Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

Water works very well to quench the thirst, yet kids hardly drink any of it these days. This week, Registered Dietitian Jane Harrison offers a few practical tips to get your child in the habit of drinking water and shake off the sugary drinks.

Jane Schwartz Harrison, RD B.S. in Nutrition, Cornell University Experience – 20 years as hospital outpatient dietitian and nutrition consultant, private practice and guest lecturer Expertise -Registered dietitian, lifestyle writer and editor at myOptumHealth.com Twitter: @myOH_Nutrition

Question: What is the best way to get my child drinking water instead of sugary drinks?

Answer:

Do you have a hard time getting your kids to drink a good old fashioned glass of water? Fierce competition from sports drinks, ice tea, lemonade, slurpies, fruit drinks and sodas doesn’t make your job any easier.

It all adds up
Consider Andy, a 4th grader, who starts his day with some orange juice at breakfast. Dad packs a juice drink for his morning snack. Lunch brings lemonade, followed by a sports drink during his afternoon baseball practice. For dinner, mom allows Andy to have “just one” cup of soda as a treat.

Though this may all sound harmless, Andy’s drinks amounted to 26 teaspoons of added sugar. This doesn’t even count his cookie at lunch or frozen yogurt after dinner.

Studies show that overall sugar intake has skyrocketed right along with the rise in childhood obesity. And sweetened drinks are the leading source of added sugar in the diet.

Studies also show that using water as a replacement is a simple and effective way to cut back on excess calories. Doing so could go a long way toward helping to prevent or treat childhood obesity as well as prevent cavities and other health problems associated with excess calories and sugar.

The case for water
We know that drinking water is the best way to quench thirst without providing added sugar and calories. But how do you encourage your kids to ditch the sugary drinks and fill up on water instead?

If you’re still in the toddler phase, take advantage of the opportunity to make water the go-to drink from the start. Remember, once kids get used to the taste and start choosing sugary drinks over water, it’s much harder to make changes.

If your kids are already hooked on sugary drinks, your task is more challenging but certainly doable! And it’s a good idea to plan on making it a gradual process to bring them back to water.

Use these tips for the best chance at success:

Educate

Teach your kids about the importance of water. They may enjoy these facts:

• Water is the most needed nutrient of all. A person can live without food for a few weeks but a person can only live without water for a few days.
• The human brain is two-thirds water.
• Water carries oxygen and other nutrients into all your cells and organs.
• Water helps to lubricate your joints.
• Water helps to prevent constipation and keep your intestines running smoothly.

Set new rules

• Have one meal or snack where you typically offer juice or another drink. At other times, simply ask “what would you like to drink – milk or water?”
• Instead of juice drinks, send them to school with light-weight metal bottles that keep water cool and fresher tasting than plastic. Not only does the water taste better, but you don’t need to worry about leaching issues from plastics.
• Bring only water to the park or playground.
• Unless your child will be active for more than one hour, bring a water jug versus a sports drink to their game or practice.

Be creative

• Keep chilled water in the fridge; provide a jug of water with slices of lemon or lime.
• Make unsweetened ice tea with lots of added lime, oranges and/or lemon. Use flavored tea bags for added taste such as mint, ginger or raspberry. Consider adding fresh mint.
• Give them their own ”grown up” glass for water (as opposed to plastic cup or sippy)
• Introduce carbonated waters (flavored but not sweetened).

Other tips

• Make a point of drinking water in front of your kids.
• Offer fruit instead of juice. In addition to having fiber and other nutrients, whole fruit has water “built in” and is a natural thirst quencher.
• Buy frozen cans of 100% juice and dilute by adding at least two cans of extra water. Do the same for lemonade.
• Add a small amount of juice to seltzer as a soda alternative

Finally, don’t rely on diet drinks as a substitute. Their super sweet taste doesn’t allow kids to get used to the taste of less sugar. And long term effects are unknown.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

We just came back from another wonderful visit to the Magic Kingdom at Disney World! No doubt, the magic continues to delight and amaze thousands of visitors every day even though the lines are long and there is always something you don’t get to do before it is all over. We enjoyed the Halloween decorations everywhere in the park. The parade at night was absolutely fantastic; or shall we say “magical”!

There was, however, no magic in the kids menu which had the usual hot dogs, chicken nuggets, mac ‘ n cheese and french fries. In one of the restaurants, we found a packaged peanut butter jelly sandwich. Packaged apple slices, carrots and grapes were available as side items. Not surprisingly, soda was everywhere, although I am glad milk and bottled water were included in the dining plan! No shortage of sugary treats and salty snacks either.

If Disney wants to stay ahead of the curve, they must bring magic to the kids menu.

What do you think?

The childhood obesity octopus is out to ruin our children’s future! What can we do to stop it?

Share your thoughts in comments below.

Artwork by: Sierra B.
©2010 Littlestomaks.com

photo credit: kodomut

Hey guys! Let’s go get some breakfast. McDonald’s or Burger King?

I was half amused, half shocked as I overheard this conversation at my physical therapy session this morning. My shoulder has been bothering me a little, which is why I have been going there for the last few weeks. This morning, an elderly lady brought her young daughter for therapy. Her second daughter joined the family a little later as she came in with her 3 year old, fairly active and energetic son. They seemed like a happy family, very talkative and supportive of each other. The boy ran around the room fascinated by the different equipment, trying to mimic the movements of his young aunt undergoing therapy for her ankle.

The therapy session coming to an end , the Grandma naturally thinking ahead of breakfast offered the choice between McDonald’s and Burger King to the family.

“I don’t care”, chimed in the two daughters casually, indicating either would be just fine.

Well, at least these consumers don’t find any difference between the two brands I thought. The food is just about the same, the price and service quite comparable and equally appealing to them. So much for the millions of advertising dollars spent by the two building their brand equity!

Just like paper or plastic at the grocery store, it doesn’t really matter!

The real problem, of course, is that the young boy doesn’t have a choice in this matter. Both of these options put him in a lose-lose situation over the long run. He has no way of knowing if there is another alternative for him. Even if he does not grow up to be overweight or obese, which I sincerely hope turns out to be the case for him, doesn’t he deserve a third option of breakfast at home?

I know it is not a good idea to judge too soon, and there is nothing wrong in going to McDonald’s or Burger King once in a while on a weekend. Still, I would have loved to hear a third option.

What do you think? Aren’t our kids entitled to better options?

Please share your opinion in comments below.

©2010 Littlestomaks.com

Childhood Obesity Awareness Month Blog Carnival

This article was written for inclusion in the blog carnival hosted by Littlestomaks to promote awareness of childhood obesity as part of the National Childhood Obesity Awareness Month. Please read to the end of this article to find a list of links to the other carnival participants.

***

Talk about childhood obesity and you are sure to be inundated by all kind of alarming statistics and cries for tax on soda, banning food ads on TV and regulating school nutrition. As a parent, you hardly have any control over any of these so-called solutions. Sure you can try to limit junk foods, encourage fruits and veggies and force your kids to sit down on the dinner table each night. It is a real challenge for nearly all toddler parents and success is not guaranteed, at least in the short term. If your child is already overweight or obese, you may have even a smaller chance of success and a clinical intervention may be needed to reverse the situation.

Is there a solution that can actually nip the problem of childhood obesity in the bud?

In my research, I was surprised to learn that there is indeed such a solution. Even more surprising was the fact that we don’t hear about it at all when solutions to stopping childhood obesity are discussed.

This surprising and simple solution is: Breastfeeding!

photo credit: c r z

The benefits of breastfeeding are well known. It provides all the necessary nutrients for your child’s growth and builds his immune system for a foundation of healthy growth during the toddler years and beyond. But did you know that it also significantly lowers the chances of overweight or obesity? Consider, for example, this conclusion from a CDC report which addresses the question: Does Breastfeeding Reduce the Risk of Pediatric Overweight?

In conclusion, breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

This conclusion was based on three different studies which analyzed data from over 50 studies between 1970 and 2004. In case you need more convincing, consider the conclusions of this German study which appeared in the British Medical Journal in 1999:

Prolonged exclusive breast feeding reduced the risk of being obese or overweight among school age children in Bavaria who were born in the early 1990s. This effect is more likely to be related to the composition of breast milk than to lifestyle factors associated with breastfeeding. Preventing childhood obesity and its conse­quences may be an important argument in the drive to encourage breast feeding in industrialized countries.

Now there are purists in the academia who say that such conclusions are not based on randomized trials, which means that it cannot be proven with enough confidence that breastfeeding alone is a cause of reduction in chances of overweight or obesity. Rightly so, because there are confounding factors present in most of these studies. Although, the conclusion about breastfeeding and a reduced risk of overweight does not change even though it becomes a little weaker. From a practical point of view, it does not matter in my opinion and breastfeeding should still be promoted as a solution to preventing childhood obesity.

Although there is considerable debate about why breastfeeding lowers the risk of overweight or obesity, these three reasons are commonly cited:

1. Breastfed babies develop better sense of when they are hungry and when they are full
2. Formula-fed babies have a higher and more prolonged insulin response which stimulates more fat and weight gain
3. Breastfed babies have a higher concentration of leptin, a hormone which regulates their appetite

If breastfeeding, and extended breastfeeding in particular, has such a protective effect on overweight or obesity in later life, why is this message not amplified in public media? How come the revised policy statement on breastfeeding by the American Academy of Pediatrics only casually mentions the benefit of breastfeeding for reducing the risk of obesity? If childhood obesity is such a huge problem, then the benefit of breastfeeding should be prominently highlighted. Why do they recommend exclusive breastfeeding for only 6 months, when extended breastfeeding to 9 or even 12 months of age show a significant risk of childhood obesity?

The rates of breastfeeding in the US are pathetically low. National average rate for exclusive breastfeeding until 6 months is only 11% (2004 data). Married women, older than 30 years with a college degree are more likely to continue breastfeeding until 12 months of age. There is clearly a need to increase the public awareness of this issue and tailor the message for different demographics of women.

During the month of September, which has been declared as the National Childhood Obesity Awareness Month, we will surely hear a lot about junk food, soda, poor quality of school nutrition, too much TV and negligent parents. There will be a lot of focus on alarming numbers and renewed cries for more Government regulation. But where is the voice of reason addressing the need to actually prevent the crisis, rather than react to finding a miracle solution? I hope you will join me in giving support to such voices wherever they are. Promoting and supporting breastfeeding seems like a simple thing to do without having to spend too much money.

©2010 Littlestomaks.com

***

Please take time to read the submissions by the other carnival participants:

7 Things Parents Say That Cause Eating and Weight Problems in Kids Michelle May, Physician and author of Eat What You Love Love What You Eat, highlights a few things parents say which can have unintended consequences (@EatWhatYouLove)

Childhood Obesity Kia Robertson of Today I Ate a Rainbow suggests that prevention of childhood obesity should start with education and educating parents about basics of healthy eating by breaking it into achievable parts (@eatingarainbow)

Childhood Obesity: A Reality Check Dr Susan Rubin, founder of BSF, suggests we change our approach to looking at childhood obesity (@DrSuRu)

Childhood Obesity: Prevention Starts in Infancy Nutrition expert Sarah Fennell reminds us that prevention is the best cure and offers a few tips to raise healthy eaters (@FoodFunHealth)

Giving Our Children a Chance at Health Registered dietitian Susan Dopart offers tips to parents for taking charge of their child’s health in the world of over-processed “kid foods” (@smnutritionist)

Healthy School Campaigns Works on Creating Healthy Food Environments A report on Chicago’s Healthy School Campaigns (HFC), a non profit dedicated to creating a healthy food environment in schools

How to Prevent and Manage Childhood Obesity Registered dietitian Jessica Levinson offers practical tips to prevent and manage childhood obesity (@JLevinsonRD)

Lessons I have Learned as a Mom Registered dietitian Alysa Bajenaru shares some of the lessons she has learned that have helped her develop a good understanding of what it takes to feed her kids (@InspiredRD)

Looking for a New Trend in Childhood Obesity? Registered dietitian Elizabeth Rahavi of the IFIC brings the focus back on family in the debate about childhood obesity (@FoodInsight)

Losing Weight: It Starts in Your Head Registered dietitian Cindy Williams reminds us of the power of attitude and mindset in losing weight and controlling obesity (@nutritionchic)

Making the Grade Registered dietitian Sally Kuzemchak evaluates her son’s school programs on healthy eating and physical activity (@RMNutrition)

Obesity and GERD: A Family Affair Jan Gambino, author of Reflux 101, writes about the link between overweight and GERD

Parents, Let’s Take a Positive Approach to Childhood Obesity Registered dietitian Ashley Rosales from the Dairy Council of California encourages parents to take a positive approach in helping their kids build healthy habits

Revolutionize the Way Your Kids Eat in Five Easy Steps Sociologist Dr Dina Rose suggests we shift our focus from nutrition to eating habits if we are serious about solving childhood obesity (@DrDrRose)

Surprising Easy Solution for Preventing Childhood Obesity Research shows benefits of extended breastfeeding in reducing risk of childhood obesity (@TwinToddlersDad)

The Problem Behind Childhood Obesity Ken Whitman, Publisher of Organic Connections, points out that our national priorities concerning childhood obesity are misplaced and calls for a renewed focus on the health of our nations kids.

Yoga Gets Kids Moving Registered dietitian Danielle Omar has an interesting suggestion for solving childhood obesity – get your kids into yoga! (@2eatwellRD)

What are your top emotions when you see an overweight or obese child?

photo credit: Joe_13

I asked this question on Twitter recently. When it comes to the topic of childhood obesity, there is no shortage of statistics. Obesity rates have tripled. Nearly 1 in 3 is either overweight or obese. A 13 year old obese child has clogged arteries just like a 45 year old. 23 million children are in the danger of never being grand parents. Health care costs of treating obesity related diseases is in billions of dollars.

You get the point. There is no shortage of numbers and research on childhood obesity.

I have been thinking about this issue quite a lot lately. Not only because the month of September has been declared as the National Childhood Obesity Awareness Month. Not also because I have written about this issue extensively in the past and I remain convinced that we must address childhood obesity NOW. Not because the media seems to not care about this issue anymore and Jamie Oliver’s TV show is no longer hitting prime time.

But mainly because it is depressing to realize that so many of our children seem destined to live a life of unfulfilled promise and poor health.

And I think I am just beginning to pay a little more attention to how I feel rather than try to understand the numbers and rationalize the proposed solutions.

Here are a few comments from my Twitter friends:

@RDAmber said

1. Sadness followed by 2. Anger and if I see them in an outpatient setting 3. Joy because at least I have a chance to help!

@JLevinsonRD shared her feelings:

sad, sorry, and wish there was something I could do for him/her.

@80Bites responded:

Compassion. And frustration, because we could help them!

@InspiredRD shared a whole range of emotions:

All of the above RT @TwinToddlersDad Anger, Sadness, Frustration, Despair? What do you feel when you see or read about childhood obesity?

@myH_Nutrition shared her optimism:

Happy. Michelle O is doing something monumental about it.

So how do you feel about childhood obesity? What kinds of emotions do you experience? Do you feel angry, sad, frustrated or hopeless? Or a completely different emotion? Share your reactions and emotions in comments below.

©2010 Littlestomaks.com

I am hosting a blog carnival on Childhood Obesity as part of the National Childhood Obesity Awareness Month. If you are not familiar with blog carnivals, a carnival is an opportunity to join your fellow bloggers to read and write posts on a specific theme, which happens to be Childhood Obesity in this case. It is a lot of fun and a great way to amplify your message with the help of like-minded bloggers.

If you are passionate about childhood obesity, I invite you to join me and other expert bloggers in this carnival. Read the guidelines below, and if they make sense, simply complete the online form at the end of this post to sign up. I will contact you to provide more details and answer questions.

Carnival details and scope

1. The day of the carnival is Tuesday, September 14
2. Open to all bloggers known for their expertise in nutrition, parenting, food, health and related fields. However, I reserve the right to accept or reject all entries.
3. Please plan on publishing your post on your own blog on Tuesday Sep 14 (anytime after midnight EST). Email me the URL of your post by noon EST on that day.
4. Completing your blog post and scheduling it in advance is highly recommended. Send me the URL as soon as it is ready.
5. Your post should be focused on the topic of childhood obesity. Since it is a very broad topic, feel free to focus on an aspect of childhood obesity you feel passionate about. Here are a few ideas:
   • Why worry about childhood obesity (stats, health issues etc.)?
   • What does the science say about childhood obesity? Is it genetic or acquired?
   • What should we do to stop and reverse childhood obesity?
   • Who is responsible? What is the role of Government, Media, Business, Community Organizations etc.?
   • Do you have a personal experience with childhood obesity or overweight? Write about your experience and feelings.
   • Can childhood obesity be prevented? Are there any early indicators of childhood obesity? What can parents do?
   • Do you know of any organizations or individuals doing admirable work to stop or prevent childhood obesity? Write a profile.
   • If you got a million dollars to run a program to decrease childhood obesity in the United States, what ideas would you try?
   • Have you come across a book on childhood obesity which inspired you? Write a review.
   • Is your child’s school doing anything about childhood obesity? Do you have a wish list?

Note: These ideas are meant to spark your creative thoughts. Please do not feel limited by them. You also do not need to address all of them in your  article.

Format and content guidelines

1. Your blog post should be original and unpublished. If you have written on this topic in the past and would like to re-publish, please try your best to give a new twist to your content.
2. Strong opinions are welcome, but stay away from excessive profanity or personal attacks
3. Use good writing techniques, check spelling and grammar
4. No word limit – use as little or as much to make your points
5. Feel free to use photos or other art
6. Feel free to use video
7. I will send you a standard header and footer code to add to your post.

Here is the online signup form:

cforms contact form by delicious:days

I am so excited to learn that the US Congress has officially proclaimed the month of September 2010 as the first ever National Childhood Obesity Awareness Month! Here is Rep. Marcia Fudge making a statement about this legislation:

There is no doubt anymore that childhood obesity is a serious problem. First Lady Michelle Obama brought the much needed high profile attention to this issue early this year when she launched her Let’s Move campaign. I am not going to repeat the awful statistics any more, but the following statement from this video should be an eye opener to everyone, even if their kids are not overweight or obese:

…unless we work to reverse this epidemic, these 23 million kids will be in danger of never being grand parents. Imagine. Living a life you know you may never live long enough to be a grandparent.

Childhood obesity is an equal opportunity health issue which threatens the future potential of our children. That is why we must address childhood obesity NOW. The month of September 2010 offers us an opportunity to make a difference. This childhood obesity awareness month toolkit offers several ways you can help.

I will be focusing on this topic on this blog throughout the month of September. It also happens to be the month I was born, so I am super excited about it!

Join me in this journey through your comments, opinions and suggestions. I look forward to hearing from you.

©2010 Littlestomaks.com

By how much would limiting TV food advertising reduce childhood obesity?

This is the question researchers from Netherlands and Australia asked in their recent article published in the European Journal of Public Health. TV food advertising has attracted considerable public scrutiny, especially from experts in nutrition and public health. There is a popular belief that food advertising plays a big role in influencing food choices and brand awareness among young kids. As a result, kids get hooked on processed food and snacks full of fat, salt and sugar. Clearly, this could be one reason why we have a rapidly rising rate of childhood obesity believe most experts.

Beliefs and opinions are common, but thoughtful scientific inquiry to support them is rare. That is why I found this article interesting because it tackles this tricky problem through a good scientific approach. The researchers candidly acknowledge that the effect of advertising is difficult to study in a direct way. In fact they did not find a single study which quantified the effect of advertising and body weight in a realistic setting. Instead, they looked at changes in the total energy intake due to TV advertising based on a single study from 1983, which concluded that an extra 25 minutes/week of exposure to TV advertisements would cause a child to eat one extra snack which would increase his energy intake by 1.4%.

This is a very small effect. The researchers then decided to set up an expert panel of academics and asked them to complete a questionnaire to estimate the effect of TV advertising on energy intake and effect of energy intake on BMI. Surprisingly, they got a very poor response rate – only 8 out of 33 completed their questionnaires. As a result, there was considerable bias and uncertainty in the data.

Bottom line, they came to the following conclusions:

1. If all TV advertising (about 80 minutes/week) was stopped, the prevalence of obesity will drop by 2.7% in boys and by 2.4% in girls
2. Based on the “expert panel” response, they estimated these numbers to be a reduction of 6.8% in boys and 6% in girls
3. They estimated that about 1 in 7, or as many as 1 in 3 children would not be obese if there were no TV advertising

Overall, these numbers have a very large amount of uncertainty. The evidence against the effect of TV advertising is weak and calls to ban or limit TV advertising are largely based on personal opinions.

Personally, we have not experienced the effect of TV food advertising in our household because we hardly watch any TV. Mostly our twins watch animated shows on demand where we completely bypass the advertisements.

I am not a supporter of cheap junk food. But I also do not support the idea of banning TV advertising. I continue to believe that the best protection against such advertising is to build the wall of your family’s own personal brand which defines your approach to food and nutrition.

Parents: what is your opinion? Do you think that your family’s food choices are strongly affected by TV advertising? Would you support a complete ban on food advertising to kids?

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Family Physician Dr. Michelle May offers a few tips to help you raise a healthy child by providing unconditional love, encouraging physical activity and promoting healthy eating habits.

Question: How can I encourage my kids to eat well and follow a healthy lifestyle?

Answer:

With the launch of Michelle Obama’s Let’s Move campaign, unprecedented attention has been paid to healthy eating and physical activity in children. There’s a huge potential for benefit but two potential pitfalls that parents need to be aware of.

First, the focus really shouldn’t be on childhood obesity. All children (and adults!) benefit from increased awareness about their lifestyle choices. Singling out overweight children contributes to the stigma and shame they already face—and may cause parents, doctors, and others to mistakenly believe that the information doesn’t apply to normal weight children.

Second, restrictive diets haven’t worked in adults and they don’t work in children. Studies have shown that children who are restricted from certain foods at home and are exposed to those foods elsewhere are more likely to choose the food, overeat it, and feel guilty afterward. Sounds just like the last diet you were on doesn’t it!

Let’s look at the keys to the development of lifetime healthy eating and exercise habits:

Build Healthy Attitudes

• Demonstrate your unconditional love for your child. Children—especially overweight children—need support, acceptance, and encouragement from their parents.
• Build self-esteem by focusing on all of your child’s positive qualities, unique talents, and individuality. By developing interests and skills that increase their success and pleasure, they will be less likely to turn to food for fulfillment.
• Help your child develop good communication skills, encourage them to express their feelings, and teach them effective coping skills to decrease the chance that food will serve that purpose.
• Emphasize the importance of good health, not ideal weight.
• Never tease or criticize a child or adolescent about their weight. Such comments are hurtful and can stick with a person for a lifetime.
• Be a positive role model. When your child observes you enjoying healthful foods and physical activity, they are more likely to do the same.
• Most importantly, sit down and eat together as a family. Family mealtimes are a wonderful way to reconnect with one another and share your day. Mrs. Obama talks about playing “Roses and Thorns” – taking turns telling about the best and worst part of your day.

Enjoy an Active Lifestyle

• Help your child build a lifetime exercise habit by making consistent physical activity a high priority in your family.
• Reduce the amount of time your family spends in sedentary activities like TV and video games. Instead, plan fun family activities that provide everyone with exercise and enjoyment.
• For children who have been relatively sedentary, physical activity should be initiated gradually to avoid injury and discouragement.
• Encourage active play like biking, swimming, and playing ball.
• Participation in individual and team sports can be a great way to build coordination, athletic skills, and self-confidence.

Develop Healthy Eating Habits

• Children have the instinctive ability to regulate their intake to meet their needs. Respect these internal cues of hunger and satisfaction.
• Do not force children to clean their plates or bribe them with dessert for finishing their meal.
• Never use food as a reward. Reward desired behavior with praise, extra attention, and privileges.
• Do not comfort your child with food. Hug them and listen to them instead.
• Do not impose stringent food rules since this may lead to rebellious eating when the child is away from parental control.
• Don’t say or imply that some foods are good while others are bad. Instead, teach children that some foods are healthier than others. This will help them learn to balance eating for nourishment with eating for enjoyment.
• Provide a variety of delicious healthy choices for snacks and mealtimes. Suggestions include fresh or dried fruits, vegetables with tasty low fat dips, reduced fat cheese or peanut butter and whole grain crackers, yogurt, fruit smoothies, whole fruit ice pops, granola bars, turkey roll-ups, or snack mixes made of cereal, dried fruit, and nuts.
• A healthy breakfast is a great way to start the day and is important for optimal performance in school. Include protein and whole grains for energy and nourishment.
• Encourage children to drink water and fat free or low fat milk instead of sugary sodas, fruit drinks, and sports drinks.
• Promote a high fiber diet by giving your child whole wheat breads and pastas, brown rice, and five servings of fruits and vegetables daily. They will prefer these types of foods if that is what they’re used to.
• Since children (and adults!) have a natural preference for sweet and high fat foods, it’s reasonable to limit the amount of sugary and fatty foods that are readily available to encourage intake of more nutrient rich foods.
• Involve children in shopping, meal planning, and preparation. This is a great opportunity to teach them about nutrition—and they will be more likely to try new foods if they helped make them.

Download Keys to Raising Healthy Children flyer by Dr. Michelle May.

©2010 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Greetings! This month, the American Dietetic Association is running its National Nutrition Month® campaign. It is a public awareness program designed to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits. This objective is very much aligned with the focus of Littlestomaks because we are all about helping parents of toddlers make smart choices about their child’s nutrition and lifelong healthy eating habits.  That is why I will be supporting this campaign by writing articles along this year’s theme of Nutrition From The Ground Up. I would like to call upon my fellow nutrition and food bloggers to do the same! I am also open to ideas if you want to collaborate!

It is Friday again, which means it is time for the usual Five for Fridays! Here are 5 nutrition related articles that caught my eye. Enjoy and do share your opinion in the comments below.

Link between childhood obesity and heart disease gains strength

30% of obese 3-5 year old children show higher levels of C-reactive protein (CRP), which is linked to inflammation and is known to predict heart disease and stroke. This is nearly twice the rate at which high levels of CRP are seen in children with healthy weight. This data is based on a recent study of 16,000 children between the ages of 1-17 published in the journal Pediatrics and cited in this week’s Wall Street Journal.

It does not mean that children who show high levels of CRP will definitely develop heart disease when they become adults. This is because CRP can be elevated due to a lot of other reasons. Still, this is a strong link between obesity and heart disease and suggests that early childhood obesity needs our immediate attention. The question I would like to get answered is if these high levels of CRP can be reversed in obese children if their weight is managed as they grow. If I find out, I will write about it!

Flooded by snacks, kids are becoming constant eaters

Kids get 27% of their daily calories from salty, fatty and sugary snacks and constant nibbling starts as early as 2! This is what a recent snacking study found from surveys of over 31,000 kids. Clearly, this is becoming a big challenge for most parents who are trying hard to encourage their kids to develop healthy eating habits. Availability of all kinds of snacks combined with our culture of bringing something to eat for every event means that kids are constantly munching.

I think the main problem is that there is no separation anymore between a regular meal and snacks – which are supposed to manage our hunger level between meals and not act as a substitute. To that end, it is important to drive an understanding – and acceptance – of this notion of separating meals from snacks at an early age. And of course, we as parents have to be a role model by consistently showing the desired behavior.

It is not about healthy snacks, although a lot of products claim to be just that. It is about healthy choices which kids should be empowered to make right from the start. If they recognize their hunger cues, and are in the habit of eating full, wholesome meals at regular times, I am sure they will be able to manage snacks on their own.

If you are facing this situation, check out these handy tips on managing snacks and treats by one of our experts.

Confused about which diet to pick? Get your genes checked!

We have all heard about low-carb and low-fat diets, and you have probably tried them all! If nothing seems to work, check out this new technology of a genetic test for diet. It may just point you to the right direction!

It is yet another weapon in our fight against overweight and obesity. Now you can find out if you are genetically predisposed to lose weight on a low carb diet or on a low fat diet. In a study of 133 overweight women, a substantially higher weight loss was reported when their diet was matched with their genetic predisposition. A separate study shows that 45% of white women have the low carb genotype while 39% have the low fat genotype. The test looks at variations in 3 genes known to affect metabolism of fat and carbohydrates.

Don’t run out to get this test yet because these results are far from conclusive. More research is needed especially with a larger group of men and women across different racial demographics. It is an important trend however, we are finally in the era of personalized medicine and nutrition!

FDA issues warning letters to rein in food labels

This week the FDA issued several warning letters to 18 food companies including high profile names such as Nestle, POM Wonderful and Beech-nut. The big guns are out to shoot down the front-of-box claims, which according to some, are getting out of control these days. There are some, including the prominent Marion Nestle, who are suggesting an outright ban on these front-of-box labels.

If you look closely at the reasons for most of these warning letters you will notice something interesting. FDA is complaining that labels like “low sodium”, “low fiber”, “plus vitamins and minerals” are not allowed on products intended for children 2 years or younger because appropriate dietary levels have not been established for children in this age range. Now whose fault is that? Clearly, inaction from the FDA has created a vacuum which is being filled by savvy marketers. It is also clear that there is a need for front-of-the box labels. Busy consumers do not have time to read and absorb the Nutrition Facts and ingredients list on the back or side panels. They want something quick that helps them decide whether they should buy a certain product or not.

The rest of the world is already moving ahead with standardizing front-of-box labels, an example of which is the traffic light food labeling system. There is no perfect answer, but we need something that works. I hope the FDA takes this on and not simply try to appear like they are doing something by issuing warning letters!

Big Words from Little Foodies

Finally a shout out for my blogger friend Jenna of KidAppeal, who is running a weekly column on her blog called Big Words from Little Foodies. She is inviting toddler parents to share mealtime funny comments they hear from their kids in response to the food on the table. We have had a lot of fun lately with our twins as we try to engage them with funny stories and watch their response! Check out stories from other parents and recipes they have shared as part of this column. We too have contributed to it with articles like diesel food for a diesel engine and eating salad like a giraffe! Share your stories of mealtime fun in comments below.

Enjoy and let me know what is on your mind.

Photo Source: just jane on Flickr via everystockphoto
©2010 Littlestomaks.com

Greetings! I thought of doing something different for this week’s Five for Fridays. Here are 5 videos which caught my eye as I looked for food and nutrition related news. Let me know what you think!

Bode Miller the “ski champ” farmer

Did you know that Bode Miller grew up a vegetarian? I didn’t, until found this video on Phd in Parenting blog! I was so fascinated by it that I decided to dig up the original source. I finally tracked it down on Stonyfield yogurt’s website under their “Yotube” video channel. It makes a perfect pitch for Stonyfield – after all, Bode Miller is no ordinary champion. One unintended message out of this video may be that organic is for crazies only! I think the positioning needs to be a little more mainstream. In any case, this video has a great message aimed to inspire the younger generation.

Watch out! Jamie Oliver is bringing his food revolution to America

It’s official folks! We are a country of fat people. If you have doubts, just check out the statistics on Huntington West Virgina – half the adults are considered obese and rates of diabetes and heart disease lead the nation! Jamie has supposedly the secret formula that can change the mindset: we don’t wanna sit around and eat lettuce all day! It is hilarious and I think it is sure to get good viewership when the show airs on ABC in March. I think it will make great TV, and although I hope it makes a real difference, I am not holding my breath for it! Good luck Jamie anyway.

Tom Vilsack on child nutrition act

Secretary Tom Vilsack answers 5 questions about his plans to expand the child nutrition program. I am all for it; I continue to believe that hunger and obesity are two sides of the same coin. Improving access to nutritious food, including fruits and vegetables, and not just focusing on low salt, sugar and fat is a good idea. Childhood obesity is a serious problem we must address now.

Michelle Obama takes on childhood obesity

If you haven’t yet seen this video by the first lady, you have got to check it out. Even though I think her Let’s Move campaign is destined to disappoint, I do admire her initiative to improve the health of our nation. She has a great personality and her message is clear and in many ways quite inspiring.

Help! My baby is fat – are you serious?

Chubby babies are cute, but is there a thing called a “fat” baby? Well, according to some researchers, people who turn obese when they grow up, begin to show a sign as early as 3 months of age! I find that unbelievable and I think this is going to send a risky signals to new parents. Babies need healthy fat, which if they are exclusively breastfed, is very easy to accomplish. Don’t be afraid of fat; the key is to work towards developing healthy eating habits during toddler years. This is yet another example of how catchy headlines can create a sense of unnecessary anxiety. The video does have some good tips from Dr. Sanjay Gupta, so check it out!

Happy Valentine’s Day! The big news this week was the Let’s Move campaign launched by the First Lady Mrs. Obama to fight the problem of childhood obesity in America. I think it is a worthwhile and timely initiative and I am glad that someone of her status is taking it on to give it the visibility it needs. While the cause is noble, the intentions are genuine and the star power is undeniable, I believe that the approach taken by her campaign is fundamentally flawed. I have serious doubts that it would create a change at the scale needed to make any real impact in the long term health of our nation.

I don’t normally consider myself a glass-half-empty-kinda guy. Yet, today I find myself compelled to give you 5 reasons why this initiative is destined to disappoint. I do sincerely hope I am wrong!

It will not change the demand for cheap fast food in any significant way

I admire Mrs. Obama’s candor in her acknowledgment that she found it hard to balance her family’s need for a healthful diet and demands of hers and Mr. Obama’s careers. Just too busy, not enough time…being unable to cook a good meal for my kids…going to fast food…ordering pizza. She certainly reflects the feelings of many Americans; however the ideas proposed under her first pillar, Healthy Choices, are simply too stale. Here is why:

• Empower customers by front-of-box labeling – interesting idea; already much talked about and being practiced, although not in a standardized way. I believe food marketers will eventually find a way around whatever regulations are introduced and customers will tune out the front-of-the-box information just the way they have tuned out the detailed and really informative nutrition facts label at the back.
• Prescription for healthier living – doctors and nurses will be encouraged to track body mass index and offer counseling for healthy eating early on. Nice thought – every time I go to the dentist, they tell me to floss daily. I don’t, even though I want to. I don’t even feel guilty about it anymore. I realize, they are just doing their job.
• Next generation food pyramid – Guess what, the USDA wants to revamp the food pyramid and online interactive tools! Great news for the academics. A busy parent is probably already overwhelmed; besides if they don’t find time to cook a good meal, do you really believe they will tinker around with online tools?
• Empowering change – very novel idea of a food atlas to show you food deserts around the country. If you live in one, watch out your property value may decline! Just kidding. Again, I think this is a gadget for the academic in us!
• Let’s move start up tools – so you need to stop watching TV and get out there and get some exercise! We all know that and no new tools are needed to convince us or help us out. There are plenty of them out there already.

The fundamentals remain unchanged – we live busy lives; we are always on-the-go; cheap fast food is readily available; it makes us feel good and solves a real problem. None of these ideas will change consumer habits in a fundamental way. At best, they will make people feel guilty, temporarily at least, but don’t expect them to change their habits.

It will not change how we farm and what we grow

What we grow is corn and beans – lots of them.  We practice industrial agriculture which is dependent on fertilizers, pesticides, genetic modifications and consumes an unbelievable amount of natural resources. If you have doubts, pick up a book by Michael Pollan. We process meat in feedlots virtually shut-off to the outside world and raise cattle on a diet of corn. Chickens are no better and quality of seafood is getting worse; what with mercury contamination and salmon being raised on corn! We are constantly battling risks with food safety because of loopholes in inspections.

The wheel of supply and demand turns day and night, getting faster with each turn as the population grows and our appetite explodes. If demand does not change in a fundamental way, how can we expect supply to change? The so called organic movement and sustainable farming are like toddlers in the face of industrial farming.

Granted that one should not expect the First Lady to address such political hot buttons. But one should also not get too enamored by the marketing of this campaign to forget that our problems really arise out of the farm driven by consumer demand.

It offers no incentives for the food industry to innovate

I was excited to read:

Let’s Move is building communities by bringing together families, schools, private industry and government to make healthy living easier

I kept looking for what is expected of the private industry and the only example I found was how the beverage industry is answering the FDA’s call to post calorie information on the bottle! This is no innovation, only a marketing gimmick to appear responsible. There are no real drivers for the industry to innovate to produce healthful products. And believe me, the so called soda tax or twinkie tax is unlikely to effect this desired behavior.

Now you could argue about the definition of a healthful product. Surely, reducing sodium, trans fat and sugar is a step in the right direction. But the fact remains that these products do nothing to reduce the share of processed food in a typical American diet. In fact, this notion is contrary to the business model – after all, the food industry stays in business by selling more of their products, not less. I would love to see food companies create products (and services) that actually increase the share of home-cooked food in an average family. That would be real innovation.

It creates another food bureaucracy

A new Healthy Food Financing Initiative through a partnership between the departments of Treasury, Agriculture and Health & Human Services will invest $400 million each year to provide innovative financing to bring grocery stores to underserved areas. The idea is to increase access to healthy food, fruits and vegetables and to get rid of food deserts across the country. To me it smells like a new bureaucracy, unsustainable in the long run and at the risk of another budget cut. It addresses the issue of supply assuming that the demand will naturally be there. Really? Why not utilize the network of food banks and offer incentives to buy healthful products on food stamps? Do we really need a new system?

It will encourage schools to game the system

School administrators now have a new goal to accomplish – try to fit the mold of a healthier school with the Healthier Schools Challenge. The scorecard is simple – reduce salt, fat and sugar and increase whole grains. This is nutritionism at its best. It is probably not difficult to meet the standards – whatever they might be – over the 5-10 year-long time frame of the program. Does it mean that kids will start eating healthy? Maybe, but not a guarantee. With no real carrots and no sticks, my guess is that schools will simply game the system to generate a hype of healthfulness. And maybe they will figure out a way to correlate small drops in average body mass index with their efforts in the cafeteria! That will make it look really convincing – yeah, right!

I know, you are probably thinking that it is easy to be critical without offering an alternative. I agree – that is why I plan to write about a few out-of-the box ideas in future and invite a discussion on them. Stay tuned!

Enjoy and let me know what is on your mind.

Photo Source: baronsquirrel via flickr
©2010 Littlestomaks.com

Greetings! Here are 5 nutrition related articles that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Snacks are in, Meals are out

That is our eating culture today according to this story in the recent New York Times. Research conducted by the Department of Agriculture and the Department of Health and Human Services between 1997 and 2002 found that fewer children ate 3 meals a day while the percentage of those who had a snack instead went up by 40%. This should hardly be a surprise since snacks are now available everywhere. And parents are asked to bring snacks to sporting events or other extracurricular activities. It is no wonder that the traditional family meal is no longer a tradition now except around the Holidays!

Right now, we are experiencing this problem first hand. It takes a lot of effort to create a distinction between mealtime and snack time. Healthy snacks have a place in a child’s diet, but when they begin to demand their favorite snacks at regular mealtimes, you have to draw the line. Snacks are meant to keep them from getting too hungry between meals. Not as a substitute for regular wholesome family meals. So we are trying to be gentle, yet firm in our approach to having our twins understand this difference. Share your tips for getting your child to eat regular meals and not demand snacks and mealtimes.

Obesity rates are flat, but that’s no reason to celebrate

New data from CDC suggests that obesity rates among US adults have reached a plateau, which means they are not rising anymore. But the bad news is that the number is quite high – nearly 34% of the US adults are obese, which is nearly double the number about 30 years ago. Although the number of obese children is at about 17%, this number as tripled over the same time frame. Some may see this as “halting the obesity epidemic”, but I think that attitude does nothing to solve the problem at hand.

This graph in the New York Times is interesting. It shows that Hispanic and African American children 2-5 year old have a higher rates of obesity (BMI is >95% of children in this age group) compared to White children of the same age. Same conclusion can be drawn for adults 20 and older. There is a clear correlation between race and, more importantly, the socioeconomic status, and obesity. And I don’t think there is any coherent strategy to target this group of people to solve this problem. There is no reason we should get complacent about “flat” rates of obesity in the US. This problem is deep and quite severe.

Fuel Up to Play 60

This is an interesting program sponsored by the National Dairy Council and the NFL to encourage kids to eat healthy, play at least 60 minutes a day and do fun activities in and out of school. Kids and Schools can enroll in a competition of sorts where they score points by tracking their food choices and activities. Even the USDA has joined in as a partner.

I think this is a great project. More than anything else, it will get kids to pay attention to what they are eating on a daily basis. I strongly believe in the power of measurement – you get better only when you measure. That is why tracking the food choices and physical activity is a good idea. And of course if they win, they get to hang out with NFL players, which is also very cool!

The only thing to watch out for is that undoubtedly dairy products including flavored milk will be pushed into schools and kids will be encouraged to grab them so they can “score” points. Milk is a far better option than soda or other sugary drinks in schools, but too much flavored milk is also not good. The reason is that it has added sugar in addition to the natural sugar found in plain milk.

Bottom line – stick to plain milk, eat fruits and veggies and give up on soda and junk food. But do bring this program to the attention of your child’s school if they don’t know about it. 60,000 schools have already signed up!

Here are 2 neat recipe ideas for you this week

Take the beef out of your burger and (still) enjoy the experience

Who doesn’t love to sink their teeth in a thick, juicy burger?! But with so many scary stories of E. coli contaminated beef recently, even the most devoted burger fan is probably looking for safer options. This article in the Well column of the New York Times offers 5 ways of enjoying a beef-less burger! You can make burger-like patties by combining fish, chicken, turkey, vegetables, beans  and mushrooms. Sounds like a good idea, certainly worth trying.

Cold quinoa salad with feta cheese

We like quinoa and we love feta cheese! That is why this simple recipe on The Nourished Kitchen caught my eye. First you cook the quinoa and chill it before preparing the whole salad. Aside from the feta cheese it also calls for chicken and pine nuts, both very healthy ingredients. I could also consider experimenting with finely chopped pieces of apple. Overall, it looks very good and worth a try.

Enjoy and let me know what is on your mind.

Photo Source: adactio on Flickr via everystockphoto
©2010 Littlestomaks.com

There is something ironic about freezing cold weather in Florida! I know, I should not be complaining because rest of the country seems to be under a really bitter cold, but I can’t help myself. It is not supposed to be that cold here. I would not mind it so much if it got cold enough to get some snow and everything shut down for a day or so. That way, we could go out and play in the snow with kids. That would be fun, but this bitter cold with the sun shining on us at the same time is simply miserable!

Anyway, enough of complaining about the cold. I hope you all had a wonderful Holiday season. I am just now getting in the groove with blogging again in the new year after a short break. Therefore, for this week’s 5 for Fridays, I am going to pick my personal favorite nutrition stories of 2009 I wrote about in this weekly column. So, here they are; let me know what you think about them.

Even Top Chefs Have Picky Kids (published Feb 20, 2009)

I have not seen the otherwise popular show “Top Chef”, but I really liked this interview with Chef Tom Colicchio in the New York Times. Despite his celebrity status, he appears to be quite modest and down-to-earth. Like most parents, he too struggles with his teenage son’s eating habits. I liked his ideas about wholesome food made from fresh ingredients and setting an example by eating healthy food at home. According to him, the choice of food is not between unhealthy and healthy, it is between good and bad! Although he acknowledges that people are busy, it is not really that hard and time consuming to make a healthy recipe (if you know what you are doing of course!). He proves that by giving an example of a 20-minute pasta dish with a yummy clams sauce.

Which vitamin is better – tablet or liquid? (published Mar 27, 2009)

There is an interesting debate going on in one of the LinkedIn groups on Nutrition. Does a tablet form of vitamin work better inside the body or the liquid form? Absorption of vitamins and minerals from a multivitamin supplement is not very well understood. In the absence of scientific data, all kinds of claims are made about liquid vitamins that they are better and they are absorbed quickly. In response to these claims, those who believe in tablets and capsules tend to make their own counter claims. It is all very confusing to everybody.

In response to my poll on multivitamins, most of those who used these supplements for their toddlers preferred the gummies or tablet variety. Very few favored the liquid form. Could be that liquid form of vitamins is not very common and tends to be more expensive.

I have been thinking about this topic lately and I intend to do some research before writing a post. In the meantime, feel free to share your opinion.

The sweet nothingness of artificial sweeteners (published May 29, 2009)

There are so many different types of artificial sweeteners available these days. And now there is all this buzz about Stevia, the real “natural” no-calorie sweetener. How do you decide which one of the white, blue, yellow and pink packets to go for as you try to grab your morning coffee? They are zero calories all right, but should you worry about possible adverse health effects, including the possibility of cancer, from some of these chemicals? And what about the fact that consuming zero calories sugary beverages does nothing to control your appetite and you might actually end up eating more even as you try to cut down on calories? Check out this very detailed article on artificial sweeteners which basically says that most artificial sweeteners are safe in moderate amounts. So go for the one that tastes the best to you. Overall, you will be better off going for just water instead of the sweet beverage and following a nutrient-rich diet including fruits and vegetables. Zero means zero after all!

30 states have 30% or higher childhood obesity rates (published Jul 3, 3009)

Scary statistics, and nothing to be proud of in my opinion. This data comes from a new report called F as in Fat – How Obesity Policies are Failing in America 2009 published by the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF). Mississippi got the top honor for its 44% childhood obesity rate – that is nearly 1 in 2 children 10-17 years old is either overweight or obese. 8 of the 10 states with highest rates of childhood obesity are in the South. Another study of children 2-5 years old in low income families shows that nearly 15% of these children are obese compared to about 12% nationwide. It is not that we don’t know the reason for this trend – children eat junk food, they spend too much time watching TV or in front of a computer, they don’t exercise, and schools are not up to standard when it comes to providing healthy meals. Still, nothing is being done about it, and seems like we have no control over the expanding waistlines of our children. Clearly, childhood obesity is a problem we need to confront with all our creativity and resources since it has terrible implications for the long term health of our nation.

Watch out, eating hamburgers can paralyze you (published Oct 9, 2009)

I was shocked beyond belief to read the unfortunate story of 22 years old Stephanie Smith, who got really sick after eating a hamburger contaminated with E. coli. She was so sick that doctors had to put her in a coma for nine weeks, after which she could no longer walk because she was paralyzed from the waist down. A very heavy price to pay for a cheap hamburger all of us assume safe for eating without much thought.

Turns out there are serious gaps in the food inspection system which is supposed to test packaged meat for E. coli contamination. Ground beef is produced by processors from beef trimmings and other parts which they buy from many different suppliers. Not all of these incoming supplies are tested for contamination before grinding. The result is that contaminated cow parts can sometime enter the ground beef supply undetected. Does not happen very frequently, but it does happen often enough to make the news. 8000 people have become sick from 16 E. coli outbreaks in the last 3 years.

No matter how many regulations and inspections are put in place, there is no way to be 100% safe because of the way meat is processed in modern plants. My advice – cut down on beef in the first place – it has been shown to increase the risk of various types of cancer. And if you do want to enjoy a burger, make sure you follow the safe handling procedures and cook it thoroughly so that the inside of the hamburger reaches 165 °F.

Photo source: dylinindustries on Flickr via everystockphoto
©2010 Littlestomaks.com