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Tuesday, June 16th, 2015
If you believe everything you read about added sugars, you’ll be convinced they’re toxic time bombs just waiting to kill us all. So don’t believe everything you read. The truth is that sugar is not a poisonous substance. Your child can have a cookie without risking his life. Yet it’s also true that most people (especially most kids) are getting too much of it–and that a high-sugar diet isn’t good for health.
But what exactly, does “too much” mean? I talk to a lot of parents who are concerned about sugar, shocked that a can of soda contains nearly 10 teaspoons of the stuff, but really don’t know what that means in the grand scheme of things.
For starters, remember that ADDED sugars are what health experts are worried about. That’s the kind put in by manufacturers or by you at home. It’s NOT the natural kind found in fruit and dairy. (Ever noticed that plain yogurt or milk still has sugar? That’s natural.) Unfortunately, the nutrition facts label doesn’t distinguish between added and natural (yet!) but you can still use this label-reading trick: Every 4 grams of sugar = 1 teaspoon. So candy with 8 grams of sugar per serving has the equivalent of two teaspoons of sugar.
Though there’s no Daily Value for added sugars, word is that the new Dietary Guidelines for Americans will likely suggest no more than 10 percent of calories should come from it. For kids, that looks like this:
- Children ages 2-3: No more than 100 calories from added sugar (about 6 teaspoons or 24 grams)
- Children ages 4-8: No more than 120-140 calories from added sugar (about 7-8 teaspoons or 28-32 grams)
That sounds like an awful lot—until you consider how much is actually in foods and drinks:
- Sheet of graham crackers: 1 tsp
- Chocolate chip granola bar: 1 tsp
- Small bowl of honey-flavored “o” cereal: 2 tsp
- Package of gummy fruit snacks: 2.5 tsp
- Packet of peach-flavored instant oatmeal: 3 tsp
- Pouch of fruit punch: 3 tsp
- Cup of sports drink: 3.5 tsp
- 2 tablespoons chocolate hazelnut spread: 5 tsp
- Chocolate cupcake with frosting: 9 tsp
Suddenly, the recommendations start to look a little tough. Have a day with a birthday party, soccer game snack, and a lollipop at the bank, and they look downright impossible.
So here’s my advice: Though it’s important to be aware and look at nutrition labels for sugar content, obsessing over numbers or counting up sugar grams for the day is no way to live. Instead, think big picture. What foods and drinks are providing the most sugar for your family—and is there a way to reduce that?
For instance, mix plain yogurt with flavored. Ditto for chocolate milk and regular milk. Designate a couple of “dessert nights” each week instead of serving it every day. Stop buying soda or buy it only occasionally. Cutting back on sweetened beverages in general can go a long way in reducing intake. The bottom line is that while there’s no need to cut it out completely, little moves like these can add up to less sugar for everyone.
Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She is the author of Cooking Light Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.
Image: Spoon of sugar via Shutterstock
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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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diet, feeding children, food, health, infants, obesity | Categories:
Diet, Health, Must Read, Nutrition, Obesity, The Scoop on Food
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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