Critical mass Health: American children exercise too little and eat too much of the wrong kinds of food. The result is a population of overweight kids. Can anything be done?

THE BALTIMORE SUN

If feeding our children is a metaphor for parenthood, we're in crisis mode, caught in a battle over what's good for our children, what's manageable within busy schedules, and what plain ol' tastes good.

Indulged with cookies, coddled with fruit rolls, pacified with Happy Meals, quieted with juice, children are being overfed. The quick fix now could spell disaster later. While there is disagreement on how fat is fat, there's no doubt that weight problems are netting younger and younger children.

And the younger the child with excess weight, the greater the chance the weight will stay with him into adulthood, where consumption-related diseases such as coronary vascular disease, diabetes and some cancers have been rising for 30 years. Obesity-related diseases kill 300,000 Americans a year.

It is inescapable that parents share a large portion of the blame: For reasons unknown, the generation having children today left home without learning to cook or manage food. These adults have poor eating habits, and the ways they have developed to cope with hectic lifestyles ' eating out and eating on the run ' can be unhealthy for their children.

"The traditions of eating have just disintegrated," laments Ellyn Satter, the Madison, Wis., dietitian-therapist who wrote "How to Get Your Kid to Eat ... But Not Too Much."

"Family meals are starting to disintegrate, and kids are on their own to feed themselves," she says.

It's not just the both-parents-work frenzy, says Satter. With the medical community's constant nutrition cautions, "The bar has gotten so high in getting a meal on the table ' 'You can't eat this,' 'You have to have that.' The list gets so long that when you sit down and plan ... it's easier to go through the drive-in."

Then there's this paradox: Many places that cater to children ' museums, zoos, theaters ' cater in every way except by offering healthful food ' not that kids want to eat healthful food, anyway.

Children choose foods they prefer, and their tastes ' as well as their sedentary lifestyles ' are heavily influenced by those of their parents, researchers say. It doesn't help that by the time they reach age 17 they will have sat through the equivalent of three years of television and untold amounts of advertising for high-fat foods.

Besides poor eating habits, the main culprit for the fat problem appears to be reduced physical activity. Recreation programs may be hot, but kids drop out in adolescence.

In the 1960s, physical education was mandatory in schools; in 1995, only 25 percent of high schools required it. In that period, the prevalence of overweight children more than doubled, growing to 11 percent from less than 5 percent in 1963. Another 14 percent of children are on the edge of being overweight.

Oddly, the trend coincides with parents' growing interest in health clubs and health foods ' even while they munch on snack foods.

"It doesn't make sense," says Ari A. Brown, a Reisterstown pediatrician. "I think it's that we are trying to do so many things, and never achieve any of our goals."

Even if a single reason were pinned down, there's still another major question: How do you get people ' parents and children ' to do the right thing?

"We know what to recommend," says Van S. Hubbard, director of the National Institutes of Health's division of nutritional research, "but are there better ways of getting people to do it?"

Kids know they need more fruit and vegetables and less fat, studies show ' but they don't reach for it, either at home or in restaurants. Neither do their parents. Nothing reveals the mixed messages adults send more than the National Restaurant Association's surveys of what consumers say they want and what they buy: More than 80 percent say they consider health when they order, but only about one-third actually buy healthful selections.

The truth is, when eating out, most people ignore any pretense at eating right.

Such indulgence was fine as long as restaurants were reserved for special occasions. But now they are a time-management tool. The average family eats out more than four times per week.

"It's so easy to do, especially as a single mom," says Helen Gordon of Towson, who takes her daughter, Abigail, 4, to McDonald's once a month. "I worry about the fat content, but it takes time away from time with her to be cooking. If we have errands to run or after-school activities, if I drive through she can get a meal and milk."

Gordon, an internist, is otherwise very conscious of her daughter's diet. She introduces something new to her every week and always offers fruit and vegetables.

Eating at restaurants doesn't have to be unhealthy. There are more choices than ever and more restaurants willing to serve half-portions of regular-menu items to children.

Choice is key to helping children develop healthy eating habits.

Satter's guiding principle, cited by nutritionists everywhere, is this:

It is the parents' job to present their children with a variety of healthful foods and to present new foods at every opportunity, whether at home or in a restaurant. It is the child who decides what and how much to eat. Teach them to eat like gourmets, Satter advises, so they will savor good food prepared in a variety of ways.

In the end, she says, kids are the best regulators of their own food.

Attempts to control what they eat may have the opposite effect, Pennsylvania State University professors noted in a 1998 survey of research on child eating patterns. Studies show that children's preferences for certain foods (sweets) increase when they are used as rewards, and that a high degree of parental control hurts the child's ability to develop self-control.

Treating weight problems is extraordinarily difficult, since the more overweight children grow, the more difficult it is for them to keep up with physical activity, the more embarrassing it is to work out in the gym and the more self-conscious they are about being teased. They lose self-esteem, friends, everything but appetite.

Dale S. Crowner Jr., a junior at Annapolis Area Christian High, was fat throughout elementary school. He stayed inside, ate chocolate and watched TV to avoid taunting.

One summer he grew tired of not being able to play sports with other kids and decided it was time to change. He started playing basketball and talked himself out of eating snacks. His parents helped ' they stopped buying junk food and bought "tons" of fruit, which he devoured.

Crowner, now captain of the basketball team and class president, is 6-foot-1 and 184 pounds. His goal is to attend the Naval Academy.

He advises parents not to push their kids into losing weight. "They are aware of the problem ' don't bring it up," he says.

To kids he says: Be determined not to give up. "It takes a lot of willpower. You should like yourself no matter how big or small you are.

"And another thing ' don't call it a diet. Call it 'changing my eating habits.' "

Two sisters keep track of what they eat

In the best circumstances, everybody would behave the way Caitlin Sloane, 10, did one night when her dad took her to get ice cream after a bull roast at St. Paul's School for Girls in Brooklandville. To her dad's shock, she said "no, thanks" -- she was too full.

Caitlin is not perfect diet-wise, of course. She and her sister, Sarah, 15, eat french fries and cookies like most kids. But in a week of keeping a diary of their eating habits at The Sun's request, they ate a lot of fruit and vegetables, too.

Fat is more likely to be displaced when fruits and vegetables are eaten. Americans' typical diet contains 34 percent fat, though the recommended amount is between 20 and 30 percent. Looking at the Sloanes' diary, Benjamin Caballero, director of the Center for Human Nutrition at the Johns Hopkins School of Hygiene and Public Health, guessed that the family's fat intake is 30 percent or less.

The family consumes a reasonable amount of cereal, reduced-fat items and a modest amount of protein from red meat, Caballero noted. Except for the beef fajitas with sour cream, which is "quite rich in saturated fat," the family clearly pays attention to what they choose to eat, he says.

The Sloanes eat well partly because mother Ann Sloane, an administrator at St. Paul's, makes family eating a priority. She serves a lot of chicken and pasta, and a salad and fruit with each dinner.

The Sloanes stopped going out to eat four years ago when Sarah, 15, became involved in sports and the Visa account needed shaving. "Part of it is time," Sloane says. "If they have homework, they'd rather have food here."

The only time they eat takeout is Thursdays ' husband Tom's night to cook.

Here's a look at the Sloane girls' food diary:

WEDNESDAY

Breakfast: Low-fat granola cereal, orange juice.

Lunch: Caitlin had cheese and mustard on wheat bread, Sarah had turkey and cheese. Box drink, granola bar, String Things fruit-flavored snack.

Dinner: Caitlin had chicken sandwich with barbecue sauce, pretzels, soft drink. Sarah had hot dog, chips, soft drink, cake and ice cream at bull roast.

Snacks: Bagel with cream cheese, Fruit Roll-up, chips.

THURSDAY

Breakfast: Bagel with peanut butter, orange juice.

Lunch: Cheddar cheese with mustard on whole wheat, banana, granola bar, String Things, soft drink for Caitlin; yogurt, lemonade, chocolate bar, ice cream for Sarah.

Dinner: canned spaghetti with ground beef added, raw carrots, bran muffins.

Snacks: bagel, snow cone, pretzels.

FRIDAY

Breakfast: granola cereal, orange juice

Lunch: Sarah had turkey with cheese on whole wheat, carrots, Fruit Roll-Ups, granola bar. Caitlin, who forgot her lunch, bought french fries with ketchup in cafeteria.

Dinner: Caitlin had mesquite-style chicken breast frozen dinner, pasta and sauce, steamed green beans, water and milk. Sara, at a friend's, had pasta and tomato sauce, soft drink, bread and butter, salad and strawberry shortcake.

Snacks: Bagel after school for Caitlin, two granola bars and milk for Sarah.

SATURDAY

Breakfast: Sarah, at home, had pancakes made from reduced-fat mix with butter-light syrup, microwave sausage, orange juice and milk. Caitlin, visiting friends, had English muffin with butter.

Lunch: pizza, coke, "much candy" at Roland Park Elementary's 70th annual May Mart festival.

Dinner: beef fajita frozen dinner with salsa and sour cream and vegetables, sliced cucumber with mild pepper rings served in a vinaigrette mix, water and milk.

Snacks: frozen cappuccino drink

SUNDAY

Breakfast: french toast (wheat bread) with syrup, orange juice.

Lunch: fresh strawberries, banana, chips, crackers with hummus.

Dinner: steaks cooked on the grill, grilled vegetables (potato, green pepper, asparagus, Spanish onion marinated in olive oil and spices), pasta with pesto sauce, garlic bread, fresh cantaloupe, fruit tart with vanilla ice cream and pecan pie.

Snacks: frozen cappuccino drink, chips

MONDAY

Breakfast: Frozen waffles with syrup, orange juice

Lunch: Peanut butter sandwich with honey on whole wheat, String Things, granola bar

Dinner: Caitlin had baked chicken breast with ribs, basted with butter and seasonings; red beans and rice; roasted vegetables, steamed beans. Sarah, baby-sitting, had frozen pizza, an orange, granola bar.

Snacks: snow cones

FOOD FOR THOUGHT

Excerpts from books on children and eating:

George won't eat his broccoli? Let him grow it. (Or, let him help you prepare it, let him dip it, give it a funny name, seat him next to a child who loves vegetables.)

-- "Meals Without Squeals -- Child Care Feeding Guide & Cookbook," by Christine Berman and Jacki Fromer (1998), Bull Publishing, $16.95

Your child learns about himself and the world from the way he is fed. ... Generally, children eat best when their parents are neither overmanaging nor overpermissive.

-- "Child of Mine -- Feeding With Love and Good Sense," by Ellyn Satter (1991), Bull Publishing, $16.95

Even the fat child is entitled to regulate the amount of food he eats. Don't try to assume that responsibility in sneaky ways ("Don't you think you've had enough?" and "Isn't that your second helping?") because your child will be on to you. Make your changes slowly. It's hard to change your eating."

-- "How to Get Your Kid to Eat . . . But Not Too Much," by Ellyn Satter (revised 1998), Bull Publishing, $16.95

Pub Date: 6/14/98

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