by Kathy Isoldi, MS, RD, CDE
Americans are plagued with concerns about impending heart disease, obesity, diabetes, cancer, and osteoporosis. We consider most of these diseases adult illnesses. Although you are at greater risk for developing these diseases as you age, the seeds from which many of the most devastating diseases grow often begin decades before diagnosis.
Evidence shows that atherogenesis (the beginning of artery plaque formation) has its origin in childhood. Currently, obesity and obesity induced type 2 diabetes in children are reported at epidemic levels. If obesity begins in childhood, there is a great likelihood that it will continue into adulthood. Researchers estimate that 50% of cancer incidence and 35% of adult cancer mortality in the United States are associated with western dietary habits. Research has also supported a relationship between low calcium intake during childhood and an increased risk of osteoporosis in adulthood.
One cannot dismiss the role genetics (and sometimes just plain bad luck) plays in the development of certain diseases. Even so, a growing body of evidence supports the idea that eating healthier will help people avoid or delay onset of illness. At this point, you are probably wondering what you need to do to give your child the best shot at health. Surprisingly, the suggested dietary changes to improve health are simple to incorporate.
Total fat intake has decreased over the past twenty years, but we are far from our goal. Recent reports estimate that fat consumption in children is about 25% higher than recommended. A diet consisting of 30% of total calories from fat, or less, has been found effective in lowering serum cholesterol without detrimentally affecting growth (in children over two years of age). Children and adolescents are eating 38% of their total caloric intake as fat calories. Artery clogging saturated fat and the unhealthy trans fatty acids account for a large majority of the total fat consumed. Increased fast food dining and more processed snack foods are major culprits in the over-consumption of fats.
In order for kids to eat less fat, they need to have acceptable alternatives available to them. Pizza, cheeseburgers, chicken nuggets, and macaroni and cheese top the list of kids’ favorite dinner choices. Cheeseburgers are 43% fat and chicken nuggets are about 51% fat. In contrast, a meal of broiled chicken, steamed broccoli, and brown rice is only 22% fat. Eating higher fat entrees is fine occasionally (once or twice a week), but often these entrees become the rule rather than the exception for dinner.
Poor choices at snack time can quickly add up daily fat grams too. Reading the nutrition label on bags of cheese doodles, potato chips, or corn chips will reveal that they are 60% fat. There is an array of delicious lower fat snack choices available for kids. Animal crackers (33% fat), rice cakes (10% fat), fresh fruit (fat free), fig bars (20% fat), and puddings made with low-fat milk (17%fat) are better choices. High fat snack foods, however, should not be eliminated totally from your child's diet. To avoid feelings of deprivation, limit the frequency of consumption of higher fat snack foods to a few times a week.
In conjunction with a high fat intake, American children eat a diet that is too low in dietary fiber. Fiber-rich foods are believed to lower serum cholesterol, aid in bowel regularity, help keep calorie intake down, and decrease the risk of developing certain forms of cancer. The recommended dietary intake of fiber for children is five grams plus the child's age. Hence, a fifteen-year-old should consume at least 20 grams of dietary fiber. Adults should aim for 20-35 grams of dietary fiber daily. In 1998, investigators found that only 45% of 4-6 year olds and 32% of 7-10 year olds actually took in the recommended amount of dietary fiber. In fact, most of the adolescents I counsel are eating about one-quarter of the daily fiber recommended. Lack of vegetables, salads, and whole grain cereal and bread products is evident in their diet recall.
Research supporting the importance of dietary fiber in the avoidance of disease is mounting. The good news is that it is easy to increase your child's dietary fiber intake with small changes and additions to his or her usual food intake. Review table 1 for a comparison of the dietary fiber content in foods from two different menus. See what changes you can make to increase the fiber in your child's diet:
The lower fiber menu is typical of what most children eat. The higher fiber menu contains healthier choices that are often well accepted by children. With a bit of guidance and a change in what is served, the whole family can start to eat healthier, higher fiber meals.
|Low fiber choice:||Fiber (grams):||Higher fiber choice:||Fiber (grams):|
|1 cup Corn Pops||0||½ cup Frosted Mini Wheats||3|
|6 ounces apple juice||0||½ cup fresh berries||2|
|Turkey on white bread||2||Turkey on whole wheat||4|
|Bag of potato chips||1||Bag of low-fat popcorn||3|
|Burger and fries||3||Chicken-- 3 ounces||0|
|Brown rice--1/3 cup||1|
|Steamed broccoli--½ cup||3|
|1 cup salad greens||1|
|4 chocolate chip cookies||2||1 fresh apple||3|
|1 ounce low-fat cheese||0|
|TOTALS:||8 grams||19 grams|
Obesity is the second leading cause of preventable death in our country. Obesity and obesity-induced type 2 diabetes incidence are rising at alarming rates in our pediatric population. Americans spend billions of dollars every year to treat obesity. Preventing weight gain is essential if we are to reduce these statistics.
The Bogalusa Heart Study found a significant correlation between higher fiber intake in children and reductions in intake of sugar, fat, saturated fat, and calories. Encouraging higher fiber, lower fat foods will help ensure avoidance of obesity and its complications in our next generation. Increased physical activity is a necessary component of obesity reduction as well. The computer age has changed the way kids work and play. Be sure your child stays physically active. Limit television and video game time. Encourage more active leisure time activities.
The chances are that your child should increase his or her intake of calcium-rich foods. A recent review of calcium needs and intake conducted by the American Academy of Pediatrics reported that the average 9-18 year old took in 700-1,000 milligrams of calcium daily. At the average intake of 850 milligrams of daily calcium, the average 12 and 1/2 year old falls short of this goal by 350 milligrams. That is 29% below the low end of the recommended level of intake. Since 1994, the National Institutes of Health has recommended the following daily calcium intakes per age group: 1-5 year olds --800 milligrams; 6-10 year olds -- 800-1,200 milligrams; and 11-18 year olds -- 1,200-1,500 milligrams.
Bone mineralization occurs throughout childhood. Absorption of calcium peaks in adolescence. Therefore, if we are to avert osteoporosis, calcium intake must meet needs during childhood, adolescence, and early adulthood. It makes much more sense to prevent osteoporosis in childhood instead of increasing calcium intake later in life when bones are no longer as receptive to the mineral. Calcium deficits in children may lead to more immediate concerns too. Recent data support the connection between low bone mass and an increase in fractures in children.
So what is a parent to do? Limit cola, sweet drinks, and juice in your home. Stock-up on milk (low-fat for children over two years of age). Use lactose-free, calcium fortified milk, and calcium fortified soy milk for children with milk intolerance or allergies. Refer to Table 2 to calculate the calcium your child consumes daily. If your child cannot (or will not) take in the recommended amount of calcium, be sure to speak with your pediatrician or registered dietitian about supplements.
Table 2 - Calcium Content of Selected Foods
|Food Item:||Amount:||Calcium Content (mg):|
|Milk, whole, 1%, 2%, skim||8 oz.||300|
|Calcium fortified juice||8 oz.||300|
|Cottage cheese||½ cup||70|
|Calcium fortified soy or lactaid milk||8 oz.||240|
To achieve the goal of reducing risk of illness thorough dietary changes, try to adhere to the following guidelines in your child’s diet on a regular basis:
- Increase the availability of whole grains (bran cereals, brown or wild rice, bulgur wheat, and whole wheat bread); legumes (lentils, kidney beans, white or black beans, and chick peas); vegetables (all fresh or steamed), and fresh fruits (apples, berries, pears, etc.).
- Limit refined cereals and grains (such as white bagels, cold cereals with less than 4 grams of dietary fiber per serving, white bread, and white rice).
- Have your child eat five or more servings of fruits and vegetables everyday.
- Include daily three to four servings (or more) of low-fat dairy foods rich in calcium.
- Limit the amounts of visible fat your child eats (the fats you add to food). Limit (but don’t eliminate) butter, salad dressing, cream cheese, bacon, nuts, and cooking oil used to prepare foods. Do not, however, limit fat intake in any child under 2 years of age, as this could stunt growth.
- Get your child moving! Find out what interests him or her. Plan an active family outing, like ice skating, instead of buying movie tickets.
Healthy Sample Meals for Your Child(4-12 years old)
Healthy Breakfast Ideas:
8 ounces skim or 1% milk
1 cup Bran Chex cereal
½ cup berries
1 cup cooked Wheatena or oatmeal
topped with 6 whole cashews and ground cinnamon
1 cup melon cubes
1 cup skim or 1% milk
Healthy Lunch Ideas:
Turkey or lean ham on 2 slices of whole wheat bread
1 teaspoon light mayonnaise
1 cup salad greens with 1 tablespoon oil and vinegar dressing
1 fresh apple
8-ounce chocolate milk box (made from low-fat milk)
1 ½ cups lentil soup
1 cup salad greens with 1 tablespoon salad dressing
1 fresh pear
8 ounces skim or 1% milk
Healthy Dinner Ideas
Pasta and Vegetables:
½-1 cup cooked bow tie pasta
½-1 cup steamed broccoli, carrots, and zucchini
¼ cup of marinara sauce
1 Tablespoon of parmesan cheese
8 ounces of skim or 1% milk
3-4 ounces of broiled filet of fish (scrod, sole, flounder, salmon)
½-1 cup steamed mixed vegetables (peas, green beans, carrots)
½ cup cooked wild rice
1 cup salad greens
1 tablespoon salad dressing
8 ounces skim or 1% milk
Let's face it. Without your child's cooperation, you have no hope of making the changes necessary for improved health through better eating. In my experience, I have found children receptive to change when you give them some power. Here are some tips to get your kids interested in following a healthier eating plan:
Discuss with your kids why you are making some healthy changes in the household menu. No child will ever embrace the idea of an apple instead of potato chips for snack unless you start to educate them as to why they need to make that choice.
Allow your child some occasional treats. Once per day, or a few times per week, allow your child to choose a "junk food" for snack. Chronic deprivation will often backfire.
Ask your kids to tell you which foods they want in the house for healthy snacks and for their occasional "junk food" treat. Let your child help you plan what is kept in the kitchen for snack time. Make sure they choose the healthy snacks as well as junk food treats.
Have your kids help you prepare healthy foods. If your child invests time in preparing the meal, he or she will be more likely to pile all that healthy food on his or her dinner plate.
Be patient. Avoid creating any disharmony about the new and improved menu items. Expect to hear some complaints. When kids know the plan and it is a fair plan, they usually come around. Keep your goal in focus: to have your kids embrace these healthier food choices, and smarter ways of eating, for a lifetime.
Kathy Isoldi is currently the coordinator of nutritional services at The Comprehensive Weight Control Program in Manhattan. Ms. Isoldi has been a registered dietitian for 18 years. She began her career as a dietetic intern at The New York Hospital, and was asked to stay on staff at the time of graduation. She received her Masters degree in clinical nutrition from New York University. Ms. Isoldi is also certified in diabetes education.
In addition to counseling patients, she held the position of chief clinical dietitian at The New York Hospital. She currently works with Dr. Louis Aronne, a renowned obesity expert. Ms. Isoldi has been working with Dr. Aronne for the past 12 years, specializing in obesity and diabetes care. She was a contributor to his successful book, Weigh less, Live Longer. She has appeared on various TV shows and been published in many magazines. Ms. Isoldi has helped thousands of patients, in her almost two decades of private and group counseling, to change their eating habits to improve health and delay the onset of illness.
Copyright © Kathy Isoldi. Permission to republish granted to Pregnancy.org, LLC.