‘obesity’

All Articles tagged ‘obesity’

New Obesity Data And Tips To Avoid It

New data published in JAMA today finds that there has been no significant change in rates of overweight/obesity overall for children between age 2 to 19 years of age since 2003. This is unfortunate news in the big fight against overweight and obesity. Conclusions from the study, “Obesity prevalence remains high and thus it is important to continue surveillance.” Obesity rates remain high at with 17% of children and more than 1/3 of adults.

The good news is that there was improvement in one small group, toddlers age 2 to 5. Numbers from National Health and Nutrition Examination Survey(NHANES) show reductions in overweight and obesity for the preschoolers by as much as 43% during the last decade. Really hoping this is a canary in a coal mine situation — perhaps they’re chirping a clue. Learning the “why” behind the reduction in obesity for preschoolers feels like a huge opportunity. However for the mass of people researched in total (over 9,000 from birth to age > 60 years) the data confirms we’re not done tipping the scales.

The research article evaluated rates of overweight and obesity between 2003-04 NHANES data and 2011-12 data on children and adults. The CDC is highlighting the success in the toddlers, stating:

While the precise reasons for the decline in obesity among 2 to 5 year olds are not clear, many child care centers have started to improve their nutrition and physical activity standards over the past few years.  In addition, CDC data show decreases in consumption of sugar-sweetened beverages among youth in recent years. Another possible factor might be the improvement in breastfeeding rates in the United States, which is beneficial to staving off obesity in breastfed children.

It’s wonderful to see signs of improvement in the small population of children included in the NHANES data but this research article doesn’t investigate how the improvements were made and/if they are stable. More research will have to unfold. We’re all desperate — parents, pediatricians, public health experts — for solutions that work in not only curbing, but reversing the rates of overweight and obesity. This data can potentially focus the light on where we need to look to study cause and effect to determine possible success stories and strategies. Five quick tips for parents now: Read full post »

No More Clean Plate Club

Some new advice allows us to do less, not more. Turns out, new research finds that controlling parenting styles may hinder children’s healthy eating habits. New data published in April 2013, finds that not only are controlling, food-related, parenting practices common, they aren’t helping teens maintain a healthy weight. In the Pediatrics study, researchers found that parents often encourage teens of healthy weight to finish all their food, providing pressure to eat. While parents to overweight teens ban some foods and encourage restriction. Neither practice is proven to improve teens’ habits or improve their health.

We really want our children to self-regulate their energy intake (food) and mounting evidence reports that controlling habits hinder this essential skill.

Four Golden Eating Rules

  • Divide responsibilities. Parents have the job of purchasing and serving healthy food. Infants, children, and teens have to choose what to eat and how much of the food that’s offered. The division of responsibilities allows you less of a role. Every parent knows that you can’t force a child to eat–the best thing to do is stop trying. Let mealtime be about feeding your body. If they don’t eat much, wait until the next meal to offer food. Children eat for themselves, not for their parents. Turn the TV off and let children feel their fullness when it arrives. 
  • Eat when your body is hungry. Stop when your body is full. Infants do this naturally when breastfeeding and when starting solids. We have to do our best to maintain that natural habit throughout toddler to teen years. This skill of responding to natural hunger and normal cues of satiety can be a huge asset for children for their entire lives. Do your best to stop engineering how much your children eat and let them learn to feel necessities.
  • Don’t make children Clean The Plate. There’s absolutely no reason to provide pressure to eat for children with normal development and normal health. Don’t reward children for finishing their dinner with more food (ie dessert) as children will often eat past their fullness. New research also finds that using smaller plates can also help control portion sizes and ultimately will reduce number of calories eaten. The benefit: it will also trigger less need to ask them to clean their plate, they’ll do so naturally on a smaller plate.
  • Eat together. The most potent education we give our children comes from our modeling habits and behaviors we think are most important. Eat together with children at meals from infancy until they leave home. Make a goal for at least one meal a day, and it doesn’t need to be dinner. That being said,  I love the book The Family Dinner by Laurie David. There’s no reason to cook special food for your children. Involve them in any part of meal prep you can, eat the same foods, and share your love of eating.

When Should I Start Baby Food?

first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune. Read full post »

What You Should Know About Energy Drinks

I think of energy drinks as the new liquid accessory for many teens. Something to hold onto with nervous hands and something to spend money on when they’re really tired or need a “boost.” Teens report drinking them because of inadequate sleep, a need for energy, and wanting to mix them with alcohol. It’s big business to market energy drinks to those in high school or college and that big business is remarkably successful. More than a 1/3 of teens (39%) say they’ve had an energy drink in the last month and “jock identity” is associated positively with a frequency of energy drink consumption.

These drinks may really make you look cool…

College students may be even more compelled to drink them; one study found 50% of students had consumed at least one to four drinks in the last month. It’s hard to remember from our vantage point, adults aren’t really the target of energy drink advertising and sponsorships. Because of that paucity of advertising, only 15% of adults say they drink them.

Trouble is, there’s nothing really good for us in these energy drinks. We don’t ever need the caffeine, guaranine, ginseng, and sugar from these concoctions. Energy drinks can have 3-4 times the amount of caffeine in a regular cup of coffee but you may never know it. The labels can be opaque and misleading. The labels aren’t regulated and the content of caffeine isn’t mandated. A can of soda can have no more than 65mg of caffeine while one energy drink (Wired X505) has 505mg. I think this should make you mad.

A recent summary came out in Pediatrics in Review to help guide teens (and their doctors) on what they need to know. But many of us are still catching up. These are not “health” drinks although some of the claims on the bottle and advertising may suggest so. Most parents would prefer their athlete drink water over energy drinks. Thing is, their athlete would do far better. Caffeine can make you anxious, have palpitations, elevate your blood pressure, cause digestive problems, and increase insomnia. The sugar in these drinks will likely just add weight, not great energy, to your athlete.

Things To Know About Energy Drinks

  • Energy drinks are not regulated by the FDA like soda is. The FDA is investigating health effects but there are no current mandates in place for manufacturers. A can of soda is limited to 65 mg of caffeine. Energy drinks don’t have those limits and often the bottles and cans don’t even list all ingredients that have stimulant-like effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Read full post »

Something For Parents At The Park

Screen Shot 2013-02-16 at 5.37.00 PMThis is post from my friend, Anne Gantt. I love this concept and am inspired by the idea of parents pumping iron at the park. I’m hoping we can move this conversation forward. Please share ideas from your own neighborhoods in comments.

As a stay-at-home mom, I spend a ton of time at our neighborhood park while my 2 ½ and 4 year-old children zip down slides, scramble over the jungle gym, or chase each other in the woodchips. While they’re running around like little olympic athletes, I mostly just stand there doing nothing. A lot of nothing. Sound familiar?

That’s originally why I daydreamed about putting fitness equipment for adults in our park. I’d love to get a little exercise without having to resort to taking a turn on the monkey bars. The interesting thing is that installing adult fitness equipment will improve the park…for kids. This truly can be a win-win.

The park in question is here in Seattle– University Playground— it has a big grassy field, tennis courts, and beautiful new equipment for kids. It also has one of the very few public restrooms in the whole neighborhood–thus attracting a crowd. It sits in a tenuous location, one block from Interstate-5 and smack in the University District, which means the park sees a lot of illicit activity. Even worse, the illicit (I’m talking drug sales, etc) activity tends to happen in the section of the park right next to the playground.

Believe it or not, I’ve picked up more than a couple of used needles out of the woodchips myself.

Our park’s unsavory elements definitely scare some people off. I recently talked with a neighbor who refuses to take his 4-year old grandson to the park out of a concern for safety. This, even though their living room window looks right out onto the playground.

Something had to change. Urban dwelling can be better than this. Read full post »

Can Soda Companies Help Fight Obesity?

Screen Shot 2013-01-28 at 10.38.06 AMI’m curious what you think. Do you think companies that make, sell, and market soda can improve the challenges we face with obesity? I’m asking sincerely. I was struck by the Coca-Cola ad (below) recently released. I’m a pediatrician and I’ve never worked for a beverage company or any company that sells products to children. I don’t like that these companies market salty, fatty, sugary products to children. As a pediatrician, I would suggest I’m very biased. The food industry spends $15 BILLION marketing and advertising to children every year. Food advertising, directly to children, is known to increase rates of obesity. Even familiarity with fast-food ads has been found to be problematic. As parents, this isn’t hard to believe; I’ve seen my boys introduced to a product on TV and then ask for it at the grocery store. Because of my bias, I’m asking you—do you think companies like Coca-Cola and Pepsi can help?

As the obesity problem persists, strategies have turned to protocols and regulation. Today, the American Academy of Pediatrics (AAP) released it’s first policy on managing weight-related diabetes. And in the past few years, the American Heart Association released a statement asking for increased regulation on advertising high-calorie, low nutrient-dense (“junk”) foods to children. In 2006, The Institutes of Medicine (IOM) said, “Food marketing intentionally targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) “junk” foods; companies succeed so well in this effort that business-as-usual cannot be allowed to continue.”  Similar sentiments are shared by the American Psychological Association, the Center for Science in the Public Interest (CSPI), Children Now, the American Medical Association, and the American Academy of Pediatrics. The public, too. Last fall, the majority (67%) of international readers polled in The New England Journal of Medicine believed we should regulate sugary-beverage consumption. This on the heels of New York’s regulation banning sale of large sugary drinks. This isn’t just about a tax. Can these companies help? Read full post »

Too Much Salt? More Bad News

Salt is back in the news. Not surprisingly, salt continues to get a bad name because eating too much salt can put us at risk. This is a bummer for those of us who prefer a salt lick to a popsicle. And it’s especially bad if we developed a salt-eating habit in childhood. An article published today found that increases in salt intake are correlated with the finding of high blood pressure. Not news, exactly. But the article asserted that for each increase in 1000mg of sodium intake each day, the risk of elevated BP increased significantly. Every little grain of salt seems to count. This was especially true among children who were of unhealthy weight (over 1/3 of the children studied). Thing is, the longer we have high blood pressure, the more damage our bodies sustain. So if high pressures start in childhood, risks increase throughout our lifetime.

Blood Pressure In Children:

  • Normal blood pressure for children shifts and changes as they grow. Normal BP varies based on age, gender, and height. Your child should have their blood pressure routinely checked starting at 3 years of age. Ask the nurse, medical assistant, or doctor to report  your child’s blood pressure and confirm the numbers are normal for their age and height.
  • Salt may increase blood pressure by causing the body to retain more water, giving our blood more volume. When blood volume and pressure increases, the changes can load stress on our heart and our blood vessels. Over time, those longstanding increases can cause damage to our organs putting us at higher risk for heart problems and/or stroke. You should know however, there are many people who develop high blood pressure as they get older who don’t eat excess salt, for unknown reasons. Medically significant high blood pressure requiring treatment is rare in childhood but can start at any age. Even so, anyone who eats excess salt is at risk for elevating their pressures at any age.
  • Many children with high blood pressure don’t know it. The article reported that 15% of the 6000 children evaluated had high blood pressure. Boys were more likely to have high pressures.

Below is a video I published previously on where salt comes from in our diet, how much salt children can consume by age, and ways to help reduce our cravings for salt as a family. Number one thing to do in any household to reduce salt intake is to reduce processed food sources–canned and processed foods account for the majority of salt in our diets. Read full post »

First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »

How To Pack A Healthy Lunch: Mama Doc 101

Although you’ll see these lunch ideas don’t look exceptionally fancy, I think the point is this: you don’t have to spend a ton of time or money giving your children healthy lunch choices. But you do have to spend some. After the pizza debacle (“a slice of pizza still counts as a vegetable”) bubbled up when congress blocked proposals for changes in school lunches, I was reminded we still have to have a significant responsibility to watch over our children’s lunches. Don’t leave lunch in someone else’s hands unless you’re reviewing the menu. At our sons’ preschool we sometimes feel they do a better job than we do (!) so this is not a post to trash school lunch programs. Some schools really are doing an exceptional job. Is yours?

Trouble is, sometimes I look at example lunch ideas for parents and I feel overwhelmed. Read full post »

Preschoolers: Movers And Shakers

The most amazing thing about vacation is how much time you get to spend outside and how much time you get to move. We’ve just returned from a week away where the boys spent the far majority of their days without a ceiling. Delicious.

Sure, it’s easy to live outside when you’re on vacation. The challenge is in our “normal” lives–the ones where we go to work, school, and complete activities. It turns out our parental efforts for safety and our need to cultivate “learners” may be getting the way of our children’s health. Sometimes we may be over-thinking things.

We’ve been touring preschoolers and kindergartens these past few weeks. I’ve been thinking a lot about the 3 dimensions in which our boys spend their days. So a qualitative study on preschool centers and physical activity published by the Academy of Pediatrics last week caught my eye.

Three-quarters of all preschoolers between the age of 3 and 5 years are in child care and more than half of them are in either preschooler, day care, or nursery school center. Most children spend the majority of their waking hours, after age 3, outside of their home. Many children spend very long days at school, leaving around 6pm to head home. After 6pm, there is little time for outdoor play. Read full post »