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Monday, June 30th, 2014
We all know that far too many kids weigh more than they should for optimal health and well being. But despite the dramatic surge in childhood obesity rates over the last three decades, there’s evidence that the levels of obesity as measured by body mass index (BMI) are starting to steady—and, in some cases, drop. In fact, national survey data shows that the rate of obesity in two- to five-year-olds decreased from an estimated 13.9% in 2003-2004 to 8.4% in 2011-2012.
Despite the glimmer of hope, a new article published in Pediatric Obesity suggests that BMI—a popular, easy to use screening tool based on height and weight—falls short in identifying children with higher than desirable body fat levels. Although the Centers for Disease Control and Prevention (CDC) describes BMI as “a reasonable indicator of body fatness for most children and teens,” a review of 37 studies of 53,521 four- to 18-year-olds found that 27% of children who were not classified (using BMI) as obese* had excess body fat levels.
According to Francisco Lopez-Jimenez, MD, Director of Preventive Cardiology at Mayo Clinic and senior author of the article, “BMI is based on body weight, not body composition (the amount of muscle and fat), and weight cannot discriminate muscle from fat.” He adds, “A child’s body weight can still be within “normal limits” even if he or she doesn’t have much muscle mass but has a high level of body fat.”
Although he considers BMI a good measure to capture population trends, David Katz, MD, Director, Yale University Prevention Research Center and Editor-in-Chief of the journal Childhood Obesity, says, “There are far more important metrics (than BMI) at the individual level—some requiring no technology other than our eyes.” While Katz acknowledges that we may not like to talk about the difference between ‘flab’ and muscle, he says we know it when we see it. “An excess of fat tissue, or flab, is potentially harmful even at lower BMIs.”
According to Lopez-Jimenez, an alternative to using BMI in children is to check waist and hip circumferences. He says, “If the waist it larger than the hip, the child likely has central obesity—unhealthy fat in the central portion of the body.” Lopez-Jimenez also notes an old teaching that may be useful: “If you cannot see the ribs of your child when he or she raises his or her arms, there’s probably a lot of fat under the skin.”
Although Katz says that BMI can be a useful (albeit imperfect) gauge of body weight, having good muscle tone and being fit can be protective even in children with a high BMI. Because health matters far more than body weight, Katz recommends that parents and clinicians assess children’s overall health with measures such as fitness, vitality, and energy level. While both Katz and Lopez-Jimenez recommend a nutritious diet and active lifestyle to help kids achieve and maintain a healthy body weight and optimize overall health, Lopez-Jimenez adds, “It is hard for a healthy child to become obese if he or she eats well and is constantly active.”
Check out four tips to help your kids eat less and better and 11 tips to nourish active kids.
*Obesity is defined as a BMI at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts.
Image of happy kids via shutterstock.
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Monday, June 16th, 2014
If the new book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, featured in The New York Times, The Wall Street Journal, and Time has made you change your child’s plate and offer her fatty foods without abandon, I urge to you to think again. Although I recommend an all-foods-can-fit approach to eating and feeding my children—an approach that some registered dietitian nutrition colleagues support and others loathe—it makes little sense to disregard current science-based advice to limit saturated fatty acids.
A strong body of evidence suggests that higher intake of saturated fatty acids is linked with higher levels of both total and bad (LDL) cholesterol—risk factors for cardiovascular disease. Also, replacing some saturated fatty acids in the diet with monounsaturated and polyunsaturated fatty acids (unsaturated fats) is also linked with low blood cholesterol levels and a lower risk of cardiovascular disease. Because of these links, current Dietary Guidelines for Americans recommend consuming less than 10 percent of total calories as saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids; keeping trans fatty acid consumption as low as possible; and reducing intake of solid fats (like butter and lard).
According to the American Heart Association, lowering saturated fatty acid intake even more—to less than 7 percent of total daily calories—can confer even more benefits when it comes to heart health.
Even though foods that naturally contain saturated fatty acids like meat and dairy foods (milk, cheese and yogurt) contribute key nutrients, it’s wise to teach children to choose such foods and others high in saturated fatty acids (including grain-based desserts like cookies and cupcakes, and dairy-based desserts like ice cream) in lower fat forms while eating plenty of fruits, vegetables and whole grains. This can help minimize saturated fatty acid intake while maximizing overall nutrient intake. More importantly, it can also help children keep their total calorie intake at a level that meets (but doesn’t exceed) their needs. Because many foods that are rich in saturated fatty acids also tend to be high in calories (not to mention taste so good), they’re also relatively easy to over consume.
Excess intake of saturated fatty acids (and fat in general) that leads to an over consumption of total calories also can contribute to excess body fat levels. Because each gram of fat has more than double the calories found in a gram of either carbohydrate or protein, calories from foods high in fat content can add up really fast and cause children to take in more calories than they need. Also, even though excess calories from any nutrient—protein, fat or carbohydrate—can increase body fat levels, excess fat calories are more efficiently stored as body fat than excess carbohydrate or protein calories. So while it’s important to make sure children get enough calories from nutrient-rich foods to meet their needs, it’s also important to help them avoid excess calories from fat (especially saturated and trans fatty acids) to prevent unhealthy weight gain and obesity.
Although many variables including genes, excess total calorie intake, decreased physical activity, increased sedentary behavior and not enough sleep contribute to the development of obesity in children, helping children establish moderate and mindful eating habits can reduce the risk. Becoming obese not only burdens children both physically and emotionally, but it also puts them at increased risk for diet related diseases such as heart disease and type 2 diabetes. It also can increase the risk of nonalcoholic fatty liver disease (NAFLD). Highlighted recently in the New York Times, the prevalence of suspected NAFLD in adolescents has more than doubled over the last three decades and currently affects an estimated 1 in 10 children. Over time, NAFDL can lead to cirrhosis, liver failure, liver cancer and cardiovascular disease. A study published in the Journal of Pediatrics suggests that increased intake of monounsaturated and polyunsaturated fatty acids (especially omega-3 fatty acids) and reduced intake of added sugars (especially from soft drinks) may reduce the risk of or treat NAFLD.
When it comes to dietary fats, helping children choose leaner cuts of meat (like sirloin or flank steak and skinless poultry), low- or non-fat dairy products, eating more fish (especially those rich in omega-3 fatty acids), nuts and seeds, and limiting fried foods and other foods made with solid fats can help them better balance their fat intake (not to mention eat better). Still, focusing on manipulating a single nutrient in the diet—whether that nutrient is fat (or a particular fat, like saturated fat), sugar or something else—misses the boat, especially because most foods contain a mix of nutrients. And ODing on any single nutrient or food is never a good idea, especially because it then leaves less room for other nutrients and foods in the diet. So the next time you hear a story or read a headline that tells you it’s OK to eat more of this or that even though you’ve heard you shouldn’t, or to eliminate this or that (even though a little probably won’t kill you), be aware that these statements are likely too good to be true or. At best, they’re an oversimplification of the science of food and nutrition. I say it’s safer to let prudence rather than headlines be your guide when making food choices for yourself and your family.
The bottom line when it comes to dietary fat and children is to offer them a wide variety of nutrient-rich foods, to teach them how to balance their food choices and to learn what proper portions of all kinds of foods to meet individual needs for growth and development. And until we know more, I prefer a total diet rather than a single nutrient approach to eating and feeding, and recommend using current science-based Dietary Guidelines for Americans to guide your food choices. Although few children and adults fully follow the guidelines (they are admittedly idealistic and challenging to follow), simply moving in the direction of meeting the recommendations can help children eat better while reducing the risk of obesity and diet-related diseases. Staying active, getting adequate sleep and managing stress can also help.
(For more on my thoughts about dietary fat and kids, check out this recent Scoop on Food post.)
Image of fresh meat and dairy products via shutterstock.
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children, dietary fat, fat, health, obesity, saturated fat, saturated fatty acids | Categories:
Diet, Health, Must Read, Nutrition, Obesity
Monday, May 19th, 2014
Have you ever given much thought to which style of serving meals might be best for your kids when it comes to their nutrition and overall health? Growing up, I remember being served food pre-plated. I was always allowed to take more if I was still hungry—and I usually did! I have continued with this tradition with my own sons who are now ages 15 and 12.
At breakfast and dinner, I pre-plate my kids’ food with an amount I think each of them will eat based on their age and stage. Sometimes they eat everything on their plates, and sometimes they leave food over. Either way, if they finish their meal and want more of something—whether that’s more milk at breakfast or some dessert after dinner—they’re allowed to help themselves.
Although I’ll serve food family-style during holidays and when we entertain friends or family, I find a pre-plated style of feeding typically works best for my family, especially on nights when we can’t eat dinner together because of conflicting after-school schedules. Sometimes simply heating up a fresh meal that’s been pre-plated and refrigerated can streamline the process of getting my kids fed. Fortunately, both of my sons eat pretty well, seldom overeat and are at healthy body weights.
Although pre-plating works for my family, many experts suggest a family-style approach to eating may be a better and more empowering way to feed growing children and prevent obesity—especially the 12 million U.S. preschool children in child care programs. In a study published in the Journal of the Academy of Nutrition and Dietetics, University of Illinois researchers surveyed 118 child-care providers who work at Head Start, Adult Care Food Program [CACFP] and other programs about their feeding practices for 2- to 5-year old children. Researchers found that while most who worked at Head Start met the Academy of Nutrition and Dietetics’ recommendation to serve foods and beverages family-style—where children select their own portions and serve themselves—most CACFP (66%) and non-CACFP (93%) providers did not.
In the study, the researchers note that serving meals family-style gives children control over the type and amount of food on their plates and helps them self-regulate their energy intakes they learn to put the right amount of food on their plate based on their internal hunger and satiety signals. They also suggest that a family-style approach to feeding increases the ability of teachers to model healthy eating compared with pre-plated service. And because there’s evidence that eating behaviors are already established by school age, the researchers underscore how important it is for adults to help children establish healthy habits during their preschool years.
According to Linda C. Whitehead, Ph.D., Vice President of Education and Development at Bright Horizons Family Solutions, “Family-style dining allows teachers and children to enjoy a meal together in a calm, respectful atmosphere. The table is typically set with child-size plates, cups, and serving bowls. Children are encouraged to not only help set the table, but to serve themselves, pass dishes to their friends and clean up afterwards.” When asked about the benefits of family-style dining, Whitehead says, “The relaxed atmosphere encourages rich conversation and social interactions. Children learn appropriate behaviors, such as turn taking and using words, such as “please” and “thank you.” It also boosts self-confidence and independence, teaches children mathematical concepts, such as less, more, half, and full and builds fine motor skills.”
In their book, Fearless Feeding, Maryann Jacobsen and Jill Castle—both registered dietitians—say that family-style feeding is an authoritative and effective way to help children eat better. As stated in their book, “Family-style meals not only shift the control to your child, but also capitalize on skill development and success.”
To help serve kids family-style, the authors recommend preparing foods in appropriate serving sizes and placing them on platters or in bowls; cutting foods like chicken breasts into 3-ounce portions; offering small potatoes; using 8-ounce glasses for milk; and using half-cup serving spoons to dish out grains, vegetables and fruits. The authors also discourage parents from using the meal table to discuss topics related to nutrition, eating, and food. They say, “Frankly, it can feel like too much pressure, especially if your child is picky or overweight.” They recommend keeping conversation topics light, fun, and entertaining so that the meal table can be a place your children enjoy. Sounds great to me!
If there’s any real downside to making family meals family-style, it might be the inevitable mess kids make when serving themselves. We all know how that goes! Whitehead suggests keeping the atmosphere positive and to see spills and messes as learning opportunities rather than frustrations. “Keeping paper towels close at hand and allowing children to help clean up never hurts,” she says.
Do you feed your kids family-style? If not, will you give it a try?
Make dinnertime easier with these one-pot supper ideas!
Image of family enjoying meal at home via shutterstock.
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breakfast, diet, dinner, family-style, health, meals, nutrition, obesity | Categories:
Health, Meals, Must Read, Nutrition, Obesity
Tuesday, May 6th, 2014
If you’re frustrated by the recent surge in childhood obesity and the way many kids are fed in this country—fed with loads of empty calorie foods and countless images and messages that tell them to eat (and eat in excess) such foods—the new documentary, Fed Up, sheds light on possible contributors and solutions. Debuting at a theater near you on May 9th, 2014, Fed Up will likely get a ton of press and will no doubt stimulate a lot of discussion about who’s to blame and what we can do as a nation and individually to turn the tide on obesity and raise healthier children.
Directed by Stephanie Soechtig and co-produced by TV-personality Katie Couric (also the narrator) and Oscar-winning advocate and author, Laurie David, Fed Up aims to “change the way you eat forever.” On it’s website, a description of the movie claims that “Everything we’ve been told about food and exercise for the past 30 years is dead wrong. Fed Up is the film the food industry doesn’t want you to see.”
As a registered dietitian nutritionist and mother of two, I was fortunate to get an early glimpse of Fed Up. It’s very well done and features many credible experts (though I was disappointed to see that no registered dietitian nutritionists—many of whom are on the front lines working with children and families to help them eat and live better—were featured). The film also offers hope for the future and provides some sensible suggestions to help families eat better (eg by cutting added sugars) and move in a more healthful direction.
Fed Up argues against the concepts “a calorie is a calorie,” “energy balance” (calories in equals calories out) and “you are what you eat” and that individuals are to blame for becoming obese. It also argues that the common advice to “eat less, move more” just doesn’t work. The movie also claims that current federal dietary guidelines are heavily influenced by industry and aren’t effective in helping children and families eat more healthfully. Fed Up also points a finger at excessive sugar intake—and the sugar industry—as main contributors to the current high rates of obesity and associated health and other problems faced by many of today’s children. The movie also blames intense marketing of nutrient-poor, high calorie, high fat, high sugar foods for unhealthy, excessive eating habits among our children and the subsequent effects of those habits on health and body weight.
Although many points made in Fed Up are valid, I do support current science-based Dietary Guidelines for Americans. Unfortunately, many children (and also adults) don’t follow (or have trouble) following these guidelines. Perhaps they’re too idealistic and seem too difficult to follow, especially in the midst of an environment that supports 24/7 eating and inactivity. Whatever the reason, Fed Up isn’t wrong when it says what what we’re doing on a national level thus far has done little to help our kids get healthier and achieve and maintain better body weights.
I encourage you to see Fed Up with your children (I plan to take mine). At the very least, it will stimulate discussion about what and how our country eats, why we eat that way, and how we can do better. Although the movie fails to mention or highlight the amazing work being done across the country by registered dietitian nutritionists to help children and families eat better (visit the Academy of Nutrition and Dietetics to learn more about what RDNs do and how we can help you and your family and community), it provides some hope for a future of healthy eating for our kids and families everywhere.
I asked co-producer Laurie David a few questions about Fed Up. Here’s what she had to say.
EZ: Why did you feel compelled to get involved with this film? Was there one specific impetus or were there many factors that led you to want to shed light on the obesity epidemic among children?
LD: The idea for the film started with Katie Couric. She had been covering stories of diet and exercise her whole career and was completely baffled as to why the problems kept getting worse. Fed Up is a result of three years of research, interviews and film making to come up with some answers.
EZ: Even though few people actually follow current Dietary Guidelines for Americans, do you agree that they’re a good place to start to help people move in the direction of eating better? If not, what small steps do you suggest that families to take to move in the direction of eating better?
LD: I think everyone is confused by all the misinformation out there. I am for simplifying everything. So here is the simple answer: eat real food, cook it yourself and enjoy it with your family. Another important step is to stop buying drinks, sodas and juices and to drink water with every meal—that will give you the great and healthy habit of craving water with food.
EZ: Given that food companies aren’t going to change the food options they provide to consumers or their marketing practices (especially to children) anytime soon, how do you suggest parents minimize the influences of these on their personal habits and on the habits of their kids?
LD: I think that marketing and advertising directly to children is immoral. I hope that after seeing Fed Up, parents will make some noise about this problem. In the meantime, parents have to debunk advertising by talking about it with their kids, pointing it out every time they see it and complaining loudly to get all branding and marketing out of our schools and in YMCAs, on Nickelodeon and in/on other places kids visit.
EZ: What are the top 2-3 take-home lessons of Fed Up for families?
LD: That processed foods are unhealthy, that nutrition labels are purposely deceiving and the only people who have your families health and well being in mind is YOU. That is why it is so important that we stop outsourcing to strangers (corporations) the most important and intimate thing we do which is feeding ourselves and our families.
Image of Fed Up movie poster via Radius-TWC.
What do you think is to blame for obesity and unhealthy habits in kids? How do you think we can/will solve the problem?
Too busy to make a healthy breakfast? We’ve got you covered! Download our Healthy Breakfast On-The-Go Guide for easy, delicious recipe ideas.
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childhood obesity, children, diet, food, food marketing, health, obesity, sugar | Categories:
Diet, Fitness, Health, Must Read, Nutrition, Obesity
Monday, April 14th, 2014
Do you give your kids juice but worry that doing so will increase their risk for obesity or type 2 diabetes or nutritionally wreck their diets? Although 100% juice, a source of sugar (though it’s naturally occurring), has been maligned in the media and by many experts—even though it’s free of “added sugars” that should be limited in any child’s diet—there’s evidence that incorporating small amounts may offer perks without the peril when it comes to kids’ health and overall nutrient intake.
In a recent study published in Childhood Obesity, researchers looked at the link between intake of beverages (including 100% fruit and vegetable juice) in early childhood and change in body fat levels from preschool to adolescence. Dietary intake using multiple sets of 3-day food records was assessed for 12 years and body mass index, waist circumference and skinfold measurements were also assessed yearly in 103 non-Hispanic white boys and girls. Researchers found that those who consumed the most fruit and vegetable juice when they were young seemed to be better protected against the development of excess body fat during adolescence than those who consumed the least fruit and vegetable juice.
Although we need more data—especially as it relates to children—a recent review in PloS One that included an analysis of four studies done in adults concluded that intake of 100% fruit juice was not associated with risk of developing type 2 diabetes.
In another study, researchers looked at usual reported intakes of 100% fruit juice among 2- to 18-year-olds. They found that compared with 100% fruit juice consumers, a significantly higher percentage of non-consumers had intakes below recommendations for several key nutrients including vitamin A, vitamin C, folate, phosphorus and magnesium. In addition, a greater percentage of 100% fruit juice consumers exceeded recommended intakes for potassium—a nutrient that many children fall short on—compared with non-consumers. The researchers concluded that consuming 100% fruit juice is associated with improved nutrient adequacy and can contribute to a healthy diet in children and adolescents.
As a registered dietitian nutritionist and mother of two, I do keep some 100% fruit juice in my home. Although my sons, aged 15 and 11, drink it, they don’t have it every day. To help my own kids meet their daily fruit quotas (about 1.5 cups for my younger son, and 2 cups for my older son), I keep plenty of fresh, whole fruit around and always offer that first. That’s because whole fruit offers fiber and, calorie for calorie, usually packs in a lot more nutrients than an equivalent amount of juice. But when I do offer juice (I only buy 100% fruit juice that has no added sugars), I offer no more than a 6-ounce box or 8-ounce cup of juice (usually orange or apple juice)—amounts that are consistent with the American Academy of Pediatrics’ recommendations (up to 4 to 6 ounces for 1- to 6-year-olds; and up to 8 to 12 ounces for 7- to 18-year-olds). I also offer it with a meal or hearty snack rather than in-between when the temptation to OD is too great.
While my younger son isn’t much of a juice drinker (he only likes mild-tasting fruits, and won’t touch candy or chocolate—which sometimes makes me question if he really is my child), my older son has more of a sweet tooth and has been known to down not one but two cups of cranberry juice when we go out to a restaurant once every week or so. Because my kids are each at a healthy body weight and because I know their usual juice intake is moderate, I don’t worry that drinking it will sabotage their diet. I do, however, think it’s wise for all parents—especially those whose kids are overweight or obese—to think twice about their kids’ juice intake in the context of their overall diet. Although we need more data, some studies suggest that increased intake of 100% juice is linked with higher body weight in children and adolescents who are overweight or obese. With that in mind, current Dietary Guidelines for Americans suggest that most fruit recommended should come from whole fruits (including fresh, canned, frozen and dried forms) rather than from juice, and that when juice is consumed it should be 100% juice rather than juices made with added sugars. I concur!
What’s your take on 100% juices in your kids’ diets? Yay or nay?
How much do you really know about toddler nutrition? Take our quiz and find out.
Image of juice glass and orange fruit via shutterstock.
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100% juice, children, diet, fruit juice, health, juice, obesity, overweight, type 2 diabetes | Categories:
Diet, Health, Must Read, Nutrition