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The Doctor Is In

The Obesity Epidemic

Tips for Raising Healthy Eaters

     Our Country is suffering from an obesity epidemic. We have easy access to calorie-laden, processed, cheap food. Healthy food, on the other hand, is often expensive and labor intensive to prepare. Parents often wonder, “How do I make sure I am providing the healthiest, most nutritious diet for my children to help them grow and stay healthy?”
     From the pediatrician’s perspective, infancy is easy. Breast milk is by far and away the best, most nutritious food for your baby and provides adequate nutrition, without any solid food, for the first six months of life. The one exception is vitamin D. Vitamin D is primarily acquired by absorption of sunlight by the skin. As we shelter our children from excess sun exposure to avoid the risks of UV radiation, many children don’t get enough vitamin D to keep their growing bones healthy. The current expert consensus is that all babies receive an additional 400 IU of Vitamin D each day.
    As a child’s muscle strength develops and a child begins to sit unassisted, usually at about six months, it is appropriate to start some pureed solid foods. By convention, it is recommended that infants start with rice cereal as it is a well-tolerated food and is fortified with iron. After a week or two, if an infant is enjoying the cereal and has no reactions to this food, one new food per week can be added. Many pediatricians recommend adding a pureed green vegetable at this stage so children acquire the taste for the more bitter food before they try sweeter foods like carrots, sweet potatoes and fruit. This is also a very good time to introduce a sippy cup or regular cup to your baby with the hope that without the comfort of the nipple the child will gradually decrease his intake of formula or breast milk. By 1, your child should be starting to get a majority of his calories from food instead of milk, and 12 to 24 ounces of milk each day is sufficient. Milk does not contain much nutritionally available iron, and excessive milk drinking, which occurs more often when a child uses a bottle, is a common cause of iron deficiency anemia. Many parents substitute juice for milk at this age. But juice in fact has a large amount of sugar and very little nutritional value. We do not recommend introducing juice to your infant at all.
     One frequent question we hear every day is how to know if your child is eating enough. Pediatricians monitor a child’s growth at each visit, so if there is a problem, we can figure out why and offer suggestions. It is important to know that a healthy child’s appetite waxes and wanes. Healthy children will have periods where they eat robustly alternating with periods of time where they appear to eat nothing. As you introduce solid foods to your child, pay attention to how receptive your child is to eating throughout the meal. When an infant is full, he will often turn his head away from the spoon being offered. Parents should take this as a cue that the meal should be ending. If you are using pre-prepared baby foods, try not to fall into the trap of assuming that the packaged amount is the right amount for your child. Not finishing a jar of baby food does not make your infant a poor eater. These pre-packaged amounts are not one size fits all. It is much healthier to trust your baby when he gives you the clues that he is full. This is important in helping him learn to become a healthy autonomous eater.
     This question of what constitutes an appropriate portion size continues to be an issue as your child gets older. The rule of thumb is that a child’s stomach is about the size of his fist and this is the right amount for a portion of grains or protein. This means that when planning your family meals, half the plate should have green vegetables; one-quarter should have a grain (like pasta, bread or rice) and the other quarter, protein. One way to control portion size is to put the food on the plate before bringing it to the table. This helps everyone limit himself to one serving.
     Of course, as a child enters school, he is exposed to a large variety of food choices. Even if your child has learned to self-regulate, it is hard to control portion sizes in our society where bigger is better and everything is super sized. As a parent you can help by limiting the junk food in your own house, avoiding soda completely and limiting juice intake. In our busy lives one of the easiest traps to fall into is eating too much fast food. Fast food typically contains more fat than is recommended. The family meal, although often difficult to organize, has the advantages of giving you control over the content of the meal, as well as providing time to wind down at the end of the day together and check in with your children. In addition to helping ensure healthy eating, family meals have been shown to have a protective effect in preventing high-risk childhood and adolescent behaviors.
     Some of the important ways you can ensure that your child eats healthfully and doesn’t fall victim to the obesity epidemic are:
·    Breast-feed your baby, if possible.
·    Respond to your infant and toddler’s cues that they are full.
·    Avoid introducing juice into your young child’s diet.
·    Learn what an appropriate portion size is for your school-age and older child.
·    Avoid the habit of fast foods and actively limit junk food.
·    Make time for family meals.
·    Be a role model for your child by making healthy choices for yourself.

Gena Lewis, MD, and Diane Halberg, MD, are both longtime primary care pediatricians at Children’s Hospital & Research Center Oakland. They treat children with many ailments including asthma, influenza and anemia. Both are a driving force in pediatric healthcare advocacy efforts, training young physicians, and ensuring that all children have access to proper medical care. Lewis received her medical degree from Temple University School of Medicine and completed her pediatric residency at Children’s Hospital Oakland. Halberg received her medical degree from the Mount Sinai School of Medicine and completed her pediatric residency at UCSD Medical Center. Both live in the East Bay and have young daughters.