Childhood obesity and overweight is becoming a major issue today. If you are facing this situation with your child, you have got to understand the notion of resting metabolic rate (RMR) and how it can help you manage your child’s weight.

I first learned about RMR from Milton Stokes, who is a registered dietitian and an expert in weight management issues. He told me that a test is now available for measuring RMR and it may even be covered by your health insurance. I was so intrigued by it that I asked him to connect me with an expert on the science behind RMR and this new measurement technique so I could share a detailed article with you. Check it out and let me know if you have any questions. I will post a follow up article to get your questions answered.

Question: What is Resting Metabolic Rate (RMR) and how does it relate to weight gain?

Scott: Weight management is a simple, yet often difficult, task of balancing energy (i.e., calories) intake with expenditure. Individuals will gain weight when they consume more calories then what they typically burn. The opposite is true for weight loss; burn more calories then calories consumed. In order to determine appropriate energy balance an individual needs to know how many calories they burn each day. Total energy expenditure (TEE) is comprised of resting metabolic rate (RMR), activities of daily living, and the thermic effect of food (TEF). RMR is the main metabolic factor and represents between 60 to 75% of TEE while TEF is approximately 5-10% of TEE [1, 2]. Essentially, the higher the RMR higher is the TEE unless you are more active then the usual individual.

Question: How does this apply to young children?

Scott: Weight gain in children is a topic of great concern. The prevalence of overweight children is 15.5% for 12 to 19-year-olds, 15.3% 6 to 11 year-olds, and 10.4% among 2 to5 year-olds. Overweight has increased five percentage points among 12 through 19 year-olds from 10.5% to 15.5% in approximately 10 years [3]. Unfortunately, future projections indicate children that become overweight as children are at substantial risk of becoming obese later in life.

The children in the U.S. lead a very sedentary lifestyle. With the advent of video games, decreased physical activity in schools, and other social pressures children are not burning a lot of calories throughout the day. In-comparison, studies have indicated that they are consuming large amounts of calories. Therefore, they are in a positive energy balance (i.e., consume more calories then what is being burned). It is not so much a question of a slow metabolism but more of an issue with lack of activity.

This being said, parents should consider having their child’s RMR and activity level measured to best determine TEE. This will help a clinician tailor a nutrition plan to meet the weight management needs of the child.

Question: What determines a child’s RMR? Is it genetic or are there environmental factors?

Scott: RMR is regulated by a complex biochemical and central nervous system. Recent advancements in the Human Genome Project have led to a better understanding of genetic influences in several disease and metabolic states. The mitochondrial uncoupling protein 2 (UCP2) gene has been linked to obesity by way of possible influence on RMR [4-6].

However, it is estimated that this specific genetic influence may only account for the about 5 % of the variance in RMR.

Other biochemical influences may be related to specific hormones (i.e., Testosterone, Leptin). Much is known about the role testosterone has on the human body by way of muscle tissue generation. However, new research has indicated Leptin influences energy metabolism as-well. Leptin is typically known for its regulation of appetite and hunger.

Individuals that are leptin-deficient are often obese and have a lower RMR then normal weight individuals [7].

Still to this day, fat-free body weight is the main contributing factor on RMR. Studies have routinely indicated fat-free bodyweight predicts 80% of an individual’s RMR. Therefore, having more muscle weight in-comparison to fat weight will result in a higher RMR.

Question: Is there a relationship between autism, asthma, food allergy or other health conditions and RMR?

Scott: RMR does change with various health conditions. Most of the time, when an individual is hospitalized for an acute illness their RMR increases. The main reason why RMR increases is the body is trying to repair itself. This is a common reason why individuals typically lose weight when they are in the hospital. In addition, medications for several psychological (depression, schizophrenia, etc.) and physiological diseases (hypertension, diabetes, etc.) have shown to slow RMR [8-11]. However, some medications may not alter RMR but have an effect on overall TEE.

A study conducted in 1999, indicated medications prescribed for children with attention-deficit/hyperactivity disorder had no effect on RMR. However, the medication did result in decreased physical activity by 16-20% [12].
Since there are many disease states and medications that can affect RMR it is important to monitor RMR during medical management of given condition. Since RMR usually changes with a 5-10% weight change it is recommended, that patients receive a RMR measurement so clinicians can prescribe the most accurate nutrition program to best manage bodyweight.

Question: Where can I get my child’s RMR measured?

Scott: Measuring RMR is still fairly new. However, technology has made measurement of RMR easier and more applicable to general wellness facilities and out-patient medical clinics. You can search for health and wellness professionals online at Microlife Medical Home Solutions . The cost for a metabolic test is approximately $50-75 depending on location. In addition, insurance companies may cover this measurement if your child is overweight and/or has an underlying medical issue that has caused abnormal weight gain.

References:

1. Segal, K.R., E. Presta, and B. Gutin, Thermic effect of food during graded exercise in normal weight and obese men. Am J Clin Nutr, 1984. 40(5): p. 995-1000.
2. Danforth, E., Jr., Dietary-induced thermogenesis: control of energy expenditure. Life Sci, 1981. 28(15-16): p. 1821-7.
3. Ogden, C.L., et al., Mean body weight, height, and body mass index, United States 1960-2002. Advance Data from Vital and Health Statistics, 2004(347): p. 1-17.
4. Yanovski, J.A., et al., Associations between uncoupling protein 2, body composition, and resting energy expenditure in lean and obese African American, white, and Asian children. Am J Clin Nutr, 2000. 71(6): p. 1405-1420.
5. Bouchard, C., et al., Linkage between markers in the vicinity of the uncoupling protein 2 gene and resting metabolic rate in humans. Hum. Mol. Genet., 1997. 6(11): p. 1887-1889.
6. Walder, K., et al., Association between uncoupling protein polymorphisms (UCP2-UCP3) and energy metabolism/obesity in Pima indians. Hum. Mol. Genet., 1998. 7(9): p. 1431-1435.
7. Klok, M.D., S. Jakobsdottir, and M.L. Drent, The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev, 2007. 8(1): p. 21-34.
8. Dickerson, R.N. and L. Roth-Yousey, Medication Effects on Metabolic Rate: A Systematic Review (Part 1). J Am Diet Assoc, 2005. 105(5): p. 835-843.
9. Dickerson, R.N. and L. Roth-Yousey, Medication Effects on Metabolic Rate: A Systematic Review (Part 2). J Am Diet Assoc,, 2005. 105(6): p. 1002-1009.
10. Procyshyn, R.M., A. Chau, and G. Tse, Clozapine’s effects on body weight and resting metabolic rate: a case series. Schizophr Res., 2004. 66(2-3): p. 159-162.
11. Fernstrom, M.H., et al., Resting metabolic rate is reduced in patients treated with antidepressants. Biol Psychiatry, 1985. 20(6): p. 692-695.
12. Butte, N.F., et al., Stimulant medications decrease energy expenditure and physical activity in children with attention-deficit/hyperactivity disorder. J Pediatr, 1999. 135(2): p. 203-207.

©2010 Littlestomaks.com

Disclaimer – Information provided in this article should not be considered as medical advice. Consult with your physician if you think your child needs an RMR test and how it can be used to control and/or reverse weight gain. I have no business relationship with Microlife Medical Home Solutions, Inc., and this article is not an endorsement of their products and services.

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 Caryn Roll advises against trying weight loss for overweight or obese children. Instead she recommends that you help them grow into their current weight through healthy eating and physical activity.

Question: My child is obese. What can I do to help him lose weight?

Answer:

Weight loss is generally not recommended for children. The goal in helping an obese child is to have them grow into their current weight. This can be achieved through healthy eating and regular physical activity.

Here a few nutrition tips that might help:

• Parents are in control of what they purchase and prepare for meals and snacks. If it becomes difficult saying no to your child about a particular food then consider keeping it out of the house.
• Give your child the choice. When they are hungry, offer something healthy. If they ask for something junky you need to hold firm and tell you child they can have the healthy choice or nothing. It sounds harsh but it is our job as parents to make sure our kids eat properly. Save treats for special occasions and for once a week family time (ice cream parlor, Sunday night desserts, family game night etc…)
• Children need to be aware of their hunger and satiety cues. If they continue to eat after they are full they will put on weight. As a parent, it is important to understand that children can be hungry anytime and not necessarily at designated meals and snacks. Consequently, ask your child if they feel full before serving second helpings.
• Make sure your children’s portion sizes and food choices meet the recommendations for Canada’s Food Guide or the USDA Food Guide Pyramid. Remember, if the food in question is not on your food guide then it should be considered a sometimes food.

©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.

This is a guest post by Christine Kane-McKenzie, owner at “Falling Through the Cracks”, a non-profit she created for single parents who have fallen through the bureaucratic cracks to help them achieve a better future. She is also a distributor for Juice Plus^+®.

A few facts about Childhood Obesity in Texas

The statistics in 1962 showed that 13% of the U.S. population was obese but by 2000 this rate had increased to 31% according to American Sports Data.  The population of Texas is about 24 million. The population of children, ages 10-17, ranks first in the US at 21.4% with 32.2% being overweight or obese, according to Trust for America’s Health .  With that said, those same children rank 31.7% overweight or obese across the US.  Their statistics also show that the state of Texas has 21.4% of children under 18 who are uninsured.  Finkelstein and his collaborating researchers reported in Health Affairs – The Policy Journal of the Health Sphere – a drastic increase in medical coverage for obesity through Medicare/Medicaid since 1998.  In 1998 approximately half of the over $78 Billion spent on health coverage was financed by Medicare and Medicaid.  Through 2006 that number is estimated to have increased $40 Billion. Taking care of our health now will alleviate most insurance costs attributed to obesity.

What I’m getting at here is our children need to understand the importance of good health, good nutrition, and proper exercise practices.  The first step to improving or maintaining a child’s proper weight is to inform the parents about nutrition, exercise, and quality time with children.

How do you determine if a child will be obese? Is it genetic?

The obesity-predisposing genotype is heritable in 10% of individuals according to a 2006 article in the American Association for the Advancement of Science.  Beyond genetics is the susceptibility to dietary variations, along with a major contribution of familial influenced learned behaviors such as exercise and regular activity away from the TV, computer, and video games according to researchers from Canada who published their findings in this article on PubMed.

Does this mean that everyone who has the obesity-predisposing genotype has to become obese?

No. It only means it’s a possibility.

The fact is anyone has the potential to become obese, unless they have hyperthyroidism, if their caloric intake outweighs their physical activity. Eric Ravussin, Chair in Diabetes and Metabolism at Louisiana State University and a prominent exercise researcher, was recently quoted in this TIME magazine article – “exercise is pretty much useless for weight loss”. Exercise is great to keep the body healthy and the ability to stave off disease processes such as diabetes, high cholesterol, high blood pressure, and stress levels.  Being in shape strengthens muscles that support the skeleton and alleviates back problems. I, for one, am living proof that obsessively excessive exercise has done nothing for me when it comes to losing weight. I felt great but the weight just hung around. During a five year period I had invested in a local work-out plan and also hired three separate trainers as well.  I was well toned, to say the least, but still gained 5 – 10 lbs and was always exceptionally hungry.

Basically, we need to expend our energy on daily activities in balance with caloric intake. Think of it this way. Our ancestors (yes, even the kids) gardened, plowed fields, bailed hay, walked or ran everywhere, scrubbed everything around the house and barn by hand, took care of farm animals, and so forth, so their energy expenditure equaled or exceeded their caloric intake (in some cases they may have not had enough food).  In any case, there were still a few individuals who became obese due to genetics.  Now days kids get up, run out the door without breakfast, get on the bus for school, sit in a desk most of the day (most schools only have P.E. a couple times a week now), come home, relax in front of the TV/video game and eat unhealthy snacks before a hearty dinner, then off to bed.  Where’s the energy expenditure?

What can be done before it begins or reverse the weight gain in children?

Children follow what they see.  If your routine is to stop at the local drive-thru, you’re setting the scene for obesity, heart disease, high cholesterol, diabetes, and other chronic health risks.  Delayed satisfaction is a great lesson for our children in this era of remote controls. Cooking wholesome nutritious meals together as a family will benefit everyone in more ways than one.  The main point is, as a parent, what we do as parents we pass on to our children.  We all want what’s best for them… is obesity one of those things?

Trimming the fat tips for the budget and the waistline

Here are a few tips for Cutting eating costs – even with special diets based on an article by the Chicago Family Health Examiner:

• Look up sites for coupons for whole foods.
• Go to farmers markets instead of the fruit & veggie aisle at the supermarket.
• Stop going out to eat so much and make good choices when you do.
• Have fun growing a garden with the kids – an herb garden, tomatoes, broccoli, and peppers are easy and really don’t take up a lot of room to plant.
• Look into supplementation  like Juice Plus+^® – 17 organic whole fruits and veggies, ground up and put into caplet’s for adults and chewables and gummies for kids for about $1.50/day.
• Another good site to look at is called “The Science of Appetite”. It has tips on what foods make you eat more, what people eat around the world, how to curb your appetite, and more.

Family fun and exercise = Quality time

Quality time is the most important part of having healthy balanced children.  Taking time to talk about health together is just as important as talking about drugs and alcohol to your kids.  Everyday should have some sort of fun activity that is shared by the family such as:

• Playing football or baseball
• Walks around the block a couple times a day
• Ride bikes
• Roller blade
• Skate boarding
• Dancing together

©2009 Littlestomaks.com
Disclaimer: I have not received any sponsorship from Juice Plus+^® and publication of this article is not an endorsement of their products by Littlestomaks.com

Aloha! Hope you are having a great week so far. Here are 5 interesting nutrition related stories of this week.

This small town wants to be a big loser

I heard this very fascinating story on NPR about Fossil, Oregon where 80 people have signed up to compete in a 12-week weight loss program. Now, before you brush it off as small potatoes, consider this – this number amounts to about 20% of the whole population and together they have already lost a total of 600 pounds. They are focusing on eating healthy, working out and sharing a sense of togetherness and community. Losing weight is one goal, but the big picture is about improving their general health. You may find it surprising that the problem of obesity, heart disease, cholesterol and diabetes is worse in small rural towns compared to large cities. This small town is way ahead of the curve in reversing this trend.

I wonder what would happen if we started keeping track of total weekly weight loss at the city level. Anyone wants to venture a guess about how many pounds your city lost last week?!

A survey of 3600 moms shows shifting food priorities

Ten years ago, the priorities were convenience and fun when it came to food choices for their kids. Now according to this new study, moms want healthy and enjoyable food and are looking to make kids appreciate eating. 86% of moms rank “healthy and nutritious” as the most important characteristics of an ideal food, while 82% say “establishes good eating habits” and 80% say “fills the child up.” A surprising finding was that moms were not that interested in “fancy” ingredients such as omega-3, choline, calcium and protein etc. and preferred “simpler” benefits such as fresh and balanced nutrition.

I think these are very interesting observations. Convenience probably is expected, and so are essential nutrients. It is just that moms want a simple, easy to understand message that can help them select the right food. The risk is that even not-so-healthy foods can be marketed under a “healthy” slogan. It is up to the well-informed to keep an eye on such sneaky practices and share this information in an objective way. What is your opinion? And what are your preferences about your food choices?

Which vitamin is better – tablet or liquid?

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.

Database for dietary supplements under development

The National Institute of Standards and Technology (NIST) is working with the NIH, USDA and CDC to develop a database which will have more accurate information about the ingredients of different dietary supplements currently on the market. New analytical test methods and standards are also under development for testing these products. This is very good news – quite often, there is no guarantee that the information on the nutritional panel of many of these commercial products is accurate and reliable. This database will be very useful in comparing different products.

Childhood soy diet lowers breast cancer risk

A new study attempts to study the effect of diet and breast cancer risk among women of Asian origin. Historically, breast cancer rates have been higher in the US compared to Asia. But when Asian women migrate to the US, their breast cancer risk increases over several generations. In this population based study, the researchers concluded that soy intake was related to lower cancer risk. The maximum effect was seen if a soy-rich diet was given in early childhood.

Now, this may be just coincidence and limited to a small population. It does not mean that you should switch to a soy-based diet all of a sudden. However, this is consistent with what I have read about the link between a meatless, mostly vegetarian diet, during early childhood and cancer risk later during adulthood. Dr Fuhrman provides supporting data in his book Disease-Proof Your Child. Dr. Spock also recommends a vegetarian diet for fewer health problems, food safety and lower cancer risk. In our household, we have dramatically reduced red meat and we mostly eat chicken and fish. The decision to go completely vegetarian is a serious one, which you should discuss with your doctor first before making big changes in your own and your child’s diet.

Enjoy your weekend!

Image source: MariahGale on Flickr
©2009 Littlestomaks.com