Good Health for African American Kids with Barbara Dixon

Last Editorial Review: 3/24/2004

WebMD Live Events Transcript

Barbara Dixon, nutritionist and African-American author, will be discussing the unique health concerns for African-American children.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Why should parents be concerned about the nutritional health of their children?

Moderator: What are your recommendations for parents who have children who are "picky" eaters?

Moderator: What can parents do to assist their children in weight management?

Dixon: test

Moderator: Welcome to WebMD Live. Today we are discussing Good Health for African American Kids with Barbara Dixon, R.D., L.D.N.

Moderator: Barbara Dixon is a Registered and Licensed Dietitian/Nutritionist and member of the American, Louisiana and Baton Rouge Dietetic Associations. She is also a member of the National Organization of Blacks in Dietetics and Nutrition, The International Society for Hypertension in Blacks and the American Association of Diabetes Educators. Mrs. Dixon is a content Spokesperson for the American Dietetic Association and expert on African American diet, nutrition and health. Dixon is a nutrition consultant for Kellogg Company and McDonald's Corporation.

Moderator: If you would like to ask Barbara a question, type /ask followed by your question (e.g. "/ask How are you?")

Moderator: Barbara, welcome to WebMD Live.

Moderator: {question presented} You have written a book, Good Health for African American Kids... what prompted you to write a book specifically targeting this group's health issues?

Dixon: I wrote this book as a result of questions that I received while on tour for my first book, Good Health for African-Americans . I received a good deal from African-American parents. I also recognized that health and nutrition issues prevalent in the African-American community had not been explored sufficiently in the past with answers sufficiently available.

Moderator: {question presented} You are a nutritionist, yet your book clearly addresses health and disease issues in children... how were your insights regarding the issues different from that of a physician?

Dixon: I would hope that more physicians are as concerned about the whole person as I; that is, not only emphasizing the prevention of disease and management, but also encouraging patients to make changes in their overall lifestyle practices, which include dietary modifications. Nutrition research today is providing physicians with new insight on the relationship between nutrients, food and health. I wouldn't say my approach is any different from a physician's, but I'd hope that more physicians today recognize that nutrition and improving those practices is just as important as the whole disease management practice.

Moderator: {question presented} Do African American children have health issues that are different from Caucasian (white) children or other ethnic groups?

Dixon: Obviously there are going to be some diseases that are more prevalent, such as sickle-cell anemia... which is not as common in Caucasian. But many of the health issues are the same. Diagnoses and treatment of diseases in African-American children affect their overall prognosis. There are several factors that are influences in this population; environment, diet, availability of quality health care, as well as genetics. But knowledge regarding health issues and prevention is crucial; there is consistently a lack of information and research specifically targeting this group. This is the reason why I wrote the book and thought it was important.

Moderator: {question presented} Could you give us a brief overview about the contents of the book?

Dixon: It was written in 1996, and one thing I appreciate is that its a great reference book; it contains 400 pages, and there are a number of chapters which cover a lot of various subject matters such as nutrition in health issues and pregnancy, how to feed children from infancy to adolescence, stress, obesity, fitness issues, common childhood ailments and diseases... so there's a variety of subject matter, and obviously coming from when and before a child is created; the health of a mother during pregnancy carried all the way through the growth pattern, adolescence, and adulthood.

Moderator: {question presented} Your book begins with a chapter on "preparing for pregnancy"... why is this an important approach to children's health?

Dixon: I believe the old adage that good health begins in the womb... infant mortality and low-birth rate babies affect the African-American population adversely, twice as often as seen in the white population. Not only that, but low birth weight babies are more likely to be born with physical and mental handicaps, and if they survive, they may have behavioral problems in childhood as well. Infant mortality and low birth weight in African-Americans can be avoided with early and continuous prenatal care. Encouraging African-American women to get the care they need to give their babies a fighting chance to a healthy life - it's a good way to start the book, because it's not that suddenly the child is there and we don't think of nursing that child prior to delivery. That's one issue that African-Americans should consider.

Moderator: What sort of behavioral problems come up in early childhood as a result of poor nutrition during pregnancy?

Dixon: Certainly we believe that even from a psychological point of view not only regarding diet, but how a mother feels during pregnancy, how she nourishes herself, her overall stress free or stressful life... I believe that research supports and shows it's carried on for the growth of the fetus. If you talk to a child that's unborn in your womb, and there's a communication and bond that occurs between mother and infant, so do the stresses that occur within the fetus that carry over into childhood. This is a wonderful area that we're looking at, because as we see children that are misbehaving in class, or having emotional problems in class, we often look at parents and the time the mother was carrying the child, and under the circumstances in which conception occurred, and we often find that the mother has been troubled. At least knowing this in advance gives us some way to begin to nurture the child, even when they're young and start school... so we begin to see the problems and can understand why the problems may be occurring.

Moderator: {question presented} What are the "risk factors" that affect the health of African American kids?

Dixon: There are several risk factors. We talk about risk factors as being contributors to a certain disease, which identify those contributors. There are several risk factors that affect the health of African-American children. The cultural and social issues are poor nutrition or fatty diet, lack of physical exercise or activity, childhood stress, too much salt or sodium in the diet, smoking alcohol or the use of drugs, poverty, and along with poverty, exposure to lead and paint if the building is not safe, exposure to accidents, and on the genetic side.... parents who carry the sickle-cell gene, parents who have diabetes, parents with hypertension, and high-blood cholesterol.

Moderator: {question presented} Why should parents be concerned about the nutritional health of their children?

Dixon: Current research, and nutrition has probably been the least researched subject matter over the years... I'm beginning to gladly see a change in the last 10 years. What research is showing us today is that diseases we know of that occur in adulthood, begin in childhood. Cardiovascular is one we're beginning to know most about; one in particular is the Bogalusa Children's Story, a town in Louisiana, and we also know other diseases like hypertension, obesity, diabetes, high blood cholesterol, and we know that these health problems are showing up in young children. I believe that parents need to start helping their children to make lifestyle changes early, particularly when the family history of these diseases are prevalent.

Dixon: I believe that it's never too early to take measures to help improve your child's future or a child's future and potentially change the health outcome.

Dixon: Now, the research now suggests that we start earlier than the age of 2, when we look at the fat in the diet, or reducing the amount of fat... but many changes can be made in diet and the lifestyle practices of a young child without adverse effects on growth and development.

Moderator: {question presented} Lactose intolerance is a problem often cited in African American children... do you recommend that Black children avoid dairy products?

Dixon: Not necessarily. For those that are now familiar with lactose intolerance, it's a condition in which a person cannot digest milk-sugar or "lactose"... the "ose" on the end signifies sugar. The problem with lactose intolerance is GI or digestive symptoms usually occur... that is, gas or bloating, sometimes abdominal or intestinal cramping, and that's following a meal or beverage that does have lactose. A lot of people confuse lactose intolerance with allergy, and there's a distinct difference. I hear parents say that their child can't drink milk and is allergic to dairy products, but you have to understand that allergies are regarding the protein content of the food, rather than due to the sugar and the problem with absorption. I always caution parents to loosely use the term allergy, because the approaches would definitely be different. If one was having an allergic reaction to the protein, then one would have to avoid it. But in lactose intolerance, it may be a dose-related issue... a child may be able to tolerate 4 ounces of milk, but not 8 without having the intestinal symptoms. In that way, we may not have to alleviate milk or dairy products altogether. We may work within the dose that's tolerated. However in some, we may have to modify the diet altogether, but this is not a hard task to do. Some parents now are becoming vegetarians... and considering putting their kids on the same type of program. I don't have to advocate that parents who want their children to drink milk to discontinue it. But there's no harm if the child cannot drink dairy products.

Moderator: {question presented} If so, how can parents be sure their children will get enough calcium for growth?

Dixon: First of all, while calcium is a good issue we're looking at, there really are a number of foods that are high in calcium other than dairy products, particularly for African-American kids who have a problem with lactose intolerance. Green, leafy vegetables... calcium fortified foods are the greatest thing that happened to our diet. Calcium- fortified orange juice, soy milks (for parents whose children can't drink regular milk), cereals, nuts (which can be used in many ways.. in vegetables, casseroles, and they're high in protein as well)... and some meats do have calcium as well.

Moderator: {question presented} Is obesity a health issue for African American children as in their adult counterparts?

Dixon: Absolutely; obesity is becoming a major issue in African-American children and adults... if I could just digress to tell you about obesity in general in this country -- in less than 20 years, from 1963 to 1980, the percentage of obesity rose to 54% amongst 6 to 11 year olds, and increased by 39% among 12-17 year olds. Today, the surveys estimate that 1 in 5 children is obese... it also estimated that 40% of obese children and 70% of obese adolescents will also become obese adults.

Dixon: In the Bogalusa heart study, which is a current study involving African-American children, girls as early as the age of 9 are found to be obese. I think that there are several factors that parents need to be concerned about; that's the fact that children aren't getting enough physical activity, spending too many hours in front of the TV or computer, as well as taking in a diet that's high in fat and calories.

Dixon: Parents should assist their children in overcoming obesity early on by involving the whole family.

Moderator: Is obesity an issue for children because the standard for beauty and the female norm is much heavier than in the Caucasian population?

Dixon: I don't really that is as much as a factor in childhood as it is in adulthood. The fact that we have obesity occurring at a younger age in African-American children, particularly girls, is because of those environmental reasons. Once African-American men and women approach adulthood, I agree with you -- the whole idea of overweight being distasteful, is not viewed the same as in white America. I believe that cultural influences there are very strong. There is not the stigma attached to being overweight, but it's not only common in African-Americans ... it's very common in people of color throughout the world. If you go to Central America, or Africa, or the Caribbean ... you will find that people of color view being overweight as a sign of prosperity. It has filtered down through the generations, and still seen as "being healthy" rather than being a negative with regards to physical beauty. We don't think it's any big deal to look like a twiggy, or a fashion model, although I will admit that young people today really are beginning to have a backlash of that because they're also seeing black models who are thinner... and as we see more black models, who are role models, who are thinner. It might be interesting what that influence will be over the years.

Dixon: It is very difficult for me to counsel African-American women; and its because of what you just said... there is less peer pressure to be thin, and yet we have an array of health problems that really are important for us to take a look at the issue of obesity as a risk factor. Often, obesity isn't in African-American males as it is in females. If you have a African-American female in my office for counseling, she needs to lose 50 pounds, she loses the first 10 pounds, and her partner tells her that she lost too much... because their standard is that they like the thighs with some meat on them. Its very difficult for the black woman today to want to be healthy and be of that weight, because she has several issues to be concerned about. Socially, she wants to fit in, and health-wise her doctor is telling her something else. No longer are those hips and body parts that made you look fine, is the norm. You must consider your overall health; that's the large dilemma in our population. Also, let's face it... the eating habits of the parents directly influence the eating habits of children... so these parents particularly mothers who plan the meal and where its going to be taken, she's overweight and you have a vicious cycle of a child who's overweight due to environmental conditions.

Moderator: {question presented} What are your recommendations for parents who have children who are "picky" eaters?

Dixon: I have several -- don't be a nag, first. The second is, make an agreement with your children about foods that they like as well as food that they might not like. Third, introduce them to new foods gradually; prepare them in a different manner until you can find one they enjoy. Fourth, set an example... don't expect them to eat foods that you won't eat. Finally, be patient for food-jags, which are common in children, is temporary. Every child is very different, some children aren't picky in childhood but as they become teenagers, they become picky... but the more parents nag their child about what they're eating, the more difficult it is for the child to change their behavior. You also have to make an agreement to have them understand that eating a certain way all the time isn't healthy. Getting them to agree with you that if you allow them to eat foods they like, but that if they eat foods that are good for them, too, because you're concerned about growth and health, children will work on that agreement with you. Introduce foods gradually -- the problem with children becoming picky is that parents often introduce too many foods at the same time. Sometimes, parents cook a certain food a certain way, and the children may not like it prepared that way, but may like it another way. I didn't like beets because they tasted yucky, cooked. So I avoided them all my life. But when I became older, I started eating them in salads, and it tasted totally different. The most important thing of all is that parents need to set a good example, and even if the pickiest child sees you enjoying foods, they may be more apt to try them.

Moderator: {question presented} Adolescents/teens are often accused of eating a lot of "junk foods"... how can we encourage them to eat healthy?

Dixon: It's true. But I find that adolescents tend to eat foods that are fun. They like the real cool foods, they tend to be driven to eat foods that their peers eat. Also, for teens, atmosphere is everything; restaurants that are an attractive place for them to meet their friends, that have foods that taste good, inexpensive, and are filling... I certainly think are the reasons kids eat the foods they do. My suggestions are, first plan at least one meal a day at home with your adolescent... get back to the old idea of family eating together. Make mealtimes fun; make it a happy time. No arguments or no scolding during that mealtime. Then your adolescent will look forward to it. Have your teen help you shop and prepare the food; in fact, plan a menu, and have them help you with a special menu. Keep healthy snack foods in the house; if healthy foods are in the house, and they're in sight, they're in mind. Drop the word "junk" food... remember three things -- balance, variety, and moderation. Suggest and teach your children and adolescents that its important to eat all foods that are... in the food pyramid -- keep the diet balanced and not just one group of foods versus another. Variety is a theme there; colors, textures, and flavors. The total amount they eat is often not what they think they need -- the reason why they eat is not because they're hungry. Help them identify their hunger or non-hunger response, and how that works with the diet being moderate in amounts. Moderation is very important to remember. Finally, as with younger children who are picky eaters... you need to set an example in your own diet. If you eat the junk foods that you're accusing your children of eating, they're going to say "well, if you can eat that why can't I?" So it's okay to criticize their diet, just make sure you're not guilty of the same. Also remember that all foods can fit into a healthy diet; there isn't such a thing as "junk foods"... there are foods that may not have nutritional value, but that's okay too. As long as the majority of your diet is made up of healthy foods.

Moderator: {question presented} What can parents do to assist their children in weight management?

Dixon: You've heard me say over and over about the importance of family, or a parent working with their children. The first thing is developing a family exercise or physical activity program; join the Y together. If you isolate a child in an activity, they'll be less excited about doing it. Change dietary habits together; this may take seeking the counsel of a registered dietician, nutritionist... one who can look at the overall family's way of eating, and can make recommendations for the entire family. And then finally, there must be time set aside, or time that's restricted in some ways for TV and computers, and more time for activity. Often parents do not limit the amount of time that a child spends watching TV or on their computer, and I always tell them to let them know that three hours an evening is all they should spend doing that, and then work on hour on physical activity. Offer your child a more structured way of life, rather than allowing them just to have endless amounts of hours and sit down, couch potatoin'.

Moderator: {question presented} What is a healthy diet for children?

Dixon: Most people are familiar with the food guide pyramid, and just recently, one was developed for children. For 2 - 6 year olds... and we'll start with the base of the pyramid ... From the breads and cereals and starches, they should have 6 servings a day. For older, it can be from 6-11. For vegetables on the next level, they should have 3 servings a day, and that would include fruits (2 servings), milk or dairy (2 servings), meat (2 servings), and less often would be the fats, at the top of the pyramid -- a variety of foods from different food groups, with more being concentrated on the vegetable and grain groups.

Moderator: {question presented} What changes would you like to see in the way health organizations, corporate America adopt to encourage disease prevention and awareness among African Americans?

Dixon: I think the most important thing that corporate America can do is provide educational information about disease and health issues that affect our population. Example, particularly with food companies.. there are certainly a development of brochures and promotions of certain foods... there should be brochures with people of color. The first thing that needs to happen is that pamphlets and booklets need to be multi-cultural. If you're going to write about hypertension or diabetes, and you're going to write a general brochure... but obviously general material is not filtering down to African-Americans. Having African-Americans pictures on a brochure, talking about the disease incidence in this population, giving them suggestions within their cultural and social influences, giving them suggestions in which we would make decisions based upon how we'd react to each other socially, and thinking about genetics... I think it's important! The second thing is funding for research regarding health issues that affect this population. For every disease or health problem we see today, there's research that goes into that particular area, but I'd venture to say that within the last 20 years, there has not been a lot of research regarding African-American issues ... as some of the key health care professionals who are African-American who are in places of making decisions regarding research. Finally, when I think about African-American health care professionals, there need to be more of us. There need to be more African-American health care providers. Our population is... more African-American are apt to see a non-African-American health care provider than they are African-American. I think it's obvious that we know our people just as Asians and Hispanics understand their culture, better than someone of another culture. Finally, that companies and corporations spend money to help us all, particularly health educators, be more culturally sensitive. This must be carried through medical schools, in our nutritional training, across the board. We're all Americans, but we do have differences. In African-Americans, our mortality rates are far worse than white-Americans.

Moderator: {question presented} Should all children be immunized?

Dixon: There are some proponents that think particularly in the African-American community ... I'll answer by saying that immunizations have had their place. They've saved a lot of lives and have been beneficial. Children who are exposed to diseases in which immunizations could have helped, there's no questions that there's benefit. And yet, there must be, in my mind, research that also eases our minds, eases parents' minds that the same immunizations are not causing disease, because we're skeptical. Our skepticism goes back to the Tuskegee study, and other type of studies, where African-Americans were subjected to being exposed to those diseases that they may not have been, under different circumstances. So African-Americans need to feel that this is not a detriment, and understand what the purpose is.

Dixon: Secondly, are they harmful? Can I be healthy without them? If I take a flu shot and I get the flu... it's being viewed as not being a healthy thing to do. They have a place, but no... there's not enough education in our community to explain the importance. Further, are they totally safe? So all these issues are important here.

Moderator: {question presented} How can I tell if my child should not be immunized?

Dixon: That's really between a parent and their child's pediatrician. Parents have to be comfortable with their child's pediatrician that they can ask him/her that question... because after all, their child's doctor knows more about the health problems of that child than I do... so they'd know if it would be a good time, or if there are going to be any effects, and it comes down to the child and the trust and the communication between that parent and the physician. I think the individual child's medical history would have to dictate that.

Dixon: Yes, there are alternatives. I think that most importantly, the parent let the doctor know that's an issue. Unfortunately, the child comes home frightened, and tells the mother/father at home, rather than let it be known in the doctor's office. Its not just a behavioral issue, there's certainly a real fear in some children... it may be the manner in which the shot was done. Oftentimes, the size of the syringe makes a difference... and I often say what the health care doctor is wearing... if children are relaxed, they react differently to procedures. The first thing the mother needs to convey to the practitioner, is whether the child does have the fear and what are their options. Its very important to discuss it with the doctor.

Moderator: {question presented} What particular problems are there between adolescent boys and girls in black America?

Dixon: I think so; there are a number that I see with my patients and their parents. I think that what has an influence on everything is environment. Many times, both young males and females are exposed to a negative element... they're exposed to drugs, early sex in both genders, if both parents are in the home, the whole issue of peer pressure behind smoking and drinking. I'd say that boys tend to be more affected by peer pressure than girls, but that girls are catching up with the boys.. because they find that it's cool to be members of a group. For both, there's less stress and emphasis on education as it once was. There's less parental controls for both males and females. The males also have an added responsibility, because they're often the heads of their households. And they're young boys, adolescents and teens become the male figure in the family, so they're growing up a lot faster than their female counterparts. They're living for the other siblings. I think that's probably the largest gap between the two, is the boy's sense of responsibility.

Dixon: The other thing that exists too along with that social issue, is that unfortunately, some will get in trouble early.. they may be incarcerated early... the girls may still be in school, if they're able to finish and not get pregnant, routine pregnancy is an issue in the African-American teen and community, the young man is not there. He's not a part of that young girls' life in raising a child and bringing the child into the world. The roles for both are much more escalated in my opinion in the African-American community. It has a lot to do with environment.

Moderator: {question presented} How can the African-American community help itself to increase the health consciousness for its children?

Dixon: That's an excellent question -- its really why I've written my books. Health care professionals have to get into the community; we can't fit into our offices. We have to work with the churches, in the beauty and barber shops. Our efforts have to be grassroots, to go into the communities, and be on the media, and we must write articles... we have to provide the knowledge. We have to be the message carrier, because the message carriers which have been present so far have not been effective. I think not only health officials, but the clergy, and those who influence... athletes, role models, all of us must save our children. We must bring our knowledge and our experiences, and we must support them. Knowledge is so important, because if you don't understand why things are happening, and you don't have hope, and you can't bring that to the community, we'll see the same kinds of problems for many years to come.

Moderator: {question presented} How is racism affecting health care?

Dixon: Contrary to what we'd like to believe -- and we'd like to say that this is a society of equal opportunity, but that's not the case, particularly for health care - if you're poor and black, you'll receive inferior health care. Even though on a state level, there might be Medicaid programs, we have to ask if the quality is there. I venture to say that it's not where it needs to be. Having the same doctor, and a doctor that knows you, that treats the family, the sense of that being in a clinic for five hours a day, and getting inferior treatment, and not being seen... the whole idea of our health care system today, and how a person who is not African-American speaks to African-Americans... research is showing us that not only African-Americans don't get screened, and don't have diseases discussed with them as in their white counterparts. But females, white and black, get similar treatment, too. There's no question that there's still racism with regards to delivery of health care. Those who can afford it, do get better. And even if you afford it, and are educated, you might still not get the best care and attention.

Dixon: I can tell you personally, I'm just a black female in an office.. and I went to a dermatologist for a skin condition, and I was talked to like a 2 year old. I resented that. The assumption that we don't care about our health, and that we don't want to know, and that we don't want to do anything is completely false.

Dixon: A fitting way to end this is on a positive note, that through these kinds of mediums, interviews like this bringing attention to the health issues that affect African-American is extremely crucial. I appreciate the opportunity to be able to take part. As we understand our differences, so we all can help each other.

Moderator: Barbara, thank you for joining us. Please join us every Wednesday at 1:00 p.m. EST here in the Pregnancy and Parenting Auditorium for our live chat event.

Dixon: Thank you. I appreciate it very much.

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