Tipping the Scales on Childhood Obesity: Part 2

Part 2 - looking at the nutrition/healthy eating aspect of managing childhood obesity and how to talk to your PCP

How do I help my child eat healthier/reduce the calorie imbalance?

Help Kids Develop Healthy Eating Habits¹²

Encourage healthy eating habits. Small changes can lead to a recipe for success!

·      Provide plenty of vegetables, fruits and whole-grain products.

·      Include low-fat or non-fat milk or dairy products.

·      Choose lean meats, poultry, fish, lentils and beans for protein.

·      Serve reasonably sized portions.

·      Encourage your family to drink lots of water.

·      Limit sugar-sweetened beverages, sugar, sodium and saturated fat.
 

Making healthier food and lifestyle choices

One of the first steps to helping your child overcome obesity is to help him or her develop a healthy relationship with food.  This may mean making some lifestyle changes. The following are options for beginning your lifestyle changes.

Eat the rainbow. Serve and encourage consumption of a wide variety of      fruits and vegetables. This should include red (beets, tomatoes), orange (carrots, squash), yellow (potatoes, bananas), green (lettuce, broccoli) and so on—just like eating a rainbow.

Make breakfast a priority. Children who eat breakfast are less likely to be overweight or obese than those who skip the first meal of the day. Focus on healthy choices like oatmeal, fresh fruit, whole grain cereal, and low-fat milk instead of sugary cereals or toaster pastries – go for more protein-based foods than carbohydrate based.

Cut back on fat. Some fat is needed to maintain good health, but these fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils. Cut way back on fast food, junk food, and sweets.

Schedule regular meal times. Children like and often need routine. If your kids know they will only get food at certain times, they will be more likely to eat what they get when they get it.

Limit dining out. If you must eat out, avoid fast food and make the healthy choices you are trying to make at home. Many fast food chains are now offering “healthier” options.  Have a Happy Meal with apple slices instead of fries. 

Make favorite dishes healthier. Some of your favorite recipes can be healthier with a few changes. You can also try some new healthy dishes that might just become favorites too!

Remove calorie-rich temptations. Treats are OK in moderation, but limiting high-fat and high-sugar or salty snacks can also help your children develop healthy eating habits.

Examples of easy-to-prepare, low-fat and low-sugar treats that are 100 calories or less:

             ·      A medium-size apple

             ·      A medium-size banana

             ·      1 cup blueberries

             ·      1 cup grapes

             ·      1 cup carrots, broccoli, or bell peppers with 2 tbsp. hummus
 

Don’t ban sweets entirely. Completely banning sweets will only incite cravings. Try to limit the amount of cookies, candies, and baked goods your child eats and introduce fruit-based snacks and desserts instead.

Limit juice and soda. Soft drinks are loaded with sugar (“empty” calories) that don’t do anything healthy for your child’s growing body. Many juices aren’t any better nutritionally. Instead of soda, offer your child sparkling water with a twist of lime or a splash of fruit juice.

Keep snacks small. Don’t turn snacks into a meal. Limit them to 100 to 150 calories.

Focus on fruit. Keep a bowl of fruit out for your children to snack on. Offer fruit as a sweet treat. Kid-friendly favorites include frozen juice bars, fruit smoothies, frozen bananas dipped in chocolate and nuts, strawberries and a dollop of whipped cream, fresh fruit added to plain yogurt, and sliced apples and peanut butter.

Help your kids understand the benefits of being physically active. Teach them that physical activity has great health benefits like:

·  Strengthening bone

·  Decreasing blood pressure

·  Reducing stress and anxiety

·  Increasing self-esteem

·  Helping with weight management
 

Help kids stay active.
According to the American Heart Association, children and teens should participate in at least 60 minutes of moderate-intensity physical activity most days of the week.  You can set a great example!

Reduce sedentary time. Although quiet time for reading and homework is fine, limit “screen time” (TV, video games, Internet) to no more than two hours a day. The American Academy of Pediatrics doesn’t recommend TV for kids age 2 or younger.

 Limit daily screen time. Studies show a link between screen time and obesity, so set limits on your child’s TV-watching, gaming, and web surfing. Experts recommend no more than two hours per day.

*these are suggestions from the American Academy of Pediatrics

**more to come on this topic in later posts

Stop eating in front of the TV. This is a bad habit many of us fall into! Tell your child that, starting now, your family does all their eating at the table. This helps form good habits and limits the number of calories you and your child are likely to eat.

Pick a different reward or punishment. Instead of rewarding your child with more time in front of the television or computer, promise something different, such as an outing or an activity of their choice.

We all want our efforts to be fruitful. So here are some factors that have been shown to predict success:

•     Including parents in the dietary treatment program – this is a team effort!

•     Strong social support of dietary intervention from others involved in preparing food

•     Regular physical activity prescription including social support – supporting your children and being a role model are sure-fire ways to help you child beat or prevent obesity!

If you are interested in looking at these ideas by age, here are some additional recommendations for kids of all ages.  Much of this is repeated from above, but is a slightly different perspective:

Recommendations by Age¹³

•    Birth to age 1: In addition to its many health benefits, breastfeeding may help prevent excessive weight gain. Though the exact mechanism is not known, breastfed babies may be more able to control their own intake and follow their own internal hunger cues.

•    Ages 1 to 5: Start good habits early. Help shape food preferences by offering a variety of healthy foods. Encourage kids' natural tendency to be active and help them build on developing skills.

•    Ages 6 to 12: Encourage kids to be physically active every day, whether through an organized sports team or a pick-up game of soccer during recess. Keep your kids active at home, too, through everyday activities like walking and playing in the yard. Let them be more involved in making good food choices, such as packing lunch.

•    Ages 13 to 18: Teens like fast food, but try to steer them toward healthier choices like grilled chicken sandwiches, salads, and smaller sizes. Teach them how to prepare healthy meals and snacks at home. Encourage teens to be active every day.

•    All ages: Cut down on TV, computer, and video game time and discourage eating while watching the tube. Serve a variety of healthy foods and eat meals together as often as possible. Encourage kids to have at least five servings of fruits and vegetables a day, limit sugar-sweetened beverages, and eat breakfast every day.

Addressing your Child’s Weight at the Doctor

The discussion of weight is never comfortable, especially when it pertains to your child. Talking with your primary care physician about any concerns you might have can begin the process of helping your child and can ultimately put you at ease.

Here are some tips on how to make talking with your doctor about weight and childhood obesity less daunting:

•    Come prepared with your concerns. Write down all your questions and concerns about your child’s weight before you visit the doctor. Write down if your child is experiencing any symptoms or behaviors you are concerned about. Be sure to ask for clarification if there is anything you don’t understand – DO NOT BE AFRAID TO ASK QUESTIONS.

•    Be aware of any pre-appointment restrictions. If your doctor is going to test your child's blood sugar or cholesterol, your child may need to fast for eight to 12 hours. When you're making an appointment, ask if any type of fasting is necessary.

•    Bring a notebook and a pen or pencil to write down important information.  There can be a lot of information to retain.  Writing down the information and resources your physician gives you will help you remember and be on the ball.

•    If you are uncomfortable discussing the topic of weight in front of your child, ask the doctor for a time when you can ask your questions over the phone or over email or even step briefly into another room to discuss your concerns.

•    If you are having the discussion in front of your child, begin to discuss aspects of healthy living before the visit so he/she doesn’t feel attacked. Have conversations about what your child thinks it means to be physically active or to eat healthy. By making the overall topic familiar with your child, they will be less likely to feel overwhelmed when you address it again at the doctor.

•    If you have a concern, be sure to voice it. Just because your doctor does not bring up the topic of your child’s weight, doesn’t mean there isn’t an issue. Even your doctor may feel uncomfortable approaching the topic, so make certain you address any worries you have before you leave.

•    Ask the doctor for recommendations and resources. If there is an issue with your child’s weight, ask what the next steps should be. There are many resources on our website as well, but your physician will be able to give you the best starting point for your child.

•    Make it a family issue. Talking about the health and habits of the entire family will keep individual children from feeling targeted and the motivation of making changes together as a team will help everyone achieve their health goals.

Some basic questions to ask your doctor include:

•    What other health problems might my child have?

•    What are the treatment options for my child?

•    Are there medications that might help manage my child's weight and other health conditions?

•    How long will treatment take?

•    What can I do to help my child lose weight?

•    Are there any brochures or other printed material that I can take home with me?

•    What websites do you recommend visiting?

Some questions you may be asked regarding your child:

•    What does your child eat in a typical day?

•    How much activity does your child get in a typical day?

•    What are the factors that you believe affect your child's weight?

•    What diets or treatments, if any, have you tried to help your child lose weight?

•    Do you have any family members with weight problems?

•    Are you ready to make changes in your family's lifestyle to help your child lose weight?

•    What do you think might prevent your child from losing weight?

•    How often does the family have meals together? Does the child help prepare the food?

Does the child, or family, eat while watching TV or using a computer?

In Summary: Strategies for Real Life

•    Recognize that you have more control than you might think. You can turn off the TV and the video game. You can choose to get off the bus one stop earlier than usual and walk the rest of the way, especially when you are with your kids. You can give your family more vegetables for dinner.

•    Think about the immediate benefits. If reducing the risk of future heart disease seems abstract, focus on the good things that can happen right now. You won’t feel so full if you have a smaller portion or skip dessert. Going hiking with your teenager might lead to a wonderful talk that neither of you anticipated. A fruit salad tastes great and looks beautiful. Dancing or playing with your kids is lots of fun and can give you a great workout.

•    Make small, easy changes over time. Suggesting that family members take a run together every day will probably get you lots of eye-rolling and “no-thank-you’s.” It’s easier and more appealing to start out with some new approaches to nutrition and physical activity that the whole family is really willing to try. For example, take a walk after dinner a couple of nights a week instead of turning on the TV. And, instead of chocolate cake with frosting, enjoy sliced strawberries over angel food cake.

Source: We Can! Families Finding the Balance, U.S. Dept. of Health & Human Services

Resources:

12. American Heart Association  “Preventing Childhood Obesity: Tips for Parents and Caretakers”  https://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ChildhoodObesity/Preventing-Childhood-Obesity-Tips-for-Parents-and-Caretakers_UCM_456118_Article.jsp

13. Kids Health “Overweight and Obesity”  http://kidshealth.org/parent/general/body/overweight_obesity.html#

Other resources:

Choose My Plate - the government initiative for healthier eating; a good resource for meal planning, tips for lifestyle changes, and more resources for weight management

                   http://www.choosemyplate.gov/

NEXT:  Activities to do with your kids!  How to keep them moving!   And for PTs - what is our role, how can we help.