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Daily Dose

Plate Size & Childhood Obesity

1.15 to read

While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

School Lunches & Obesity

1.30 to read

Since we have been talking about healthier school lunches, I thought I would share with you an interesting article in last month’s Pediatrics which related to regulations on school snacks.  

While the nutrition standards for school meals changed for the 2012-2013 school year, the new guidelines do not effect foods in vending machines, snack bars or other venues within the school that are not a part of the regular school meal programs. These foods (typically snacks and drinks) are termed “competitive foods” as they compete with school breakfasts and lunches. 

This study looked at weight changes for 6,300 students between 2004-2007 and followed the students from fifth to eighth grade.  They found that adolescents in states with strict laws regulating the sale of “competitive foods” gained less weight over this 3 year period than those living in states without laws. 

As the childhood obesity epidemic continues (the CDC now estimates that 1/5 of American children are obese), public health officials continue to look at ways to improve a child’s eating habits during the school day.  The laws surrounding snack foods at school differ by state. There are no laws in some states, weak laws (where recommendations were made but there were no specific guidelines), and strong laws (where detailed nutritional standards were issued). 

The study did not conclude that strong laws were directly responsible for the differences in a student’s weight gain, but it did conclude that these outcomes tended to happen in states with strong laws.  That would seem to make sense to me as most children including my own, if given the opportunity, would at times choose vending machine snacks over a healthy school lunch. 

I also think that this is more common as the children become teens and seem to “snack” for lunch while multi-tasking rather than sitting down to eat a well balanced lunch. I continually hear this comment from adolescent patients of mine when I ask them about their lunch habits, and many of whom eat “off campus” if allowed, and choose fast foods over a healthy school cafeteria lunch.  Off school lunches seem to be another issue as well. 

One of the lead authors on the study stated, “competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent”. It seems like this might be a good cause to discuss with your own state representative.

Daily Dose

Cut Soda to Fight Childhood Obesity

Getting rid of sugar-laden drinks and replacing them with water has a dramatic impact on the amount of calories children consume and could help in the fight against childhood obesity. Researchers from Columbia Mailman School of Public Health in New York found that children get 10 to 15 percent of the daily caloric intake from empty calories.

"The key observation is that when kids substitute sugar-sweetened beverages with water, there is a significant decline in total energy intake without any compensatory increase in the consumption of other beverages or food," said Dr. Y. Claire Wang. Dr. Wang also noted that substituting calorie-free beverages "is a simple and effective way of eliminating the excess calories while improving the diet quality." Sugar-sweetened beverages "should be viewed as treats, not necessities, and water is a perfect substitute for the purpose of thirst-quenching," Wang said. Wang and her colleagues looked at diet data from the 2003-2004 National Health and Nutrition Survey of over 4,000 children aged two to 19 years. They found that substituting sugar-sweetened beverages with water was associated with significant reductions in total calories consumed. Wang and colleagues estimate that replacing all sugary drinks with water could cut out an average of 235 calories out of kids' diets each day. Since the late 1970s, consumption of sugary drinks by children and adolescents has increased "substantially," and is thought to be "an important contributing factor to obesity," the researchers point out in the Archives of Pediatrics and Adolescent Medicine. "Replacing these liquid calories with calorie-free beverage alternatives therefore represents a key strategy to eliminate excess calories and to prevent obesity in childhood," they conclude.

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Kids, Media & Obesity

1.45 to read

A recent study released in Pediatrics looks at mounting research showing that a child’s media use may be linked to their body weight, not only due to the fact that they don’t get as much exercise if they are watching TV and using other media, but also due to other issues related to media exposure. The policy statement from the American Academy of Pediatrics, entitled “Children, Adolescents, Obesity and the Media” states that, “American society couldn’t do a worse job at the moment of keeping children fit and healthy – too much TV, too many food ads, not enough exercise, and not enough sleep.” It has become my routine during well child exams, beginning as young as 2 years of age, to ask parents as well as older children, “Do you have a TV in your room?”, “Do you have a computer or DVD player in your room?” I am still amazed at the number of young children who answer “yes” to this question.  Fortunately, many also respond “No”, and then ask me when they may have a TV in their room?  My standard answer is “When you leave home and go to college or work.”  Most parents are relieved with this response. A few don’t understand why I am even asking the question. This new policy statement reiterates that parents need to be paying attention to the amount of “screen” time their children get daily. Total non-educational screen time (again, the definition of educational may vary from family to family), should be no more than 2 hours per day. This limit on screen time should also be enforced in child care centers, after school program and in community centers. According to the statement, the numerous ads on air for junk foods and fast foods, only increases a child’s desire for these foods. It is easy to keep your child from buying Cocoa Puffs or Fruit Loops (just randomly selected, you can fill in your cereal) when they have never seen the cute ad for these sugary cereals. I still remember, “Trix are for kids!”  Children who are allowed to stay up late at night watching TV are not only exposed to numerous ads, but at the same time do son get enough sleep, and the combination puts them at greater risk for childhood obesity. Dr. Victor Strasburger, one of the lead authors states, “Kids see 5,000 to 10,000 food ads per year, most of them for junk food and fast food.” By asking parents and their children about screen time pediatricians can encourage a family to have a well thought out plan for limiting screen time while encouraging outside activity. These recommendations will hopefully translate into less screen time, less exposure to advertising, less sedentary activity and ultimately a healthier weight for children. What do you think? I would love your comments and feedback.

Daily Dose

Infant Weight Gain & Obesity

1:15 to read

A new study out of Harvard that was published in Pediatrics, looks at infant weight gain and links to childhood obesity. This is an interesting study, as previous studies had typically looked at weight alone as a predicator for future problems with obesity. In this study the authors looked at both weight and length as a measure of fatness.

They also looked at weight as a dynamic process, in other words, it was not how much you weighed, but how quickly you gained the weight in infancy. The authors found that the correlation between rapid infant weight gain and later obesity was striking. Other studies have also looked at the relationship between infant and childhood weight but this study makes a compelling argument that early rapid weight gain, even in the first months of infancy, could have long term health consequences.

So, armed with this knowledge, what can a parent do? Follow the AAP guidelines to exclusively breast or formula feed your baby for the first six months of life. If a your-baby is formula fed, limit their daily intake to an appropriate amount for age. Many parents, for a multitude of reasons, decide to add cereal to their baby's bottle in hopes that this will "make their infant sleep through the night". To my knowledge there has never been any data to confirm this, (maybe the Mommy network) and additional calories in infancy may lead to long-term consequences. Juices and early introduction of your-baby foods may also add unnecessary calories. This study points out the need to modify weight gain in infancy in a manner that will balance the needs of an infant's brain as well as their body, during this time of rapid development.

That's your daily dose, we'll chat again soon.

Your Child

USDA New Rules: Healthier School Lunches

1.45 to read

Government funded school lunches will offer more fruit and vegetables and less fat on their lunch plates starting next September.

New guidelines by the U.S. Department of Agriculture (USDA)   were announced Wednesday when First Lady Michelle Obama, and Agriculture Secretary Tom Vilsack, visited with elementary students.

"Improving the quality of the school meals is a critical step in building a healthy future for our kids," said Vilsack. "When it comes to our children, we must do everything possible to provide them the nutrition they need to be healthy, active and ready to face the future – today we take an important step towards that goal."

It’s been more than 15 years since the school lunch program has had an overhaul. The changes will affect over 32 million kids who eat at school. The new regulations will be phased in over the next three years, starting in the fall.

Under the new regulations, schools will be required to offer fruits and vegetables every day, increase the amount of whole-grain foods and reduce the sodium and fats in the foods served. Schools will also be required to offer only fat-free or low-fat milk. In addition, the menus will pay attention to portion sizes to make sure children receive calories appropriate to their age, according to Kevin Concannon, USDA under secretary for food, nutrition and consumer services.

The new requirements are part of the Healthy, Hunger-Free Kids Act signed into law last year by President Barack Obama and championed by the First Lady Michelle Obama as part of her Let's Move! campaign.

"As parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably balanced diet," Mrs. Obama said. "And when we're putting in all that effort the last thing we want is for our hard work to be undone each day in the school cafeteria."

The new guidelines apply to lunches that are subsidized by the federal government. The government will help school districts pay for some of the increased costs. Schools will receive an additional 6 cents per meal in federal funding. The overall cost to implement the changes is expected to be about $3.2 billion. To help with the costs, Concannon said schools will have more flexibility in how the program is administered. Students, for example, will be allowed to pick and choose more items as they move through the line, rather than getting a plate served to them.

Some of the changes will take place as soon as this September; others will be phased in over time. The subsidized meals are served as free and low-cost meals to low-income children. The 2010 law will also extend to nutrition standards of other foods, sold in schools, that aren't subsidized by the federal government. Included will be "a la carte" foods on the lunch line and snacks in vending machines. Those standards will be written separately and have not yet been proposed by the department.

Wendy Weyer, director of nutrition services for Seattle Public Schools, said her district is already complying with many of the new USDA standards, and taking other steps, such as having partnerships with local farmers and planting school gardens. "Seattle has been very progressive with changing the way we offer meals, offering fruits and vegetables every day, as well as whole grain-rich foods," she said.

Weyer said the biggest challenge is reducing sodium content, "while keeping the meals palatable for our students."

Statistics show that about 17 percent of U.S. children and teenagers are obese, according to the Centers for Disease Control and Prevention. The new standards are aimed at providing a higher nutritional content as well as a variety of healthier choices. 

“We strongly support the regulations,” said Diane Pratt-Heavner, spokeswoman for the Maryland-based School Nutrition Association. “The new nutrition standards for school meals are great news for kids.” Pratt-Heavner said parents will play an important role in supporting the new standards.  ”We all have to work to get the kids to make these healthier choices,” she said. “Students are more apt to pick up a fruit or vegetable in the lunch line if they have been introduced to those foods at home.” 

Vilsack said food companies are reformulating many of the foods they sell to schools in anticipation of the changes. "The food industry is already responding," he said. "This is a movement that has started, it's gaining momentum."

The new standards did not come easily. Congress last year blocked the Agriculture Department from making some of the desired changes, including limiting french-fries and pizzas. Conservatives in Congress called the guidelines an overreach and said the government shouldn't tell children what to eat. School districts also objected to some of the requirements, saying they go too far and would cost too much.

Some schools are already making voluntary changes in their menus, but others still serve children meals high in fat, calories and sodium.  The guidelines are designed to combat childhood obesity and are based on 2009 recommendations by the Institute of Medicine, the health arm of the National Academy of Sciences.

Sources: http://usnews.msnbc.msn.com/_news/2012/01/25/10234671-students-to-see-healthier-school-lunches-under-new-usda-rules,  http://www.google.com/hostednews/ap/article

Daily Dose

Family Dinners Help Fight Obesity

1.15 to read

Sadly, the problem with obesity in America does not seem to be going away, and is not even improving!! The latest data shows that adult obesity rates have risen in 23 states in 2009 and the trend continued through 2010 and 2011.

Obesity and the problems associated with it, type 2 diabetes, heart disease, joint problems etc. begin in childhood. If we cannot change our children’s eating and exercise habits we have no hope of stemming the tide of ongoing obesity. By 2020 the headlines might read, “Obesity rising in all 50 states” with the majority of the population dealing with this crisis. In that vein we must not only begin modeling better eating habits for our children, but do so by returning to the idea of family meals. Family meals were the “norm” when I was growing up. We were fortunate to have breakfast and dinner at home each day and we were expected to be present for those meals. I know it was hard for my mother to do this as she worked when I was young, and my father travelled a great deal of the time. But parental sacrifice has not changed over time, and we all know that we will often do things “just for the kids”. The good thing about preparing meals these days is that the grocery stores have made it quite easy for even a very busy family to be able to prepare a “home cooked” meal. All of the chains have rotisserie chickens available and also offer prepackaged meats such as meat loaf, pre-made hamburger patties, or fish filets. The salads are also prepackaged and you can even buy fruit already cut up. I am “thrifty” and don’t mind making my own hamburger patties or cutting up fruit, but picking up a chicken on the way home from work is often a quick way to begin a dinner. The chicken can be used in a salad or used as a main course. We parents just have to be a little more inclined to drive through the grocery store rather than the fast food restaurant. I am still convinced that our children will eat what we prepare and gather together for meals if that becomes the norm once again. Our kids are busy too, and they will appreciate knowing that dinner will be there every night, and that it will be healthy. Leading by example is the best way to begin. We can’t afford not to try! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Baby

Longer Breast-Feeding Time, Less Childhood Obesity

2:00

A new study looks at the duration of breast-feeding and babies who are high risk for obesity, as they get older. Researchers found that the longer mothers breast –fed these higher risk babies, the less likely the babies were to become overweight later.

"Breast-feeding for longer durations appears to have a protective effect against the early signs of overweight and obesity," said lead researcher Stacy Carling, a doctoral candidate in nutrition at Cornell University, in Ithaca, N.Y.

Carling and her colleagues followed 595 children from birth to the age of 2. They tracked the children's weight and length over this time, and compared individual children's growth trajectories to how long the children breast-fed.

Which children are considered at high risk for extra weight gain? Researchers found that babies whose mothers were overweight or obese, mothers with lower education levels and mothers who smoked during pregnancy were more likely to have overweight children. Almost 59 percent of the children at risk for being overweight had mothers with one or more of these characteristics, compared to about 43 percent of the children not at risk for excessive weight gain.

Higher-risk babies who breast-fed for less than two months were more than twice as likely to gain extra weight than those who breast-fed for at least four months.

Although the study didn’t prove that longer breast-feeding actually reduced risk for obesity, it did provide several reasons why the link between the two may exist.

"Breast-feeding an infant may allow proper development of hunger and satiety signals, as well as help prevent some of the behaviors that lead to overweight and obesity," Carling said.

"Breast-feeding, especially on demand, versus on schedule, allows an infant to feed when he or she is hungry, thereby fostering an early development of appetite control," she said. "When a baby breast-feeds, she can control how much milk she gets and how often, naturally responding to internal signals of hunger and satiation."

The study did not include information on whether the babies were exclusively breast-fed or how often they were getting milk at the breast versus from a bottle, but the time required to reduce obesity risk was not long.

"The difference of two months of breast-feeding may be enough to reap some benefit," Carling said.

There are many reasons mothers choose to breast-feed for shorter periods, and some mothers are not able to breast-feed at all. For mothers that choose to breast-feed, Carling believes they need to be supported on many levels.

"Ultimately, increasing breast-feeding rates in the United States means increasing knowledge and support at a variety of levels from institutional to interpersonal," Carling said. "Our study recognizes the benefit of longer duration breast-feeding in a specific population and, hopefully, this and other studies will lead to more customized breast-feeding promotion in those populations at higher risk for overweight and obesity."

The findings were published in the January print issue of Pediatrics, and funded by the U.S. National Institutes of Health. The authors reported no conflicts of interest.

Source: Tara Haelle, http://consumer.healthday.com/women-s-health-information-34/breast-feeding-news-82/breast-feeding-for-longer-may-protect-infants-at-risk-for-obesity-694218.html

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