Aside from the common cold, the most common medical problem I encounter in my practice is pediatric obesity. This is a major problem, on several levels. The prevalence of obesity is currently approximately 9% among children aged 2 to 5, 17.5% for children aged 6 to 11, and 20.5% for adolescents aged 12 to 19 (and This is just obesity, not to mention simply being overweight, which is even more common!). Globally, the prevalence of pediatric obesity is approximately 17%, affecting 12.7 million children and adolescents. The older children (and adults) get, the harder it becomes to lose weight, so the best strategy to combat obesity is to avoid it in the first place. Fortunately, there are concrete steps parents can take to avoid this pervasive, potentially lifelong problem.
Diet: Key to Prevention
“Eat food, mostly plants, not too much.” This wise advice was given by Michael Pollen in his book "The Omnivore's Dilemma." When Pollen talks about "food," he refers to unprocessed, "real" foods, as opposed to the highly processed food substances that are so common in American diets.
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Supermarket: A Territory of Challenge
Consider, for a moment, your average supermarket. The first aisle has fruits and vegetables, the last aisle has meat and dairy, and almost everything in between is junk food (sugar cereals, granola bars, cookies, crackers, pasta, spaghetti sauce, soda, juice, etc.). Middle aisle products tend to fall into the highly processed food category. What do I mean by "transformed"? Processed foods are typically made from a combination of finely milled, high-calorie white flour (think pizza, pasta, cakes, cookies) and many unhealthy additives, like simple sugars that are poorly metabolized .
The Film “Fed Up”: A Revelation
A few years ago, before seeing the movie "Fed Up" on Netflix (which every American parent and teen should watch), I didn't fully understand why processed foods were so unhealthy, and I'm still learning. But a major point made by this film is that "a calorie is NOT a calorie!" What do I mean by that? I used to tell people that the science of dieting was simple: 3,500 excess calories equaled one pound of weight gain, so eat fewer calories and lose weight; but this turned out to be false. Not only is it important to know how many calories you're consuming, but it's also crucial to know where those calories come from. Calories obtained from healthy, single-ingredient, wild-gathered foods (such as fruits, vegetables, and complex starches like potatoes) are metabolized more efficiently than calories obtained from highly processed foods . In other words, junk food tends to pile up on our thighs (and other parts of the body where fat accumulates), while healthy foods generally don't cause weight gain.
Whole Grains: A Healthy Option
Like fruits and vegetables, unprocessed whole grains (like whole oatmeal, barley, quinoa, bulgur, and brown rice) are healthy choices because they are both filling and metabolized efficiently. A general rule of thumb is that if an item at the supermarket only has one ingredient, it's probably healthy; whereas a food that comes in a can and contains a multitude of ingredients is probably unhealthy.
“Low-fat” Foods: Not Always Healthy
Another important observation in the movie "Fed Up" is that foods labeled "low fat" may not be healthy because they are "high in sugar." Over the past 20 to 30 years, the food industry has promoted low-fat foods as healthy choices, but the advertising is very misleading. Yogurt, spaghetti sauce, and cereal are all examples of foods that seem healthy, but can contain tons of added sugar, much more than you realize. A Danimals smoothie, for example, contains 10 grams of added sugar (equivalent to 2.4 teaspoons). One cup of Ragu Old World Traditional spaghetti sauce contains 12 grams of sugar, and Frosted Flakes cereal contains a whopping 11 grams of sugar in just ¾ cup. The numbers may not seem like much, but they add up quickly over the course of the day.
Limit Sugar Consumption
How much sugar should children eat each day? Guidelines published by the AHA state that children under the age of two should consume NO added sugar daily. That's right, NONE. Children over the age of two should consume no more than 6 teaspoons of added sugar per day (25 grams). For example, an eight-year-old child who drinks a Danimals smoothie has consumed 40% of her recommended daily sugar intake. I hate to admit it, but my eight-year-old daughter consumed four of these smoothies in 20 minutes, and she's no different than any other American kid. On average, children in the United States consume 19 teaspoons of added sugar every day!
Check Nutrition Labels
When buying food for your children, check the nutrition labels carefully. Look for simple sugars like fructose, high fructose corn syrup, honey and sucrose. Excess simple carbohydrates harm the average American diet, contributing to the obesity epidemic and leading to diabetes and other long-term health problems.
Types of Fats: The Good and the Bad
In addition to limiting excessive amounts of sugar, parents should monitor the types of fats their children consume, as well as the amount. All humans need fats to survive, but some fats are much healthier than others. Let's start with the good ones. Polyunsaturated and monounsaturated fats are found in fish and plant foods, such as avocados, olives and nuts. Liquid vegetable oils like soybean, corn, safflower, canola, olive and sunflower also contain unsaturated fats. Unsaturated fats are healthy when consumed in reasonable amounts.
Now the bad ones. Saturated fats are concentrated in butter, red meat, chicken skin, non-skim dairy products and coconut oil. The dreaded "trans" fats are partially hydrogenated oils used to cook many fried foods and baked goods such as pastries, pizza dough, pie crusts, donuts, muffins, cookies and crackers—the things we Americans love to eat. Why are these fats so unhealthy? Unsaturated fats and trans fats tend to clog arteries over time, leading to heart attacks and premature death.
The USDA recommends that about 30% of our dietary calories come from fat, and most should be unsaturated. Remember, fats are more calorie dense than carbs, so small portions can be very high in calories. When it comes to fat consumption, a general rule of thumb is to eat the healthy kind (unsaturated fats), but not too much.
Encourage Good Eating Habits
Serving vegetables and fruits at the start of a meal to encourage children to fill up on healthy foods is never a bad idea. When children eat healthy foods first, they are less likely to consume large amounts of unhealthy foods. What should you do if getting your little one to eat vegetables is a challenge? Late in the afternoon, when you've turned on Sesame Street for an hour to make dinner, offer your child a bowl of vegetables. As she stares at the screen with glazed eyes, she will insert healthy foods into her mouth without even realizing it; Before you know it, the bowl will be empty!
Avoid Restaurants and Prioritize Family Meals
Another good rule of thumb for cultivating a healthy diet is to avoid restaurants in general, and more specifically fast food places like McDonald's. In restaurants, parents have minimal control over the ingredients used in meals and no control over portion sizes. Excessively large portion sizes are a major contributing factor to obesity in all age groups. Portions at fast food restaurants like McDonald's may be smaller, but they are loaded with unhealthy, high-calorie ingredients. Almost all kids love those delicious McDonald's fries and Chicken McNuggets; but these "foods" are fried in partially hydrogenated vegetable oil, one of the worst ingredients for the human heart.
The importance of eating regular family meals cannot be overstated. From a medical and psychosocial perspective, one of the healthiest things a family can do is eat dinner together at home. Here are some of the proven health benefits of home-cooked family meals, as noted by the AAP, and they go far beyond weight-related issues:
- If at least one parent is home and the meal is prepared at home, eating three or more family dinners per week reduces the risk of overweight children by 12%.
- Families eat significantly healthier foods when eating meals at home. Healthy eating habits learned in childhood persist into adulthood.
- Chatting around the table improves young children's vocabulary, ultimately leading to improved reading skills.
- Eating family meals at least three times a week significantly decreases the risk of developing eating disorders in children and adolescents, such as anorexia and bulimia.
- Children's social-emotional well-being is improved by regular family dinners, leading to better peer relationships and better academic performance.
- Teenagers who eat regular family dinners have fewer problems with cyberbullying and are less likely to engage in substance abuse and high-risk sexual behavior. Overall, they have better mental health, including a reduced risk of depression and suicidal thoughts, and greater hope for the future. Having regular family meals is also a strong predictor of academic success in adolescents.
Drinking Water: A Healthy Habit
Here's another simple rule to avoid obesity: drink water, all the time. Soft drinks and juices are loaded with simple sugars. Remember the recommendation of 25 grams of sugar per day for children over two years old? A 12-ounce can of regular Coca-Cola contains 40 grams of sugar! The juice isn't much better; A 12-ounce glass of apple juice contains 39 grams of added sugar. Because children tend to drink a lot, they may gain weight from poor drinking habits. In 2017, the AAP released a statement recommending not giving juice at all in the first year of life. Regardless of age, if children eat fruits and vegetables, there is no reason they need to drink juice. By four months of age, children should be given water to drink with their solid meals, a pattern that should continue into adulthood.
Whole Milk: An Overrated Product
What about whole milk, which is recommended for toddlers ages one to two? My feeling about whole milk is that it's overrated and not very healthy. The important nutrients in milk, namely fat, calcium and vitamin D, can all be obtained from other, healthier sources. If children eat a well-balanced diet with adequate intake of these nutrients, there is no reason they need to drink whole milk. If a family has a toddler under the age of two who is already having weight issues, I generally recommend switching to low-fat milk immediately.
For a truly provocative and interesting perspective on the potential harms of consuming animal protein, particularly milk and meat, check out the movie "Forks and Knives" on Netflix. This documentary presents the lifelong work of two respected and experienced physicians who concluded that a plant-based (vegan) diet is the most essential ingredient for maintaining long-term human health. Extensive research by these doctors has suggested that a plant-based diet significantly reduces the development of heart disease and cancer. Additionally, people with coronary heart disease might be able to reverse some of the damage by adopting a plant-based diet, a truly astonishing finding.
Exercise: An Essential Component
Although exercise is important for maintaining a healthy weight, it is not as important as following a healthy diet. Why that ? A person's calorie intake, relative to their basal metabolic rate, is primarily what determines weight gain. However, one of the best things parents can do to prevent obesity in their children is to provide them with plenty of exercise. How much exercise? The AAP recommends 60 minutes of sweaty, breathless aerobic exercise every day. When it comes to exercise, more is better. Sixty minutes is the minimum recommendation, but families should feel free to do more. I admit, I continually schedule too many activities for my own children to keep them moving, especially during the cold New England winter months when playing outside is difficult. When choosing sports, I try to select activities that combine aerobic activity and strength training. Having adequate muscle mass is important for weight maintenance because muscles burn a lot of calories at rest. The more muscle a person has, the higher their basal metabolic rate. Sports that combine aerobic activity and strength training include activities like gymnastics, dance, swimming and cross-country running.
Screen Time: A Key Factor
No discussion of pediatric obesity would be complete without mentioning screen time. While it's initially cute to see toddlers handling cell phones and iPads, bad habits can quickly develop and become overwhelming. The AAP currently recommends that children under 18 months have ZERO daily screen time.
Given the structure of American society, this may be asking too much, especially of weary parents who occasionally use educational television as a babysitter. Kids can learn a lot from shows like Sesame Street and Super Why, so I never blame families for turning on the TV while they cook dinner, clean the house, or trick the kids into eating vegetables (I did it too!). However, screen time should be monitored and limited. For children over the age of two, the AAP recommends limiting screen time to one hour per day, maximum. This includes cell phones, iPads, computers, televisions, etc. Children who consume more than two hours of screen time per day are at risk of many problems, such as social isolation and a sedentary existence leading to excessive weight gain and poor cardiovascular health.
Studies have shown that simply keeping a television in a child's bedroom is a risk factor for obesity, so avoid putting one there, and don't let your child fall asleep while watching television. Parents who want to cultivate a healthy lifestyle should monitor screen time and limit its consumption from the start.
Avoid Food Temptations
The best way to avoid eating unhealthy foods is to not keep them at home. There's no need to feel guilty about depriving your children by not buying them junk food. Between birthday parties, special occasions, school celebrations, holidays (think Halloween, Christmas, Valentine's Day, Easter, etc.) and visits to Grandma's house, I guarantee they will receive a lot more junk food than they need. Below I have included a list of healthy foods and not so healthy foods. Stock up on the former and avoid buying the latter. If junk food is not at home, there is no temptation to eat it.
Healthy Foods—Eat Frequently
- Roast chicken (serve without the skin if possible)
- Fish
- Fruits
- Nut
- Potatoes
- Vegetables
- Whole grains (oatmeal, barley, brown rice, couscous, quinoa, etc.)
Less Healthy Foods/Pseudo-Foods—Eat in Moderation and Check Labels
- Anything with a lot of added sugar (soda, juice, candy, some yogurts, sugary cereals, granola bars, sauces)
- Bakery products (cakes, pies, cookies, crackers, etc.)
- Anything fried, especially at fast food restaurants; most of these products are cooked in partially hydrogenated vegetable oil—bad for your heart!
- High-fat dairy products
- Red meat: steak, ribs, lamb chops and bacon
For more information on nutrition and health, check out Eat Move recommendations.
