What You Should Be Eating -- Elizabeth Ward, MS, RD

Last Editorial Review: 10/23/2003

By Elizabeth Ward
WebMD Live Events Transcript

We talked with nutrition expert Elizabeth Ward, MS, RD, about what makes up food -- proteins, carbohydrates, fats, water, fiber -- and how these components affect your body, your health, and your appetite. What does sugar really do to your kids? And what should your child be eating?

The opinions expressed in this transcript are those of the health professional 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: Welcome to The WebMD University Student Lounge, and to our "Let's Eat!" course, sponsored by Blue Cross Blue Shield of Massachusetts. Today's lounge guest is our course instructor, nutrition expert Elizabeth Ward, MS, RD, author of Healthy Food, Healthy Kids.

Member: My son, who is almost 10, has been heavy for the past several years. He definitely does not eat well -- pizza and Chinese food are a good portion of the week's food intake. Are there any good suggestions you have to help him become a healthier eater?

Ward: I have a lot of suggestions. And the first is to take a look at how the entire family eats, and to evaluate what food is in the house, and what this child has access to outside of the house. Mom tends to be the gatekeeper in the home, and if she is in charge of purchasing the food and planning the meals then there is a lot that she can do. So the first trick would be to plan to go shopping. I know this sounds very simple but many people don't do it on a regular basis. When you do not have healthy foods in the house then take-out foods such as Chinese food and pizza, which tend to be high in fat, become the norm for dinner. When fruits and vegetables, low-fat dairy products, whole-grain cereals and breads, and lean meat and chicken are in the cupboards and refrigerator, then kids will reach for those foods first. It's very important for children to get a minimum of 60 minutes of physical activity a day. That often means cutting back on TV and computer time.

Member: Is there a good way to get my son involved in the planning of meals? Make it more of a game?

Ward: Oh, yes. I'm all for getting kids involved in planning. You know it gives them a sense of empowerment to be able to be part of the process. And if you're offering healthy choices then you can't go wrong. I think the first thing you need to do is find recipes that you can agree upon with your son, and these can be very simple. Then take your child shopping. Taking kids to the supermarket is often the first way to get them interested in different foods, such as fruits and vegetables. Then have kids help you make the meal. When children are involved they are more interested in what they are eating.

Moderator: Our questioner mentioned the son liking Chinese food and pizza. I'm sure there are good ways to make those foods at home to be healthier than the takeout versions. Any suggestions for us?

Ward: Yes. Pizza is a great kid-friendly food and it's easy to make at home. Purchase prepared dough at the supermarket or bread dough from the freezer, tomato sauce, and reduced-fat cheese. Add vegetables or fruit. Kids might think that pineapple chunks are fun on pizza, for example. And stay away from the high-fat meats, such as pepperoni and sausage. Your pizza will be much lower in fat and calories than the take-out variety. Stir-fry dishes made at home can be much healthier than restaurant Chinese food. Use chopped chicken or tofu, beef, or pork and add a mixture of vegetables like broccoli, carrots, celery, and water chestnuts. And you will have an interesting dish that's much better for you. And of course, serve it with rice.

Member: How bad are kids' cereals, and how can I get my children to want to eat something other than Froot Loops?

Ward: Don't buy it. It's easier to keep kids away from sugary cereals when you don't buy them. Kids don't know the difference, many times. So if you want to "wean" your child off of the sugary cereals my advice is to mix them 50-50 with a very low-sugar cereal such as Cheerios or generic store-brand Cheerios. Don't buy the sugary cereals anymore, and gradually switch your child over. In the meantime, you can take heart in knowing that most cereals are fortified with many of the vitamins and minerals that kids need, including the sugary cereals. If your child is not a big milk drinker, cereal is an excellent vehicle for milk. So it's not as bad as it seems.

Member: They really do know the difference once they are over 2, and they are slammed by commercials every day.

Ward: It's true that commercial television targets children, so I suggest cutting way back on television time or watching PBS.

Member: How bad are hotdogs? My kids seem to want them all the time.

Ward: I don't like hot dogs. But I let my kids eat them sometimes. Hot dogs are high in fat --saturated fat --and sodium, and they contain preservatives that are potential carcinogens. So my advice is to limit hot dogs or make sure that your child is consuming a source of vitamin C such as orange juice, strawberries, or kiwi fruit at the same meal. The vitamin C in these foods seems to help reduce the chances of the preservatives doing harm.

Member: Should kids limit their fat intake and to what extent?

Ward: This is a topic that is widely debated among health professionals. The general feeling is by age 2 we can begin to move kids toward the goal of a 30% fat or less diet. And by that I mean at age 2 we begin, so by age 5 they are on a diet that is healthy but relatively low in fat. Now having said that, I have to qualify the statement. Kids are growing at a tremendous pace and they need fat in foods for energy. So when parents severely restrict fat they run the risk of a child who doesn't grow properly. Since certain fatty foods (whole milk and cheese) provide a wide array of nutrients, then the child on the very low-fat eating plan runs a risk for many nutritional deficiencies. I think leaving out very low-nutrition foods such as candy, cookies, cake in the name of better health is not a bad idea, but restricting favorite foods too much in a child can come back to haunt you later on.

Member: Is it alarmist to call our country's current state of obesity an epidemic?

Ward: Absolutely not. Epidemic is right on the money. And the saddest part of all is that young children are heavier than they have ever been in recorded history. I think that we all have to work together to stop children from becoming overweight because overweight kids turn into overweight adults. And an overweight child has so many strikes against him from a health perspective, and a social perspective as well. We have to, as a country, look at the way we live. The way we live influences what we eat and how we eat and how much activity we get. And those changes can start at home.

Moderator: There is a lot of debate out there about the food pyramid and its emphasis on grains at the base. The "anti-carbs" contingent is growing. What's an average family to believe about the proper balance of their diet?

Ward: It's funny about the food pyramid. What most don't notice is the range of suggested serving sizes. When it comes to the grain group, it ranges from 6-11 servings per day. And six servings really is not that much. It amounts to one cup of cereal, two slices of bread, and a cup of pasta at dinner. And if people measured out what they ate, they would see that this [recommended amount] is very small! The idea of the food pyramid is a good one. We are so far off from the basic premise of the food guide pyramid, which is to eat a diet based on plant foods. I think a lot of people eat too many simple carbohydrates without eating enough fruits and vegetables, dairy foods, and protein foods. For example, a bagel can weigh between 4 and 5 ounces, the equivalent of 4-5 servings from the grain group of the pyramid. But what it really boils down to is calories when it comes to weight control. If you eat more calories than you burn, you will gain weight. No matter what form those calories are in.

Member: I'd like to work some veggies into meals, rather than have them be side dishes, so my kids will be more likely to eat them. What, besides the obvious casseroles, can you suggest I try making?

Ward: Anytime you can put vegetables in soups and casseroles and dishes like meat loaf, you are winning the covert battle with your child. You can try offering vegetable juice instead of fruit juice. I always serve vegetables with a dip or a sauce on them. And I am prepared to give my kids a little more fat in the form of a dip or sauce so at least they get the vegetables in. I also give them peanut butter or hummus with vegetables, too. Don't forget about baked or mashed potatoes as a vegetable. That's OK, too. You can offer them vegetables in different forms. You can puree carrots, for instance, or puree a veggie and add it to a soup without the child even knowing it.

Moderator: We sprinkle cinnamon on sweet potatoes. Works for our daughter.

Ward: I think some parents don't think about potatoes as being a vegetable. Some have the idea they are just starchy and served in the place of bread or pasta, but they do double duty in the sense that they provide carbohydrate but are also a vegetable. Sweet potatoes are an excellent substitute for the white potato. Try roasting vegetables, which brings out the sweetness, and just makes it different for a child. Kids tend to reject foods over and over before they accept them. Try to give them vegetables in their "natural" state over and over. One day they will pick them up and eat them. And that's one hurdle you'll be over.

Member: How much juice should my preschooler be drinking each day? She really loves it but I'm afraid it's affecting her appetite.

Ward: Juice should be limited to 4-6 ounces per day and should always be 100% fruit juice. I prefer juices with something added to them, like calcium. Vitamin C is also added to juices. You are definitely going to have to give your child a "juice allowance," but you can stretch it by mixing it with club soda or seltzer water. If a child is truly thirsty, she should be drinking water.

Moderator: Are those added nutrients you've mentioned, in juices and cereal, as easily absorbed and utilized by our bodies as nutrients found naturally in foods?

Ward: The calcium that's used in most orange juices these days in incredibly well absorbed. I would say I feel just as good about getting calcium from orange juice as I would about getting it from a dairy food. Vitamin C is typically well absorbed as well even when it's added.

Member: My children are 9 and 4 1/2. How do I get these picky eaters to eat healthy? My husband and I eat very low-fat and my daughter won't even try the food I cook.

Ward: Satisfying everyone at all times is next to impossible. I go through it every night at dinner. Kids will eat when they are hungry. If you think about this, it's really a matter of physiological need vs. appetite. For example, if you are very, very hungry and you have not eaten for days, you will eat what's put in front of you. I'm not suggesting this extreme approach, of course, to getting your child to eat. However, I think we worry too much, and when a child is hungry, she will eat. Kids have a lot of choices these days. And I think they know it. And sometimes part of the issue is manipulation on the child's part.

All I can say is, continue to offer the same foods you are eating, maybe adding butter or dressing to make them more appealing to your child, and I think that eventually your child will come around and realize "this is what's for dinner." That does not mean that you have to avoid making her favorite foods, which may be higher in fat than you like. In fact I suggest doing that. Because it shows her that all foods fit into a healthy diet.

Member: Is there a downside to my 4-year-old daughter "grazing?" She eats a healthy diet, but definitely seems to prefer eating small portions throughout the day rather than three larger meals.

Ward: There is nothing wrong with grazing as long as you or your child fits in all the foods that are required to stay healthy. My problem with a 4-year-old grazing is that she doesn't get the sense that there are three meals (basically) in a day, and sometimes the eating is done in combination with other activities such as watching TV. And I do not think this is a good habit to get into. Kids need to separate food from other activities, so if she continues to graze, she needs to come to the table. Or stop wherever she is, and just sit and eat.

Moderator: Elizabeth, you mentioned "all the foods that are required to stay healthy." Easier said than done sometimes! This questions addresses that:

Member: I want to eat well, but when I get to the market, I get overwhelmed. What is a good rule of thumb when shopping for food?

Ward: Make a list. Don't go to the store hungry. Those are the two cardinal rules I live by. If you have a list and a sense of the ingredients you need for a few meals, it will give you a framework for purchasing. I have a list in my book, Healthy Foods, Healthy Kids, to help parents shop at the supermarket. It's a list you can copy or refer to from week to week. You can pick and choose what you need from the list. It gets you started. In order to get into the habit of shopping from week to week or every two weeks, you need to get into the habit of going after certain cereals, fruits, and vegetables. Then branch out after this.

Member: How much water do I really need daily? And can I include other drinks in that total or not?

Ward: There's the idea out there that an adult needs eight 8-ounce glasses of water a day (64 ounces), which is not exactly right. And it can keep you in the bathroom all day long. You can count the fluid in milk and juice and soda toward your fluid needs. You don't need to drink 64 ounces of water in addition to those other beverages unless you are very active. A diet that's high in fruits and vegetables is also high in fluid. So fruits and vegetables are another source of fluid for your body. So probably six to eight 8-ounce servings of fluid a day, total, would be fine for most people in addition to five servings of fruits and vegetables a day.

Member: I am about to start taking more iron and I hear that can cause constipation problems. What are some natural ways to add fiber in my diet to counteract this?

Ward: Fiber is found in whole grains (cereal such as raisin bran or whole-wheat Chex and fruit at breakfast), whole grains at lunch like bread, rice, or pasta with vegetables and fruit. Then snack on popcorn or veggies and a dip. At dinner, add more whole grains like quinoa, barley, or brown rice. Getting at least five servings of fruits and vegetables a day is a good idea. Also make sure you get six to eight glasses of fluid a day. Fluid plus fiber helps prevent constipation. At lunch, a good idea is also black bean soup or chickpeas in your salad.

Member: White rice is not whole-grain, correct?

Ward: Right.

Member: Why do I get such bad gas when I try to increase fiber in my diet?

Ward: Could be for a couple of reasons. One is you are packing in too much fiber too quickly. You have to "ramp up" from a low-fiber diet to a high-fiber diet. The second may be the types of fiber you are adding. Broccoli and legumes [beans and peas] can be particularly gassy. It may be a matter of trial and error with you. Whatever food you add, add it in small amounts. If it makes you gassy, go to another high-fiber food. Also make sure you are taking in adequate fluid. Basically your body gets used to a high-fiber diet in two to four weeks. Don't give up trying.

Member: Is NutraSweet better for my kids than sugar when it comes to soft drinks?

Ward: Here is my feeling about artificial sweeteners: If your child is having an occasional soda or sweetened food, then there is no need for an artificial sweetener. If your child is consuming so much soda that you need to cut calories or cut sugar by giving them an artificially sweetened version, then your child is consuming too much soda. I do not believe in giving kids artificial sweeteners. I think it sends the wrong message.

Member: My kids won't eat brown rice. I thought white rice (like Basmati) that was not enriched was still pretty healthy. Is this correct?

Ward: Yes, white rice is very healthy. It's just not as high in fiber as brown rice. It's fine for children. But if interested in increasing fiber intake, then brown rice would be the choice. If it's fortified, which grains tend to be, then they are great choices, whether brown, Basmati, or white.

Moderator: We are out of time. Thanks for joining us, members, and thanks to Elizabeth Ward, MS, RD, for being our guest.

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