Family

Weight, Language, and Self-Image

The language we use when talking to a child about their weight is very important. Doctors say that they themselves take great care in the words they choose when they talk to a child or their family member about weight and body mass index, even if their official classification falls under obesity.

 

The New York Times recently published a piece by pediatrician Dr. Perri Klass, who writes that physicians try to take care in order to avoid further hurting a child who may already be unhappy about their weight. A new policy statement jointly issued from the American Academy of Pediatrics and the Obesity society urges pediatricians to use seemingly neutral words instead of words like “overweight” and “fat.”

 

Past and ongoing research into the social and emotional effects of obesity agree that comments on weight can have a large impact on a child’s self esteem. According to Dr. Rebecca Puhl, a clinical psychologist who is one of the lead authors of the policy statement, “Weight is now one of the most frequent reasons kids are teased or bullied.” One of her studies followed more than a thousand teenagers into their early thirties, and found that children who were bullied because of weight were correlated with binge eating, poor body image, and eating to cope with emotions (not to mention other eating disorders). These correlations, in turn, were linked to obesity in adulthood as well. The effect was present for men and women, but more pronounced for women.

 

Dr. Puhl says that healthcare professionals might be some of the few allies overweight children and teenagers can have. After all, they are most likely teased by family members as well as their peers. Another ally that comes to mind is teachers - where appropriate, they can intervene in a bullying situation, as well as promote body positivity and physical activity.

 

We can all be allies if we understand and recognize that making comments about a weight does not encourage positive change; instead, making comments about weight can result in negative, longterm impacts. It is important to make sure that children and teens have access to healthy, positive influences for their physical, mental, and emotional health.

New School Lessons: Eating Healthy

We hear a lot about the obesity epidemic in the United States, especially among children and adolescents. However, the impact that school meals have on childhood weight and overall health has been overlooked. A piece in the Wall Street Journal earlier this year looks at five creative ways schools can encourage students to eat more healthily. These interventions have been formulated to help schools meet the guidelines under the Healthy Hunger-Free Kids Act of 2010.

 

Intervention One: Product Placement

Salad bars that feature at the front, or in the center, of a school lunch line are much more likely to attract students. Some Maryland elementary schools opened all-you-can-eat salad bars that featured five different fruits and five different vegetables a day and saw the number of students buying salad go up. In fact, one study found that strategic placement of vegetable options can increase consumption by as many as five times. Other schools planned the timing of vegetable snacks, so that hungry students were more likely to reach for them before a meal.

 

Intervention Two: New and Improved Advertising

Changing children’s preferences can be as simple as slicing up fruits for those with orthodontic appliances, or using more colorful bins to display fruits at lunch. “Stealth nutrition,” according to the WSJ piece, can also come in the form of food names that appeal to a young crowd (e.g. “X-Ray Carrots or Turbo Tomatoes.”) Attention-grabbing cartoon stickers on fruits can also increase consumption.

 

Intervention Three: Tracking Real Consumption

This is an intervention that can reduce waste, and at the same time, determines which foods are popular with students and which are not.  Researchers at some Chicago elementary schools recorded what foods were purchased and thrown out in order to determine the relative popularity of certain food groups.

 

Such measures can also increase parental involvement: some schools send home weekly report cards that record what a child ate throughout the week, based on lunch swipe summaries. Instead of remaining in the dark about what their children eat at school, parents can talk with their children about their meals or even compensate for missing nutrients at home.

 

Intervention Four: Bring in the Experts

Children can’t be expected to enjoy food that adults would also avoid. Chefs can consult for school menus or cook directly in schools. Over time, partnerships with chefs and local food sources can have a big impact.

 

Intervention Five: Field Trip!

Nutrition education should not have to be boring. In fact, it absolutely should not be, since a child’s first impression of a food item is crucial. Some elementary schools have started taking students on field trips to local farms, teaching ways of sustainability along with familiarizing students with new fruits and vegetables. They encourage students to make note of how a fruit smells, or what color a vegetable might be.  In NYC, the Wellness in School Program encourages students to make healthy choices for themselves based on what they observe in the fresh produce and nutrition labels they encounter.


 

Securing a Good Start to Education

Today’s topic addresses one that may seem obvious to us, but also surprising in the United States. Children who grow up hungry in the first few years of childhood have been shown to lag behind classmates in school years later. Food insecurity, or being without reliable access to nutritious food, is a phenomenon that can be found in the United States: more than 13 million children are currently living in food-insecure homes nationwide. A recent article summarized in NPR (originally published in the journal Child Development) found that children who live in these homes before the age of five are more likely to lag behind their classmates in school socially and cognitively.

 

Also, it appears that these children don’t catch up to their peers. Researchers used data from the U.S. Department of Education from 2000 to 2006 to follow more than 10,000 children born in these households throughout their young childhood. They also interviewed the parents of these children to ask them about recent times they may have worried about food for the household. The researchers found that the younger that children were when they were exposed to food hardship, the stronger the negative effect on their performance in kindergarten (performance was measured by their ability to pay attention in class, their tendency to be hyperactive or throw tantrums, and their math and reading skills).

 

This negative effect might not be entirely attributable to the children themselves. After all, if children are hungry, then their parents are likely to be as well. The researchers affirmed that parents who are hungry can be more irritable and tired, and are less likely to engage with their children. These findings are certainly not surprising, but they confirm some important facts about early childhood and the important link between nutrition, parent interaction, and school performance. It is difficult to design interventions for very young children before they attend daycare or preschool, but the projections from this stage in life to performance in school cannot be ignored.


Food insecurity is definitely not just a foreign phenomenon, and not just an adult one. That there are millions of American children at risk of being insufficiently prepared for school should shock us all - but thanks to this kind of research, we’ll be able to lay the groundwork for erasing this gap in potential for children starting now.

Social Incentives for a Healthy Lifestyle

 

A recent article in the New England Journal of Medicine argues that the infrastructure to harness healthy habits already exists within our social interactions. The support from friends and families can help us make healthy decisions on a daily basis. The article outlines five rungs of social incentives used to improve patients’ health and to test their effectiveness. Here is a short description of each of the rungs illustrated in the article:

 

Rung One: “Patients have no explicit social engagement.”

Since health is at once a public and a private matter, some of our most important daily health maintenance routines are invisible to the world. The authors point out that our health can be invisible even to us - without a pedometer, we don’t have a grasp of our daily activity. Realizing the correlation between self-awareness and developing healthy habits, CHIL has partnered with New York City schools to bring pedometers to students. Read more about our pedometer program.

 

Rung Two: Patients’ activities, outcomes, or goals are visible to others.”

In order to encourage healthy behavior, you and your family can physically partake in habits, such as taking daily medications and vitamins, in a visible place. Restaurants have started to use this model to promote handwashing by moving the sink out of the bathroom and into a more public space.

 

Rung Three: External support is explicitly established.”

Signing up for external support, such as text alerts, to remind you and your kids to exercise can increase healthy outcomes. For everyday challenges, such as lowering blood sugar levels, simple interventions like weekly phone calls with a mentor can be more effective than expensive drugs.

 

Rung Four: “Interventions leverage reciprocity.”

It’s all about being committed to a friend’s goals as well as your own regardless of your age. Even physicians are known to work in teams to competitively improve outcomes. This element of competition can certainly energize patients combatting chronic diseases such as diabetes.

 

Rung Five:Reputational or economic incentives are layered on top of social commitments.”

This is the ultimate goal in the five-rung model. Individuals and teams can work together to create leaderboards and competitions. By doing so, there can be an increased sense of accountability as people work together toward a reward. Patients have greater potential to succeed if teammates know each other beforehand and are introduced to incentives together.

 

 

Forming New Year's Resolutions to Keep

Happy New Year! Many of us want to start off on the right track in the new year by making resolutions. These resolutions aren’t limited to adults; kids can make them too along with their parents and siblings! Resolutions don’t have to be notoriously difficult to keep either.

 

Many families may strive to eat healthier and get more exercise. Dr. Thomas McIerny, the former president of the American Academy of Pediatrics (AAP), pointed out the importance of these goals - they improve health and they establish healthy habits that will stay with children throughout their lives..

 

Check out the AAP’s tips for parents and kids to help you formulate healthy resolutions this year. Let’s break them down and take a look:

 

Eating:

  • Focus on developing healthy attitudes about food and where it comes from by avoiding a “clean your plate” mentality that discourages conversation about food.

  • Establish a “regular routine” of meals and snacks, and always eat meals at the table. As mentioned in our previous blog post, children who eat with family tend to experience a diverse range of foods and avoid overeating.

  • We also talked about picky eaters who can pose as a challenge to parents. But we should keep two truths in mind: when a child rejects a certain food, it’s always a good idea to try again later; parents also remain their children’s best role models.

Play:

  • Anything can become physical activity such as a walk around the neighborhood, or going out to the yard. Take advantage of this as a group.

  • Limit screen time for children. Each day brings new research that further proves that devices can distract from good sleep or ruin concentration. Televisions, phones, and video games are all ubiquitous in our daily lives, but we can take steps to limit their influence in our lives.

  • Encourage your children to participate in sports and dance teams that can introduce them to new friends while also providing physical activity.

 

Here are some tips from Stanford University’s Children’s Hospital on how to achieve these goals:

  • Make small goals: these are easier to keep, so it won’t be as discouraging if you fail to meet a very ambitious goal about a habit that takes time to develop. Establishing one activity to do each week is a great start.

  • Have roles and a buddy system: Family members can remind each other about their goals and help each other stay on track. Encourage kids to be active participants in choosing their next goal.

  • Have a rewards system: Small, non-food rewards can accumulate to bigger awards, which kids can choose for themselves (e.g. a trip to the beach or playing a favorite game).

  • Practice simple journaling: It can build awareness, according to Cindy Zedeck, director of the Pediatric Weight Control Program at Lucile Packard Children’s Hospital Stanford. Journaling can help you think about the choices you’ve made that day.

Understanding Food Allergies

We hear a lot about diverse kinds of food allergies, and whether or not they are getting more common as a whole. However, a new report published by the National Academy of Sciences says insufficient data or research methodologies make the number of people in the U.S. who actually have food allergies difficult to determine. Also, despite the general agreement among many health experts that food allergies have increased over time (and not just due to better methods of diagnosis), it remains difficult to confirm this with data.

 

According to an NPR report on this announcement, an important reason for the difficulty in getting these numbers is that it is challenging for parents to recognize and diagnose their children’s allergies. Food allergies and other conditions, like lactose intolerance, sometimes have “[overlapping] symptoms,” as explained by Dr. Virginia Stallings, a nutrition pediatrician at the Children’s Hospital of Philadelphia, for the NPR article. The difference is that food allergies can potentially be dangerous, while lactose intolerance, while very uncomfortable, does not pose an immediate danger to the person.

 

The more severe symptoms of food allergies - some examples given in the NPR report include difficulty breathing and swollen lips - should receive immediate medical attention. However, since symptoms are often milder than these, and since there is no single blood test or other procedure that precisely points out a food that a child can be allergic to, it is best to rely on expert advice to navigate the path to finding out a child’s allergy.

 

Some experts have noted that parents have their children unnecessarily avoid a food for fear of an allergy. According to a pediatric food allergy program director interviewed in the article, a common “gold standard” test that they use to diagnose a food allergy, the “oral test challenge,” is surprisingly obvious. Patients [literally] eat small portions of foods they might be allergic to, and if they start having an allergic reaction, the medical supervisor stops the test and administers treatment. Such a method might be perplexing to parents who are looking for more sophisticated science in identifying their children’s allergies, but more research is needed to develop these methods.

 

Children also sometimes outgrow their allergies, and can be determined allergy-free with the same kinds of tests. In the meantime, parents and teachers can do more to learn about children’s food allergies in case an emergency happens at home or at school when there are no nurses around. According to the article, school nurses are usually the only ones trained to administer potentially life-saving epinephrine shots in many schools. The National Academy of Sciences suggests that more school officials be trained to react to food-allergy related emergencies.

Voting: A Lifetime Habit

Election Day was already a week ago, but it’s always a good time to think about engaging with children and students about their civic duty. Research shows that voting is as much a habit as it is a privilege or a responsibility. Eligible voters who vote in their first three elections are more likely to remain lifelong voters, according to the New York Times.

 

The United States is an advanced democracy, and one in which parents have a major influence in forming their children’s voting habits. Partisan leanings aside, the act of going to polling stations with our parents on election day itself (or sending in ballots beforehand) is something that positively influences us as citizens. As an example, Dr. Perri Klass, the author of the New York Times article, said, “In fact, if you look at the American Academy of Pediatrics website for parental advice, you will be told, ‘Children do best when routines are regular, predictable and consistent.’” Voting routines are not necessarily the same thing as annual physical exams or making daily healthy decisions to eat right and getting exercise, but they are a building block for children to make empowering, healthy decisions that will last them a lifetime.

 

Although American citizens may not be old enough to vote until they are 18 years old, children can still observe how adults in their lives approach national and local elections from a young age. One  good way to teach children about voting at elementary schools where they are often doubled as polling stations every four years. In some of these elementary schools, young children can accompany their parents in these polling booths. Dr. Klass wrote that civic engagement as part of a family’s daily life - talking about politics at dinner or actively participating in student government - cements habits that stay with students as they grow up and become eligible for elections as young adults.

 

Our most recent election exposed many fault lines in the country, and has been one of the more divisive ones in recent memory. Yet the health of the voting public depends on voters who will return to the polls to vote about the issues that they care about the most, and to pass this behavior to their children. Parents may have mixed feelings about exposing their children to politics at a young age, but there is no denying that parents have a major influence in their children’s future by teaching them to voice their beliefs on the ballots at a young age.

Picky Eaters and Their Families

We may often be quick to judge a child or their parents when we see a picky eater. Picky eaters can be perceived as unadventurous or a product of poor parenting skills. However, parents of picky eaters have more to worry about than social judgement. Pediatricians say that children who develop picky eating at an early age can have growth and development problems.

Parents of picky eaters have real reason to worry about their children’s proper intake of proteins, vitamins and minerals, and vegetables. After all, a child’s appetite is a major indicator of his or her health. Picky eaters are also hard to pinpoint because they generally eat as much as other children do, and they can also be thin or overweight. This means that even though they are probably not eating properly, they are getting their caloric intake in ways that are not nutritionally ideal. Parents look to pediatricians to reassure them that their child is growing at a normal rate, which is usually the case. However, in rare instances, doctors will test for developmental disorders like autism, gastrointestinal disorders, or food allergies. These abnormalities are definitely not the norm, but even the original issue alone - pickiness - can be a cause of major stress for parents.

Here are three tips that parents can do to alleviate picky eating habits:

  • According to Dr. Natalie Muth, a pediatrician interviewed for the New York Times, it’s important to expose children to new flavors even while their mother is pregnant and breastfeeding. It is ideal for children who are starting to eat solid foods (between 6 and 18 months) to have frequent exposure to many different foods at an early age.  

  • It’s ultimately up to the child to choose what to eat. Pediatricians recommend following a division of responsibility at the table: parents can provide diverse food choices and show that other family members, including other children, are trying different kinds of food.

  • Children who are learning about tastes may exhibit some sort of neophobia - fear of the new and unknown. They may be partial to eat “white foods” such as fried foods, breads, rice, and chips. Families who cater to children who are partial to these foods by giving them separate meals from everyone else in the household are actually encouraging picky eating.  In the New York Times article, Dr. Muth suggests that one family should eat one meal together. By eating one meal as a family, children can be eased into different types of food as they watch other family members eat the same meals.

Training young children at an early age to appreciate a variety of foods will help children develop healthy eating behaviors, therefore benefiting their health in the long run. Parents can help with children’s learning process by actively engaging with them to establish a dialogue about their food preferences. That way, parents can also encourage autonomy and responsible decision-making in their children by allowing them to make healthy food choices. The act of eating itself can be an activity for the family, and a way for a child to invest in his or her future.