Weight Watching for Kids

We are a state full of chubby youngsters, but that doesn’t have to be. A new program by Nemours aims to help. Prepare for life without apple juice.

Nutritionist Mary Trotter and Dr. Karyl Rattay (from left,  with Christopher Rattay and Juliana Cannuli) sing the praises of the Nemours program 5-2-1-Almost None as a way to help Delaware’s children become healthier. (Photograph by Christian Kaye)In four months Dylan Jones, 13, of New Castle has made some dramatic lifestyle changes, with benefits that may last well into his adult life. He has morphed himself from a teenager with an emerging weight problem and a so-so interest in sports to a fitness training fanatic. In doing so, he has moved from the group of 77 percent of Delaware youth who do not get enough exercise into the group that is on a healthier course.

“We were members of the Y, but we weren’t very active,” says Eileen Thorp, Dylan’s mom. “Dylan was aging out of middle-school sports and was not very interested in sports in general. Things got to a point where I thought we needed to do something different.”

At Thorp’s suggestion Dylan agreed to try working with a personal trainer at the Y. His initial six-week introductory course led immediately to an intensive 12-week course.

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“Our programs focus on cardio or aerobic training, strength training and skills,” says Paul Capodanno, youth wellness director at the Bear-Glasgow Family YMCA. “When Dylan started, he could do about 10 minutes of aerobics. Now he’s way beyond 30 minutes.”

That branch of the Y has a special youth fitness center with junior-sized exercise equipment for kids 8 to 13 years old, so Dylan can work out any time, separate from his training class.

Capodanno says Dylan’s interest in training stems in part from a curiosity about fitness principles and a desire to learn new exercises and techniques. “He’s a great kid to be around because of his interest,” says Capodanno.

While Dylan may have found his path to a healthier lifestyle, Delaware’s kids, and kids nationally, face a challenging environment. Hectic schedules, poor eating habits, changes in school curricula and other factors are leading to unhealthy habits. In addition to under exercising, 36 percent of Delaware’s kids are overweight or at risk of becoming overweight.  

In response, Nemours Preventive Health Services has launched a campaign to make Delaware’s kids the healthiest in the nation. Its approach to getting there is a program called 5-2-1-Almost None. The name connotes eating at least five fruits and vegetables a day, limiting TV, video game and computer time to two hours, getting at least one hour of physical activity, and taking in almost no sugary drinks.

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In addition to this social marketing effort to increase the public’s awareness, Nemours is working with more than 200 organizations to improve eating habits and create more opportunities for physical activity.

Much of the work to tip the scales in favor of healthier kids involves schools, day-care centers and pediatricians. A pilot program in some schools provides 150 minutes of physical activity a week. Nemours has helped day-care centers improve activity and meal programs for 3- to 5-year-olds. And Nemours is pushing pediatricians to use the body mass index as a screening tool for kids as young as 2. (BMI uses height and weight measurements to estimate how much body fat a person has.) “It is useful because our perceptions are changing, and many of us may not recognize when someone is overweight,” says Dr. Karyl Rattay, a senior policy analyst for Nemours Preventive Health Services and a practicing pediatrician.

Overweight kids are at risk for some hefty health problems, including asthma, high blood pressure, depression and certain cancers. But there’s one that rises above the rest.

“We’re seeing a 10-fold increase in Type-II diabetes, which used to be called adult onset diabetes. Now it’s much more common in kids,” Rattay says. “The national Centers for Disease Control estimates that if childhood obesity continues to rise, one in three children born in the year 2000 will develop diabetes during his lifetime. And whether you develop diabetes when you’re 10 or 70, you have about 10 to 15 years before you develop kidney failure, blindness or amputations. So if we don’t get things turned around, it’s just a matter of years before we see people in their 20s and 30s with these problems.”

Page 2: Weight Watching for Kids, continues

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Weight problems in kids do not appear overnight. Subtle and inadvertent behaviors, repeated over time, lead to bad habits that are tough to break.

“The French fry is the most common first vegetable for kids,” say Mary Trotter, a Nemours nutritionist. “It’s easy to understand how that happens. The child is sitting on the parent’s lap or at the table and mom or dad lets them try one.”  

Taste preferences for both good and bad foods are established early, and they carry into adulthood, says Doug Tynan, a psychologist at Nemours.

Among recent changes in dietary recommendations for youngsters, children should not be given juice during their first year. And when they start on juices, they should drink no more than one serving per day. Whole fruits should be given instead of juices, in part, Trotter, says, because they contain fiber, which is important in everyone’s diet.

Tynan has several suggestions for good dietary habits. Among preschool and school-age children, it is important to establish an eating schedule and to learn when to stop and to know what it feels like to be full. It is also important for kids to know what it feels like to be hungry and to be able to tolerate some hunger.    

For all ages, Tynan says, parents need to model good behavior. Parenting style also plays a role.

“Parents need to set limits for young children and create expectations for their older kids,” Tynan says. “Parents shouldn’t be authoritarian with older kids, such as cutting out bad foods altogether. Rather, they should be authoritative and include compelling explanations so their children can understand the reason for the limits.”

Tynan says it’s important to engage kids in the process of changing behavior through motivational counseling. Motivational counseling means trying to get a child to express a concern about being overweight, then getting him to commit to doing something about it.  

For some kids, losing weight or becoming more active is easier in a social environment, where several people share the same goal. That’s where programs and places like the Y can be helpful.    

It’s difficult to follow a recommended diet, Trotter says, so parents should follow a reality-based approach. For example, snacks play a role in a good diet by providing energy between meals, she says, so decisions like cutting them out may be unnecessary. “The key is that snacks should be nutritious,” she says. “They should not be treats.”

Www.mypyramid.gov has tools to help plan meals, evaluate diets, and estimate dietary needs for kids and adults. The tool for diet planning, age and sex specific for children, shows the amount that a child should consume in each food group.

But national data shows that only about 20 percent of the population eats the recommended number of fruits and vegetables. Trotter says people should start with simple goals. Her No. 1 recommendation is to reduce sugary drinks, including soda, fruit drinks—even juices—to almost none.

“In one of our demonstrations, we ask people to guess how many teaspoons of sugar are in a 12-ounce soda. Most people’s guess is far too low.” The answer is 10 teaspoons of sugar. Twenty-ounce sodas, the common size in most convenience stores, have 15 teaspoons. Most 12-ounce sodas have about 120 calories.

Rattay says the overweight problem in children is not a matter of flagrant overeating.  It’s a matter of 100 to 150 calories a day or, in other terms, a can of soda.

Small changes can lead to big changes, which is what happened with Dylan Jones. His short personal training class led to a commitment to fitness—and more.

“He’s now more careful about the foods he chooses,” says his mom. “And he makes me want to work out. The elliptical machine is tough, and he makes me want to beat that thing.”

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