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The question

My teen daughter is fat. She's way over her normal BMI, and I've tried talking to her - politely - and asking if she wants to go to the gym together, or work out a healthy meal plan. It just seems to make it worse - she eats way more after our talks. What can I do?

The answer

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There are two main things you need to consider: the factors that contribute to your daughter's current weight and the manner in which your concerns have been communicated to her.

You say that your daughter is "way over" her normal Body Mass Index (BMI). I will assume that she falls close to or within the "obese" range.

By definition, obesity is a medical condition where amount of body fat may adversely and significantly impact health, including increasing the likelihood that one will develop a range of serious health conditions and contributing to shortened life expectancy. For these reasons, expressing your concern and trying to improve your daughter's health is important. Try to support her to make some changes.

For all of us, our weight is the result of many factors - including those that are out of our control (e.g., genetic predisposition) as well as factors that are controllable (e.g., eating habits, exercise/activity levels). Unidentified or untreated health conditions (e.g., thyroid dysfunction) may also play a role. For this latter reason, ensure your daughter has had a recent medical examination.

Unfortunately there is considerable stigma in our society regarding weight issues. I wonder to what extent your daughter has dealt with teasing or negative attitudes from family, friends, and kids at school.

This could likely be contributing significantly to her feelings of low confidence and self-esteem, including feelings of shame and even low mood or depression. Your daughter may feel hopeless – particularly when kids deal with obesity from a young age, they may develop strongly ingrained beliefs that nothing they do will be effective in terms of changing their situation.

You indicate that your daughter eats "way more" after your talks. Many individuals (even those that do not struggle with obesity) engage in emotionally-driven eating and this leads me to think she is likely becoming highly stressed after your conversations.

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Think about how you are approaching these conversations: it is important to remain non-judgmental, non-accusatory and supportive in your verbal and non-verbal communication. Express to her genuinely why you are concerned about her weight rather than telling her what to do (as this may come across as lecturing and critical). Ask her what her goals for weight/food/exercise are, and if there are ways that you can support her goals. The reality is she may find it too difficult to speak openly to you given history.

Offer to help her find a professional (family doctor, dietitian, nutritionist, psychologist) with whom she could speak to openly and confidentially.

Send psychologist Joti Samra your questions at psychologist@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Samra.

Click here to see Q&As from all of our health experts.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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