Archive for the ‘ Obesity ’ Category

Is Your Child Eating Too Much Protein?

Wednesday, January 7th, 2015

In my years as a pediatric dietitian, I have seen many concerned parents who were worried that their babies and picky toddlers weren’t getting enough protein. In the past few months, however, I started receiving more questions about the long term consequences of too much protein in the diets of healthy babies and toddlers.

While we still don’t have lots of good research regarding the excess protein issue, a few studies came to a similar conclusion: There seems to be a link between high dietary protein in the first 24 months of life and a higher risk of being overweight or obese later in life.

The studies highlight one crucial detail: The only type of protein associated with faster growth and risk for excess weight was dairy protein, found in milk, cheese, and yogurt. This seems to mean that excess protein from meat or vegetables is off the hook.

Why dairy? Some experts think that something in dairy affects hormonal secretion, in particular IGF-1 (insulin-like growth hormone) and insulin. But this idea is called an “early protein hypothesis” for a good reason, in that we still don’t have enough evidence to pinpoint exactly how or why dairy produces this effect.

So how much protein should your baby or toddler eat? Overall, experts suggest that a maximum of 15 percent of all energy should come from protein for children from 6 to 24 months. This translates to 30 to 45 grams per day, depending on the energy needs.

The good news is that the recommended intakes of protein established by the Institute of Medicine and followed by the American Academy of Pediatrics are well below this limit: only 11 grams per day for babies from 7 to 12 months and 13 grams per day for toddlers. As you can see, your little one probably doesn’t need as much protein as you thought.

The trick is to make sure your baby or toddler is getting enough protein, but not too much. Thankfully, it’s less difficult than it might seem.

Whether you are breast-feeding or bottle feeding, for the first 6 months your baby gets all the protein he or she needs from the breast milk or formula.

When solids are introduced and babies start drinking less formula or breast milk, make sure to include good protein sources like meat, fish, eggs, and beans to compensate for the decrease in the intake of formula or breast milk. Bonus: High protein foods like meat and beans also provide iron and zinc, which are nutrients of concern for breastfed babies.

Limit dairy to a one-half or one serving per day for babies and two to and two-and-a-half servings per day for toddlers. One serving of dairy is 8 ounces of milk, 8 ounces of yogurt or 1.5 ounces of hard cheese. (Remember, milk is not recommended for babies under 12 months of age.)

Many parents of picky toddlers will be relieved to know that 2 cups of dairy foods per day will cover about 120 percent of their protein needs.

Here is the protein content of some common foods. Remember, babies need 11 grams a day, and toddlers 13.

  • Milk and yogurt – 8 grams per cup
  • Cooked chicken – 8 grams per oz.
  • Egg – 7 grams
  • Cooked beans – 3 grams per 1/4 cup
  • Pasta – 7 grams (!) per cup.

Chances are, there’s no need to worry about your child getting too little protein unless he is a very selective eater and forgoing all dairy foods.

Of course, if your doctor suggests that your baby or toddler needs some catch-up growth or requires more protein due to a medical condition, his or her protein needs will need to be specifically calculated. The recommendations above are created for healthy, typically developing babies and toddlers.

This is a guest post by Natalia Stasenko, MS, RD. Natalia is a pediatric dietitian and mother to three young daughters. Find her at Tribeca Nutrition and on Twitter.

Quick Tip: Baby Food Storage
Quick Tip: Baby Food Storage
Quick Tip: Baby Food Storage

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Marketing Junk Food to Kids

Tuesday, December 9th, 2014

In an effort to stop marketing unhealthy foods to children and curb childhood obesity in America, the Washington, D.C.-based Center for Science in the Public Interest (CSPI) recently asked five candy companies including Tootsie Roll Industries, American Licorice Company, Haribo of America, Perfetti Van Melle, and The Topps Company to join the Children’s Food and Beverage Advertising Initiative (CFBAI).

According to CSPI, letters to the five candy companies were also signed by prominent organizations including the American Heart Association, the Campaign for a Commercial Free Childhood, The Yale Rudd Center, Prevention Institute, as well as other physicians and public health experts.

On the plus side, CSPI reports that three of the nation’s largest candy companies—Hershey, Mars, and Nestle—already belong to the CFBAI, a voluntary self-regulation program founded in 2006 and administered by the Council of Better Business Bureaus (BBB).

As described on the BBB website, the CFBAI “is designed to shift the mix of foods advertised to children under 12 to encourage healthier dietary choices and healthy lifestyles.” Currently, the three biggest candy companies in the United States—The Hershey Company, Mars, Incorporated, and Nestle USA—currently participate in the initiative. More than a dozen companies including The Coca-Cola Company and Burger King Corporation have also signed on.

According to Maureen Enright, Deputy Director, CFBAI, as part of the initiative, candy and other companies voluntarily agree to use CFBAI’s uniform nutrition criteria to govern what foods are in child-directed advertising (CFBAI covers advertising on TV, radio, print, on the internet, and in mobile ads and apps) or do no child-directed advertising. Currently, CFBAI participants that make candy, including Hershey, Mars, Nestlé and Ferrero, don’t advertise directly to children.

In a press release, CSPI notes that according to both the National Academies’ Institute of Medicine and the American Psychological Association, children under age eight aren’t mature enough to understand the persuasive intent of advertising. The press release states that, according to the Institute of Medicine, television food advertising affects children’s food choices, food purchase requests, diets, and overall health.

I fully support this initiative as well as the encouragement of CSPI to have candy companies (and all food companies, for that matter) to do more to protect the health and well being of children. I’m all for anything we can do to better the environment to encourage kids to eat more healthfully and moderately, especially since kids fall short on many foods including fruits and vegetables and whole grains and tend to over consume foods made with solid fats and added sugars (collectively, these are called SoFAS according to current dietary guidelines).

According to national survey data, kids’ between the ages of two and eighteen consume an average of 646 calories from SoFAS—or about one third of their total calorie intake. Current guidelines suggest up to five to 15 percent of daily calories from SoFAS. For a child or adolescent who consumes anywhere from 1,000 to 1,800 calories daily, that’s about 137 to 161 calories, the amount you’d find in 5 to 6 Hershey kisses.

Besides focusing on advertising of unhealthy foods to kids, I strongly believe that we have to rethink our ubiquitous access to such nutrient-poor foods. Why is it that so many checkout counters at places ranging from gas stations to electronic stores are decorated with shelves of candy wrapped in colorful wrappers? And what about all those coolers, many also at checkout counters, packed with sugary beverages? And vending machines…they’re everywhere, and they’re usually packed with a range of snack foods, many of which fare more like dessert (fortunately, those with 20 or more locations are now required to follow new federal calorie labeling guidelines).

It’s hard to resist the urge to buy impulse items, and what parent hasn’t given in to their kids’ demand for something at a checkout counter or vending machine at least on occasion? It seems to me that besides limiting or altogether obliterating candy and other nutrient-poor food advertisements, especially those that are geared to impressionable children, we also need to have rules about what and how stores sell food.

You might argue that businesses of all kinds have a right to sell what they want and to position such items where they want. But isn’t it wrong on some level to sell candy and other such items at a store that’s not really in the business of selling food? Or to sell food on low shelves, at eye level, where it entices kids? If we are going to make any progress in helping to teach our children to eat well, we need to create an environment—not just at home, but outside the home—that doesn’t sabotage practicing healthy eating and lifestyle habits and teaching them to our kids.

CSPI has been extremely successful in many of their initiatives, and I hope this latest attempt to get candy companies to step up to the plate to limit potentially harmful advertising of less than healthy foods to children catches on. I’m not sure the rules will ever become mandatory, but achieving this would at very least be a big step in helping our kids eat and live more healthfully.

What’s your opinion?

Image of chocolate bar with caramel via shutterstock.

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Are Eating Habits Set in Infancy?

Sunday, September 21st, 2014

Are kids’ diet habits set in infancy, as a recent New York Times article suggests? According to the article, the findings of several new studies published in Pediatrics suggest that, “Efforts to improve what children eat should begin before they even learn to walk.”

In one study, researchers looked at the association between bottle-feeding practices during infancy with maternal feeding style and children’s eating behavior at six years old. They found that bottle-feeding practices during infancy may have long-term effects on both maternal feeding style and children’s eating behavior at age six. Frequent bottle emptying encouraged by mothers during early infancy increased the likelihood they’d pressure their six-year-old child to eat enough and eat all the food on their plate. Also, high bottle feeding intensity during early infancy increased the likelihood mothers would be especially careful to ensure their six-year-olds eat enough. Based on the findings, lead researcher Ruowei Li, MD, PhD suggests breastfeeding as the first feeding choice for infants. She adds, “When feeding at the breast is not feasible, supplementing breastfeeding with expressed breastmilk is a good alternative, but special attention is needed for infants’ internal feeding cues while bottle-feeding.”

Another study found that infrequent intake of fruits and vegetables during late infancy is associated with infrequent intake of these foods at six years of age. The researchers concluded that it’s important for parents to find ways to encourage their infants to eat fruits and vegetables despite perceived barriers to produce intake.

Two other studies, also published in Pediatrics, unsurprisingly found some perils associated with sugar-sweetened beverage (SSB) intake. In the first study, infants who drank any amount of SSBs were two times more likely to drink them at least once daily at age six. Based on their findings, the researchers point out the importance of establishing healthy beverage practices in infancy.

In the second study, 10- to 12-month-olds who drank SSBs more than three times a week were twice as likely to be obese at age six than those who consumed none as infants. The researchers concluded that SSB consumption during infancy can be a risk factor for obesity in early childhood.

We all do our best as parents to raise and nurture our kids, which includes trying to feed them well, and help them meet their basic nutrient needs. I know I felt empowered when my sons who were breastfed would grow at each and every visit to the pediatrician. It made me feel great to know that my milk alone, at least for several months when they were exclusively breastfed, fed them. But as kids grow, like everything else feeding gets a little more complicated. Transitioning from breast milk or formula to “real food” can be a real challenge for many.

Also, since food is love in many cultures, learning how to feed your growing infants and toddlers enough, but not too much, to meet their needs can be easier said than done. This makes it even more important that parents learn and respect their children’s mealtime cues e.g. that they’re hungry or that they’ve had enough. I always say that if your kids’ trips to the pediatrician show they’re growing at a rate that’s consistent for him or her, it’s likely they’re at least meeting their calorie needs. If they’re moving too much in one direction or another on growth charts, that’s when it’s important to really consider dietary tweaks. In such cases, working even a few times with a registered dietitian nutritionist can help parents not only know what and how much their child needs but how to help them meet those needs without food fights.

As infants grow into toddlers and then full-fledged school-age children and become exposed to more and more nutrient-poor options whether at school or when on-the-go, things get even more complicated and challenging. But as the Pediatrics studies illustrate, it’s vital for parents to simply try to feed their children well starting in infancy. We can do this by exposing them to a wide variety of nutrient-rich foods such as fruits and vegetables (pureed or mashed), by eating with/in front of them, and by making mealtimes calm and pleasant.

While it’s ideal to start kids off on a nutritious path when they’re very young by offering to them a variety of nutrient-rich foods and to limit their exposure to empty-calorie, nutrient-poor foods and fast food, even when kids are older it’s never too late for parents to make some changes in the home and when on the go or at a restaurant to help the whole family move in a more healthful direction. Food preferences can still change and develop as children grow, and just because your child doesn’t like or accept a particular food at a young age doesn’t mean he or she won’t at age 12 or beyond. The key is to repeatedly expose children to a wide variety of foods and to keep discussions about eating and food positive and encouraging so that they feel enticed rather than pressured to eat well.

It’s also helpful to present foods in different and appealing ways, and to involve kids, even when they’re older, in shopping for, preparing, and cooking food. That can help them develop a love and appreciation for quality foods and healthy eating practices and help them develop skills that they can bring with them as they grow.

Keeping more of the foods and beverages you want your children to consume more of around the house and limiting their exposure at home to items like SSBs and other empty-calorie foods and beverages can also encourage healthier habits. Enjoying family meals can also help infants and all family members feel more connected to one another and even can enhance nutrient intake, protect against obesity, and have other health benefits.

Even if eating habits are at least in part set in infancy, that’s no reason for us parents to not at least try to improve what and how we offer foods and beverages to our children. Habits can be enhanced and tweaked at any age, and if we make more nutritious choices for ourselves in front of our children, and show them through our example the joys of eating moderately and mindfully, it’s likely that over time our children will internalize that. And hopefully, that will also encourage them to follow suit.

You can check out new nutrition guidance for 2- to 11-year-olds in a previous Scoop on Food post here.

How do you help your infants eat well and develop more healthful food and nutrition habits?

Image of girl eating watermelon via shutterstock.

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Get Fit With Play (and the Giants’ Victor Cruz)

Tuesday, September 16th, 2014

Are your kids playing enough? There’s so much evidence that making time to just run around can benefit kids (and us parents) in more ways than one.

A review of 86 articles published in the International Journal of Behavioral Nutrition and Physical Activity concludes that physical activity in children is associated with numerous health benefits including reduced body weight and improved cardiovascular health.

While the review found that more physical activity was linked with greater health benefits, even modest amounts of physical activity were shown to have tremendous health benefits in high-risk children (e.g., those who were obese or had high blood pressure). And while moderate physical activity is recommended, vigorous activities also can provide even more health benefits.

The review confirms that although aerobic-based activities like running and biking have the greatest health benefit since they stress the cardiovascular and respiratory systems, high-impact weight bearing activities can benefit kids’ bones.

According to The Wellness Impact: Enhancing Academic Success Through Healthy School Environments, being active can be a boon to kids when it comes to academic performance and the ability to concentrate in class. Despite the health and other benefits of physical activity, only one in three kids are active each day.

Although children and parents know it’s vital to incorporate physical activity into their lives, knowing what to do and actually doing it are two different things. That’s why I’m excited about the new ‘For the Love of Play’ campaign.

Launched by Fuel Up to Play 60, the nation’s largest in-school wellness program created by the National Football League and National Dairy Council and in collaboration with the U.S. Department of Agriculture, just the name of the campaign makes being active and fit sound fun and not like a chore that must be done. The goal of the campaign is to encourage not just children, but parents, teachers, and really everyone to get up, get active, and play for at least 60 minutes a day.

The campaign has enlisted the support of Victor Cruz, wide receiver for the New York Giants. I had the pleasure of speaking with Cruz about his own experience and thoughts about getting and staying fit. And who knew he could hula hoop?! Even more reason to love him! Here are some highlights from our interview:

EZ: What are some activities you enjoyed most as a kid?

VC: I grew up on a one-way block, along with seven boys who were all my age. I loved so many sports, and together, my friends and I played everything: dodgeball, baseball, wall ball, basketball, and of course football!

EZ: I read that when you were in college, you—like many student athletes—struggled balancing football with your academic studies. What helped you overcome that, and what would you tell kids who want to succeed both on and off the field/court?

VC: I always say to each his own. We each have our own goals. The key is to take advantage of your talents and passions when you’re young, and to learn to manage your time. You’re only young once, so it’s important to look at the big picture and decide what your goals are and how you’re going to achieve them whether that’s playing a specific sport competitively or studying for a specific career. Sometimes you’ll have to make choices and decisions—like choosing to study that extra hour instead of seeing friends. But if you stay true to yourself and learn to budget your time, and cut back if what you’re doing stresses you out too much, it’ll all work out in the end.

EZ: What are some physical activities you enjoy doing with your daughter?

VC: I spend a lot of time with my daughter and my nephews playing basketball, dancing, walking, or just jumping around. Even in the winter, when it snows, we play football and make snow men. And my daughter loves to make angels in the snow. No matter what the weather, we find something to do to stay active and have fun at the same time.

EZ: What’s your advice for children or adults who get sidelined with injury and can’t be as active as they’d like?

VC: Even if you’re hurt, there are different ways you can move to stay in shape and get some physical activity in. For example, if you hurt your arm, you can still workout your legs, do calisthenics, or walk outside or on a treadmill. Even if you’re sad or distraught by your injury, it’s important to try to continue your passion to lead an active life to stay ahead of the curve and competition (especially if you’re a competitive athlete). You also need to tell the negative voices in your head to stay positive and to keep positive people around you as you heal.

EZ: What excited you about the ‘For the Love of Play’ campaign?

VC: I wanted to get involved because I love helping kids get active. When I was young, I played a ton—mostly outside. Of course that was before video games, which now keep kids inside and on the couch. As a kid, I always wanted to get outside and play—and play hard. So this campaign is a perfect fit for me and gives me a great opportunity to encourage kids and the adults who care for them to get out and play for a total of 60 minutes a day at school, at home, and everywhere in between.

EZ: What are some perks (besides the obvious!) that you’ve derived from being active?

VC: Being active helps me feel more focused and provides me with a positive jump start to my day. Staying active keeps my body in line, and is a catalyst that makes me want to take care of my body and live a healthy lifestyle. It makes me want to not only put positive things (like healthy foods) into my body, but to put out positivity to the rest of the world.

Students, parents, and educators can get more information and learn more about ‘For the Love of Play’ campaign and how to participate in the #LoveOfPlay social media sweepstakes for a chance to win NFL prizes by visiting Fuel Up to Play 60.

Check out my previous Scoop on Food post, 11 Tips to Nourish Active Kids, here.

How do you and your kids/students stay fit?

Image of Victor Cruz hula hooping via Greg Tietell.

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Kids and Carbohydrates: How Low Should They Go?

Monday, September 8th, 2014

A recent study published in Annals of Internal Medicine found that, at least in adults, a low-carbohydrate (<40 grams/day) diet led to greater weight loss and more beneficial improvements in blood cholesterol and triglyceride levels than a low-fat (<30% of daily energy intake from total fat) diet. Researchers concluded that restricting carbohydrates may be an option for those who want to lose weight and reduce cardiovascular risk factors.

The study, highlighted on Good Morning America, in The New York Times, and in countless other outlets will likely have many parents, in their efforts to manage their own weight, continue with their low carb ways. And if parents are eating low carb, should they encourage kids—especially if overweight—to do the same? I hope not!

For one, carbohydrates provide the basic fuel needed by the brain, red blood cells, and entire central nervous system. Carbohydrates also supply the body with serotonin, a brain chemical that helps regulate mood, appetite and sleep. Too few carbohydrates—and serotonin—can very well make kids feel sleepy and irritable. And what parent in their right mind wants to do anything to encourage that?!

According to current Dietary Guidelines for Americans, about half of kids’ calories should come from carbohydrates. More precisely, the range suggested is 45 to 65% of total calories. Based on What We Eat in America, kids fall into that range, and get an average of 53 to 56% of their total calories from carbohydrates. But while many kids can certainly afford to curb their intake of carbohydrate by at least a little bit, especially with obesity rates as they are, it’s wise for them to reduce intake of sugary snacks and drinks that provide empty calories rather than forgo grains (even if refined, like pasta or white bread) and other carbohydrate-rich, nutrient-packed foods.

That doesn’t mean kids should OD on white bread, pasta, white rice, sugary cereal, French fries, cookies, and donuts to get their carbs. Going overboard on such foods, especially when served in bloated portions at fast food and other restaurants (not to mention ballparks), will most definitely leave less room for other nutrient-rich foods to help them optimally grow and develop.

Currently, kids consume most grains in their refined rather than whole form. So one key way to improve (if not slightly reduce) kids’ carbohydrate intake is to help them replace some of the refined carbs in their diet with whole grains. Current Dietary Guidelines for Americans urge three to six grains daily, with at least half as whole grains, for kids who consume 1,000 to 2,400 calories. (For reference (see page 16), two to five-year-olds require at least 1,000 to 1,200 calories; six- to 10-year-olds require at least 1,200 to 1,600 calories; 11- to 14-year-olds 1,600 to 2,000 calories; and 15- to 18-year-olds require at least 1,800 to 2,400 calories daily.)

Although they tend to get a bad rap (or is it wrap?!) because they’re carbohydrate-rich, whole grains are sources of nutrients such as iron, magnesium, selenium, B vitamins, and dietary fiber. Whole grain intake has also been linked with reduced heart disease risk. It may also help reduce constipation, and promote healthy weight.

Some whole grains that kids enjoy include popcorn, air-popped, with canola or vegetable oil; cooked oats or whole grain, high fiber cereal (eg low fat granola or another crunchy cereal mixed with fresh fruit, nuts and/or seeds, or low fat yogurt); and brown rice mixed with stir-fried poultry or beef and vegetables.

For ideas on how to enhance the taste and flavor of whole grains and to serve them and other carbohydrate-rich foods in appealing ways, check out the Meal Makeover Moms website. Also, there’s evidence that nudging your kids toward whole grains by making them more fun can also help. A recent study published in BMC Public Health found that presenting kids with whole wheat bread in fun shapes can help increase their intake.

When it comes to kids and carbs, it’s also important to remember that carbohydrates aren’t just found in grains. Fruits and vegetables (which kids don’t get enough of, anyway), beans, nuts and seeds, and milk are also sources of carbohydrates and can create the foundation for a healthful dietary pattern for most children. Depending on their individual calorie needs, current guidelines recommend that kids aim for one to two cups fruit (whole fruit preferable to juice), one to three cups vegetables (including dark green, red and orange, legumes, and starchy vegetables), and 2 to 3 cups dairy foods including low-fat or nonfat milk/yogurt.

I’m all for encouraging kids to have fewer carbohydrate-rich foods like French fries, potato chips, cookies, candy, and soda. But it’s essential that they not throw out of their diets fruits (despite their natural sugar content) and other foods that provide quality carbohydrates and other important nutrients to keep them healthy.  Such foods are also vital for kids who are very active or athletic since carbohydrates are the main fuel for their working muscles.

If your child is overweight, you may think that it’s perfectly fine to forget about any possible benefits carbs provide and to simply cut them from their diet. If you mean cutting many of the extras like cookies and cupcakes, I’m all for that. But if you mean cutting all pasta, rice, bread, or crackers, whether or not they’re whole grain, I say that sticking to small portions of those foods is better than not including any of them. Even refined grains provide nutrients (though not as much as whole grains). There’s also proof that cutting portions rather than carbs may be enough to promote healthy weight management.

A recent year-long study published in Journal of Pediatrics of more than 100 obese 7- to 12-year-olds found that lowering carbohydrate intake was just as effective as a standard portion-controlled diet (an energy-reduced, low fat diet) for weight management. However, the researchers also found that the low carbohydrate diet was more difficult for the kids to follow, especially over the long-term. They concluded that either diet can effectively help kids lose weight.

When it comes to kids and carbs, my bottom line is this: choose smart carbs in smaller portions rather than cutting them altogether. That way, kids can reap their many nutritional and other benefits carbohydrate-rich foods provide while still consuming a healthful and still edible diet.

Image of healthy cereal rings via shutterstock.

What’s your take on carbs and kids?

How to Make Snack Puppets
How to Make Snack Puppets
How to Make Snack Puppets

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