Winning by Losing
By Richard Trubo
Not only are 61% of adults overweight or obese, but plenty of children have joined the battle of the bulge as well. About 25% of children are part of the "rounding of America," and many have become just as hungry as their adult counterparts for deliverance from their ever-widening waistlines.
"This is an epidemic and a crisis," says Sheah Rarback, MS, RD, a spokesperson for the American Dietetic Association (ADA) and a registered dietitian at the University of Miami School of Medicine's pediatrics department. Overweight kids have a higher risk of developing a number of unsettling health problems, from high cholesterol levels to type 2 diabetes.
As the numbers on the scale soar, so do the reasons that children are plumper than ever: Fewer meals eaten at home and more at drive-thru restaurants where high-fat, grab-'n'-go foods dominate the menu ... schools eliminating recesses and physical education classes ... and too many indoor distractions that turn kids into couch potatoes rather than encouraging them to break a sweat outdoors.
"I call it the S.O.B. syndrome -- the 'sitting on your butt' syndrome -- in which kids are watching more TV and playing more computer games rather than becoming physically active," says pediatrician Alvin N. Eden, MD, clinical professor of pediatrics at Weill Cornell Medical Center in New York City.
Is Dieting Risky?
Most parents know that potbellies are bad for their child's health and self-esteem. But some are also convinced that restricting calories may be just as hazardous to their youngster's well-being. Yet while it's true that under 2 years old, your baby needs fat for proper body and brain development, a sensible lower-fat diet for older children may be just what the doctor ordered, particularly if obesity runs in the family.
"Some fat in the diet is important in children for their proper growth and development," says Denise Bruner, MD, president of the American Society of Bariatric Physicians, whose members specialize in treating obesity. "I generally say that a diet with 30% of its total calories from fat is acceptable in children."
According to Eden, "Starting at age 2, every child, whether fat or thin, should be eating a prudent diet lower in saturated fat, cholesterol, and refined sugar. In my practice, for instance, I recommend that every child over age 2 start drinking skim or 1% fat milk. They should consume more complex carbohydrates, too, such as salads and pasta."
With the best of intentions, some parents have put their child on the same fad diets that they've become hooked on, often oblivious to any potential health risks. The Atkins diet, for example, promotes unlimited amounts of protein and fat, and severe restrictions on carbohydrate-rich foods, which some experts believe could be a prescription for nutritional misfortune in kids.
"The Atkins diet is so restrictive that children can become deficient in many vitamins and minerals," cautions Rarback. "It is low in calcium, for instance, and growing children certainly need calcium. It is also low in grains that are fortified with iron, folic acid, and the B vitamins.
"Anyone on the Atkins diet needs to take supplements, and I'm very uncomfortable with children being on any diet where they rely on pills for their vitamins and minerals."
There are even some diet books aimed specifically at children, most notably Sugar Busters! for Kids, whose authors include three physicians. An analysis of the book, recently issued by the ADA, says that "there is little to criticize about this diet since it encourages a very healthy lifestyle, including nutritious foods that children typically avoid." At the same time, the critique from the ADA questions the program's restrictive nature, which makes foods like sugary sodas, french fries, candy, white rice, and potatoes taboo; the ADA notes that by denying children their favorite foods completely, it sets them up for eventual failure.
"It's unrealistic to tell an 8-year-old to never eat desserts again," says Rarback. "Make them 'occasional foods.' It's not every mouthful that counts -- it's the total diet."
Losing the Right Way
If your child needs to tighten his belt, keep these guidelines in mind when choosing a diet plan:
- Set modest goals. "A growing child shouldn't lose more than one pound a week," says Eden. So go slow, and avoid diets that are overly restrictive.
- Reduce saturated fat. More foods should come from the fruit, vegetable, and grain groups, and less from sugar-rich foods and high-fat meats and dairy products.
- Limit portion sizes. To help reduce the intake of calories, don't weigh down your child's plate with food. "With the availability of 'super-sizing' at fast-food restaurants, you can get 500 extra calories for a few more pennies, which isn't the bargain that some kids think it is," says Bruner.
- Get the family involved. Parents should adopt healthy eating habits themselves, advises Bruner. "Not only will they become role models, but their overweight children won't feel singled out for attention about their weight."
- Make exercise a daily activity. Get your youngster involved in family activities such as biking, swimming, and hiking. "Children can't lose weight with only diet or only exercise," says Eden. "They must do both."
- Reduce TV time. When kids are watching TV, they're not exercising and they might be eating. A study at Stanford University concluded that children who limit their time in front of the tube tend to be thinner than youngsters who are glued to the screen.
No matter what your child weighs, make sure he understands that he's OK. A sensible weight-loss program can help children feel better about themselves. "It's an important step in helping them take charge and build up their self-esteem," says Rarback.
Originally published May 6, 2002.
Reviewed by Gary D. Vogin, MD.
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