Thursday, January 25, 2007

Childhood Obesity: Asking the Tough Questions

In today's Telegraph an article asks - what can be done to tackle the obesity epidemic?

An "alarming" obesity epidemic is condemning an entire generation of British children now at primary school to increased rates of serious health problems, a committee of MPs has warned.

The report criticised the Government for doing little to curb the problem, which already costs Britain £3.5 billion, and argued that schools should tell parents when their children are overweight or obese.

What do you think can be done to tackle Britain's obesity epidemic? Who or what is to blame? Should parents be taken to task if their offspring are overweight? Or would that risk stigmatising the children in question?

If you have children, how do you encourage them to be fit and healthy? Why do you think British - and American - children are generally more prone to obesity than their European peers?

Not a day goes by in the US that we're not reminded, by the media and policy makers, that childhood obesity is rampant, our children at risk for a host of ailments in their future if we do nothing to stop this crisis, and they may even have a shorter life expectacny if we don't do something to reverse the trend.

Go to any mall, playground, school, or other place children are and it's obvious that many more children are overweight than in previous generations; where previously one or two might have stood out in a crowd as heavier than the others; today it seems the thin children stand out from the crowd. Simple observation tells us that there are more children who are overweight today than in years past.

One question asked in the above article, "If you have children, how do you encourage them to be fit and healthy?" provides me an opportunity to share my strategies.

1 - Buy, prepare and serve quality food at home

2 - Encourage active play - climbing, exploring, running, jumping, skipping; provide adequate downtime to relax and rest; engage son in daily activites as part of his routine each day (help carry in groceries, help carry folded laundry to room, etc.)

That's it.

We often hear that children, especially toddlers and pre-schoolers, are picky eaters. While that may be true, that doesn't mean we should feed them anything just to get them to eat something.

Often I see parents offer really great options only to cave in to whining for something else; it's easier to give the child what they want because it's often uncomfortable to think we're making our child(ren) unhappy or distresed; so the french fries or chicken nuggets are rationalized as acceptable because at least the child is eating something and is happy. Then some parents seem to go out of their way to provide whatever the something else is; at a recent holiday party we attended, a mom I know actually brought McDonald's for her children because that's what they wanted; never mind the incredible spread provided by the hostess, the kids wanted burgers and fries, what can you do?

Needless to say, thus far, my stategy to provide quality food, the majority prepared at home, is working. If my son doesn't want to eat something offered, that's okay; if something else is readily available as a choice, he's can have that to eat if he'd like. What he isn't given is the opportunity to whine his way to junk foods or a separate meal prepared just for him; our family meals offer enough variety that we'll each find things we like - if we don't like something, no biggie, don't eat it, pick something from what else is prepared.

My husband and I do take an "all bets are off" attitude when we're eating outside our home, where our son is likely to be offered foods we don't typically have at home. We've been pleasantly surprised that the habits he's developed at home continue (on his own) when he's allowed to choose and eat whatever he wants from what's being served.

A quick story that illustrates what I'm talking about.

We recently visited family and he had an incredible time with his cousins. Dinner was an delicious spread of Middle-eastern foods along with a pot of blue-box macaroni and cheese prepared for the kids since the food was spicy. Plated for him, by his aunt, was the mac & cheese, some vegetables, and the lamb and chicken.

What did he eat? The chicken, lamb and vegetables. He did take a bite of the mac & cheese, chewed it a bit and then asked to spit it out, he didn't like it. I wasn't surprised, he doesn't like pasta. I chalk his dislike of pasta up to it being pastey and bland compared with what he normally eats.

So what does he normally eat?

Instead of just telling you his menu, let me show you his typical day of eating - the foods prepared for him on an average day at home. Let me also say he's in the 95th percentile for height; 50th percentile for weight; and 20th percentile for weight-to-height ratio. Oh, and he doesn't eat off the china - I've plated the food before serving it to him on regular plates for the picture taking, so the foods aren't lost in the patterns on the plastic plates for kids!

Breakfast - broccoli and cheese omelet; yougurt with blueberries and strawberries.



What he actually ate - the yogurt and berries and about half the omelet, picking out all the broccoli to eat it; he also had some whole milk.

Lunch - cheeseburger, ketchup (no HFCS type), grapes, spinach



What he actually ate - about 2/3 of the burger, all the spinach, most of the grapes; he also had some whole milk and cod liver oil.

Dinner - chicken curry, basmati rice, green & yellow string beans with carrots, kiwi and sliced tomato with ranch



What he actually ate - the chicken, kiwi, most of the string beans and carrots, whatever rice stuck to his chicken, tomatoes and ranch; he also had some whole milk.

Snacks - sliced apple, cashews, raisins, whole wheat pita triangles, hummus



What he actually ate - apple with skin removed, cashews, three of the raisins, and he used the pita triangles as a means to scoop up the hummus, ate one bite from the pita and left the rest; he also had some juice heavily diluted with water.

I've had some criticize his eating, suggesting that he's being deprived of nutrients because he's not eating enough grains or starches.

If this is your first reaction to his day of eating, you can relax - after accounting for what he actually ate, his day provided every last vitamin, mineral, trace element, amino acid and fatty acid he needs.

In this day he ate about 1265-calories; of which 63g was protein.

His typical day of eating provides all essential micronutrients; yet it does not conform to the dietary recommendations that insist specific macronutrient ratios - 55% carbohydrate, 15% protein, 30% fat - as necessary to meet nutritional requirements; that encourage copious consumption of grain products; that suggest reducing fat after two is critical to avoid chronic disease later in life; and that minimize the effect of added sugar in the diet.

We're often told that if we'd only feed our children according to the recommendations and encouraged more phyiscial activity, we'd not see obesity in children.

What the experts fail to consider is this - the diet they're recommending is short-circuiting our children's natural satiety signals because it is challenging the metabolic pathways and failing to meet all nutrient requirements beyond the macronutrient level (carbs, protein, fat) to the micronutrient level (essential fatty acids, amino acids, vitamins, minerals and trace elements).

Children have much smaller stomachs than adults, thus can't eat nearly the same volume as adults, yet require more calories per pound because of energy expenditure and growth. Their diet needs to be energy-dense and nutrient-dense in less volume than an adult.

So what are we told to feed them once they turn two?

We're specifically told to eliminate or strictly limit the nutrient-dense, calorie-dense foods and feed them more foods that are low in fat to keep dietary fat and cholesterol within limits; provide them a diet rich with carbohydrates from grains, cereals, sugar, fruits and vegetables; limit meats to those that are lean; switch to low-fat/skim dairy products or dairy replacements like soy milk; and be mindful to include snacks and variety in the diet.

Here is a sample menu, from the American Academy of Pediatrics (AAP), that illustrates the standard recommendations today; it is designed for a child weighing 21-pounds:

BREAKFAST
1/2 cup iron-fortified breakfast cereal or 1 cooked egg (not more than 3 eggs per week)
1/4 cup whole milk (with cereal)
1/2 cup juice
Add to cereal one of the following:
1/2 banana, sliced
2-3 large sliced strawberries

SNACK
1 slice toast or whole wheat muffin
1-2 tablespoons cream cheese or peanut butter (spread)
1 cup whole milk

LUNCH
1/2 sandwich-tuna, egg salad, peanut butter, or cold cuts
1/2 cup cooked green vegetables
1/2 cup juice

SNACK
1-2 ounces cubed cheese, or 2-3 tablespoons pitted and diced dates
1 cup whole milk

DINNER
2-3 ounces cooked meat, ground or diced
1/2 cup cooked yellow or orange vegetables
1/2 cup pasta, rice, or potato
1/2 cup whole milk

While I commend whomever designed this menu for using only whole foods, with no packaged snacks, I cannot find much else to praise; namely because, while it provides adequate amino acids, the menu fails to provide adequate intake of Vitamin E, Vitamin K, Copper, Selenium, Potassium and omega-3 fatty acids.

While it provides a similar amount of protein (60g) as what I prepared for my son (63g), and doesn't contain much added sugars, it does pack a potential punch to blood sugars and insulin with 154g of carbohydrate and less fiber (10g versus 15g). Add to this, that even though volume weight is virturally identical to the diet consumed by my son (1367g versus 1368g), it provides 100 more calories than his; if the higher amounts of food suggested as snacks are included, it could provide 400 calories more.

The recommended diet offers more calories, a high level of carbohydrate to be metabolized as glucose in the body, less fiber and inadequate levels of many essential nutrients.

Why are we making recommendations that are nutritionally inadequate and a metabolic challenge?

We seriously need to start re-thinking our dietary recommendations for children; right now our dietary recommendations and policy are failing them because our phobias about dietary fats have seeped into their lives as we've modified their diet to limit fat and include an abundance of carbohydrate-rich foods that does not, at the end of the day, have the desired effect.

Our children are gaining weight because the diet we're recommending they eat is higher in calories without providing all essential nutrients (even with all the fortification of foods) and is a burden on their metabolism.

As a parent I can only do what I believe is best for my child; and when it comes to food, the best for my child is a nutrient-dense diet that targets essential nutrients, not a specific ratio of carbohydrate, protein and fat; nor a specific number of servings of grains, beans, meats/fish/poultry, milk, fruits, nuts, seeds or vegetables each day.

As a member of a larger community, I can only share my experience and results.

The rest is up to you.

12 comments:

  1. Anonymous12:22 PM

    OMG, will you adopt me and make my meals?

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  2. Anonymous5:12 PM

    Strangely, despite an identical upbringing (as far as I can tell) my eldest son is a salad lover, my youngest does not vegetables in any shape or form, apart from very occasional french fries since he was able to say no. And never suffers from constipation. I can't work it out

    Neil

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  3. Two sets of grandkids, one very yuppie, organic veggies, health oriented; their kids refuse to eat any and all veggies, and even have their doubts about fruit. They do all the right things, offer, encourage, don't make a big deal out of it. Doesn't work. Other set: somewhat the opposite, the kids love every veggie that grandpa fixes for them. MORE MORE.

    Go figure.

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  4. Anonymous12:27 AM

    Despite my best efforts to provide a politically correct diet for my children as they grew up, I caved. I fed them only real food. In fact, i did not give them enough of the good stuff as I realize today. So altho they got too much starches and sugar, at least it was natural. REAL butter and homemade cakes and cookies and potatoes. Real meat for dinner, tho I avoided beef for far too many years. We couldn't afford to eat out, so I cooked for them every day. I only wish I had not been afraid of eggs and had not fed them cereal for breakfast every day.

    Nevertheless, they grew up active in mind and body and no one has a weight problem, unlike me. The girls are athletes and have healthy attitudes towards their bodies and the boys, tho they drink far too many sodas, understand the importance of real food. They also have real appreciation for fine foods.

    I think the MOST important thing is to give kids REAL food, homemade, not produced by any industrial method. Low carb would be best, of course.

    Marilyn

    ReplyDelete
  5. Two sets of grandkids, one very yuppie, organic veggies, health oriented; their kids refuse to eat any and all veggies, and even have their doubts about fruit. They do all the right things, offer, encourage, don't make a big deal out of it. Doesn't work. Other set: somewhat the opposite, the kids love every veggie that grandpa fixes for them. MORE MORE.

    I hear from a lot of people similar experiences - one child loves veggies, the other not so much, or won't touch them.

    I can't say why my son eats as well as he does on his own - he really likes good foods and tends to shun junk food without anyone telling him "no" or "no more" and has a real aversion to grain-based foods and starchy foods.

    To me, that's a good thing, but I can't say with any certainty that it's because of me or my influence; perhaps it's because he didn't have cereals as his first food?; perhaps because I didn't eat much of it when pregnant?; perhaps it's just a matter of taste? I dunno.

    ReplyDelete
  6. I think the MOST important thing is to give kids REAL food, homemade, not produced by any industrial method. Low carb would be best, of course.

    I agree it's important to provide whole (real) foods, with as much made from scratch (you control ingredients) as possible.

    While my son eats virtually no packaged/processed foods, I can't say he eats "low-carb" - it's really more controlled-carb than anything else...and carbs do make up a higher proportion of his calories than they used to (I think because his energy needs have increased as he's grown), but carbs still are not the primary source of his calories each day.

    ReplyDelete
  7. I have 2 adult children. My eldest ate all the good stuff up until he was 3 years old when he began refusing most vegetables and virtually anything else offered to him unless it was chocolate. My daughter grew up loving veggies and salads. As my kids aged I realized that the best I could do is set a good example and offer them what I considered healthy foods. The rest was up to them. My son is very healthy food conscious with his now 5 year old daughter and eats pretty healthy himself. The jury is still out on my daughter.

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  8. Anonymous4:06 PM

    What a great mom you are. Your son is very, very lucky.

    I have no kids of my own, but I do get really disgusted when I see or hear what most parents feed their kids these days. I have a coworker who gripes all the time about how her son won't eat meals because he snacks on junk all the time. The kid is four years old! If he's eating junk, then she must be feeding it to him. Gimme a break! Parents need to take responsibility for and control of what their kids are eating. I don't recall having a choice as a child....we had to eat what my mother cooked or go hungry. Period.

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  9. Anonymous4:07 PM

    I have no kids of my own, but I do get really disgusted when I see or hear what most parents feed their kids these days. I have a coworker who gripes all the time about how her son won't eat meals because he snacks on junk all the time. The kid is four years old! If he's eating junk, then she must be feeding it to him. Gimme a break! Parents need to take responsibility for and control of what their kids are eating. I don't recall having a choice as a child....we had to eat what my mother cooked or go hungry. Period.

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  10. My husband and I are trying to move to a low carb/controlled carb lifestyle for our own health, and I'd like to get our 15 month old off to a good start so she doesn't have the same weight struggles my husband and I both had as kids. We both grew up with the low-fat, low-calorie approach, and while both of us have rail-thin siblings, and despite eating the same way they did, we've always been overweight. I don't want to pass that heritage on, and I think the controlled carb lifestyle is the best way to do it, nutritionally speaking. But how do you handle food for a child without molars?

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  11. But how do you handle food for a child without molars?


    Cutting food into really small pieces, making chunky purees and selecting softer foods are some ways to include a wide variety of nutrient-dense selections. You might be surprised by what a toddler without molars can eat if it's cut small or is prepared tender/chunky!

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  12. Anonymous2:02 PM

    If you want to read an interesting first-person account of childhood obesity, check out:

    http://www.orato.com/node/2009

    ReplyDelete