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Wednesday, October 10, 2007

When your kids' eating habits make you crazy...

Jerry Seinfield and his wife, Jessica, have two picky eaters so Jessica has written a book, "Deceptively Delicious." Basically, it's how she fools her kids into eating healthy food: Pink pancakes, for instance, because she adds beets to the batter. Good idea or not? Personally, I've never been a fan of tricking kids; my theory is, it'll come back to haunt you sooner or later. On the other hand, it depends how frantic you are at the lack of nutrition your children are getting. Obviously, Seinfeld was high on that scale. Meanwhile, new research shows that picky eating is as much a genetic issue as environmental.

In case you're a parent who's problem is on the other end of the spectrum -- kids who eat more than they need -- keep reading for a column of mine, "With youth weight gain, food isn't the only issue."

Thursday, April 11, 2002
CHILD CARING / BARBARA F. MELTZ

WITH YOUTH WEIGHT GAIN, FOOD ISN'T ONLY ISSUE

JOEY WAS 9 WHEN HE BEGAN TO GAIN WEIGHT. HIS PARENTS DIDN'T SAY MUCH TO HIM, BUT JOEY KNOWS THEY TALKED TO EACH OTHER ABOUT IT. ONCE, HE OVERHEARD HIS MOM SAY TO HIS DAD, ``I'M WORRIED ABOUT JOEY'S WEIGHT.'' HIS DAD SAID, ``ME, TOO. WHAT SHOULD WE DO?''

This did not make Joey eat less. His parents recently had gone through a nasty divorce. To hear them agree about anything was music to his ears. He gained 35 pounds in a year.

Weight-loss specialist Caroline Cederquist of Naples, Fla., uses this anecdote to make the point that children overeat for psychological reasons, just like adults. "Kids don't just eat because they're hungry," she says. "They eat because something tastes good even when they aren't hungry, or because the food is there and everyone else is eating it, and yes, they definitely eat for comfort."

Childhood obesity is a serious problem in this country. According to the Centers for Disease Control, the number of 6- to 11-year-old children who are overweight or obese has doubled in the last 20 years, and the number of overweight 12- to 19-year-olds has tripled. That translates to roughly 13 to 14 percent of all American children.
Pediatrician Walter Murphy of Plymouth sees the increase reflected in his practice. "I'm spending far more time on overweight children than I ever used to," he says.
Jane Franks, coordinator of school health services for Lexington, calls it an epidemic that puts children at serious risk. Her town is looking for creative ways to head off the problem: This year, a middle school and elementary school launched successful Breakfast Clubs, and Hasting Elementary is looking for parent volunteers to lead jump-rope and walking clubs at recess as part of a proposed fitness program .
Medically, risks for overweight children can surface even in 5- to 10-year-olds, with elevated blood pressure, high cholesterol, and nighttime breathing problems. Toronto pediatrician and obesity researcher Miriam Kaufman sees an increase in joint problems among overweight teenagers. By far, however, the most dramatic medical problem is that childhood obesity tends to progress into adult obesity, which translates to heart disease, Type 2 diabetes, and high blood pressure.
"Bottom line, we're talking about a shortened life span," says Murphy.
Then there are the social and emotional issues. Social stigmas continue to surround those overweight. In one study cited by pediatrician David Ludwig, director of the Obesity Program at Children's Hospital, young children were shown photographs of lean people and heavy people and asked to describe them. The words for the overweight people were strikingly negative, says Ludwig: lazy, dirty, unhealthy, not smart. "To say that overweight kids can be teased pretty badly is an understatement," says Kaufman, co-author of "The Overweight Child" (Firefly).
Parents often are unsure how to cope with any of this.
For starters, deciding your young child is overweight is not always easy. Children are constantly growing; weight gain is normal, indeed necessary, to fuel a growth spurt. Parents are not necessarily wrong to assume that a child, especially a prepubescent one, will outgrow today's pudginess when pounds redistribute over a newly taller frame. On the other hand, there is no magic line children cross that says, "Now you're overweight."
If you're worried, Murphy recommends asking a pediatrician to chart your child's growth. "If I've been tracking a child and he's been in the 75th percentile all along and now he's suddenly in the 90th, that's a red flag," he says. To be in the 75th percentile means that a child's weight is greater than 75 percent of the population; to be in the 90th means she weighs more than 90 percent of the population. Overweight is somewhere in between, and the determination is somewhat subjective, influenced by genetics and body frame as well as attitude. "Parents and children have different tolerance levels about this," says Kaufman. What is aesthetically overweight to some may not be to others.
Equally tricky is when and what to say to your child. "If you push too hard for her to be thin, [it can] lead to an eating disorder. If you're too lax about weight gain, it likely will continue," says psychologist Kelly Brownell, director of the Yale Center for Eating and Weight Disorders.
It's a mistake, however, to not say anything. "An overweight child knows he is different from other children," says Ludwig. Parents who say nothing hoping to spare a child pain may, instead, be depriving her of support.
Then there's the other extreme. Kaufman says she is stunned by the teasing some overweight children experience at home from parents and siblings. Family members may think they are doing the child a favor by hoping to shame or guilt him into eating less, but it doesn't work that way.
"A child can say, `I don't like being fat, pass the doughnuts,' all in the same breath," says Cederquist. "Under age 11, they don't have the cognitive ability to understand cause and effect."
This is why the current thinking in helping overweight children targets the family, not the child.
"Kids should be eating what the family eats - no special diets. The parents do the work by making healthy food choices," says Cederquist.
This takes a major commitment by parents to set limits on food choice and portion size; to limit television and computer time (Cederquist and others recommend no more than an hour a day); create exercise opportunities (30 minutes a day beyond physical education); and limit fast-food intake.
"You can't bring junk food into the house and say, `You can't eat this,' " says Murphy. "If you want cookies for yourself, put them in the trunk of your car and keep them there!" He isn't joking.
Some parents are too quick to recognize a child's weight problem, others too slow. Not surprisingly, it tends to correlate to their own issues with weight. "Parents often feel they're to blame, but the environment is a big part of the reason we're seeing so much childhood obesity," says Brownell. He and others say television, videos, and computer games are a huge problem not only because they take time away from physical play, but also because TV exposes the typical child to 10,000 food ads a year, 95 percent of them for unhealthy food items, such as sugared cereal.
Another culprit is schools that have soda and snack food vending machines. Brownell urges parents to lobby for their replacement with machines that offer water, milk, and healthy snacks. To school administrators who say they need the revenue, he says team up with sports equipment manufacturers instead.
"It's a whole lot healthier," he says.
Afterthought: Who says parenting can't be reduced to a few simple rules? "Graceful Parenting" by Eve Dreyfus (Celestial Arts, www.tenspeed.com) is a small book, simply written and sparsely illustrated, but Dreyfus, a child psychiatrist, manages to pack in a lot of wisdom and information. Her 25 rules, one per page, include `Yelling doesn't work," "Ty to avoid time-outs," and "No guns."

Contact Barbara F. Meltz at meltz@globe.com.

SIDEBAR 1:
PARENTS SET FAMILY'S EATING HABITS
1 CHILDREN WHO ARE BREAST-FED ARE AT LOWER RISK FOR CHILDHOOD OBESITY.
2 AVOID MAKING YOUR CHILD FEEL DEPRIVED. IT'S NOT THAT YOU CAN NEVER BUY ICE CREAM, BUT BUY A PINT THAT GETS CONSUMED AT ONE MEAL, NOT A HALF-GALLON THAT STAYS IN THE FREEZER. IT'S NOT THAT HE CAN EAT ONLY THE BANANA WHILE HIS THIN SIBLING GETS THE BANANA SPLIT; BOTH CAN HAVE THE BANANA SPLIT, JUST NOT VERY OFTEN.
3 TWO- TO 4-YEAR-OLDS WHO ARE PICKY EATERS ARE AT RISK FOR BECOMING OVERWEIGHT BY 6 OR 7 BECAUSE PARENTS TEND TO CATER TO THEIR TASTES AND PUSH FOOD ON THEM EVEN WHEN THEY AREN'T HUNGRY. WHEN THEIR APPETITE KICKS IN AT 6 OR 7, THEY DON'T HAVE HEALTHY EATING HABITS TO RELY ON.
4 TELL AN OVERWEIGHT CHILD, ``EVEN THOUGH WE WANT YOU TO EAT HEALTHY SO YOUR BODY IS HEALTHIER, YOU DON'T HAVE TO LOSE WEIGHT FOR ME TO LOVE YOU.''
5 A healthy portion size for most foods is the size of a deck of cards.
6 Get a child into the habit of eating when he's hungry, not because something tastes good. When any child wants more, ask: "Are you still hungry?" Many times he'll say no. If an overweight child wants more of something that's high in fat, tell him, "You've had your serving of meat. You can have more vegetable or salad." If that's not what he wants, hold firm. "Children need to understand what it feels like to be hungry or full in order to have a healthy relationship with food," says weight-loss specialist Caroline Cederquist, author of "Helping Your Overweight Child" (Advance Medical Press; www.drcederquist.com), which offers recipes and guidance for good food choices.
7 Avoid using food as a reward.
8 Put fat in food where children appreciate it - for instance, on the icing instead of in the cake. (Substitute applesauce or pineapple juice for shortening.)
9 Find ways to make exercise part of your child's life (walking to school). Exercise together (take a family evening walk, a Saturday hike). Adding exercise by signing her up for a class tends to backfire; an overweight child is often too embarrassed to wear shorts or a bathing suit.
10 If you sign her up for a sport, go for one high in activity (not baseball). When possible, ask a coach: "If you're looking at my kid and thinking, `He's too big to be fast, I'm not going to play him,' can you tell me beforehand, so this won't be a bad experience?"
11 Avoid connecting food to self-esteem, for yourself or your child. Not, "You're so bad, you ate two pieces," but, "That was a bad choice, huh?"
12 The Centers for Disease Control is piloting a new approach to childhood weight gain prevention. Called motivational interviewing, it encourages practitioners to ask parents, "Do you think your child has a weight problem?" rather than tell them he does, and then to find out what they feel capable of doing about it rather than dictate remedies. "The goal is to prevent parents from feeling blamed and therefore guilty and reluctant to return for help when they haven't followed a particular regime," says CDC's William Dietz.
13 Helpful Web sites include www.nhlbisupport.com/bmi/ (National Heart, Lung and Blood Institute); www.cdc.gov/growthcharts (Centers for Disease Control).

Posted by Barbara Meltz at 12:20 PM
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