could right a book myself about weight loss, gained and everything in the middle ..PUN intended. ;)

Weight issues may seem black and white on the surface (Calories in - calories burned) is a complicated issue with so many variables and you did touch on some.

I agree with Moose that being overweight does not automatically indicate depression.. but I am certain it is true of some. But so is stress, fear, anger ..pick your emotion. Some may have been depressed during the weight gain period but come through and find difficult to lose.

I think it can be genetic, a specific dx being the culprit, cultural,inability for delayed gratification, learned behaviors, being poor, (although wealthy people certainly struggle too), incest - sexual issues forced on someone and they put up a barrier, and back to genetics ..some people do gain easier.

I remember back in grade school in the 60s there was only one really fat girl in all the classes in our grade and the same for high school 70s) only ONE fat girl ..I mean the 250 -300 type. I was chunky up and down yo-yoer in hs but not fat (just thought I was). But ..I think that so many more people are overweight today. ABSOLUTELY! Inactivity has to be one of the catalysts for this condition. When we were kids ..we were out all day and ACTIVE!

BUT ..I did not let my boys roam like I did and other kids in my generation did because unfortunately it seemed like more crimes committed and I was protective of them. Also .. an overweight person's vice shows for all the world to see. There are plenty of thin people who have habits that are just as destructive ..except they can conceal them up to a point.

For me is love. It is nurturing, fun, tastes good, soothing ..*one* of the best ideas God had. :) I assume food in heaven is non caloric.:)

Food is comforting when sick. I can gain wait with a cold because I am constantly trying to soothe my throat with soups and stuff. And when angry .. I stuff feelings down with food. If I ever get to my perfect weight ..there is a chance I may actually be a bi*c* and didn't know it.

And set points. I've heard that when you hit a new weight then lose it ..your body wants to go right back up to that point and then gain past it ..and so the yo-yoing begins.

It *is* easy to judge people if you have not been through it yourself. And when you think of *political correctness*, overweight people are fair game and don't get the same benefit of the doubt. I think that is because ..people see the black and white and don't understand or care about the gray that got them there in the 1st place.

Also ..especially for girls ..the media triggers unrealistic goals for young girls and anything less causes a hit to their self esteem.

I think when guiding children to lose weight or remain at a good weight ..that it is important to focus on GOOD *NUTRITION* ..over body image. Obsession over body image can be fertile ground for eating disorders and more.

The reason I thought I was fat at 13 pounds overweight at 17 was because I thought I should look like the petite size 7 like my cousin and girls in school. But I am 5'8" and truly lg boned. That never would've happened. And so kids need to know there are all kinds of body shapes that are not overweight .. but their own unique structure. I think discussions on food need to be positive and look at the good from doing x,y and z. Never ever be punitive or mock someone. That is most definitely counterproductive for weight loss.

Anonymous said...

Hi Doc,
As always, great post. This is giving me an opportunity to comment on some other posts of yours. I have been hesitant to mention this as I don't want to seem critical when it is obvious you are a caring, thoughtful doctor and human being. Several times, and specifically regarding a little girl with leukemia, you have mentioned that children in your ER are given blue italian ices. Can we talk about this for a moment? Does this seem like something the medical profession should be providing, or even endorsing, to people, sick or healthy? Sugar, corn syrup, artificial flavor, artificial color. These aren't ingredients we should be giving any children, but especially ones with leukemia that present to the ER. I just found it so ironic that you all worked so hard for her health, only to feed her this artificial, chemicalized junk in the end. Yes, people "know" what foods are unhealthy, but when they are endorsed by the medical profession how can they take it seriously?

I would love to open a dialogue around this subject. I have worked in the healthcare setting for over 15 years, and the food we feed patients is atrocious. We are supposed to be advocating for people's HEALTH.

Jabulani said...

Hey Jim, great post, but the bit that got me is the final paragraph. As a school governor, I see children of all family types. I too wish that for each and every child there was a special adult for them. Sadly, in my experience, there isn't. Which kind of makes it important that those of us who DO have access to children - through whatever setting - should try to be role models for them. That's a tough call. Who's up for it??

Cal said...

This is a difficult subject because in one hand we must teach our children that exercise and healthy eating plus keeping a healthy weight is important for overall health. But in the other hand we must also teach fairness and that all people are equal and worthy regardless of their physical appearance and weight. They may however question why is someone obese. Recently my daughter told her teacher at school that she weighs herself every morning. I was afraid the teacher was going to think we are obsessed about her weight (she is a "perfect" 50% percentile kid). The truth is that we, the parents, are more obsessed about our weight, as we tend to gain weight easily and both need to keep an eye on it, and of course she thinks it is routine to weight one self every morning.

Have Myelin? said...

When my kids were growing up I would insist on two vegetables, one fruit/salad, meat and a bread. If we had dessert it was always homemade and a treat. They didn't know what "fruit loops" or "Hawaiian Punch" was.

Food banks are filled with what I call "non-edible foods". Why so many boxes of ramen noodles?'s cheap. =(