How Can Parents Help Overweight Children?
Oct. 27, 2003 -- With 15 percent of American children tipping the scales into the overweight zone, experts point to three main culprits: fast food, inactivity and stressed-out parents who have weight problems of their own.
"This may be the first generation of kids that has a life span shorter than that of their parents," said Keith-Thomas Ayoob, an associate professor at Albert Einstein College of Medicine in the Bronx, N.Y. There are numerous health issues related to childhood obesity, such as Type 2 diabetes, and even heart disease.
Yet there are solutions to the problems that cause childhood obesity. Here are tips from pediatric doctors, nutritionists, professors and researchers from around the country.
1. Get Rid of Fast Food and Fatty Snacks
Children's diets are low on fruits, vegetables and dairy, yet high on snack foods with no nutritional value. The simple way to decrease the likelihood of child obesity: keep unhealthy snacks out of your cupboard, and teach kids the building blocks of a healthy diet, nutrition experts say.
Make fresh fruit and lowfat yogurt the staple snack foods as your child grows up, and the lessons will stick as they get older, said Dr. Howard Eisenson, a program director at Duke University's Diet and Fitness Center.
Help your child write up an after-school snack menu plan with fruit and vegetables, lowfat cheese, baked chips and pretzels, rice cakes, reduced-fat crackers and cut-up vegetables on the list of snacks to combat before-dinner hunger pangs, said Eileen Paul, a dietitian with Group Health Cooperative in Seattle.
Try limiting your kids' after-school spending money so that children won't have the means to impulsively buy junk food, and teach them about healthy lifestyle benefits so they won't want to, said Julie N. Germann, a psychologist and program coordinator at the FitMatters Weight Control Program at LaRabida Children's Hospital in Chicago.
2. Skip the Soda
Instead of water, children are drinking more soda, juice with added sugars and sports drinks — all high in calories, but low on the ability to alleviate hunger. Replace the empty-calorie beverage with skim or 1 percent milk, a small 8-ounce glass of juice, then lots of water, said Mary Martha Smoak, a dietitian and diabetes educator at Wake Forest University School of Medicine in Winston-Salem, N.C.
If a child must drink soda, choose diet, and if they want juice, try Crystal Light as a lower-calorie option, or fruit itself, which contains fiber and slows the absorption of sugar into the body, said Dr. Robert Lustig, professor of clinical pediatrics at the University of California in San Francisco. Though it contains fat, milk is satiating and a good choice, he said.
3. Get Out Your Cooking Utensils
Many experts cite the decline of sit-down family meals as one of the factors that can lead to weight gain in children.
"Meals should be scheduled, eaten together and not in front of the TV,"said Dr. Sandra G. Hassink, director of the Weight Management Clinic at the Alfred I. duPont Hospital for Children in Wilmington, Del.
About 34 percent of Americans' total diet consists of restaurant food, fast food and snacks, nearly double what it was 25 years ago, Eisenson said. Not only are restaurant portions huger than ever, the food tends to be high in calories, sugar and salt, but low in valuable nutrients such as vitamins, fiber, and calcium, experts say.
"Restaurants are minefields," said Michael F. Jacobson, executive director of the Center for Science in the Public Interest in Washington. Pack a picnic basket for drives, and cook more at home. Working parents can try using the weekends to plan weekday meals.
"Use the weekend and a crockpot to prepare dinners, pack children's school lunches and portion out the foods for our children who stay home alone after school," said Ellen Homlong, a dietitian with the Samaritan Regional Health System in Ashland, Ohio.
4. Be a Role Model
Many experts say that parents concerned about overweight children should consider their own lifestyles, and influence: 64 percent of American adults are overweight or obese themselves, and there is a correlation between overweight kids and parents.
"The parents can't keep Coke and Doritos in the house, make poor meal choices and expect the kids to munch on celery," said Dr. Terry Maratos-Flier, an investigator at the Joslin Diabetes Center at Harvard Medical School. Even if you're "on a diet," it doesn't mean you are setting a good example, especially if you watch too much TV and are still buying fast food.
"Often, the parents of obese children 'go on diets,' but it is far rarer to see obesity in families that make a long-term commitment to healthful living," said David Katz, an associate professor at Yale University School of Medicine and the author of The Way to Eat. "Kids never respect 'Do as I say, not as I do.'"
Teach children what proper serving sizes are, and how to balance out calories, said Jeffrey S. Hampl, an associate professor at Arizona State University's department of nutrition. Tell children "We had a couch potato day, so let's drink some water with dinner instead of soda," Hampl said.
5. Turn off TV, Video Games and Get Active
Inactivity is another factor that leads to childhood weight gain.
"Many of my obese patients spend their free time watching television, playing video games or sitting at the computer," said Dr. Kevin Sheahan, of the pediatrics department at Alfred I.duPont Hospital for Children. Experts suggest parents limit TV viewing and video games to no more than two hours per day, and making sure children get 30 minutes of exercise per day, preferably by making after-dinner walks or bike rides a family ritual. Althea Zanecosky, a professor of sports nutrition at Drexel University in Philadelphia, places an egg timer on top of the computer to limit sitting time. Her family is active.
"We walk the dog together, we have a volleyball net in our back yard and play badminton and volleyball — three seasons," Zanecosky said. "My husband coaches both daughters' township athletic teams, and we do yard work (leaves, snow, garden) together."
Take the TV set out of the kid's room, place a treadmill in front of it and tell kids they can watch television as long as they are walking on the treadmill, suggests Dr. Robert Lustig, professor of clinical pediatrics at the University of California in San Francisco.
"The mild physical activity will burn some calories, the kid won't be able to walk AND eat, and the kid will watch less TV, and hopefully do something else," Lustig said.
Exercise is a community issue, too. If children aren't engaging in regular aerobic activity during physical education classes, parents should press their school boards and community centers to support and encourage healthy exercise, said Connie Diekman, director of nutrition at Washington University in St. Louis.
6. Be Wary of School Lunches
Healthy nutrition efforts at home can be dashed with one visit to the school cafeteria, or the vending machines in many school hallways. Help kids pack a brown bag lunch the night before, said Andrea Garber, an assistant professor of pediatrics at the University of California at San Francisco. A good lunch includes a whole grain (no white bread or bagels), a protein such as turkey or peanut butter, and fruit and vegetables (baby carrots or apple slices) and milk bought at school or carried in a thermos.
Consult the school board or parent teacher organization to find out what is on the cafeteria menu, and if it's something like pizza and fries, push for healthier choices. "Healthy food choices in the cafeteria require more creativity, not necessarily more money," said Carol Koprowski, a dietitian at the University of Southern California.One school in New York hired a chef that developed a series of menus that are healthy, and well-received by students. The secret was recycling leftovers, using veggies from one day's lunch to be part of the next day's soup, Koprowski said.
7. Watch Portion Sizes
Kids have become used to larger portions, and are consuming more food as a result. Use Tupperware and Ziploc bags to control portion sizes, said Ellen Homlong, a dietitian with the Samaritan Regional Health System in Ashland, Ohio.
"This makes freezing of meals and lunch making easier and you can portion out the chips, pretzels etc., and put the child's name and day on it to facilitate a control over the amount eaten when they are alone," Homlong said. At restaurants, choose lowfat, low-calorie items, share meals, and take home a doggie bag to avoid overeating.
"Instead of a burger and large fries, try a grilled chicken sandwich and a small order of fries," said Amy Jamieson, coordinator of SHAPEDOWN program at Fairview Hospital in Rocky River, Ohio. "It is important not to deprive kids of all foods, and more important to show them that it is not the food that is 'bad,' but more, how often it is consumed over time. Setting up a "diet mentality" can only set kids up for failure."
8. Don’t Be the Food Police
If your child is overweight, do you banish the ice cream and monitor their every mouthful of food? Children over 5 are not able to self-regulate what they eat, or how much, Lustig said.
"An obese child cannot and should not be tempted," he said. "A structured house with consistency is necessary for success."
But children should be allowed treats on occasion, many said. "If you eat a healthy diet 80 to 90 percent of the time, the treats are not really an issue," Ward said. Tell kids that snacks are fun foods that are OK to have sometimes, she said.
Parents should be careful not to "treat" kids for good behavior, though. Fat-laden high-calorie foods should not be used as rewards for children, said Dr. David M. Krol, an assistant professor of pediatrics at Columbia University.
9. Don’t Single Out Your Overweight Child
Experts are also worried about the emotional tolls, as chubby children grow into overweight adolescents. "An overweight child continues to gain weight, becomes socially more ostracized, so he or she eats more from stress and loneliness, becomes heavier, and even more unhappy," said Madelyn H. Fernstrom, director of the University of Pittsburgh Medical Center's weight management center.
The way you talk to the child about how their weight impacts their health depends on the age of the child, but being open is always best, said Martin Binks, director of health psychology at Duke University. Point out that people come in different shapes or sizes, and it doesn't make them a good or bad person, he said. Since children with weight problems are already stigmatized by their peers, doing the same at home would only hurt their self-esteem further.
Families should engage in healthful eating and exercise habits together, and no one should be singled out, overweight or not, Katz said.
"This provides the strength of unity and solidarity," he said. "It removes the stigma from the overweight child, and helps safeguard self-esteem."Fat Like Me airs tonight from 8 to 9 p.m. ET on ABC. For more information on family nutrition, go to www.menshealth.com.