With a plan, parents can protect children from obesity
Wednesday, March 30, 2005 7:40 AM PST
By Washington Post
Printable version
E-mail this articleEleven-year-old Adam Barnett has learned a new way to eat. For breakfast on a recent morning, he had a bowl of high-fiber cereal with milk and mixed fruit. The lunch he carries to school typically includes a peanut butter sandwich, fruit, yogurt and skim milk.
He often snacks on high-fiber, low-fat health bars or cucumber pickles -- and he drinks plenty of water. Fried potato chips and French fries have been banished from his home in Newton, Mass. Pizza, when it's served, is often homemade on small loaves of whole-wheat pita bread.
Adam does not consider his new pattern of food choices a "diet." He calls it an eating plan, or a healthier way to eat, and he's been following it for almost three years.
"I've been doing really well on it, and I'm going to keep it up," he said.
Adam learned about the eating plan at Optimum Weight for Life (OWL), a research and treatment program for overweight children directed by David Ludwig, a Harvard pediatrician and obesity researcher at Boston's Children's Hospital.
OWL is based on a growing body of research suggesting that a diet rich in fruits and vegetables but low in refined starches and sugars, and which also contains protein, unprocessed whole grains, some dairy products and a moderate amount of fat, may be healthy for the heart and least conducive to weight gain and diabetes. In the medical literature, such an eating plan is called a low-glycemic-index diet.
Adam's mother, Laura, knew by the time her son was 8 that he would need to learn to manage his weight. As adults, she and Adam's father had struggled intermittently with their own weight problems. At 8, Adam weighed enough to qualify as obese, and he seemed to be hungry all the time.
The family's pediatrician, concerned that the boy was unhealthily heavy, referred Adam to OWL, which treats overweight kids 4 and older. After Adam underwent an initial medical evaluation, he and his parents attended group sessions to learn about the new eating plan.
Adam watched a slide show to get the basics of the plan, while his parents learned how it is thought to work. Starchy foods like potatoes or bread made from white flour are rapidly broken down to sugar by the body, tending to raise blood sugar levels rapidly and trigger a corresponding surge in insulin. A few fruits -- bananas and watermelon, for instance -- also cause a quick surge in blood sugar (glucose).
Such foods are said to have a high glycemic index. ("Glycemic" is a medical term that means "putting sugar into the blood.") On the other hand, protein and fat, as well as most fruits and vegetables, which are high in fiber, take longer to digest, so they raise blood sugar more gradually and do not provoke such a large or sudden insulin surge. Hence, they have a low glycemic index.
Whole grains that have not undergone much grinding or processing are also digested slowly. In addition, including some fat as part of a meal slows the emptying of the stomach, so that nutrients are not delivered too rapidly to the intestines, where digestion and absorption into the bloodstream take place. Studies by Ludwig and his research team have found that children who were given a breakfast containing foods with a low glycemic index were less hungry during the day and consumed fewer calories than those who ate a breakfast containing an equal number of calories but composed of high-glycemic-index foods.
To Adam's mom, part of the appeal of the OWL program was that Adam would be less eager for snacks between meals -- although healthy snacks are permitted in moderation. Laura also liked the plan's flexibility. "What I think works about it is, it doesn't say `You can't have' and `You can have,' " she observes. "It tries to say `More of this, less of that.' You keep foods in proportion."
Following the plan required big changes in Adam's eating habits.
"At the start, it was just so hard for me," Adam recalls. At one point "I said, `I can't do this,' and I almost stopped. But my mom and dad encouraged me to go back."
A year into the plan, a leaner, trimmer, more muscular Adam -- weighing 34 pounds less than he did the previous year, despite his growth -- said he had gotten used to it and no longer found it hard to follow. "It's one of the easiest things I do," he said. "It's just part of my regular schedule. I don't sneak treats at school or anything."
Following a low-glycemic-index eating plan like Adam's is not the single "right" way for a child or a family to eat healthfully. In fact, despite the popularity of weight-loss regimens such as the South Beach Diet that are founded on similar concepts, most nutrition experts concur that diets based on foods' glycemic index still need additional study, especially in large clinical trials designed to test their long-term effects on body weight and overall health.
Nevertheless, the OWL plan's emphasis on eating plenty of fresh fruits and vegetables, whole grains and nonfat or low-fat dairy products while including sources of "healthy" fats such as olive oil, nuts and fish are principles that most nutrition scientists and dietitians endorse -- and they also form the basis of the federal government's latest dietary guidelines. Most American families could probably benefit from some of the lessons about healthy eating that Adam and his family have learned.
Parents can no longer take for granted that their children will grow up knowing how to make good food choices and maintain a desirable weight. Recent decades have seen pervasive changes in our daily patterns of eating and activity -- changes that make excess weight gain likely for just about everyone at some time. Teaching children to make choices that add up to a healthy lifestyle requires a degree of sophistication that simply was not necessary for parents in the past.
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Faced with an environment packed with fattening foods and resounding with cues urging us to eat more of them, what can parents and other adults do to teach children to resist these seemingly irresistible forces?
It's not as hard as it seems. By making small changes in daily routines and in the home environment, parents have more power than they may think to improve the family diet and move their own habits and those of their children in a direction that can help everyone to achieve or maintain a healthy weight.
The University of Colorado's James Hill estimates that the "energy gap" causing so many children and adults to gradually gain weight probably amounts to an average of 100 calories per day -- that is, on average, people are likely consuming about 100 calories more than they expend in activity. That's equivalent to about one slice of bread or two-thirds of a can of soda.
It should be possible for many people to eat 100 fewer calories a day without drastically altering their lifestyle, Hill suggests. For instance, eating three bites less of a typical fast food hamburger could reduce intake by 100 calories. Walking an extra mile each day, about 2,000 to 2,500 extra steps, would burn 100 calories. Because children do not inherently know how to make such choices, Hill writes, "as a society, we should be more willing ... to carefully manage the food and physical activity environments of our children at home, in school and in other places."
People often complain about what they view as conflicting dietary advice from experts and inconsistent findings from scientific studies about nutrition, yet in many broad areas there is little or no disagreement. Experts on nutrition and obesity are virtually unanimous about a number of steps parents and other adults can take to improve the chances that the children they love will grow up with healthy eating habits.
Meals should be a family activity, a time for parents and children to be together. Starting in infancy, children should be able to see the face of the person feeding them. Just as a baby should never be put to bed with a bottle or propped in a seat with one, older children should generally not be expected to eat meals alone.
Limit eating and drinking to areas of the home such as the kitchen or dining room, since children become conditioned to expect food in physical settings where it is usually offered. Do not allow children to eat -- even snacks -- while watching television. There is ample research evidence that television viewing contributes to the epidemic of childhood obesity, because kids tend to ingest excess calories almost unconsciously while watching TV.
• Eat dinner free; help boost community health
The public is invited to a free soup and salad dinner from 6-8 p.m. Thursday at the Student Center at Lower Columbia College.
Participants will be asked to brainstorm ways to spend a $50,000 "prevention" grant --- money from the state that must be spent to help residents of the area be healthy. "We want to involve churches, individuals, everyone," said Melanie Willis, "to plan nutritional and physical activities."
Willis is an educator with the Cowlitz County Health Department, which is sponsoring the dinner and administering the grant. The department is seeking to address obesity in Cowlitz County, where more than 67 percent of residents are obese or overweight.
Shapedown
A weight management program for children and teens has new classes starting April 13. According to a press release from the Diabetes and Nutrition Center, the class helps young people get into shape and change habits such as eating when bored or depressed, snacking on fast foods or being glued to the
television. The class, which will be held at the Child and Adolescent Clinic, is taught by Mary Dykes, pediatric nurse practitioner, and Peggy Norman, registered dietition. For details, call Norman at 414-7566.
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