Weight management for preschoolers

Your heart wants to go out to young new parents. Everywhere they turn, they hear frightening news suggesting that their children are headed for premature graves and being endangered by bad foods and unhealthy lifestyles. This generation will be the first to have shorter life expectancies than their parents, they’re told, and to save them, massive interventions and heightened diligence are urgently necessary.

Parents almost never hear that there is little support for such alarm. They're rarely told that more children today are blessed with having enough to eat and that today’s kids have better diets than any generation in recent history. Nor are parents often reassured that most American kids are eating well within dietary recommendations. Parents almost never hear that the government’s own data continues to show that children are living longer and healthier lives than ever before, and there’s no hint to suggest that might change. Children today are expected to live a full decade longer than babyboomers born in 1950, according to the latest Center for Disease Control and Prevention estimates. Parents rarely hear that a striking majority (98.2%) of children today are healthy. Parents are almost never reminded that kids are nearly half as likely to die in childhood today than they were just two decades ago, and five times less likely to die in childhood than kids born in 1950!

It appears there’s no interest in spreading good news… perhaps because there would be nothing to sell?

Parents will want to brace themselves for what’s coming, both for themselves and for their children’s wellbeing.

Prepare to be scared … thin

A new $50 million advertising campaign was launched this week in Monroe County in New York. Incredibly, its goal is to first alarm parents about their child’s weight and then “offer helpful” weight maintenance advice. Reporter Justina Wang with the Democrat and Chronicle reported that the ads “will attempt to rouse parents with a mix of bleak warnings and upbeat messages,” explaining:

In one commercial, the camera pans through empty gyms and swimming pools while a narrator gravely wonders about the life expectancy of the younger generation: "What happens next is up to you." In another, children dance and play to an energetic jingle about eating more fruits and vegetables. Bill Murtha, CEO of Roberts Communications, which produced the commercials [said] the strategy is to "shake them first, then give them a hug."

The ads unveiled Tuesday are the latest addition to the Greater Rochester Health Foundation's 10-year anti-obesity campaign, which also includes funding children's fitness and nutrition programs, and pushing for healthier school lunch menus and safer play areas.

For each of the next two to three years, about $1 million of those funds will go toward the public awareness ads, which will also run on the radio, in print and online. Another $750,000 over the next three years will help pediatricians talk to parents about obesity, foundation representatives announced Tuesday… As part of the effort, the foundation is also distributing booklets to local pediatricians' offices that will recommend ways that physicians can disarm families when talking about childhood obesity, like using the words "unhealthy weight" instead of "overweight."

According to the director of the Monroe County health department, this is one of the largest public health campaigns the county has ever seen. The Greater Rochester Health Foundation’s child obesity initiative is called “Be a healthy hero.” The health messages, however, are far from healthful, helpful or sound.

Zero Tolerance

The initiative say that a “healthy weight” for all children is defined by the “healthy range” on BMI child growth curves. There is no natural diversity in sizes, shapes, or growth and maturity allowed. “Carrying too much fat is not healthy at any age,” according to the program literature. “If your child’s weight is more than what is considered a healthy weight based on the BMI charts, then your child may be overweight or obese.” The costs for children with too much body fat, parents are told, are adult chronic diseases like heart disease, diabetes, asthma, cancer and arthritis.

Deep breath for parents: Healthy children normally grow and develop differently, complete with growth spurts, and each child tracks in a different range on the height and weight growth curve, largely depending on his/her genetics. There is no sound evidence that parents need to fear healthy baby and puppy fat. The U.S. Preventive Services Task Force recently reviewed 40 years of evidence and found no support for fears that “overweight” or “obesity” in childhood is related to health outcomes or adult chronic diseases. Instead, the evidence shows that BMI fails to predict fitness, blood pressure, body composition or health risk. Even a recent 50-year prospective study found no association between children’s BMI and heart disease later in life, and other research has found weight to be unrelated to children’s risks for insulin resistance. In fact, the USPSTF expert Childhood Obesity Working Group even took the unprecedented step to censure the American Academy of Pediatrics and American Academy of Family Physicians for endorsing BMI screening of children and for their use of BMI growth curves.

The stereotypical belief that obesity in children is caused by bad behavior and bad diets is unmistakable in the Be a Healthy Hero campaign. “Changing behavior takes time,” the program says. Parents of children with BMIs at the 85^th percentile and above are advised to not put children on a diet, but eat ‘healthy,’ however by every definition, it promotes a diet of restrictive eating and low-fat foods, and avoidance of fattening foods.

If parents have done everything they can and their child is still ‘overweight,’ they are advised to get to the bottom of the extra calories or unhealthy foods their child may be getting or sneaking in, further cut down what they’re feeding their child, begin recording and monitoring everything their child eats and does to balance calories in and calories out, talk to their child about his/her emotional eating issues and why they’re eating, and talk to their doctor:

● Check to see what your child may be eating when away from home. Some school cafeterias have a swipe card that shows parents what their child eats at school.

● Talk with your childcare provider to see what is being served and what your child eats.

● Look for hidden calories. Examples: dairy products, mayonnaise, or salad dressings.

● Double-check your portion sizes. Plates are much larger than they used to be, so filling up a plate with food adds hundreds of extra calories.

● Check your cupboards to see if there is unhealthy food that your child may be eating when you are out of sight.

● Keep a daily journal of what your child eats, how much physical activity they get, and how much time they spend on the computer and watching TV. Share this with your doctor.

● Talk to your child about his/her eating habits and see if they are eating when they are hungry, bored, or sad.

● Talk with your child’s doctor about your concerns.

The program also advises parents to get their child to be more physically active because “kids have become so inactive in recent years.” They’re told to “make it about having fun — not about weight,” but the ideas to increase activity are so zealous and structured, they even include “run in place while watching your favorite TV show.”

These poor children. They are being set up for lifetimes of guilt and poor body image, disordered eating and unhealthy relationships with food and activity. If they're fat, their parents are being told that they are diseases waiting to happen and that their size must be because they're eating too much and not getting exercised enough. And if they're not fat, the clear message is that everything should be focused on not getting fat.

Deep breath for parents: As the research continues to show, children will naturally grow to be a wide range of shapes and sizes, unrelated to what they eat or do. It’s become widely believed, and may seem intuitively correct according to popular beliefs, that eating less and exercising more will prevent obesity among healthy children - we're not talking famine victims, which no medical professional would ever suggest is a healthy start for any child. The clinical and prospective evidence, however, continues to demonstrate that bad foods or diets don’t make children ‘obese’ any more than healthy eating will keep them thin. The DONALD (Dortmund Nutritional Anthropometric Longitudinally Designed) Study, for example, clinically followed German children for 17 years and found that no matter what or how much the children ate during childhood or adolescence, they naturally grew up to be a wide range of weights. While there were great differences in the children’s diets, these differences weren’t at all related to their weights. Canadian researchers looked at the diets of more than 130,000 kids in 34 countries and found that kids’ body weights had nothing to do with how many fruits, vegetables or soft drinks they consumed. Multiple researchers, using a variety of methodologies, have for decades failed to find any meaningful or replicable differences in the caloric intake, foods or eating patterns of the ‘obese’ compared to the non-obese to explain obesity.

As the 1996 American Heart Association Scientific Statement for healthcare professionals concurred after its evidential review: “Studies of diet composition in children do not identify the cause of obesity in youth.” It also found no consistent differences between fat and lean children in energy expenditures, or obesity and sedentary activities (such as watching television). According to this expert review of the evidence, energy expenditure in fat children is actually similar to non-obese children when indexed to their lean body mass.

Data from the Youth Risk Behavioral Surveillance System of the U.S. Centers for Disease Control and Prevention, and a review of the evidence for children’s physical activity conducted by Australian researchers, for example, have also found no sound evidence to support fears that today’s children have become a generation of sloths. In fact, their levels of activity and play, as well as physical fitness, have been shown to have changed little in the past 60 years. Nor have expert reviews found support that television or screen time, technology which has replaced older sedentary activities, have led to child obesity. In fact, kids who log in the most screen time are often the same kids who are also the most active.

Yet, according to the latest ad campaign, “healthy children” are defined not just by BMI, but by whether they eat right and are active. The program calls for four steps that mean children are healthy, beginning with limiting screen time and logging in at least one hour of intense activity per day. The specific dietary advice includes 5 fruits and veggies each day and “zero sweetened drinks” — no sweet drinks, not even flavored milk or fruit juice. There is no evidence that this makes for healthier children.

Which brings us to the larger, national campaign, referenced by this ad campaign, coming out next week …

MyPyramid for toddlers and preschoolers

The USDA Center for Nutrition Policy and Promotion, and the American Dietetic Association are unveiling a MyPyramid for Preshoolers. In the July issue of MyPyramid e-Post, Brian Wansink, Ph.D., executive director of the CNPP, thanked the more than 45 corporate stakeholders and organizations that have supported this new dietary pyramid. While said to teach parents how to feed their tiny tots from the age of two to eat healthy and to balance food intake with exercise, this diet program is as restrictive as the MyPyramid for older children and teens and shares similar safety concerns for the youngest children. [Update: MyPyramid for Preschoolers is now available here.]

Its first key message is to balance calories with activity, starting them early on a lifetime trying to manage their weight. It depicts the same frenzied intensity on sports and exercises to emphasize burning calories. The second key message is to limit fats and sugars. Low fat diets — with only oils found in fish, nuts and from vegetables and no animal fats — and no added sugars are advocated for preschoolers from age two. The sample menus focus on high-fiber whole grains, fruits and vegetables, lean or low-fat proteins (baked, broiled or grilled poultry or fish, and nothing fired) and fat-free or low-fat dairy. Added sugars and fats are nowhere to be found.

Deep breath for parents: Expert reviews of the evidence, including the largest by the USPSTF, have found no quality evidence to support the effectiveness of counseling kids about healthy eating, or to support low-fat or calorie-restrictive eating plans for children to prevent obesity. Growing children need a variety of all types of foods, including "fattening" foods, for good nutrition and normal growth and development. The USPSTF found that no diet and activity program has been shown to be effective in preventing childhood obesity or to improve health outcomes or physiological measures — such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness — nor to lead to better health outcomes in adulthood.

While parents — concerned that their child might become fat or develop heart disease, cancer or diabetes — are trying to feed their child healthfully by restricting fats, sugars, salts and calories, pediatric medical professionals caution that there is no sound evidence that any such dietary interventions prevent any of those feared conditions or that they are healthful or beneficial for children.

Growing children are not little adults. Dr. John C. Kostyak at the University of Delaware, for example, found that children need fat in their diets. Their little bodies need more fat to fuel growth processes, such as higher rates of protein synthesis, lipid storage and bone growth, and to meet their energy needs. The belief that toddlers and children should be on low-fat diets is more controversial than most parents ever hear. The National Academy of Science’s recommendations in 2002 were that children 1-3 years old be allowed as much as 40% fat, and children and teens up to 18 years of age consumer up to 35% of their calories as fat (25-35%). Low-fat, high-fiber diets do not meet the nutritional needs for young children and can disrupt normal growth and development. Little kids also need the calories found in energy-dense foods and sugars. Sugars don’t make children fat or contribute to any chronic disease, either, nor are they empty calories that are adversely affecting children’s nutrition. Beliefs that high dietary fiber is good for young children is also unsupported in the medical literature and can have adverse effects on growth and mineral absorption.

Rather than being healthful, restrictive eating plans in children are not harmless and can be unsafe. They have led growing numbers of children to suffer from nutritional shortfalls, fail to thrive and fall behind on linear growth. Misinformation about what entails healthy eating for toddlers and preschoolers is being found to have serious health risks for children. And already, children as young as 5 years of age are suffering from eating disorders and anorexia, as they attempt to eat ‘healthy’ and not get bigger.

It’s heartbreaking that even before they’re potty trained, children are being introduced to grown-up worries about diseases of aging, their body weights and what they eat. Meanwhile, so few parents ever hear that there is no reason for the panic about the dire state of their children’s health and diet, and that a little more balance can help them take a deep breath and not get caught up in extreme solutions that might do more harm than good. But one’s heart goes out to young people and parents who never hear the other side of the story. Eating has become a minefield to navigate, with the only value of food seen in terms of its health properties, rather than as fuel that tastes good and can be fun to eat. Helping our children enjoy — “enjoy” being the operative word — a wide variety of foods without fear or guilt, and to trust their appetites, is a healthful gift that will last them a lifetime.

© 2008 Sandy Szwarc