Bucking the Trend: Preventing Childhood Obesity
By Alison Ventura, PhD
We've all heard about it - the number of U.S. children classified as obese has increased dramatically over the past 30 years. In the 1970's, only around 1 in 20 children were classified as obese, whereas the most recent surveys show this proportion has tripled.1 Obese children are at higher risk for a whole host of problems that were once thought to only affect adults, such as type 2 diabetes, metabolic syndrome, and heart disease. These scary statistics mean families need to be aware of the factors that contribute to childhood obesity so they can encourage healthy habits and growth patterns early on.
Vegetarian families have a head start on preventing childhood obesity, as research shows vegetarian children and adults tend to be leaner than their non-vegetarian peers. In fact, in a position statement released July 2009, the American Dietetic Association (ADA) concluded appropriately planned vegetarian diets are healthful, nutritionally adequate, and may prevent and treat certain conditions, such as heart disease, obesity, hypertension, type II diabetes, and cancer.2 However, the development of childhood obesity is complex and does not arise from only one or two behaviors (for example, drinking soda or watching television), but from a great many factors that occur throughout a child's development. Thus, although the ADA's statement suggests a vegetarian diet is a great first step towards preventing childhood obesity, there are even more steps that can be taken to further reduce the risk of childhood obesity.
Obesity develops when too many calories are consumed relative to the amount of calories used, which can happen regardless of whether children are eating a vegetarian or a non-vegetarian diet. There are contributors to childhood obesity at each developmental period. By being aware of how actions and choices can contribute to childhood obesity, families can be ready to make as many of the best choices as possible.
An incredible amount of growth and development occurs in the womb, so this is a prime time to give children a healthy start! There are several steps pregnant women can take to decrease their unborn children's risk for obesity later in life. The main focus of research in this area has been on factors that influence infants' birth weights because infants born too small or too large have an increased risk for obesity later in life. Very low protein diets increase the risk of having a baby with a low birth weight, while diets that are very high in carbohydrate or in fat can lead to a very large baby. Additionally, children whose mothers smoked during pregnancy or who were overweight before or during pregnancy are at increased risk for obesity. Pregnant women, or women planning to become pregnant soon, can work with registered dietitians to create vegetarian eating plans that ensure adequate amounts of calories, fat, protein, vitamins, and minerals. For more information about vegan diets during pregnancy, see http://www.vrg.org/nutrition/veganpregnancy.php
Much research has shown that children who were breastfed during infancy have a lower risk of being obese. We are still trying to understand exactly why this is, but it is probably because the unique ratio of nutrients in and properties of breast milk help infants gain and maintain an appropriate amount of weight during infancy and later in childhood. Breast-feeding may also help preserve infants' natural ability to feed in response to hunger and fullness. Specifically, the visual cues afforded by bottle-feeding (e.g., the amount of formula in a bottle) may make it tempting for parents to encourage their infant to finish the bottle, regardless of whether the infant is hungry for the whole bottle or needs that much formula. Because breast-feeding parents do not have these same visual cues, they may be more attentive to the infant's expressions indicating fullness and better able to trust their infant's ability to self-regulate intake in response to need.
Another benefit of breastfeeding is that flavors from the mothers' diet are passed to the infant through breast milk (for example, if a lactating mother eats a garlicky meal, her infant will receive garlicky milk). Although this may sound strange, this experience is actually very important for infants to learn about the flavors and foods their families eat and helps infants be more accepting of commonly rejected foods, like vegetables, during the introduction of solids. Getting young children to accept healthy foods can be one of parents' and caregivers' biggest challenges during infancy and toddlerhood; by breastfeeding and eating a wide variety of flavors and foods during lactation mothers can help children be more accepting of healthy foods, and maintain healthy weight gain patterns during infancy and later childhood.
Childhood and Adolescence
The average portion size of foods offered in most stores and restaurants has increased over the past few decades. For example, 20 years ago the average bagel had a 3-inch diameter and contained 140 calories whereas today's average bagel has a 6-inch diameter and contains 350 calories. Both children and adults tend to eat more when served a larger portion of food, regardless of how hungry they are or how many calories they need. Educate yourself and your children about what portion sizes are appropriate; the United States Department of Agriculture (USDA) Food Guide Pyramid's website it a great place to start (www.mypyramid.gov). Additionally, check out http://www.bcm.edu/news/packages/visualcues.cfm to learn some easy tricks for estimating appropriate portion sizes for many typical foods (for example, a serving of raisins is ¼ cup, which is about the size of a golf ball). You and your children can even make a game out of coming up with visual cues for portion sizes for your family's favorite foods.
Food Away from Home
In addition to coming in larger-than-necessary portions, restaurant foods, and fast foods in particular, also tend to be higher in calories, fat, salt, and sugar, and lower in fiber, than foods prepared at home. This means that even if your children eat a smaller portion of these foods, they still may be eating more calories than they need. If your family's schedule makes taking the time to prepare meals at home difficult, take advantage of the increasing number of ready-prepared foods at your local grocery store. You can throw together a quick, healthy, and satisfying meal in minutes by purchasing pre-washed, bagged salad greens; pre-cut vegetables in steamer bags; marinated tofu; and quick-cooking grains. Additionally, as your children grow older and take more control over their food choices, help them to recognize healthy choices at their favorite eateries. The Vegetarian Resource Group's online restaurant guide (http://www.vrg.org/restaurant/index.htm) has some great suggestions for vegetarian-friendly restaurants and the USDA has a variety of resources to help you and your children make healthy choices when eating out (http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=358&topic_id=1611&level3_id=5972&level4_id=0&level5_id=0&placement_default=0). Note that not all of the USDA's suggestions are geared to vegetarians.
The term 'sweetened beverages' is used to describe drinks like regular (non-diet) soda, fruit punch or any fruit juice that is not 100% juice, or sports drinks. Increases in sweetened beverage consumption have been associated with increases in obesity. The high-fructose corn syrup that sweetens most of these beverages may contribute to excess weight gain. Additionally, children who drink more sweetened beverages tend to drink fewer healthier beverages. Encourage your children to drink water, fortified soy milk, low-fat or fat-free milk, or 100% fruit juice instead of sweetened beverage (note that the American Academy of Pediatrics recommends limiting even 100% fruit juice consumption to 4 to 6 oz/day for children aged 1 to 6 years, and 8 to 12 oz/day for children aged 7 to 18 years3).
Regular physical activity is important for helping children stay fit and maintain a healthy growth rate. The Centers for Disease Control and Prevention (CDC) recommends children get 60 minutes of moderate to vigorous physical activity (that is, activity that 'works up a sweat') every day (http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html). Unfortunately, many schools do not offer recess or physical education, or only offer PE a few days a week. Thus, it is up to you to encourage your children to engage in some sort of physical activity after school and on the weekends. Structured sports programs are a great way to keep children active, but unstructured activities like jump rope, hopscotch, riding bikes, skating, walking the dog, marching band, dancing, climbing or even active games like Wii or Dance Dance Revolution, all fit within what the CDC considers moderate to vigorous physical activity. Even better, engage the whole family in regular physical activity by planning active family time. Create a habit of taking a walk together after dinner or going for hikes in your local parks on the weekend. Play active games with your children and be a good role model by being open-minded about and enjoying active endeavors. Active family time will both help your family bond and improve your family's health.
Screen Time and Sedentary Behavior
With all of the new technologies available, children are spending an increasing amount of time in front of televisions, computers, or video games, and less time being physically active. Time in front of TV and computer screens has been shown to promote childhood obesity in several different ways: (1) children are less active (in fact, one study found children's metabolisms are actually lower when watching TV than when resting!); (2) children are influenced by the food advertisements that occur during commercials that are predominantly for foods high in fat, salt and sugar; and (3) children who eat in front of the TV are more likely to snack on more energy-dense snack foods, leading them to eat more calories throughout the day. Additionally, because it is easy to "zone out" while in front of a TV or computer, studies have shown that eating in front of a TV or computer screen may lead both children and adults to eat mindlessly, or to eat more than they intend or need because they were distracted from their hunger and fullness cues. The American Academy of Pediatrics recommends limiting children's television, computer, and video game time to less than 2 hours per day. Also, encourage your children to separate eating and screen time to help them avoid mindless eating.
Children who sleep less than the amount recommended for their age group are more likely to be overweight. Sleep deprivation seems to lead to increased hunger, as well as cravings for foods high in fat and sugar, which can lead to overeating and obesity. Be familiar with how much sleep your children need and encourage them to meet sleep recommendations on most nights (see http://www.sleepfoundation.org/article/sleep-topics/children-and-sleep for current recommendations).
Parents' Feeding Practices
Feeding practices are the choices you make about which foods you offer; when, how frequently, and how much food you offer; and how you interact with your children over food. You can help your children develop healthy food preferences and eating behaviors by employing feeding practices that are patient, positive, and attentive to your children's hunger and fullness levels. Here's how:
With respect to the foods you offer: make a wide array of healthy foods readily available in your home. Keep pre-cut and -washed fruits and vegetables in the fridge or on the counter and encourage your children to choose them when they are hungry for a snack. Plan meals that include a variety of vegetables, fruits, whole grains, and plant-based protein sources.
With respect to when, how frequently, and how much food you offer: set structured meal- and snack-times for your family, and try to eat together as often as possible. Family mealtimes are a great opportunity to interact with your children and teach them about wholesome foods, healthy eating behaviors, and appropriate table manners. Additionally, be aware of the portion sizes you serve (see the Portion Size section above) and allow your children to eat in response to their hunger and fullness levels. Try not to restrict your children's intakes or pressure them to eat, as these types of feeding practices can inadvertently teach children to eat in the absence of hunger, leading to habitual over-consumption and excess weight gain. Talk to your children about whether they are hungry or full and help them learn to pay attention to and eat in response to these feelings.
With respect to interacting with your children about food, keep mealtimes positive and fun. Adopt the attitude that feeding responsibilities should be shared between parents and children: parents get to decide when, where, and what to eat, while children get to decide how much to eat.
Parents as Role Models
Parents provide their children with both genes and environments. Thus, overweight parents have a higher risk for having overweight children than normal weight parents because these parents may pass on genes that predispose their children to be overweight, as well as lifestyle patterns and habits that also contribute to overweight. You can't change your genes, but you CAN change your lifestyle patterns and habits! Adopt a 'do as I do' not 'do as I say' motto with your children by maintaining healthy dietary, physical activity, and sleep patterns as a family.
Summary: 10 Tips for Preventing Childhood Obesity in your Family
- Give your child the best start by maintaining a healthy diet and weight during pregnancy; consult with a registered dietitian to make sure your pregnancy diet meets all requirements for calories, fat, carbohydrates, protein, vitamins, and minerals.
- Breast-feed to promote healthy growth, responsiveness to hunger and fullness cues, and acceptance of a broad array of healthful solid foods for your infant.
- Educate yourself and your children about what portion sizes are appropriate for their specific nutritional needs. Serve these portions sizes on a regular basis.
- Strive to cook balanced meals at home; if this is not possible, educate yourself about the healthiest fast-food and food away from home options.
- Encourage your children to drink water, low-fat or fat-free milk, soy milk, or 100% fruit juice instead of soda.
- Get your family moving! Encourage your children to get 60 minutes of moderate to vigorous physical activity most days of the week by making exercise a family affair.
- Limit screen time (television, computer and video games) to no more than 2 hours per day.
- Be familiar with how much sleep your children need and encourage them to meet sleep recommendations on most nights.
- Practice responsive feeding by recognizing your children's levels of hunger and fullness, setting limits, and sharing feeding responsibilities with children.
- Adopt a "do as I do" not "do as I say" attitude; model healthy eating and physical activity behaviors for your child.
1 Hedley, A.A. et al., Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004. 291:2847-2850.
2 Craig WJ, Mangels AR. Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009;109:1266-1282.
3 American Academy of Pediatric. The use and misuse of fruit juice in pediatrics. Pediatrics 2001;107:1210-1213.