Step By Step: Kids Trimming Down
• NOTES from Part 5 •

Pediatrician — Stewart Gordon, MD

It’s important for children and parents to gain and maintain control of their weight. It helps insure good health. A number of illnesses are brought on or made worse by weight problems; conditions like Type II diabetes, high blood pressure, high cholesterol, joint problems and even cancer.

One of the most important aspects of trimming down or staying trim is staying active. In this age of television, computers and video games, many children are spending too much time stretched out on a sofa or sitting in front of a computer.

• Research shows 20 percent of American children between the ages of 8 and 16 take part in physical activity only twice a week at the most.
• That’s while 25-percent of our children watch at least four hours of television each day.

Risk associated with television sets

Youngsters who spend most of their free time watching television are much more likely to battle a weight problem. Putting a television in the child’s bedroom compounds the problem, especially if obesity runs in his or her family. Television sets in children’s bedrooms are strong predictors of those who will be overweight, even before they reach school age. 54-percent of children have television sets in their bedroom.

Community needs

Not only do we want you as parents to help keep children active, we want you to make demands on your communities. The American Academy of Pediatrics has issued a statement saying change is desperately needed in opportunities for activity in child care centers, schools, after-school programs and, other community settings. We need to make sure parks have equipment that encourage children to use their muscles, things like monkey bars, modular climbers, tunnels and slides. Parents, pediatricians and other members of our communities need to encourage city, county and parish leaders to keep parks safe and clean, enticing to our families.

Physical education in schools

We also need to focus more clearly on what’s happening with physical education in our schools. The U.S. Departments of Health and Education has issued a report saying physical education is at the core of a comprehensive approach to promoting exercise in schools. The report goes on to say all children from pre-kindergarten through 12th grade should participate in quality physical education daily.

The agencies say the programs are necessary to help students develop the knowledge, attitudes, skills, behaviors and confidence needed to be physically active for life.

• One out of every four students has no P.E. at all.

• The number of kids who take P.E. daily decreased from 42-percent in 1991 to 15-percent in 1996.
• A 1994 study showed that only 17-percent of students in middle schools were required to take P.E. daily, while only two-percent of high schools had mandatory P.E. each day.

It’s an issue that has many in the health care profession very concerned.

Psychologist — Denise Sellers, Ph.D.

One of the most common dilemmas for families is maintaining a pattern of normal eating. Some people skip breakfast because they are rushing off to work or school. Some skip lunch because they have had a big breakfast and don’t feel hungry at lunchtime, so they compensate with snacks. Those same people may feel deserving of a huge meal at dinner time.

Still others eat only one meal a day, so they feel that they are entitled to a big one; never mind the snacking throughout the day, often on fattening chips, beverages and candies. These eating patterns can blur the line between what’s normal and what’s dysfunctional eating.

Normal eating

Normal eating is distinguished by regular eating habits: typically three meals a day and snacks to satisfy hunger. It is regulated mostly by internal signals of hunger, appetite and satiety. We should be able to eat when hungry and stop when we have satisfied that hunger.

Normal eating has many benefits.

• It enhances our feelings of well-being. We eat for health and energy, also for pleasure and social reasons. Afterwards, we feel good.
• Normal eating means that food choices are more likely to provide variety, moderation and balanced nutrition.
• Normal eating promotes clear thinking and mood stability. It fosters healthy relationships within our families, on our jobs, in schools and communities. Thoughts of food, hunger and weight occupy only a small part of the day, perhaps 15 percent.
• Normal eating nurtures good health, vibrant energy, and the healthy growth and development of children. It promotes stable weights, expressing both genetic and environmental factors.

Dysfunctional or disordered eating

• The patterns are irregular and chaotic. People plagued by dysfunctional eating patterns can face a variety of issues. They may end up fasting, binging or skipping meals. Either under-eating or over-eating has a negative impact on the body. Either you get much more or much less energy than the body needs to function effectively.
• Instead of feeling better eating, you will probably feel worse.
• Fatigue, irritability, moodiness, chills, and the inability to concentrate are some of the many symptoms of dysfunctional eating.
• Thoughts of food, hunger, and weight may occupy 20 to 65 percent of your waking hours or more. Potential health problems vary depending on the level of the dysfunctional eating habits.
• People with the dysfunctional patterns are at higher risk of developing eating disorders.

Parents it’s very important for your entire family to develop normal eating habits. You should encourage your children to practice normal eating patterns:

• having breakfast, lunch and dinner, with snacks in between to stave off hunger
• offering a variety of nutritious foods at regular intervals
• planning meals and having healthy snacks around the house
• helping your children identify hunger and fullness

It’s very important for you to be a good example of normal eating. It needs to be a matter of permanent lifestyle, not just something you do for a few weeks or a few months for the sake of your child. Parents, you are responsible for what you present to your children to eat and the manner in which it is presented. And, children you are responsible for how much and even whether you eat. Both are enormous responsibilities. Neither parents nor children can afford to under-estimate your responsibilities.

Positive parenting

Moms and dads you’ll be amazed by how much you can accomplish through “positive parenting.” It almost always makes healthy lifestyle changes easier for you and your children. This involves

• reinforcing healthy behaviors and ignoring or redirecting unhealthy behaviors
• emphasizing the use of praise and rewards to shape behavior by paying attention to accomplishments
• making sure your children have limits on things like television, video and computer time
• limit on the places your children can eat
• rewards, encouragement and praise for increased activity and selecting healthy food choices
• advising children against problematic behavior like sneaking food or lounging like a “couch potato”
• positive encouragement to avoid problematic
• not tempting your child by having unhealthy foods around the house
• limits on when your child can have snacks
• making suggestions for better choices when children ask for unhealthy choices

Remember parents, the best way to lead is by example. You need to maintain a positive attitude about your children and yourselves. You should exercise regularly and buy healthy foods at grocery stores and at restaurants.

Registered Dietitian — Heidi Schumacher

Many of us include snacks in our eating routine. It’s a way of life for both adults and children. Snacking in itself is not “bad” for us if we are doing it for the right reason – we’re hungry. Children often need snacks.

• Small children cannot get all of the nutrients they need in just 3 meals. They can’t eat that much at one time.
• Older children experiencing growth spurts sometimes need extra treats.
• Athletes who burn lots of calories may need “heavier snacks” such as a sandwich or larger servings.
• Some kids who are just very active need snacks to meet their overall nutritional needs.

Parents you simply have to make sure you prepare healthy snacks that are not loaded with sugar.

Ideas for snacks

Vegetables like carrots, cucumbers and broccoli are great snacks. So is fruit like apples, oranges, bananas and grapes. Clean and chop your veggies and put them in small bags for your kids’ convenience. It’s even better if you have low-fat dips to go with them. Many children love the low fat salad dressings you can buy in any store. One of my favorites is a low-fat Ranch dip I make myself. Simply combine the low-fat dressing with sour cream.

A pita or tortilla wrap stuffed with grilled vegetable or tuna, apples and celery is another favorite for many of my young patients. Or you can make a fruit cup, by mixing fruit with cottage cheese. Some children enjoy snacking on dried fruits like apple slices or raisins.

In addition to fruits and vegetables, other suggestions include, frozen fruit bars, wheat crackers or cereal. Look for those with 3 or more grams of dietary fiber per serving, pretzel sticks, graham cracker squares, vanilla wafers, fruit yogurt, a small scoop of sorbet or frozen yogurt, low-fat popcorn, English muffin toasted and topped with jelly or a small amount of reduced-fat cheese and salsa.

Reading labels

Use your food labels to help you find other snacks that are lower in sugar and fat. An easy food label rule is the 5/15 rule. Look for products with 5 grams of fat or less and 15 to 20 grams of sugar or less. That’s per serving. Watch the serving size on your nutrition labels. Keep in mind that the fat gram rule does not apply to the healthier fat-containing snacks like nuts and peanut butter. Also remember that dairy products will show higher sugar grams because of the natural milk carbohydrate, but they also make great snacks.

Parents, we don’t want to give the impression that your children can never have a high calorie snack such as cake, pie or a cup of ice cream. But, make these kinds of snacks special treats. And, make sure they are not served right before your meals.

Things to beware of

• Excessive snacking because you are bored, depressed, anxious, or just out of habit, can become a problem.
• It’s risky to snack while doing other activities like your homework. Chances are you aren’t paying attention to what you are eating.
• Sometimes people snack just because they are tempted by foods they see in vending machines, convenience stores and fast-food restaurants.
• Try to avoid unplanned snack, especially when you are not hungry. That’s especially if you are battling weight problems.

Remember there is no such thing as bad foods, but, bad choices. You have to balance your child’s snacks, with regular meals and his or her health risks.

Exercise Physiologist — Melinda Sothern, Ph.D.

The amount of work children have to do to improve their size and shape can vary. We were born with bodies that were perfectly symmetric, meaning the left and right sides were identical. However, we use some parts of our bodies more than others, while working or training, causing some people to become unbalanced. That’s when it helps to do exercises to improve body-balancing and flexibility.

Some people end up with hunched shoulders and a hanging head. If you have this problem, there are exercises you can do to regain proper posture.

• Sit upright on the floor, leaning slightly forward from the hips. Keep your body straight and your shoulders down.
• Pull your shoulders back. Then stretch an exercise band between your two hands, holding your arms straight out.
• Pull the band to the upper abdomen over a period of two to four seconds.
• Squeeze your shoulder blades together. Take two to four seconds, then, return to the starting position, keeping your back stationary.

Do eight to 12 repetitions of this exercise. It works your upper and middle back muscles.

You can improve your shoulder posture with chest stretches.

• Stand with your feet about 18 inches apart. Then slightly bend your knees and push your hips forward as you tighten your stomach.
• Pull your arms back, pressing the elbows toward each other, as you press your shoulders back and squeeze the shoulder blades toward each other.
• Keep breathing and keep your head, neck and shoulders relaxed.
• You should slightly tilt your chin upward and hold this position for 15 to 30 seconds before releasing.

Some of you might have a bulging stomach, which stomach crunches can help eliminate.

• Lie on the floor with your arms behind your head.
• Interlock your fingers behind the base of your neck.
• Bend your knees at a ninety degree angle and put your feet flat on the floor.
• Keep your chin tilted straight back while relaxing your head in your hands throughout the movement.
• Press your lower back against the floor and hold your abdomen in while lifting your upper body from the trunk on the count of two.
• You “should not” roll your head or shoulders forward.
• You “should” look up at the ceiling, keeping your head relaxed in your hands, and holding for one second. On the count of two, return to the starting position.

Do ten to twelve of these movements.

Some of you may be slanted more to one side than the other. In that case, you should practice single shoulder stretches.

• Stand with your feet 18 inches apart.
• Tighten your hips and push them forward.
• Tighten your tummy and slightly bend your knees. Then raise your right arm straight above your head just to the side of your right ear.
• Bend your elbows and drop your hand down between your shoulder blades.
• Then reach up with your left arm. Bring it over your head to grab the right elbow.
• Then gently pull your right elbow toward your left side.
• Hold this position for 15 to 30 seconds. Then, gently release.
• Repeat this exercise with the left arm.

You should perform this exercise from one to three times a week.--

Sometimes exercise is needed primarily to improve strength and flexibility.

Children six or seven years old and older can accomplish this with overhead presses. Stand tall and erect with a set of weights that is appropriate for your size.

• Hold your stomach and hips tight.
• Raise the weights to your shoulder level.
• Then slowly raise the weights over your head just in front of your ears, extending your arms fully.
• Then stretch up and lift your shoulders.
• To return to the starting position....lower your shoulders and bend your elbows out to the side.
• Then lower your hand, with weights, to your side over about four seconds.

You should repeat this exercise from eight to 12 times.--

Squats are great for working on your thighs and hips.

• Stand up straight, holding your stomach muscles tight.
• Do not lock your knees.
• You can hold your hands on your hips or hold them out front to help you keep your balance.
• Allow about 18 to 20 inches of space between your feet.
• Slowly, bend your knees and lean your body slightly forward to the count of four, bending at the hip.
• Make sure to keep your back straight and your heels on the floor.
• Do not allow your knees to extend past your feet.

Do this eight to 12 times.

Remember movement is necessary not only to burn calories but to maintain strong bones and muscles. You do not want to succumb to the comfort of a sofa or bed, unless or until you are simply exhausted from physical activity or it’s time to go to sleep.

• NOTES from Part 5 •
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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.