Teaching Children to Eat Lean

Teaching Children to Eat Lean

By Wendy Gordon

Everyone is talking about childhood obesity... Jared Fogel (the guy who lost 235 pounds eating Subway sandwiches) is speaking at schools, emphasizing the importance of exercise and a healthy diet. The rapper 50 Cent is "spokes-rapper" and judge for a nationwide cooking contest where student chefs in various cities will compete to create the most "nutrient rich" cafeteria lunch recipe, with the winner receiving a $100,000 college scholarship. Researchers at Ohio State University are recommending larger child safety seats in cars. The American Academy of Pediatrics just released an official policy statement on the crisis. As I write this article, I see in today's newspaper that thousands of children all across the world engaged in a simultaneous exercise session, organized by a New Jersey gym teacher to combat the "obesity epidemic."

Are we truly raising a generation of pudgeballs? According to a recent National Health Survey the obesity rate among children has increased by over three times since 1960. Over 33% of American children are overweight and 15% are obese. A study by the World Health Organization in 2004 estimated that at least 20 million children under the age of 5 are overweight worldwide, or 13.9%. Obesity rates are higher among black and Hispanic children.

When I worked in a pediatric clinic in the late 1970's, overweight was primarily defined by growth charts (a difference of 50% or more between height and weight percentiles indicated a problem). Now overweight and obesity are commonly identified using BMI (body mass index), a mathematical formula that calculates a relationship between height and weight. Children with BMI's between 85-95% are considered overweight; those with BMI's over 95% obese.

The trouble with both height/weight charts and BMI (as opposed to more accurate means of body fat evaluation, such as skin-fold measurements) is that they do not differentiate between fat and muscle mass. According to BMI measurements, hunky guys like Brad Pitt and Russell Crowe are overweight. My six year old son is sturdily built, with barely an ounce of baby fat. When I plugged his height (10% by the growth charts) and weight (50% by the growth charts) into the BMI equation, he came out in the 90th percentile: "overweight."

So I think these statistics may be creating a false illusion of crisis. A term like "epidemic" implies the existence of an infectious disease rather than a correctable behavioral and nutritional problem. Nevertheless, it is an incontrovertible fact that children are getting steadily heavier. The incidence of obesity related disorders such as hypertension, type II diabetes, and joint injury, previously seen almost exclusively in adults, is also increasing. While obese children tend to be taller than average, as they grow into adulthood, they often lose the height advantage while retaining the excess weight. No doubt some children have a genetic propensity to obesity, but environmental changes are obviously accentuating this tendency.

Most experts blame a toxic combination of inadequate physical activity and excess junk and processed foods. Increasingly, what's now referred to as "screen time" (TV, computers and video games) is replacing traditional children's play. Watch a child's zoned out eyes in front of the TV screen and you will see that television watching requires no more energy expenditure than the basal metabolic rate. Even playing a game of Monopoly uses up more calories. TV advertises high calorie junk foods, while the slim figures of TV stars convey the message that these foods do not impact weight. TV characters rarely sit down for family meals. Almost half of children aged 8-16 watch 3-5 hours of TV per day, and that's not counting computer and video game time. Studies show that children who watch more TV tend to be heavier.

Children have loved candy since time immemorial, but only in recent years have empty calorie foods such as candy and chips become so prevalent and abundant, filling entire aisles at super markets and warehouse stores. In a 1999 study, 51% of children ate less than one serving per day of fruit or non-deep-fried vegetables. Children drink 16% less milk than in the late 1970's, and 16% more carbonated soft drinks. The consumption of non-citrus juices such as apple and grape mixtures increased by an astonishing 280%. In many households, sit down family meals are a lost art, replaced by drive through fast food, over-sized portions of Applebee's Carside to Go, or reheated frozen pizza in the microwave.

Schools also play a role. Many schools have phased out physical education and/or recess in response to budget cuts or pressure from the No Child Left Behind act to "teach to the test." School cafeterias may never have reached heights of culinary delight, but at least they used to churn out balanced meals of mystery meat and overcooked vegetables. Now these home cooked repasts are often replaced with packaged processed food, or even fast food or vending machines. Overcrowded schools and overbooked schedules limit lunch time to a stomach-churning twenty minutes, or shove it into a bizarre time of day (some schools start their lunch periods as early as 10 a.m.!). Home economics classes, which used to teach rudimentary cooking and meal planning to adolescents, are a relic of the past. Some schools offer nutrition education, but not nearly enough.

The American Academy of Pediatrics recommends that all doctors check routinely for possible weight problems, and inquire as to their young patient's diet and physical activity. Unless a child is severely obese, most health professionals do not recommend a weight loss diet. Rather, they suggest "weight maintenance," with the goal of slowing weight gain so that as the child grows, the ratio of height to weight will normalize. Overly strict caloric regulation can lead to nutritional deficiencies. Eating disorders are also a potential side effect, if too much of an issue is made of frequent weigh-ins and onerous dietary restrictions. Diet and exercise counseling, with an emphasis on behavior changes, should be the most significant part of the process, as there's no better time to develop healthy eating and exercise habits than childhood.

Most of the advice being churned out by the Academy of Pediatrics (or Jared Fogel or 50 Cent, for that matter) fits into the common sense category. Parents should pack healthy lunches, turn off the television set and eat meals together. The family should go on a hike or bike ride, or shoot hoops at the local community center and choose fresh vegetables at the co-op.

Well, duh. I have no argument with the current concern over childhood obesity, or with most of these suggestions. What I do take issue with is the "pathologizing" of a situation that is largely a matter of will and priorities for those who take care of children, most specifically. As children reach adolescence, controlling their behavior becomes somewhat more difficult, but when we're talking about children under twelve - please! Are these kids driving themselves to McDonalds? As tempting as it is to blame greedy corporations, and despite the significant role of health care professionals, day care centers and schools, the responsibility for tackling childhood obesity remains primarily in the home.

As a mother of four, I speak from experience. We have an interesting family demographic in our household, with children ranging in age from six to twenty-five. Watching the older kids grow to adulthood reaffirms my conviction that good eating and exercise habits, instilled early, last throughout life. My children grew up just fine without fast or processed foods, and while they certainly have been exposed to these things out in the wider world, they still prefer the wholesome diet they grew up with. Both my daughters are excellent healthy cooks, and as for my twenty year old son... Let's just say he's a healthy eater. Not everyone has the time or inclination to be a gourmet chef, but it isn't that difficult to put a simple, well balanced meal on the table. Perhaps the biggest need is for a return of those Home Ec classes (for adults as well as adolescents) teaching basic cooking skills like throwing together pasta, sauce and ground turkey, or a simple stir fry of meat or tofu and vegetables. It takes no more time to prepare a simple meal like this than it does to drive to Burger King, and it saves a lot of money. As for the junk food such as chips, candy, and soda, the easiest way to cut your family's intake is not to buy it. We are not helpless victims of advertisers.

Our family has steadily cut down on TV time over the years, to the extent that my six year old son watches no television at all except the occasional video on weekend nights. He plays video or computer games very rarely, under adult (or older sibling) supervision. As far as "screen time" goes, Nancy Reagan had it right ... Just say no. Children are by nature active. If they aren't plunked in front of a screen they will run around and play tag and hide and seek, just like children have done for generations. And yes, by all means on nice days go for a family walk or hang out at the playground.

As for the schools, again it comes down to priorities rather than feasibility. Try negotiating with your school board and PTA for more enlightened lunch service and nutrition education programs. The nation's soft drink companies just announced a plan to pull sugary soda drinks from schools within four years. Several schools in our area (Portland, Oregon) have partnered with community gardens, giving the children a valuable insight into where food comes from, as well as providing the cafeteria with fresh organic produce. There is also always the option of packing a nutritious lunch from home.

I've quoted Nancy Reagan, so I may as well quote Nike too. Just do it.

Wendy Gordon is a writer and restaurant reviewer who lives in Portland, Oregon. She has a Masters Degree in Clinical Nutrition from the University of Chicago, and is on the Board of Directors of Food Front Grocery, a co-op in Portland.