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Monday, August 18th, 2014
A public service announcement (PSA) called “Rewind the Future,” launched as part of the Children’s Healthcare of Atlanta’s Strong4Life campaign, has garnered a lot of media attention—and considerable criticism—from health experts and parents alike. Although the PSA first surfaced in April 2012, it recently blew up on the internet, garnering an estimated six million views so far.
The PSA begins with a 32-year-old man named Jim who at 5’9” and 300 pounds is wheeled into a hospital while having a heart attack. After the doctor asks, “How the hell does this happen,” the video flashes backwards through the man’s life, attempting to illustrate how he got there. At various stages of Jim’s life, he’s shown eating ice cream and pancakes, being out of breath while playing with his kids or walking on a treadmill, hiding food in his room, playing video games, being rewarded candy by a teacher for earning good grades, being exposed to fast food by his parents (his dad orders pizza and his mom goes through a drive-thru), and acting up at meal time—and being pacified with French fries by his mother. The video ends with the message, “There’s still time to reverse the unhealthy habits our kids take into adulthood” and a link to the Strong4Life website.
While the PSA has certainly sparked conversation, I was surprised when a Good Morning America poll inspired by the PSA revealed that eighty-one percent of viewers believe parents are to blame if their kids are obese. Only nineteen percent believe they are not. Although parents certainly play a major role in their children’s eating habits, I don’t believe pointing fingers and playing the blame game are the way to inspire meaningful change and better physical or psychological health in children. And while I appreciate the idea of prevention of obesity and its consequences, I don’t feel that blame and shame as suggested in this video are the answer.
Several experts have also spoken out against the PSA. In his recent blog post about the PSA, Yoni Freedhoff, MD, a family doctor and Assistant Professor at the University of Ottawa refers to the PSA as “…everything that’s ugly about society’s attitudes towards weight boiled into a two-minute video treatise on how gluttony and sloth are to blame for obesity….oh, and add in lazy parents.” Although he agrees that parents have a role to play in all of this, he believes that fear and shame aren’t likely to get them there. He writes, “If guilt or shame had any lasting impact on weight or behavior, the world would be skinny, as guilt and shame are the two things that the world bends over backwards to ensure that people with weight never run short of.” Freedhoff also says that shaming the symptom without tackling the cause is likely only to add to the belief that fat shaming has a role to play in fixing the environment.
In another blog post, California-based registered dietitian nutritionist Aaron Flores wrote, “Just like many other ads, the sensational tone shames both parents and kids. It says nothing of the fact that health comes in different shapes and sizes. It makes it seem as if a parent makes one mistake feeding a child at an early age, they’ve doomed their child to an early death. Nothing could be further from the truth. It’s this black and white thinking that leads us to think of foods as “good” or “bad” and lead to a life of dieting and binging.” Flores goes on to suggest that what parents need is to learn how to help children feel comfortable with all different kinds of foods and to nurture children’s self confidence with food and their body. He adds, “The last thing we need is to create environment that leads our children to hate their bodies, seek diets and (develop) unhealthy relationships with food.” Terrific points, no?
Although obesity, especially among children, is certainly something we all need to be concerned about and address, the findings of a recent study from the Rudd Center for Food Policy and Obesity at Yale University and published in American Journal of Preventive Medicine suggest that this video and others like it may not be the answer. The study found that stigmatizing obesity-related public health campaigns were no more likely to instill motivation for improving lifestyle behaviors among participants than campaigns that were more neutral.
As someone who always thinks you can attract more bees with honey, I, too, believe that rather than shocking or shaming parents, emphasizing what they can do more of—for example, offering more produce and cooking more at home, and choosing choose smaller portions while dining out—can empower them to feed their children better and help children actually eat better. It can also have a wonderful side effect of helping kids develop more healthful food, fitness and lifestyle behaviors they’ll carry with them as they increasingly make more decisions about what and how much to eat and move. Over time, this can help prevent many of the diet-related diseases many children, including those who are overweight, can develop as adults.
When asked about the rationale for the PSA, Stephanie Walsh, M.D., Medical Director, Strong4Life at Children’s Healthcare of Atlanta wrote in an email, “The video was designed as part of a larger movement to empower parents” and to “remind parents of the power they have to influence their child’s health and help them to consider making small steps towards lifestyle change.” In response to criticisms that the video unfairly blames and shames parents, Dr. Walsh added, “This video was not designed to place the blame on parents or make people change; it was designed to make people consider making a change.” She also suggests that people must first realize the importance of changing a behavior before they actually make a change. Although she concedes that the video dramatizes the problem, she notes that the scenes depicting unhealthy habits are real examples of the struggles many of their patients and families face— reigning in screen time, motivating kids to be active and decreasing the amount of sugar their kids drink. She adds, “The video was designed to focus on behaviors that we, as parents, can control.”
What are your thoughts? Does this video go too far, or do you think it will inspire parents to help their kids eat and live better?
Image of mother and kids having a snack at a fast food restaurant via shutterstock.
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Diet, Health, Meals, Must Read, Nutrition, Obesity
Friday, July 18th, 2014
This is a guest post by Karen Cicero, Parents’ Contributing Food and Nutrition Editor.
Fish, whole grains, veggies—these probably aren’t your kids’ favorite foods (okay, they might not even like them at all), but it’s worth your time to work on it. Here’s why: A new study of 9,000 children ages 2 to 9 in eight European countries found that those who most closely follow a Mediterranean diet are 15 percent less likely to be overweight. I admit that it doesn’t sound like a huge deal, but considering nearly 1 in 5 American kids ages 6 to 11 is overweight, it makes a significant dent. Plus, since obesity rates increase as kids get older, it’s worth getting on the right track before the tween and teen years.
What’s so special about the Mediterranean approach? The researchers think that the high fiber content and healthy fats found in foods like nuts, avocados, olive oil, and produce may help prevent kids from overeating. “This is the first study I’ve seen that makes the connection between the Mediterranean and obesity in kids,” says Lauri Wright, R.D.N., a spokesperson for the Academy of Nutrition and Dietetics and mom of three. “We already know that this type of eating plan is healthy in many other ways—like helping to prevent heart disease—so it’s wonderful that it may have extra benefits for children too.”
Of course, you’re not going to be able to switch your child’s eating habits overnight, but take these steps to make your family’s meals and snacks more Mediterranean:
* Do over dip. Swap the creamy salad dressings your kid drenches his baby carrots in for healthy hummus.
* Make pizza at home. Use thin whole-grain crust. Make it yourself (find a recipe here) or buy pick up a package of whole-wheat Naan bread (my daughter prefers it for her pizza!). Top it with whatever veggie your kid likes—even if it’s corn.
* Start working in more seafood. Let your child give it a try in a no-pressure situation, like when it’s on a buffet or when she’s having a bite of yours. When my daughter was a toddler, she used to swipe clams and mussels from my plate, at first mainly because she was intrigued by the shells. But then she began requesting a bowl of her own! Eventually, work your way up to homemade fish nuggets—Wright coats pieces of mild fish with applesauce and then rolls them in cornmeal before baking. When you’re ready to move onto grilled fish, top it with a salsa made from your child’s favorite fruits. That’s how I got my daughter to taste salmon and sea bass, which are now her faves.
* Build on veggie success. Chances are, your child likes a lot of different kinds of fruits and a few veggies. Combine a favorite with something that’s unfamiliar or not as well liked (such as corn with red onions or cucumbers with radishes or watermelon with baby spinach) to increase the chance that he’ll eat it. Salad can be a tough sell so start with mild butter lettuce and add a lot of fun familiar ingredients (like dried fruit, sunflower seeds, or orange wedges). Kids may also enjoy salads more if they’re chopped. Even though it takes longer to prepare, you’ll have a happy, healthier eater as a reward.
Image of Mediterranean food via Shutterstock.
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Health, Meals, Nutrition, Obesity, Snacking, The Scoop on Food
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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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