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Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

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Childhood Obesity

Childhood Obesity & Weight Management

Your Teen

Good Family Relationships Helps Teens Avoid Obesity

1:30

Two of the most valuable resources a teen can have are a stable family and a good relationship with their parents. Adolescents that have these two important components in their lives are more likely to develop healthy habits that may protect them from obesity, according to new study.

"A high level of family dysfunction may interfere with the development of healthful behaviors due to the families' limited ability to develop routines related to eating, sleep or activity behaviors, which can lead to excess weight gain," said the study's lead author, Jess Haines, of the University of Guelph in Ontario.

For the study, the researchers reviewed information on about 3,700 daughters and 2,600 sons, aged 14 to 24, in the United States.

About 80 percent reported having close and stable families. The findings showed that 60 percent of daughters and 50 percent of sons said they had a good relationship with their parents.

Researchers also found that teens with good family relationships are more likely to be more active and get enough sleep. Two factors, in addition to a healthy diet, that contributes to reasonable weight control.

The daughters in these families ate less fast food, and were less likely to be overweight or obese, the researchers discovered.

They also noted that fathers play an important role in helping their sons develop better choices that allow them to maintain a healthy weight.

"Much of the research examining the influence of parents has typically examined only the mother's influence or has combined information across parents," Haines said in a university news release.

"Our results underscore the importance of examining the influence fathers have on their children, and to develop strategies to help fathers support the development of healthy behaviors among their children," she said.

"It appears the father-son parent relationship has a stronger influence on sons than the mother-daughter relationship has on young women," said Haines.

As kids grow into adolescents, a tug of war between independence and parental control often develops. Research has shown that ongoing positive family relationships offer protective influences for teens against a range of risky behaviors. Sometimes it may feel like as our teens mature, family influence begins to wane - but that’s not the reality. This study points out how important a stable home life and good relationships are in helping teens develop a lifetime of healthy habits.

The study was published recently in the International Journal of Behavioral Nutrition and Physical Activity.

Story source: Mary Elizabeth Dallas, https://consumer.healthday.com/public-health-information-30/family-health-news-749/parents-play-key-role-in-teens-health-712354.html

Daily Dose

Sugary Drinks & Kids

1.15 to read

Do you buy soft drinks?  Several recent studies have been in the news and seem to confirm what I have thought for a while - sugary soft drinks really have no place in a child’s diet.  I must admit I was a mom who purchased different soft drinks of every color of the rainbow.  But about 15 years ago, I just stopped buying them altogether as I was convinced that not only did they all have enormous amounts of sugar, they were expensive, and if I bought them they somehow “disappeared” quickly from the refrigerator. They were like many other foods: “can’t just eat one”. 

Over time my kids stopped complaining that we didn’t have any “Cokes” and my husband decided that he would drink sugar free drinks if he was going to have a soft drink at all.  I would occasionally buy soft drinks for a party or something, but other than that our children resorted to drinking milk, water and Gatorade after sporting events. And guess what, they didn’t run away from home, even after threatening that it was “not fair”. 

I have routinely asked parents and children if they drink soft drinks.  I am continually amazed at how many families have soft drinks as their beverage of choice for dinner.  Calories, calories, calories, and all unnecessary, yet alone the cavities that might be forming. 

New research now confirms that drinking sugary beverages interacts with genes that affect weight, and in certain individuals will cause even greater weight gain and eventually may pack on pounds leading to obesity. With 1/3 of U.S. children being overweight or obese, this research would confirm that children (and I would ditto this for adults) DO NOT NEED to drink sugary soft drinks at all. Several other studies have shown that by giving overweight or obese children alternatives to sugary drinks, such as water of sugar free alternative beverages,  you can reduce a child’s weight gain.  Those children who continued to drink sugar sweetened beverages during different studies gained anywhere from 2-4 lbs more per year than those who cut out the sugary drinks.  If this is per year, then think of the cumulative effect. 

Lastly, many tweens and teens not only drink sugar sweetened drinks but they “super size” them or get free refills. Just recently NYC made headlines when a law was passed restricting the sale of drinks larger than 16 ounces, all in hopes of helping combat obesity. 

So parents take a stand and stop buying the drinks. If they are not in the house or available, most kids would not have access. Limit them for a special occasion.  That is a good place to start.

Daily Dose

Parenting Gone Too Far?

1.15 to read

I recently read an article in The New York Times about another new “parenting” book. I am not sure I understand this latest addition to a group of what I would call “extreme parenting” books. 

Similar to the Tiger Mom, or the American mother who extolled the French “method” for parenting, this new book, to be titled “ The Heavy”, is written by a mother who discusses her daughter’s weight issue and how she “enforced her daughter to diet”. 

Dara Lynn Weiss’s book deal stems from a recent article she has written for Vogue detailing her own parenting methods for dealing with her 7 year old overweight daughter.  In the article, Ms. Weiss discusses placing her daughter on a “strict” diet and punishing her for making poor food choices. 

She has gotten a lot of buzz on TV, radio and online for her methods, which included not only restricting her daughter’s food choices, but humiliating her daughter as well as discussing her own adult issues surrounding body image and weight control. 

I see far too many young children who are overweight and have ongoing issues with food choices. I also spend a great deal of time trying to help educate the parents of these children on how they can help their child become a “healthier eater” without using the word DIET.  

For a child who is 7-8 years old, as is Ms. Weiss’s daughter, the majority of the discussion revolves around the food that is available in the home, how the entire family eats, how much exercise a child gets, and what the child eats for lunch (whether they take their lunch or buy a school lunch). The discussion never includes words like “shame, punishment, or humiliation”, but rather terms like “healthy eating for growing bodies, modeling eating habits, and teaching children about better food choices.”  

While this approach may seem boring it does work.  Parents truly are the “boss” of the majority of their child’s food choices for the first 8-10 years of a child’s life. Why do you have to berate or punish a child in order to promote good nutrition? We are not talking about a teen who is driving through fast food joints, or eating from the 7-11 counter. 

Lately it seems that unless you’re writing “books on parenting that anger parents” or cause a huge backlash on Internet sites, no one wants to read them?  

A good parent does not need to use EXTREMES.  Is there no middle ground any more?  Can we not go back to the days of “everything in moderation”. The pendulum seems to have swung so far that a mother can score a major book deal while berating her young daughter and in my mind setting her daughter up for a serious eating disorder in the future. Yes, I also take care of a fair number of anorexic and bulimic patients (mainly girls) and unfortunately many of them have mothers with body image and eating disorders as well. 

So, while I do agree with Ms. Weiss that overweight and obese children must have parental involvement and  the necessary diligence to change their eating habits, I don’t agree with her methods. I am happy that the issue is being discussed but there has to be a better way.  Another bestseller? I hope not for my patients. 

What do you think? I would love your feedback!

Your Baby

Obese During Pregnancy Linked to Obesity in Offspring

2:00

Not every time, but often, you’ll see obese couples and their kids are either obese or on the threshold of obesity. While adults have the power and the life experience to understand the health issues associated with obesity, their children – depending on their age- are reliant on on their parents making healthy choices for them.  

 Is generational obesity inherited or a case of families making poor choices where food and exercise are concerned – or both?

Researchers from the University of Colorado School of Medicine wondered if children born to obese moms might be predisposed to being obese due to their womb environment.

The team of scientists analyzed stem cells taken from the umbilical cords of babies born to normal weight and obese mothers. In the lab, they coaxed these stem cells to develop into muscle and fat. The resulting cells from obese mothers had 30% more fat than those from normal weight mothers, suggesting that these babies’ cells were more likely to accumulate fat.

No cause and effect was established, but the scientists noted that further research was needed. “The next step is to follow these offspring to see if there is a lasting change into adulthood,” says the lead presenter, Kristen Boyle, in a statement.

She and her colleagues are already studying the cells to see whether they use and store energy any differently from those obtained from normal-weight mothers, and whether those changes result in metabolic differences such as inflammation or insulin resistance, which can precede heart disease and diabetes.

Other studies have found a high correlation between parents’ Body Mass Index (BMI) numbers and their children ‘s BMI, particularly between mothers and their kids. Further, the BMI of grandmother’s and their grandchildren is also high.

What is a healthy weight gain for a pregnant woman? It depends on how much you weigh before getting pregnant.

The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM); most recently in May 2009. Here are the most current recommendations:

•       If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.

•       If you were underweight or your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.

•       If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.

•       If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.

These recent findings point out again, how important it is for pregnant women to consider the possible long - term health affects on their unborn offspring when making decisions about their own health.

The report was presented in May to the American Diabetes Association.

Sources: Alice Park, http://time.com/3906135/obese-moms-wire-kids-obesity-during-pregnancy/

http://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bc

 

Daily Dose

Have Your Child's Blood Pressure Checked

1:00 to read

When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Obesity Epidemic Continues

The obesity epidemic continues with no end in sight. It is one of our major public health problems and the ongoing health care concerns of patients with obesity are well known. There have been many different studies looking for a biologic basis for obesity. There is a new study just released from the International Journal of Obesity that suggests that there is behavioral link for obesity.

In the study 226 families, both children and their parents were followed over three years with serial height and weight measurements. The results showed that obese mothers were 10 times more likely to have obese daughters, while obese fathers had a six-fold chance of having an obese son. In both cases, children of the opposite sex were not affected. Researchers therefore believe that the link for obesity may be behavioral rather than genetic. It would be very unusual to have genetics influence children only along gender lines. Rather, it seems that there may some form of “behavioral sympathy” related to becoming overweight. It seems that daughters copy lifestyles of their mothers, and sons their fathers. Looking further, researchers noted that eight in 10 obese adults were not severely overweight or obese when they themselves were children. In other words, the parents are passing their eating habits and behaviors on to their children, which brings us back to “modeling behavior”. I bring up the discussion of eating habits and nutrition when children are beginning their first table foods. Parents want to feed their children healthy foods, but they also worry if their child will not eat what the parent has prepared. Starting from the first foods the “notion” of eating healthy needs to be positively re-enforced. One way to do this is by preparing meals together which can teach cooking skills along with making healthy food choices. The idea that our children are going to like everything that we make, or clean their plates is obsolete. I think that our job as parents is to provide good food choices, a happy family mealtime and to be models of healthy eating. With this should come daily exercise. This study seems to confirm that it may be nurture, not nature that is contributing to the worldwide obesity problem. That’s your daily dose, we’ll chat again tomorrow.

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!

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