Step By Step: Kids Trimming Down
• NOTES from Part 3 •

Pediatrician — Stewart Gordon, MD

The biggest concern about being overweight is not in how you look, it’s in taking care of your health.

• The cost of hospital stays associated with childhood obesity has tripled in the last two decades from 35-million dollars in 1979 to 127-million dollars in 1999.
• The number of children hospitalized for diabetes related symptoms nearly doubled from more than 1.4-percent to almost 2.5-percent. This drastic increase is not in Type I Diabetes, the form that had normally been linked to children; it’s Type II Diabetes, a form that had almost always been limited to adults. Children now account for almost 20-percent of all Type II cases and 85-percent of those children are very overweight.
• Obesity is being blamed largely for a three-fold increase in the number of children hospitalized for gallbladder disease in the last two decades.
• Doctors are treating five times as many children for severe cases of sleep apnea, where obesity is listed as the secondary diagnosis.

The U.S. Surgeon General predicts that obesity will replace cigarette smoking as the leading causes of preventable illnesses and deaths, without drastic intervention. Our own research at the Pennington Biomedical Research Center shows the younger a child is, the more likely he or she is to adopt a healthier lifestyle and stick to that lifestyle.

In fact, the odds of an overweight child obtaining a normal weight decrease drastically as the child gets older.

• A four-year-old who is overweight has a 20 percent risk of becoming an overweight adult.
• An overweight adolescent has an 80-percent risk of being overweight for life. Once these children become overweight adults, they are usually in for a lifetime of battling unwanted pounds.

Research shows the average American goes on a diet from three to four times a year. And, only five percent of dieters actually maintain their weight loss for more than one year. That may have a lot to do with the way the body handles food. Once a mature woman or man gets use to consuming a certain number of calories, it seems his or her body adjusts, cutting back on caloric needs as he or she eats less. Therefore a person who has spent years living off 15 hundred calories a day may not lose a substantial amount of weight, at first, if he or she cuts back to eating only 11-hundred calories a day. It may take the body as long a year to stop preserving those calories, which is nothing more than stored fat.

Even if a person loses ten pounds, there is a good chance that five of those pounds will be water; three will be fat and two muscle. Once the patient regains weight, it’s almost always fat, with much less muscle than the person started off with. Therefore yo-yo dieting is often worse for an individual than not dieting at all.

This is why we emphasize changes in lifestyle. We want you to teach your children at a very early age to

• eat healthy meals
• become movers both in doing chores around the house and in establishing an exercise routine
• use their mind to maintain healthy attitudes about eating, and exercise.

They need to clearly understand they can’t lose 20 pounds and keep it off if they resort to their old lifestyle.

Psychologist — Denise Sellers, Ph.D.

One of the most important concepts to learn when trying to change behavior is that of habit formation. Habits are things we do over and over again, sometimes not even being aware that we are doing them; things like brushing our teeth before bed, biting our nails and tapping our legs.

We all have eating and exercise habits, things that we are used to doing, and often do over and over again. Some of our habits are healthy for us. Others are not so healthy. It is crucial to identify unhealthy habits and learn how to change them when we get serious about losing weight.

Habits are usually made up of what we call a behavior chain. The chain has three parts: A, B and C. A leads to B, which leads to C. A helpful way to remember this is that A stands for antecedent or what comes first. The antecedent leads to B- the behavior and then there is C---the consequences.

A common scenario in some households will demonstrate this behavior chain. Little Jerry comes home from school feeling bored and sad. He feels the easiest thing for him to do is sit down and watch television. Then he goes to the refrigerator and pours himself a glass of whole milk. He also grabs a bag of chocolate chip cookies to eat while watching TV. This is something Jerry loves to do. Jerry’s mother sees him and asks, why are you eating in front of the TV and, why are you eating high-calorie snacks instead of the low calorie foods that are on your healthy eating plan? He says he is sad and doesn’t feel like staying on the diet any longer. The antecedent in this story is Jerry coming home from school bored. This happens with kids. Jerry has experienced it before. And, the behavior for Jerry is almost always the same. He grabs a high calorie snack and sits down to watch television. The consequence for Jerry is negative. His behavior will cause him to gain weight and feel even worse, so he decides he is a failure and can’t stay on a diet.

I f you have identified some unhealthy habits in your lifestyle, you have to make a plan to change them. Sometimes it’s hard to change the A. You may find that you simply don’t want to change the A or antecedents. But, you will have to change the B (behavior) if you are serious about losing weight. One of the most common bad habits our patients have is eating in front of the TV. Every time they watch TV they feel they need a snack. Let’s call A (the antecedent) watching television. The B (behavior) is often eating, sometimes mostly junk. And, the C (consequence) is over-eating, or eating when they are not hungry.

Children, you can still watch TV when you change your behavior. However, you will drink water instead of eating food or having high calorie drinks. And, you will exercise during commercials. The consequence will almost certainly be that you will start feeling better and you’ll also lose weight.

And parents, when your children start improving bad habits, your job is to reward them. For example, you may want to allow them to spend the night with a friend or allow a friend to spend the night with them. Changing unhealthy habits is hard. Children will no doubt have many setbacks before they can change their unhealthy habits for good.

Children, another helpful habit is learning to talk positively to yourself. When we say things to yourself, it’s called “self-talk,” talking to yourself in your own head. What you say will often make you feel “good” or “bad” about yourself. For example, if your teacher hands out a test in class, and you think, “I’m going to fail.” You will probably feel nervous. If you think, “I have studied hard and this will be okay”, you will feel confident. So even though the situation is the same, its how you think about something or yourself that will make you feel good or bad.

You should practice stopping and noticing how you respond when something happens to you. Do you think something positive or negative about yourself? Telling yourself negative things can make you believe that you are incapable and unpopular. On the other hand, talking positively can make you feel that you can do anything, and that people like you. I have some examples for you of how this process works. See if any of them sound familiar to you.

• You think that you have an unpleasant appearance, you come to believe that no one likes you because you’re fat.
• You think that you need to avoid classmates, so you come to believe that no one wants to be with you.
• You think that you can’t compete with other children, so you believe you can’t play ball because you are not fast enough.
• You think that you are not able to do things well, so you believe you can’t succeed at anything.
• You think that you cannot handle stressful situations, so you believe you can’t deal with life’s hardships.

Registered Dietitian — Heidi Schumacher

Research shows Americans eat more than five of their meals each week away from home. Making healthy choices and “filling in” your diet with adequate servings of fruits, vegetables, and dairy products require planning and diligence.

In general, restaurant meals often consist mainly of foods high in proteins (meats and cheese), carbohydrates (potatoes, breads, rice) or starchy vegetables. Their food tends to be higher in calories and fat. In addition, they often offer fewer fruits and vegetables.

Plus, restaurant portions are often larger than what is recommended by the U.S.D.A.’s food guide pyramid. A child in the 7 to 11 age range needs only about 4 ounces of meat or eggs per day and adults only about 6 ounces per day. It is common for restaurants to serve meat portions that are much more than six ounces per serving. Parents you should encourage your children to split large entrees if they are battling weight problems. If they can’t agree on a meal, encourage them to get doggie bags to have a second meal or snack later. If you allow your children to eat huge cuts of meat, chances are, they will not eat their vegetables. Consequently, they will miss out on some of the vitamins and minerals available in these side dishes. And, the foods they will fill up on will lead to extra calories and fat. Remember, even a healthy food can be a bad choice, if you overeat, because of huge servings.

It is possible however to eat healthy while eating out. You simply have to plan ahead. Think about where you will eat out for dinner. Plan the rest of the day’s meals accordingly. You may need to eat more fruits, vegetables and dairy products, and less high-fat food during the day.

Pick your restaurant wisely. Look for restaurants that offer a variety of menu choices. That’s where you are more likely to be able to choose a healthy balanced meal.

Get to know menu language. Look for signs that something is higher in calories. Tell tale signs include words like “Alfredo, cream sauce, in lemon butter, fried until golden brown, breaded, au gratin, and escalloped.” If you don’t know what something means, ask!

Ask for sauces, salads dressings, and butter to be served on the side. That way you can limit how much you eat.

Avoid all you can eat buffets if you don’t have the will-power to eat smaller amounts. Sharing an entrée with someone else or asking for an appetizer as your entrée is always a good way to eat smaller amounts. It is also acceptable to ask your server to put ½ of the entrée in a to-go box BEFORE you start eating.

Don’t look at the dessert menu, or share dessert with someone else.

Stop your waitress from bringing complimentary appetizers such as chips and salsa or ask if the restaurant has lower calorie alternative such as tortillas and salsa. While eating out in restaurants is popular in today’s busy world, fast food restaurants are even more popular.

Many parents rely on fast foods as they race from one activity to the next. You can make healthy choices in fast food restaurants. But, you have to be careful. The hamburgers and French Fries are often loaded with fat. Don’t assume that a chicken or fish entrée or a salad will be low-fat or low calorie. A fried fish burger or fried chicken sandwich may have more calories and fat than a large hamburger. It depends on how the meats are cooked, and the type bread and condiments served with them. A taco salad can weigh in at a whopping 900 calories and 60 grams of fat. Many fast food restaurants are trying to meet the demands of consumers looking for healthier foods with baked or grilled chicken and salads. But, be careful about the dressings you use. Look at the restaurant’s nutrition facts. You can get these charts from most restaurants or download them from the internet. That way you can plan in advance to make the healthier selections before your next trip to the restaurant.

This cheat sheet will also help.

• Ask what items are grilled or baked.
• Get mayonnaise, tartar sauce and/or salad dressings on the side.
• Get your sandwich or salad without cheese. Low-fat cheeses are rarely available in fast food restaurants.
• If EVERYTHING is fried, get a smaller serving.
• Consider side items of garden salads, corn on the cob, or low fat ice cream cones instead of French fries, fried apple turnovers, or coleslaw.

Exercise Physiologist — Melinda Sothern, Ph.D.

Any kind of movement is helpful in achieving physical fitness. It also helps in shedding unwanted pounds. Some people have to work harder than others. More than a decade of research has shown us that some overweight kids may have to establish a structured exercise routine to lose weight. This is especially true for older, heavier kids. Parents, there are some very valuable things you need to know as you work with your kids to establish a routine.

First of all, you should set goals that are easy to accomplish. You may think the goals are too easy. But, keep in mind; you don’t want the youngsters to become discouraged because they can’t complete a task. It is much better to start off slowly and succeed, than it is to set high standards and fail.

Children have to select activities that are fun for them. If they are not fun, chances are, the children won’t do them over an extended period of time. And, kids have to feel safe while doing the exercises. Remember, children who are severely overweight have more difficulty exercising than children who are only modestly overweight.

It is fine for boys and girls, who are very overweight to do moderate exercises for only 20 minutes a day and for only one or two days a week, until they build up more stamina. Those children should do exercises that support their weight, like swimming and riding bicycle. Water supports the child’s weight while he or she is swimming. This makes it easier to move the arms and legs, burning calories and strengthening muscles. A bike supports the child’s upper body while he uses his leg muscles to rotate the wheels.

Now to you kids...you should warm up for about five minutes at the beginning of your routines. This is to increase the blood circulation from your heart to other parts of your body where it’s needed for more strenuous activity. The idea is for you to simply move your arms, legs and shoulders slowly. This can be done through a variety of movements like

• marching in place for three to five minutes
• doing arm circles forward and backward, about 20 times in each direction
• tapping your feet 20 times, before rising on your toes ten times
• doing modified jumping jacks (Instead of jumping; alternate placing each heel out to the side on the floor, while placing your arms above your head)

This movement causes the heart to pump more blood to the limbs, giving the muscles the energy they need for more intense exercises.

As you wrap up your exercise routine, you should also practice “cool down” procedures. Instead of coming to a sudden halt when swimming, riding your bike, jogging or walking, you should work your way into a slow and easy pace for about ten minutes. You can also cool down using the same routines you used to warm up.

This kind of movement will also cause blood to leave the muscles and return to the heart and lungs. Failure to implement a cool down procedure can cause dizziness or nausea. It can also cause muscle cramps.

Kids, it is okay for you to start off doing only 20 minutes of exercise a day, once or twice a week. As time progresses and you lose weight, you should work your way into a more challenging exercise routine. After three or four weeks, you should be able to exercise three days a week from twenty to twenty-five minutes a day and eventually get to thirty to sixty minutes a day, three to five days a week. It may take three months or longer to build to this point.

You should also be able to add more variety to your exercise routine; jumping rope, hiking, skiing, martial arts, brisk walking, playing baseball, softball and much more. Parents, I helped write a book called Trim Kids that outlines the exercises your children should be able to do as they lose weight and gain more stamina. You don’t have to buy this book. But, I’m sure you will find lots of helpful information in it, including tips on how to do exercises safely. It is normal for children to feel a gentle burning as they begin a new exercise routine. However, you should consult with a coach or a doctor, if the child feels serious pain.

There will be days when your children won’t feel like exercising. On those days, you will have to gently nudge them on. If you don’t, the kids will probably end up playing computer games or stretched out on a sofa. You do not always have to insist that they do exercises. You can give them options of doing things like raking leaves, pulling weeds or shooting basketball. However, make sure they only get occasional diversions away from exercises to insure a successful program.

As you help plan your kids’ exercise routine, it’s critical for you to recognize the need for parental involvement. Our research at the Pennington Biomedical Research Center shows children will eventually give up on their exercise programs, if parents don’t participate. If you walk with your child, she’ll walk more. If you clap when she endures for an extended period of jump rope, she’ll jump more. If you get in the pool with your child, she’ll stay in longer. Children generally do what they see their parents do.

• NOTES from Part 3 •
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LEGAL DISCLAIMER: This information is for general information purposes only and does not address individual circumstances. It may not be right for you and should not be relied upon in making decisions about your health. Always consult your doctor for medical advice.