WHEE (Weight, Health, Eating & Exercise) is a community support diary for Kossacks who are currently or planning to start losing, gaining, or maintaining their weight through diet and exercise or fitness. Any supportive comments, suggestions, or positive distractions are appreciated. If you are working on your weight or fitness, please -- join us! You can also click the WHEE tag to view all diary posts.
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(N.B. While I am a pediatrician, and have lectured on child health and fitness issues for many years, I am still learning from my audiences ways in which to discuss weight and fitness issues with children and parents. Please feel free and encouraged to offer constructive comments as to how I might improve the following discussion.)
Today in this country one out of every five meals eaten by children is a fast food meal. Combine this with the knowledge that American children spend an average of almost five hours each day in front of some sort of screen, and it should come as no surprise that the percentage of overweight and obese children has tripled in just the past twenty-five years.
Roughly one-third of American children are now overweight or obese. Minority children, and children from poor households, are even more likely to tip the scales. Today’s generation of children is facing the likelihood of being the first in modern history to live shorter life spans than their parent’s. This is nothing less than a national tragedy in slow motion.
Once rare in children, one-fourth of new cases of type 2 diabetes are now diagnosed under age 21. Of children born in 2000, one in three are expected to develop diabetes during their lifetime; nearly one in two if a person of color. What are we doing to our children?
We should be concerned about childhood obesity not simply out of a worry for their self-image in a thin-obsessed society. Being overweight or obese as a child increases the child’s lifetime risk of:
• High Blood Pressure
• Type 2 Diabetes
• Certain Cancers (such as Colon)
• Elevated Cholesterol
• Coronary Artery Disease
• Heart Attacks and Strokes
• Asthma and Asthma Attacks
• Liver and Gallbladder Disease
• Kidney Disease
• Early-onset Puberty
• Polycystic Ovary Syndrome
• Sleep Apnea Syndrome
• Bone Disease
• Iron, Vitamin, & Mineral Deficiencies
• Depression and Anxiety
• Bullying, Teasing, & Social Exclusion
• Cigarette Addiction
• Illicit Substance Abuse
• Adult Obesity
What causes overweight? The simplest explanation is this: energy intake exceeds energy spent. Overweight and obesity is rarely due to a medical cause. Genetics play a role – between 30 to 70 percent according to researchers – as does environment. As one obesity researcher famously once said, "genes load the gun, and environment pulls the trigger."
Early-life factors known to increase the risk of overweight and obesity include:
• Parental Obesity (75 percent risk of child obesity if both parents obese)
• Large for Gestational Age birth weight
• Maternal smoking during pregnancy (especially in the first trimester)
• Maternal diabetes during pregnancy
• Formula feeding in place of breast feeding during infancy
Obviously, you can’t change your child’s genes. If there is a family history of overweight or obesity, despite your best efforts your child may still become overweight or obese. But people who are overweight or obese are seldom that way solely because of their genes...cultural factors (diet and lifestyle) play some or most of the role.
Cultural factors known to increase the risk of overweight and obesity include:
• Single child
• Children of older or single parents
• Food preparation by children
• Eating alone
• Eating in front of the television
• Not eating enough fruits and vegetables
• Being made to eat when full
• The enormous food variety in stores (double from just 20 years ago)
*Cost per calorie. The least expensive calories are junk food calories, a fact that contributes to the disproportionate rates of obesity among our nation's poorest households.
• Portion size inflation in home & restaurant meals
• More processed foods (higher in calories and carbohydrates, lower in fiber & nutrients)
• Half of U.S. meals now made outside the home (fast food, sit-down restaurant, take-out)
• Too few omega-3 fatty acids in the American diet
• The sale of unhealthy foods and beverages in American schools
• The excessive consumption of soda ("liquid candy") and fruit juice & fruit drinks
• Less physical education in modern schools, especially at the elementary school level
• Our societal over-reliance on automobiles
• Poorly-planned urban sprawl with lack of safe, accessible places for children to play
• Greater parental fears of children’s safety, limiting walking, biking, etc.
• Sleep deprivation
And the number one cultural factor increasing the risk of overweight and obesity?:
• Screen time. The average child now spends more time indoors, stationary, in front of some type of screen, than any other activity besides sleeping. Modern parents are not so much letting their children watch television as asking television to watch their children. Children who spend an average of four hours or more in front of a screen each day have a 30 percent risk for obesity. Children spending less than one hour per day have only a seven percent risk for obesity.
Good health is a family affair. While a child’s health is certainly influenced by others besides their parents, no matter the setting the responsibility for assuring healthy eating belongs to the parent.
Yet today’s parents must face off every day with an unhealthy environment that grabs children and won’t let go. The child’s natural environment is littered with junk food and junk food advertising: at school, at the supermarket, at the movies and the mall, on television, and sometimes at their friends’ houses, at childcare, or at their grandparents’. It’s difficult for even the best parent to compete with this.
Therefore home must be a safe haven for healthy eating practices. Parents need to get the bad food out, and let the good food in! Here are some ways how:
• Read It Before Eating It! Learn how to read nutrition labels. Look at serving sizes, calories, and saturated fat content. Consider taking a nutrition class.
• Get The Junk Food Out! Cookies, donuts, potato chips, candy, ice cream...if they’re not available, kids are less likely to ask for them. Dessert should be no more than once weekly...make it a scheduled event, such as Saturday Treat Night, so that the kids learn not to ask on other days.
• Eat Real Vegetables! Potatoes don’t count. Corn and peas barely count. Make certain a non-potato vegetable is present at every lunch and dinner.
• 5 Fruits or Vegetables A Day! Fruits and vegetables are okay anytime for snacking. Keep a drawer full in the fridge. Whole fruits & vegetables are high in nutrients and low in calories
• Get The Soda Pop Out! We drink it like water, but it’s not. Sugar-sweetened carbonated soft drinks are no more than liquid candy. These nutrient-empty drinks give children unnecessary sugar, caffeine, and calories while increasing the risk of being overweight, of tooth decay, and of weaker bones. A rare treat of a soda when out to eat at a restaurant is okay...but no more.
• Get The Juice Drinks Out! Pre-packaged juice drinks are also high in calories and nearly empty of nutrients. If you’re buying them for packed lunches, be sure to buy the lowest calorie varieties.
• Fruit Juices Do Not Equal Real Fruit! Juices such as 100 percent apple juice or grape juice are virtually empty in nutrients, and higher in calories than soda. Buy only 100 percent grapefruit juice or orange juice, and limit your child to 6 ounces per day, such as with breakfast.
• Eat At Predictable Times! Children thrive on routine. Children eat more when unsure when the next meal or snack time is.
• Watch The Snacking! Children under age 5 need two healthy snacks per day. Children over five should only have a healthy after-school snack. Keep busy...boredom equals hunger.
• Eat At The Table, Not In Front Of The TV! Families that eat together have lower rates of obesity and drug use in the children and teens. Eating alone equals eating more. And when we roam with food, or eat in front of the television, we eat worse foods and more of them.
• No More Clean Plate Rangers! Do not make your children eat when they are not hungry. This only teaches them not to listen to their bodies, a great way to increase their risk of obesity.
• No Making Separate Meals! The parent’s job is to prepare a healthy, balanced meal. It is the child’s job to decide whether or not to eat it. If they turn up their noses, excuse them from the table. But if they’re hungry later, reheat their dinner and offer it again. Never make a separate meal! However, the child should always be allowed to substitute fruits and vegetables.
• Eat A Healthy Breakfast! Children who eat a healthy breakfast (such as Cheerios in 1% milk with a piece of fruit) have lower risks of overweight and obesity and less impulsive snacking.
• Reduce Omega-6-Fats! These are essential fatty acids, but we eat too much of them. They are found in corn, soybean, and sunflower oils...all commonly found in pre-processed meals and snack foods. These oils attach to receptors in the brain to cause lethargy and the "munchies"! When oil is needed, use monounsaturated oils, such as olive and canola oil, and the specially-made "high oleic acid" versions of saffron oil, sunflower seed oil or peanut oil.
• Increase Omega-3-Fats! These fats are proven to be good for the brain and heart, and to protect against obesity when eating an otherwise healthy diet. In fact, they make it easier for the body to access energy from body fat! The best sources of these fats are Alaskan or Pacific salmon (caution: Atlantic salmon is high in toxins), and wild or farmed trout. Avoid deep-frying the fish. Grass-fed beef is also a good source of omega-3-fats. Taking a daily supplement of 400mg EPA with 200mg DHA every day can be beneficial if your child dislikes seafood.
Parents also need to facilitate lifestyle smartness at home:
• Get Outside & Get Some Sun! Kids eat less when they’re busy, and they burn more calories. Fifteen minutes of sunlight a week allows for good production of Vitamin D, which, besides helping to make strong bones, also reduces Seasonal Affective Disorder and improves mood. And when we feel better, we eat less.
• Exercise regularly! Exercise benefits not only the body, but the brain as well. Besides reducing weight gain, exercise improves the ability to sit still and focus, and reduces the risk of depression and anxiety. Your child needs at least 30 minutes of aerobic (increasing the heart rate) activity at least 3 times a week.
• Get Enough Sleep! Children need more sleep than do adults. The average American child gets 1-2 hours less sleep per night than they need. More sleep is associated with less weight gain, by helping to achieve hormone balance that promotes burning rather than storing energy when awake. More sleep helps at school, too!
• Limit Screen Time! There is a clear correlation between screen time and overweight and obesity. Limit your child’s screen time to no more than an average of two hours per day. Purchase a kitchen timer to help keep track of the time.
A future WHEE Series Diary from this author will continue the discussion on the ways in which our schools and communities can be recruited for the battle to prevent childhood obesity.
Until then, this parting thought:
The most important thing is not how much you weigh. It is to be heart healthy. Aerobically active people who are overweight (but not obese) have fewer health problems, and live longer, than sedentary thin people. The goal is not to be thin, but to be healthy.