Happy New Year! Hope you all had a wonderful time with your loved ones over the Holidays.

I took a little break from blogging but now it feels great to be back! I am looking forward to continuing our journey in child nutrition in 2011, but first I would like to invite you to check out these top 10 posts of 2010 in terms of page views and comments. Some of them were written in 2009 and made the list then, but continued to attract interest in 2010. Science driven, yet practical, nutrition knowledge indeed can be timeless in some ways! Thank you for interest and support over these years.

Whether you are a brand new visitor – or a regular reader of this blog – I hope you will find them interesting and useful as you try to manage your growing child’s nutrition needs. Share your own experience, offer advice, or simply ask a question in your comments below. I would love to hear from you!

	Simple Recipes – Chicken with Quinoa   This is a very easy recipe to make! Quinoa, in my opinion, is the unrecognized superfood because it is a good source of protein and low glycemic index carbs. It also provides a good mix of vitamins and minerals.
	Milk Allergy and Ear Infections   Dairy allergy can be one of the underlying causes of recurring ear infections. This article by Jasmine Jafferali, MPH, explores this issue in a simple, yet practical, Q&A format.
	Ask the Expert – Sushi and Toddlers  If you are a sushi lover and you are thinking about introducing your toddler to sushi, you have got to read this informative piece from registered dietitian Janet Helm. She writes a great blog at Nutrition Unplugged with tons of excellent information about nutrition and food trends.
	All Natural Toddler Multivitamin   My review of Floradix Kinder Love Children’s Multivitamin Liquid Extract Formula attracted a lot of attention because it is based on herbal extracts and fruit juices. It claims to be easy on the child’s digestive system while providing vitamins A, B, C, D and E. It is not a good source of minerals.
	Looking for a Multivitamin Supplement?  This is a “mini” guide to toddler vitamin supplements on the market. If you are considering a supplement for your child, you can use a simple comparison chart in this post. Centrum Kids and Flintstones Complete offer a good balance of complete vitamins and minerals. But the most important advice is to rely on a balanced diet with plenty of fruits and vegetables.
	Product Reviews – Buddy Fruits  This is a simple fruit puree and makes a healthy snack when you are on the go. When we found it in our local supermarket early last year, it wasn’t as commonly available as it is now. Can be a little messy for small children, but overall not a bad choice for a quick snack.
	Basmati Rice: It is Very Easy to Cook and You Will Love It’s Flavor and Fragrance  We love basmati rice! It is an excellent source of low glycemic index carbohydrates. Try my simple recipe to cook it as a separate side dish. You can also try some of the links in this post for other great recipes.
	Simple Recipes – Pasta with Spinach and Mushrooms  This is a simple variation of our recipe Chicken with Pasta and Vegetables. It hardly takes any time to prepare and we save it for those hectic days when we have to quickly put something together for dinner.
	Traffic Light and Food Labeling  Clearly, consumers want simple and easy to understand front of the box food labels. FDA is worried about accuracy and manipulation by the food industry. A traffic light based food labeling system is gaining popularity in UK and Australia. It is not perfect, but clearly a step in the right direction.
	Milk Choices for Toddlers   Registered dietitian Jill Castle offers an overview of several different milk choices for toddlers in case cow’s milk is a concern. Jill blogs about child nutrition at Just the Right Byte.

Web statistics are surely important, but here are a few of my personal favorites. I hope you will check them out and leave me a comment with your opinion!

1. Surprising easy solution for preventing childhood obesity
2. How worried should you be about your underweight child?
3. Do children need more vitamin D?
4. Nutrition trivia – 10 facts to know about protein
5. Resting metabolic rate and weight management

©2011 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.

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.

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

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, registered dietitian and contributing editor of Parents magazine Sally Kuzemchak offers tips for creating a healthy food environment at home to foster lifelong healthy eating habits and preventing childhood obesity.

Question: My son just turned one and since I have struggled with obesity most of my life, can you suggest what I can do nutritionally to ensure my son doesn’t face the same struggles?

It’s great that this is on your radar and that you want to take action while your son is still so young. As you already know, you can’t do anything about your son’s genes. But you can make sure he grows up with healthy eating habits and physical exercise. That can make a huge difference for him and help lower his chances of obesity in both childhood and adulthood.

Here’s how you can establish a healthy food environment at home:

Keep your kitchen stocked with a wide variety of nutritious foods that are yummy and accessible, like a bowl of fresh fruit on the counter and snacks like low-fat yogurt and whole grain crackers front and center in the fridge and cupboard.

Plan regular meals and scheduled snacks instead of all-day grazing or constantly grabbing food on the run.
Include a small amount of goodies like desserts or chips that you treat as “sometimes foods”. You don’t want these foods to become forbidden and more desirable.

Eat most meals at home together as a family at the table. Researchers have found that children who eat meals with their families (and the TV turned off!) get a much healthier diet overall.

Offer milk and water as the primary drink choices. Sweetened drinks like punch and regular soda are linked to weight gain among kids and adults—and you can even skip fruit juice if your son eats a lot of fruit. You should also ask your child’s doctor about giving your son two-percent milk right now instead of whole. The American Academy of Pediatrics recently stated low-fat milk is a better option for toddlers who have a family history of obesity (after age two, you can switch to one-percent or skim).

Model healthy choices and attitudes. As a parent, you’re the single biggest influence on your child right now. Let your son see you take the kinds of positive steps you want him to make as well, like drinking water instead of soda, enjoying vegetables with meals, and being active. And avoid making any critical comments about your weight or your body, since studies shows that those negative attitudes can rub off on kids and damage their self-esteem too.

©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.

photo credit: jbelluch

Would you offer Cheetos® to your 1 year old? What about soda?

I was at a birthday party this weekend where I noticed someone giving a small child a piece of Cheetos. The child clearly relished the taste as she licked away the last bits of cheese from her mom’s fingers. One point of view could be that it is ok to introduce different tastes at an early age. Others may say that this is how children get hooked on junk food and that is why we have a childhood obesity problem.

What do you think? Do you have a list of forbidden foods you will never let your child eat no matter what?

©2010 Littlestomaks.com

Greetings! Hope you are enjoying your summer so far. In this week’s Five for Fridays, I want to focus on food advertising to kids. Many people believe that food advertising, especially on TV during children’s programming, plays a big role in influencing food choices and brand awareness among young kids. Some experts go on to linking such advertising to overweight and obesity in children and suggest we should put a ban on advertising during children’s programming. However, as I wrote in my article Ban TV Food Advertising to Reduce Childhood Obesity – Really?, there is little evidence to support the link between TV advertising and childhood obesity. Sure, there is a lot of passion and strong opinions about the effect of TV advertising on kids, but there is not much data.

In this article I want to first explain why I am against the banning food advertising to kids even though I am dead against junk food and fully agree with its impact on our health problems. Then I want to offer a few suggestions on how to reduce the influence of TV advertising so that the marketers are forced to change their message.

Here are a few reasons for my opposition to the notion of banning TV food advertising:

• It goes against the idea of freedom and personal choice – just the way consumers have a right to choose what they want to buy, food marketers are also entitled to promoting their products. Unless, of course, there are proven health risks of high degree and regulations are adopted to control public promotion. I don’t believe food advertising can be considered in the same way as tobacco advertising, at least for now.
• Banning specific advertising is discriminatory – some may say that promotion of  unhealthy food products should be restricted. That means some other type of food products may be allowed freely. This is like saying ban the ads for cars with low safety rating and allow only certain types of cars to be advertised. Who draws the line between the so-called unhealthy foods and healthy foods from advertising point of view?
• TV is not the only channel for food advertising – the fact is that there is a declining trend in watching advertising on TV. Other channels like internet, mobile phones, printed media and in-store advertising are becoming more popular with advertisers. To what extent should we ban food advertising?
• Banning unhealthy food advertising does nothing to promote healthy foods and eating habits – Even if a ban on the so called unhealthy food products is implemented, it does nothing to promote healthy foods and eating habits. The focus should be on the positive, not on the negative. Why not invest in a public awareness campaign to counterbalance the current advertising? Are we so afraid to go head-to-head against the clever food marketers?
• Banning TV food ads does not reduce the duration of TV watching – say we have no food advertising on TV anymore. It does not mean that there will be a reduction in the amount of average time a kid sits in front of the TV. What is needed is a change in lifestyle and eating habits, not a ban on TV advertising.

Now that I have pitched a few reasons why I don’t like the idea of banning food advertising on TV, I should also add that there are many ways we can collectively reduce its influence. Or at least create an environment where food marketers are forced to improve their message to serve the public good and not simply the interests of their shareholders. Government has a role to play, but so does everyone else. Here are few ideas that come to my mind; I am sure there are many more if we take a step back and think about this problem differently.

• Require a disclaimer on health risks in food ads - just like the ads for drugs have a disclaimer on potentially harmful side effects, a disclaimer should be required from foods high in calories, salt, sugar and fat. Before that happens, clear standards need to be established on a per-serving level so consumers can make an appropriate choice.
• Require a warning on product package – just like the Surgeon General’s warning on health risks of alcohol and tobacco, foods containing high calories, salt, sugar, fat and additives should be required to have a standardized warning on the label.
• Create and publicize a national database of unhealthy foods – just like a list of recalled products, there should be a database of foods that can be classified as unhealthy based on clear standards. Consumers should be able to report as well as search for products before making a purchase decision.
• Monitor and take aggressive action against misleading claims in food marketing – the problem is that functional claims are allowed and marketers use confusing language to convince customers into buying their products. It takes a lot of knowledge and savvy to cut through the confusion. This is where I see regulators playing a very important role.
• Launch a massive public awareness campaign – get on the offensive and launch a public awareness campaign. The argument I have heard is that it is too expensive and there is no way to beat the food marketers with huge budgets. We need to get creative – why not incent business majors to build and launch a public service messages as a part of their marketing class? Harness the power of social media and encourage key influencers in each community to fight this battle. There can be many low-cost creative ways of doing this.
• Empower parents to build their family’s personal brand – food brands are powerful, no doubt, but parents are the ultimate gatekeepers of their children’s nutrition and eating habits. The problem is that they are overwhelmed by information from different sources which may appear to be very confusing and even intimidating at times. With a little help, I think parents can develop their own brand which defines their unique approach to food and nutrition. It gives them a tool to evaluate food advertising and allows them to reject messages that are inconsistent with their brand. It is kind of an abstract idea but if companies can do it, why not individuals and families?

These are only a few different ideas, and by no means, I can claim to have all the answers. My hope is to start a conversation from a slightly different perspective. When it comes to the politics of food, a lot of focus is on the supply side of the equation. I would love to shift the conversation to the demand side for a change.

Will you join me in this conversation? Share your ideas in comments below.

Enjoy your weekend!

©2010 Littlesotmaks.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

The Dietary Guidelines Advisory Committee established jointly by the US Department of Agriculture (USDA) and Department of Health and Human Services (HHS) came out with a report this week. It is a lengthy report based on a lot of data. Most of their conclusions and recommendations are not really unexpected or surprising – cut down on fat, sugar and salt; manage total energy intake; engage in physical activity etc. We have heard them all one way or another.

What caught my interest was data on top 5 dietary sources of energy for children and adolescents, and in particular, for children 2-3 years old and 4-8 years old. Here is a portion of this table for these two age groups:

Grain based desserts include cakes, cookies, doughnuts, pies, crips, cobblers and granola bars. 100% fruit juice does not include orange or grapefruit juice.

Nearly 30% of the average daily caloric intake for the two age groups is delivered by these top 5 food groups. A quick look at these food groups confirms the carb-rich diet of today’s children (and adults alike).

Another troubling fact is that 35% of calories in a typical American diet (both kids and adults) comes from added sugar and solid fats. This is more than double the amount recommended by different agencies.

There is no shortage of data to prove that our diets and eating behaviors are not so healthy. There is also no shortage of blame being passed around – profit-hungry food industry, aggressive food marketing to children, poor quality of school nutrition, lack of physical activity and high cost of healthful foods. Again we have heard them all one way or another!

The report recognizes the challenges in changing this pattern of unhealthy eating, but does little to emphasize the importance of personal responsibility. It seems to imply a command-and-control, top-down type of an approach rather than empowering individuals and parents to make small changes on a daily basis. Individuals can make a difference, but they seem to think that the system is far stronger than the individual.

What do you think? What small changes can you make to make sure your family and children do not fall into the average category?

Have a great weekend!

©2010 Littlestomaks.com

News about childhood obesity is everywhere these days. Hardly a day goes by without a screaming headline in the media about this issue. Jamie Oliver has further popularized it by his TV show and even Mrs Obama has taken up this cause via her Let’s Move campaign. There is no doubt that we must address childhood obesity, but what about the problem of underweight and short stature? How worried should a parent be if their toddler falls under the 5th percentile in weight and height?

Recently, registered dietitian Teresa Wagner tackled a reader question in our Ask the Expert column about a toddler not gaining weight. I received a follow up email from another reader who was worried that her 8 month old child was below the 5th percentile and not eating much. The tone of her message reflected her extreme worry and frustration at not knowing what to do.

There is a reason why our media does not focus on this problem. The numbers, when taken as a whole nationwide are not that high. See below a chart based on the 2008 data CDC’s Pediatric Nutrition Surveillance System (PedNSS) on growth indicators. The PedNSS system is a public health surveillance system which monitors the nutritional status of children from low income families under Federal programs. Data comes from public health clinics where these children are seen for routine care, nutrition education and supplemental food.

Percentage of children 2-5 years old who are underweight or of short stature is between 3-5% for Whites, Blacks and Hispanics. These numbers are even smaller for American Indians and Alaskan Natives. Compared to the 20-30% obesity rates, these numbers are too low to capture the attention of mainstream media and policy makers. Besides, the media loves to show extreme images of either very fat kids or severely malnourished starving kids from the third world countries. Anything else does not make the cut for prime time!

As a parent, it is natural to worry. It becomes a personal issue and fancy nationwide statistics do not make a difference. The frustrating part is that it is not always possible to get enough credible information to make informed decisions. The result is that each day becomes a battle to force feed a child in the hope that she will put on some weight. Since children have a natural ability to regulate their food intake based on their current needs, it may seem like they are not eating enough. Anger, frustration and despair are the emotions most parents feel under these circumstances.

Here are 5 questions you can consider to assess the situation and take appropriate actions

Is there a trend in my child’s growth chart numbers?

A single data point on the growth chart, although important, should not cause concern. Take time to understand growth charts and their limitations so you can use them to evaluate the general growth pattern of your child. Another thing to keep in mind is that your child may not be in the normal range for both weight and height. For example, our twins are tall for their age group but lag behind in weight. From this perspective, I like the BMI for age chart because it takes into account both weight and height at the same time. You can use this online calculator for BMI chart or ask your doctor about it.

Is there a medical reason for slow growth?

This is where keeping a close eye on your child’s growth pattern will help you find medical issues that may be affecting her growth. There may be known birth defects or undiagnosed metabolic or digestive disorders. Severe case of reflux like GERD is also a concern. Detecting them early and working with a specialist for corrective action is very important.

Is there a specific reason for poor appetite?

Nearly all toddlers are picky eaters and it is natural for them to frequently show poor appetite. But if it persists over a long period of time, you will need to be extra vigilant so you can find the root cause. Are there food allergies? Special environmental or seasonal triggers? Does a change in menu or feeding schedule help? The important thing is to pay attention to the unique needs of your child so each feeding is most effective. Siblings around the same age, twins or multiples need different treatments based on their individual personalities. Clearly a challenge for most parents, but there is no perfect answer. Practicing the principles of attachment parenting and nutrition can help.

Does my child seem different than his siblings or other family members?

Although it is not always a good idea to compare your children, you have to take into account your family history and genetic makeup. In some ways, a consideration of these factors is probably more important than the growth charts which are based on population averages. If your family ethnicity is not one of mainstream population, it is unlikely that the growth chart standards will be accurate for your child. Evaluate your child’s height, weight and BMI through the lens of your family’s history to determine if there are differences you should be concerned about.

Are there any special circumstances in my family?

Every family goes through ups and downs – financial, emotional or health-related – often over an extended period of time. Assess if you have certain stresses in your personal life or your family situation at the moment. Even toddlers pick on them easily even if they cannot articulate it. If these problems persists over a long period, there may be slow weight gain or even a loss in weight. Recognize these problems early and seek help from family, friends or your doctor to manage them.

One last thing to remember – early childhood height and weight is often a poor predictor of adult height and weight, except in the case of overweight or obesity. You may be surprised how fast your child can grow upon reaching puberty. Keep a close eye on the growth charts, spot the problems early and take appropriate action. No need for excessive worry just because of a couple of low points on the charts!

Most importantly, focus on building healthy eating habits. Offer a variety of foods in healthy balance and moderation.

Are you concerned about an underweight child? Please share your personal story in a comment below.

©2010 Littlestomaks.com

Greetings! I am on business travel this week. That is why I have decided to pull out a few noteworthy reader comments from my archives this week instead of the usual Five for Fridays.

I am constantly inspired by your comments and I learn a lot from them. I want to say thanks to those who spend time reading my posts and leave a comment behind with some advice, helpful tips or a question for further research. Some of them have their own blogs, which I highly recommend you to visit whenever you get a chance.

Enjoy, and feel free to leave a comment of your own.

1. When a reader asked about food sources of vitamin D, Dr. Joanna Dolgoff listed these on her Ask the Expert post about Vitamin D deficiency
   

Foods that contain Vitamin D include fortified milk, fortified yogurt, fortified breakfast cereals, wild salmon, canned tuna, cod liver oil, sun-dried shitake mushrooms and egg yolks. I think the fortified milk, yogurt and breakfast cereals will work best for a toddler!

2. Nona Nita reminded us that dollars and sense is not everything in response to a Five for Fridays entry on home gardens:

Even if growing my own tomatoes will cost more, I like the idea that I am going to use heirloom seeds that have not been hybridized. I will be able to keep the seeds from my produce to grow more next year. Not only will I get tomatoes like they used to taste when I was a kid, but saving the seeds from the tomatoes to use next year will be a great lesson in the cycle of life for my grandchild. Hooray to the Obamas for being great role models! Hooray to you for a great blog!

3. Reiza was concerned about mercury in tuna when she read dietitian Janet Helms’s Ask the Expert article on sushi for toddlers

My kids have all eaten sushi since infancy. You raised some issues I never even considered. I don’t think we’ll stop (my twins are over 5, but not my son), but we’ll definitely be asking more questions.

One thing I want to know, though, is how much sushi with tuna would a child need to consume to be worried about mercury? I’ve always limited canned tuna, but I never thought mercury would be an issue with such small pieces like you find in sushi.

In response, Janet Helm added:

Thanks for your message. You’re right. The small amount of tuna in sushi should not be such a problem, since the recommended limit is 12 ounces per week. A 3-ounce portion is about the size of a deck of cards, so you can estimate the number of ounces your kids may be consuming.
So if you’re not eating tuna more than once a week, you’re probably well within the “safe” range for mercury.

4. Dr. Ayala offered her perspectives on healthy snacks and indulgences in response to a Five for Fridays entry on childhood obesity

I don’t particularly like the term “snack”, as it can mean a small meal, which could be very healthy, or, more commonly, a highly processed packaged food you can eat on the go anytime and anywhere.

I therefore don’t use “snacks”. No matter the name, I make the small meals between the other bigger meals healthy–fruits, vegetables, nuts, leftover food from yesterdays’ dinner. That’s what I serve my kids when they come home from school quite hungry and in between meals.

As for the indulgences that I do think should not be denied–I call them dessert, and my kids call them “junk”. A good time to eat them is after the meal. I think there’s a place for ice-cream, chocolate, cake or whatever indulgence one fancies, but the key to really enjoying those and eating healthily is moderation and great quality. A small dessert (when a kid isn’t too hungry) made of high quality ingredients is a pleasure. Snacking on chips, cookies and donuts (even if low-fat)is not particularly satisfying, doesn’t hit the spot, and is just a bad habit.

5. Alina shared her concern and hoped for better nutrition at schools in response to Ask the Expert article on managing concerns about daycare food

I like the idea of bringing food to daycare but unfortunately many daycares do not allow found to be brought in. Also, a toddler wants to eat what everyone else is eating since the kids all eat together. Improving the nutrition of daycare (and all school food in general) is a very important topic. It would be nice for policy-makers and law-makers to embrace the need for this change!!

Photo source: Robert Whitehead on Flickr
©2010 Littlestomaks.com