Biographies

Pediatrician Dr. Stewart Gordon explains growth charts, body mass index, the link between genetics and obesity, the need for safe, clean playgrounds and much more.

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Psychologist Dr. Denise Sellers examines the benefits and risks of losing weight; the importance of when, why and how we eat; and the need for attention, accountability, availability and a positive attitude from parents; plus much more.

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Dietitian Heidi Schumacher teaches the importance of planning meals based on the food pyramid, the value of fruits and vegetable in our diet, how to select healthy snacks and much more.

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Exercise Physiologist Dr. Melinda Sothern demonstrates exercises to help children lose weight and get in better shape. She shows parents how to create an environment that encourages activity and much more.

Extended Biography:


Melinda S. Sothern, PhD is an Associate Professor of Research and directs the Section of Health Promotion in the Division of Behavioral and Community Health, at the School of Public Health, Louisiana State University (LSU) Health Sciences Center. She also directs the Prevention of Childhood Obesity Laboratory at the LSU Pennington Biomedical Research Center. Her research has been widely published in scientific journals and recently in a book for parents and pediatricians entitled Trim Kids (2001, Harper Resource, NY , NY ). She is currently serving as a co-investigator in the NIH-sponsored, 6-year study entitled , Increasing Physical Activity Patterns in Adolescent Girls: the TAAG Study, with seven other sites nationwide and directing the physical activity intervention of the NIH-funded study, Environmental Approaches for the Prevention of Weight Gain: The Wise Mind Study. She will begin serving as Principal Investigator on another NIH-funded study entitled, Insulin Sensitivity in African American and Caucasian Children with Low Birth Weight in October of 2004. Dr. Sothern is currently preparing a two-volume, Handbook of Pediatric Obesity (Marcel Decker, NY , NY) that details prevention, etiology, and clinical management and a position paper on pediatric obesity for the American Dietetic Association. She is considered a national spokesperson for overweight youth and has been featured extensively in national and international television, radio and print media.

Dr. Sothern has directed the research efforts and treatment program of the Pediatric Obesity division at LSUHSC since 1991 and at LSUPBRC since 2000. A licensed clinical exercise physiologist, she revolutionized the pediatric exercise science field with her work in physiologic function and childhood obesity, and moderate-intensity, progressive exercise for children with chronic diseases. The results of her research have been widely published in scientific journals including Clinical Pediatrics, European Journal of Pediatrics, Diabetes, Journal of the American Dietetic Association, Pediatric Diabetes, Obesity Research, Journal of Investigative Medicine, International Journal of Pediatrics, Acta Pediatrica, Pediatric Exercise Science, Southern Medical Journal, Pediatric Clinics of North America, Nutrition, American Journal of the Medical Sciences and more.

Dr. Sothern has led her field in establishing standardized guidelines for prescribing exercise for children with increasing levels of obesity. Her work in motivating overweight children to be active, based on Social Cognitive Theory (Hunter, 1986, Bandura, 1980), has set the standard for health promotion programs in children nationwide. She is best known for her work in promoting active play as a means of preventing and treating childhood obesity. She has been a member of the American College of Sports Medicine(ACSM) and the North American Association for the Study of Obesity (NAASO) for more than fifteen years, and in 2004 became a fellow of NAASO and currently serves as Past Chairman of the Pediatric Obesity Interest Group. She is also past member of the NAASO Public Affairs Committee and current member of the Publication Committee. She was recently selected to participate as a scientific presenter for the NAASO Distinguished Lecture Series and also serves as a member of the faculty of the America Dietetic Association Certification in Pediatric Obesity Treatment.

Dr. Sothern has served as Invited Keynote Lecturer at the University of Florida at Tampa, the Canadian Diabetes Association, Annual Meeting of the North American Association for the Study of Obesity, American College of Nutrition, Nashville, Tennessee, American College of Sports Medicine, San Francisco, CA, De Vel Lecture Series, Grand Rapids, Michigan, Council on Obesity Diabetes Education (CODE), University of Texas, University of South Florida Annual Conference on Obesity, Clearwater, FL, Ohio State Association for Health, Physical Education, Recreation and Dance, Kent, Ohio, Vermont Blue Cross Conference on Child Health and Nutrition, University of Kansas, University of Kentucky 2002 Endocrine Conference, Harvard Obesity Research Meeting, Cambridge, MA., and many more.

Dr. Sothern is a scientific reviewer for the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, the Journal of Pediatrics, The International Journal of Obesity, The American Journal of Clinical Nutrition, Archives of Pediatric Medicine, Pediatrics, Journal of Sport and Exercise Psychology, Medicine and Science in Sports and Exercise, British Medical Journal, British Journal of Nutrition, Journal of Sports Psychology, International Journal of Behavioral Nutrition and Physical Activity, European Journal of Pediatrics, Nutrition, Journal of Gastroenterology and Nutrition, Clinical Pediatrics, and Obesity Research . She provides scientific advice to several major corporations including: Radio Disney, ABC Company, Swing Sets, Inc., eDiet.com, Healthy Living Academies, Roche Diagnostics Corporation, Gerber Food Company, Kraft Foods, Inc. Basic Research, Inc. Sanofi-Synthelabo, Inc. Vida Health, Inc. Louisiana Public Broadcasting Systems, United States Attorney, Medical Education Systems, Roche, Inc. Ross Products Division, Abbott Pharmaceuticals, BASF-Knoll Pharmaceutical Company, Nestle, USA and more.

She has been featured in national television, radio and print media including Good Morning America, The Today Show, Fox News TV, 48 Hours, Nicolodeon TV, The Oprah Show, CBS The Early Show, Inside Edition, The Dr. Phil Show, Discovery Channel, CNN International, Yorkshire TV British Broadcasting Co., USA Today, Associated Press – World News, The Washington Post, Wall Street Journal, National Geographic, Parents Magazine, Parenting, Better Homes and Garden, Ladies Home Journal, McCall’s Magazine, Prevention Magazine, Teen Vogue, Delicious Living, Marie Claire, Very Best Kids, and many others.

• NOTES from Part 1 •

Pediatrician — Stewart Gordon, MD

Defining overweight and obesity

• Overweight generally applies to excess pounds that can be the result of either fat or muscle, or a combination of both. Healthy muscle is not nearly as disturbing as a buildup of fat. In fact, muscle can be desirable.
• However, there are times when a child is overweight because of a disproportionate amount of fat based on his over-all weight and height. If the child and his or her family don’t intervene, the fat will continue to pile on, leading to obesity.
• The word obese refers to an excess in body fat, not muscle. A pediatrician or family doctor can distinguish between fat and muscle by doing a routine physical exam and evaluating the child’s medical history.

Most doctors plot the development of children on growth charts. The charts allow physicians to compare the child’s weight and height to that of other kids his or her own age. The charts allow doctors to easily determine whether a child’s weight is normal, low or high for his age. The charts also help in determining trends in child development.

• There are separate charts for girls and boys as they grow differently.
• There are gender specific charts that are used from birth to 36 months and charts that track growth from the age of two to 20.

You can get a copy of your child’s growth chart from his or her doctor. Or, you can start plotting your child’s growth yourself by getting a chart off the Center for Disease Control’s website.

To plot a child’s growth chart, you’ll need to know his or her age, height and weight. I like to use their age in years and quarters, for example—3, 3¼, 3 ½, or 3 ¾.The bottom curve is for weight and the top curve is for height. Find the child’s age on the bottom of the chart. Move up the side of the chart to find his weight. Move across the weight line to the intersection with the age line. Place a dot there. That dot will be near a percentile line. That percentile line will show you how the child stacks up with other children his or her age.

To check growth, go the child’s age once again. Look at the side of the chart for stature/height. That intersection of height or stature and age is the point in which you plot your chart. That percentile line shows the child’s height compared to others his/her age. You must then compare the weight and height lines. The child may be fine if he is both taller and heaver than 75 percent of the children his age. However, if he is the same height, but much heavier, you may have reason for concern, and should consult with the child’s physician.

Remember, the weight could be muscle. It could be fat or both. You will want to start helping your child develop a healthier lifestyle if it’s fat. We generally allow for a child’s weight to be 20-percent greater than what’s considered ideal, before we say he or she is overweight.

Psychologist — Denise Sellers, Ph.D.

The most important step in losing weight and staying healthy is developing the right attitude. Children will not succeed in trimming down and living healthier lifestyles if they don’t have strong motivation. That desire can come from many places.

• Wanting to wear clothes designed for children or teens
• Wanting to end teasing
• Wanting to feel better
• Wanting to avoid illnesses older relatives suffer

Children must realize that it takes a serious commitment and changes in lifestyle to lose weight. Next, children need to realize life is a bunch of tradeoffs. We all make sacrifices to obtain certain benefits. Losing weight is no different.

Once your child decides to lose weight, have him or her take a sheet of paper. Draw a vertical line down the center of the paper. Tell the child to outline the benefits of losing weight as opposed to the sacrifices. Some of the most common sacrifices we see in our clinical setting include:

• Giving up junk food, desserts, and fast food.
• Becoming more active. They don’t like, walking more and playing more.
• Watching less television and spending less time on computer games.

However, once kids begin a healthier lifestyle, they find they feel better for several reasons.

• They are healthier because they eat healthier meals.
• They exercise more.
• They start losing weight.
• They look better.
• They can get around better, running and moving faster.

You may notice, many of the sacrifices involve food. But, the rewards involve emotional and physical health. The kids’ dilemmas with food may be difficult, but they are manageable.

There are some things you can start doing right away to help your children start living a healthier lifestyle.

• Have them set up a schedule of when they can eat. Write it down and stick with it. For example, make sure the child gets breakfast, a morning snack, lunch, an afternoon snack and dinner.
• The child should always eat in the same place while at home, preferably at the kitchen or dining room table. Make this a requirement for all meals, drinks and snacks. Water is the only exception. The child can drink it anywhere. We don’t want children to get use to eating all over the house. They should only associate one place with food.
• We don’t want children to do anything else while eating. No watching television, studying, reading or playing. Chances are, they’re not paying attention to what or how much they’re eating if they are doing other things while snacking or having a meal. Children may be inclined to over-eat.

Sometimes the child will feel like eating when it’s not time based on his or her schedule. The child should make a list of things he can do both inside and outside to take his mind off eating ahead of schedule, things like riding his bike, drinking a glass of water or reading a book.

A tremendous amount of emphasis is put on what you eat. But, the way you eat equally as important. There are techniques for eating that will help you become healthier, and eat in a more healthy way.

Let’s call them the “rules for eating.”

• First of all, practice chewing more, fifteen to thirty times per bite. This will help you eat slower and digest your food better.
• Eat slowly. Taste your food and enjoy each bite. This helps your brain know when your body is full.
• Take smaller bites. This will help in eating slowly.
• Don’t take seconds, except for vegetables which are usually low in fat.
• Leave some of every type of food on your plate. It’s okay. You don’t have to be a member of the clean-your-plate-club. Stop eating when you are full.
• Take smaller portions. Generally speaking, a serving is about the size of your fist.
• Leave the pots or serving bowls of food in the kitchen. If you put them on the dinner table, you’ll be tempted to eat more food.
• Use a smaller plate. This will cause you to fill it with smaller portions.
• Put your fork down after every bite. This will cause you to slow down.
• Eat at least three bites of every food. That way you can really focus on the taste of each food, before deciding what you like or dislike.
• Drink a large glass of water about 15 minutes before each meal. This serves two purposes. You’ll meet your body’s requirements for water and the water will help you feel full sooner. You’ll be less likely to overeat.
• And, another reminder, eat only at the table... not in front of the T.V. You need to focus on enjoying your food and making sure you don’t overeat.
• Parents and children you can’t under-estate the importance of paying closer attention to when, where, and how you eat.

Registered Dietitians — Heidi Schumacher and Denise Delphin

Diet is a primary area of focus for anyone who commits to eating a healthier lifestyle. All foods can be included in a healthy eating plan, including foods that are high in fat and sugar. The key is to find balance. Many parents find they need to add more fruits, vegetables and whole grains to meal plans. In addition, parents should serve more meats and dairy products that are low in fat. You can still serve foods that are high in fat and sugar, and even processed foods as long as you don’t serve them often and children get smaller quantities. Parents should get a copy of the food pyramid to learn more about how to plan balanced meals.

Dairy Products

According to the pyramid, children should eat three to five servings of dairy products; milk, yogurt and cheese each day. Note the range...three to five servings of a dairy product. If a child is trying to lose weight, he should only have three servings each day.

Most dairy products are now available in low-fat varieties. You should shop for those products. Pay close attention. Servings for adults and children are different. A serving of milk or yogurt for a toddler or pre-school aged child is one-half cup instead of one cup.

Meats, Fish, Beans, Nuts, Eggs

The pyramid says kids should eat two to three servings of meat, poultry, fish, dry beans, eggs or nuts. Again, you should go with the two servings. If you decide to go with three servings, use smaller servings.

Two ounces of meat is an adequate serving for many school-aged children. However, the appropriate meat serving for adults is generally three to four ounces. Some people may be tempted to skip some of these foods all together. But, you shouldn’t. This is where you get your protein, calcium, iron and zinc.

Vegetables and Fruit

We should have three to five servings of vegetables and two to four servings of fruit. We don’t recommend that you cut back too much in this area. Most fruits and vegetables are low in fat and sugar while they are good sources of zinc, iron, calcium and protein.

It’s sometimes difficult to get children to eat more fruits and vegetables. It sometimes helps to have washed, peeled fresh fruits and veggies in bags in the refrigerator where they are convenient and ready to serve. It also helps to have low fat dips for these foods.

Carbohydrates

The remainder of your child’s diet should include low fat carbohydrates such as breads, cereals, pasta and rice. Whole wheat items and lower sugar cereals are more nutritious. They provide good sources of energy with lots of vitamins, minerals and fiber.

Exercise Physiologist — Melinda Sothern, Ph.D.

Children can achieve a healthier lifestyle through play, exercise, and helping with the chores around the house. Movement is essential to maintaining strong bones, a healthy heart and a strong immune system. It’s also necessary to burn off unwanted calories.

You expend only 30 to 50 calories and hour when you sit down. You burn twice that many when you stand up. You expend 200 calories and hour by just walking slowly. Children generally burn more calories playing than they do with structured exercise

Encouraging play

You can encourage children to play by surrounding them with things like a swing set, a sand box, a sprinkler, a wading pool, balls, wagons, ladders that lead to tree houses, badminton, croquet, and miniature golf sets. Store toys where children can see them and have easy access to them.

Sometimes the kids don’t need toys at all to get them to play. One of their favorite games is “tag”. It works well for the kids’ immature metabolic system. One child runs after another until he touches him or her. Kids’ bodies are not mature enough for long periods of physical exertion. They prefer short spurts of intense activity. Tag answers this physiological need to run very fast for very short periods of time then stop and rest. Just by doing this, children can burn off 350 to 400 calories an hour.

If you don’t have a yard

Parents who don’t have yards for children to play in should take the kids to the park. Encourage them to play with kites, monkey bars, swings, teeter-totters, tunnels, and all of the other wonderful playground equipment. Parents should play with their children. Throw Frisbees. Pitch balls or ride bikes.

Inside activities

If it’s too cold, too hot, too dark, or too wet to play outside, find things to do inside. Get your children a boom box and some C.D.’s of their favorite music. If your kids are younger, make sure they have balls that are soft enough for them to play with inside. Clear a space that’s big enough for the kids to play jump rope and Hula Hoop in a bedroom, hall or playroom.

When your children watch television, encourage them to play/work with a stretchy band or do squats or crunches during commercial breaks. If your children enjoy the telephone, get them a cordless phone and make them walk for as long as they talk.

Doing chores

Teach children the value of getting exercise while doing their chores. Encourage them to help you change the sheets on beds, transfer clothes from the washer to the dryer, put dishes away and water plants. Practice parking far away from the grocery store instead of looking for the closest space.

• NOTES from Part 2 •

Pediatrician — Stewart Gordon, MD

Excess weight contributes to many medical conditions, including high cholesterol, high blood pressure and diabetes. One of the ways to see if a child is overweight is to measure his or her Body Mass Index, or BMI.

The BMI adjusts the weight for height using the formula BMI equals Weight in kilograms divided by Height in meters....squared. To find out how many kilograms your child weighs...take his weight in pounds and divide it by 2.2. Your answer is your child’s weight in kilograms.

To find your child’s height in meters, multiply his height in inches times 2-poing-54. Divide 100 into your answer and you have your child’s height in meters. Now you are ready to find the BMI by multiplying the height in meters times itself and then dividing your answer into the weight in kilograms. Once you’ve gotten your answer, you can get a BMI growth chart from the CDC’s website or your doctor to keep track of how your child is doing.

The chart will not only tell you if your child is overweight. It will also tell you whether he or she is at risk of becoming overweight. Every child is different and we have to look at more than just the numbers to determine who is or isn’t overweight.

• If both parents are obese, there is an 80% risk that the child will be overweight.
• If one parent is obese, there is a 40% risk that the child will be overweight.
• If neither parent is obese, there is only a seven percent chance the child will be overweight.

Remember, your child’s pediatrician is a great resource in helping you make this determination. The main reasons to treat childhood obesity are to help our children feel better about themselves, and avoid serious illnesses.

Psychologist — Denise Sellers, Ph.D.

People trying to live a healthier lifestyle should focus on three basic goals: a healthy diet, exercise and drinking lots of water. Many people who are overweight focus primarily on losing their weight. That goal can seem impossible. You should concentrate instead on your diet, exercise and drinking lots of water and fewer sweetened beverages. It’s fine for “weight loss” to be the long term goal. But, your behavior has to be the focus of your “short-term” goal. To stay focused:

• Be specific about exactly what you plan to do. Instead of saying “I will exercise more,” say “I will exercise for 20 minutes three days a week.” This way, you know exactly when you have reached your goal.
• Your goals should be something you can control. You may not be able to control exactly what time you will have dinner each night, but, you can control whether you choose to have a snack after dinner.
• You should phrase your goal in a positive way, saying what you will do, instead of what you won’t do. For example…say “I will eat fruit for snacks”, instead of saying “I won’t eat candy.”
• et easy goals. Make sure your goals are only a little harder than what you know you can accomplish. As you meet your goals, you can make them more difficult. This may sound funny, but, we want you to feel good about what you’re doing. Reaching your goals help.

Parents you should work with your children on a set of rewards for meeting goals. Those rewards should be the result of meeting goals, not for losing weight.

As you set your goals and work toward accomplishing them, you’ll be faced with many challenges, especially when it comes to changing your relationship with food. It is important to have a set time for both your meals and snacks. Some kids may think they feel hungry between snack and meal time. Often what they are feeling is not hunger, but a craving.

Hunger

• An emptiness or grumbling in your stomach.
• A decrease in energy and tiredness.

Cravings

• You’ll see a food you like and then want to eat it.
• Someone will offer you food. And, you will want it, even though you are not hungry.
• You’ll smell food as you pass a restaurant or bakery and want it.
• You’ll see food advertised in newspapers, magazines or on television and want it.
• You’ll eat before bed, simply because you are in the habit of doing it.
  You’ll have a large dessert after a large meal because it’s customary.

Eating because of a craving is one of the easiest ways to consume too many calories and put on extra weight

Parents and children, you also need to be aware of urges to eat. Some of those urges will be external. Others will be internal.

External urges to eat

• Being in environments that trigger a desire to eat; a party, a movie theater, or a special event, like a circus or restaurant
• The sight or smell of food
• Being around people who are eating
• Activities will make you want to eat: watching television, studying or reading.

Internal urges

• Hunger, cravings, or certain moods.
• Some people eat to overcome boredom, sadness or burnout.

,b>As you become more aware of your eating habits, you need to recognize:

• where you eat
• what you eat
• how much you eat
• how fast you eat
• 
  how often you eat

You will move a lot closer to living a healthier lifestyle when you learn to eat for only the right reasons.

Registered Dietitian — Heidi Schumacher

Food Labels

Food labels provide a lot of information for people who are trying to lose weight, information about fat and sugar content and the fiber and minerals in food. The federal government requires nutrition information on almost all processed foods. But, first you must understand how to read the labels to get the vitamins, minerals and even fat you need to stay healthy. The labels will also tell you which foods to eat less of. People trying to lose weight should look for products that are low in fat and sugar but high in fiber, vitamins, and minerals.

Calories

The fat and sugar we take in reveal themselves in the form of calories. Calories are energy we obtain from food. If we don’t burn off excess calories by working, playing, or doing exercises, they turn into body fat.

Beverages and Sugar Content

A major source of calories for children is beverages. In fact, more than half of our children’s sugar intake comes from beverages alone, not food.

20-ounce soft drinks are favorites among families on the go. It doesn’t matter if it’s a Coke, Pepsi, or other generic brand. With a quick glimpse at the label, you might think that it contains 100 Calories. Upon closer inspection you will see that there are two-point-five or two-and-a-half servings of drink in the containers. Most people buying a 20 oz. bottle of soda will drink all of it within a short span of time, taking in not 100, but 250 calories. So not only do you need to look at the number of calories that are listed on the bottle, but also the number of servings.

Some of you may wonder where all these calories come from. That’s where sugar content labels come in. This label shows 27 grams of sugar. Remember that a 20-ounce bottle of soft drink is equal to 2.5 servings or 67 grams of sugar for the whole container. That’s the equivalent of 14 teaspoons of sugar. That’s how much sugar you take in when you drink a 20 ounce bottle of Coke. A very common sugar additive in these “artificial beverages” is high fructose corn syrup. Not only are the beverages full of sugar from the high fructose corn syrup, but they also lack nutritional value in the form of vitamins that are found in natural, 100% fruit juices.

Water is the best beverage. We should drink on average, 64 to 80 ounces of fluid per day. Most of that fluid should come from low-fat milk, 100 % all natural fruit juice, or plain water.

Compare diet drinks to regular drinks. Notice that it says no calories and no sugar. Talk to your pediatrician and dietitian about the use of artificial sweeteners.

Cereal (Sugar and Fiber Content)

Cereal is another common source of sugar. Look for breakfast cereals with less than 15 to 20 grams of sugar per serving. More importantly, use breakfast cereals to help meet part of your child’s daily fiber needs. Look for breakfast cereals that contain more than 3 grams of fiber per serving. An added benefit of cereals containing fiber is that it will help to slow down your body’s absorption of sugar.

The Fat in Butter and Margarine

Margarine and butter are also common staples in most homes. One of the concerns with regular margarine and butter is the fat content. That’s where most of our calories come from in many spreads. The label will tell you that a serving of butter or regular margarine is roughly one tablespoon. That one tablespoon of butter contains over nine grams of fat or 100 calories. That takes up 14-percent of the total fat intake an adult should have in one day, the “DV or daily value” area on your label indicates this. Keep in mind, however, that one tablespoon is not a whole lot, and we usually eat much more than that with our meals. One stick of butter or margarine contains almost 100 grams of fat and1000 calories. There are eight tablespoons of butter in each stick.

Keep in mind the harmful effects some fats can have on our bad cholesterol levels. Most margarine is made from “hydrogenated or partially hydrogenated vegetable oils.” Hydrogenation is the process in which liquid vegetable oils are made harder. This process creates “trans fats” and saturated fats, both of which can raise your bad cholesterol levels and clog your arteries. This clogging process begins as soon as you are born. When buying margarine, look for the ingredient “liquid vegetable oil” instead of “hydrogenated vegetable oil” and/or look for margarines that say “trans-fat free” in addition to being lower in total fat.

The word lite/light can also help you spot healthier margarine. Federal laws prevent the use of “light” on labels unless the product contains one-third fewer calories or 50-percent less fat than the original product. Low is also used to describe calories, meaning less than 40 calories per serving.

While we worry a lot about fat, no one should be on a diet that’s fat-free.

Children, especially, need about 60 grams of fat a day. This value ties in with the percentage value on the food label. A good amount of your daily fat intake, however, should come from the “heart-healthier fats” or the monounsaturated fats, such as nuts, olive, canola or peanut oils, and avocados. A much smaller percentage should come from the saturated fats found in high-fat dairy products and animal fats.

Our families consume a lot of fat from fried or baked foods because they contain a lot of oil. Remember that even when cooking with a healthy olive, canola, or peanut oil they still contain 2000 calories and 200 grams of fat a cup. A small amount goes a long way.

Exercise Physiologist — Melinda Sothern, Ph.D.

The way you move plays a major role in the rate in which you burn calories. There are some activities that are also more effective than others in building strong, flexible muscles that will give your children much more endurance.

Think of your body as a car, with three different engines. All three engines work at different speeds; burning varying amounts of energy.

Let’s call the first engine, engine number one. That’s when you shift into high gear to do fast-paced or rigorous exercises like running fast, lifting a heavy weight, or doing gymnastics stunts. You expend a lot of calories during a short amount of time while operating on engine one. But you can only do intense, vigorous exercise for very short periods of time, especially if you aren’t use to it. An untrained child will not be able to operate in this mode for long. Engine one generally works best for skilled, powerful athletes; weight lifters, jumpers and sprinters.

That’s not to say your child should never shift into engine number one. However, the child needs to know that if he uses that engine, he shouldn’t come to a complete stop when he gets tired. The child should simply shift to a lower gear.

Engine number two comes next. You use this engine when you walk, jog or ride your bike at a brisk pace, not too fast, not to slow. A child who hasn’t trained can usually operate on engine number two for about three to five minutes. Aside from causing the child to tire quickly, engine number two causes him or her to burn glucose, a sugar that the body produces from carbohydrates. As the body burns off glucose, lactic acid builds up in the muscles, creating a burning sensation. The energy from your muscles is also being zapped, causing fatigue. While it may be difficult for an overweight child to start off with engine number two, it is important to perform high-energy activities that strengthen the muscles. The longer a child can operate on engine number two, say five to six minutes, the more anaerobically fit he becomes.

That leaves us with engine number three. That’s where your child and you want to begin when you start trying to get in shape and lose weight. Engine number three allows you to dance, walk, jog or climb stairs slowly. You can also do other activities like swimming, dancing, and field sports like soccer, softball and volleyball. The great thing about engine number three is that you can keep going for long periods of time without tiring out. After about 20 minutes of activity, your body will begin burning off more stored deposits of fat. The longer you move with slow to moderate speed, the more calories and fat you will burn off. Your child will burn off even more calories, if he or she hasn’t eaten for several hours before beginning an exercise routine.

The child should be able to gradually build up to use engine number three for longer periods of time. He or she should also be able to use engines number one and two for longer stretches of time. But, it’s a process you can’t rush. The heavier the child, the longer it will take for him or her to keep his or her engines going for longer periods of time.

Sometimes children will complain of discomfort. Parents you need to be patient and understanding. Remember, excess weight is physically disabling. Children need encouragement, not criticism.

Perhaps the best way to get your children to practice on each of their engines is to get them to exercise to music. Select music with three different tempos, fast for engine number one, medium-paced music for engine two and slower music for engine number three. After several minutes of playing music with a slower beat, change to a song with a faster beat, and then one with a very fast tempo.

• 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 4 •

Pediatrician — Stewart Gordon, MD

One of the main questions many people battling obesity ask is whether it is in their genes. Researchers are spending a great deal of time trying to answer this question. Scientists at the Pennington Biomedical Research Center in Baton Rouge, Louisiana are among them. The center’s director, Dr. Claude Bouchard talked extensively about the research.

Claude Bouchard
Director, Pennington Biomedical Research Center:

“We have in the population of kids and adults probably five-percent of them, we don’t know exactly how many, but it is a small percentage who are obese because they have a clear genetic defect. One gene is totally incompetent, not capable of producing protein that it normally does. The absence of that protein changes metabolism, affecting the regulation of appetite, satiety, or energy expenditure. In the long term these children become obese, generally severely obese. That’s five-percent. It doesn’t explain the whole obesity epidemic.

Over and above that, we clearly see some family lines. These family lines are not determined by one gene, in our genetic language, we say they depend on multiple genes and multiple genes acting directly, but also interacting among themselves, one facilitating the effect of the other. And, these genes in turn interact with the environment. So it’s a very complex picture.

When we talk about predisposition to become obese; if the environment is obesigenic, it has the kind of conditions that favor the development of obesity. This genetic disposition may be strong, weak, very light. It depends on the amount of susceptibility genes that you carry. For example for those families where obesity is very prevalent and severe it is quite likely that you have many of these predisposing genes that are acting. And in families where most people are lean, it doesn’t mean they don’t have any of these genes, but they may have a few copies only.

There are people who believe that everybody in an environment like the United States where the obesogenic environment is the strongest that we’ve seen on earth, 100 percent of us will become obese one century from now, two centuries from now. Energy expenditure is reduced to a minimum and food is available in abundance. It’s good and it’s cheap, this favors us eating more than we expend. Our whole environment has been designed to decrease the amount of work that we do.

The war began with the advent of agriculture. We invented the wheel and it lasted for a millennium. We have won the war. We are not using our muscles, or barely, just a little bit. The problem is that we have diseases associated with this sedentary lifestyle and obesity is one of them. Our cities are built that way. Our buildings are designed to reduce the amount of physical work. So at the end of the day, there are always 300 to 400 calories that we have not expended and that plays a role in our biology. If we were able to recover them by walking here to go to the store, taking the steps in the building for a couple of floors, adding them up over a period of years, it makes a huge difference.”

Some people are at higher risk than others. That’s why the American Academy of Pediatrics is urging doctors to look at family history in predicting the long term risk of obesity.

But it’s something Families can monitor too. Children who grow up in impoverished neighborhoods are more likely to feel unsafe going out to play...thus “not” getting the exercise they need. These same kids are less likely to have fresh fruits and vegetables, while they are more likely to eat fried foods that are loaded with saturated fat. They are also more likely to drink carbonated beverages, loaded with sugar. Parents you can also look at your family tree. Does your family appear to be more prone to gain weight either because of genetics, your cooking and eating traditions and-or a lifestyle where you just don’t move around enough? If so, you will want to pay much closer attention to your kids’ eating habits and make sure you live an active lifestyle.

In addition to this, pay attention to the psychological, social, and cultural issues that could have a negative impact on your children’s weight. There will be some conditions that you can control. Others you can’t. But, the more we all know, the more ammunition we have in trying to keep our children within a healthy weight.

Psychologist — Denise Sellers, Ph.D.

The things you say to yourself can make you feel good or bad about just about everything you do. Positive reinforcement is much better than negative thoughts. It’s important to identify situations that tempt you to eat unhealthy foods and what you can say to yourself to feel good about making healthy choices.

Children, there will be days when you will walk into the school cafeteria and see pizza loaded with meat and cheese. The ingredients may or may not be the healthier brands. Under ordinary circumstances, you might say, I can’t resist pizza. Besides, I have so much weight to lose, one piece won’t matter. With that kind of negative thinking, you will eat the pizza and feel bad about yourself.

However, with the opposite approach, you might say, “even though I like pizza, I can resist it. I’ll have a salad instead and stick to my plan.” Then you will feel good about yourself for choosing the salad.

I’ve prepared a list of examples of positive self-talk for you when you have to make these important choices. Use these suggestions and make some of your own up to help you stick to your plan and feel better.

• I “can” do anything I want to do badly enough.
• I “do” anything I want to do badly enough.
• Yes, I “can” stay on my eating and activity plan.
• Yes, I “do” stay on my eating and activity plan.
• I look great since I’ve lost weight.
• I look and feel so much better.

And, this one is very important.

• One slip is not the end of the world.
• So I slipped. I’ll make up for it by riding my bike or taking a long walk, or skipping dessert at my next meal.

Children remind yourselves:

• I can resist temptations such as school parties, holidays, friends-over-night-pig-outs.
• I resist tempting situations all the time.
• I like being active.

As you make progress, you need to remind yourself by saying:

• I am much more active and physically fit.
• My parents, relatives and friends are proud of my success.
• I am proud of my accomplishments.
• I look great.
• I feel great.
• I am great.

These changes will help you with both your self-esteem and body image. Self-esteem is the way you feel about yourself. Body image is the way you feel about your body. Positive self-esteem and body image help promote total health. I want you to

• Make a list of three things you like about the way you look. Then, I want you to list three other things you like about yourself.
• Write down what you think your parents like about you.
  Write down what you think your friends like about you.

Sometimes when we have poor self-esteem or body image, it’s hard to find things we like about ourselves, and things we think other people like about us. Now write an example of negative self-talk you have about yourself. For example, you may want to say, “I have big legs.” Then, turn those negative statements into more positive statements. My legs “will get” or “are getting” stronger and more muscular. When you tell yourself positive things, you feel better and think of yourself in a more positive way.

Shifting now to parents, there are many things you can do to encourage and support your children. We call the process by which you support your children the A-Factor: attention, attitude, accountability, and availability.

We want you to give positive attention to your children’s behavior. Many parents are used to giving negative attention to their children, or noticing bad behavior. We want you to “catch your child being good.” Your primary charge is to be positive, upbeat, encouraging and empathetic and help build your child’s belief in himself. Hold back the criticism when your child loses ground. Help him identify healthier options and acknowledge to him that he is successful.

• Perhaps the most substantial change we ask you to make is in your attitude. Regardless of whether your past responses have been positive, negative or neutral, now is the time to reframe your attitude so that you are the “healthy food movement.” This means cheer for vegetables and boo fast food commercials.
• Then there is accountability. You have to hold yourselves accountable for what your children eat. Understand that if you don’t keep track of both what you and the child eat, your child won’t monitor what he eats either. You are a big part of you child’s success or failure.
• And finally, make adjustments so that you are available to meet your children’s needs. Find the time for conscientious food shopping and cooking. You also need to launch more activity around the house. Being there does make a difference. Your child cannot do it alone and needs help from you.

Registered Dietitian — Heidi Schumacher

Long, before Americans recognized our growing tendency to become overweight, parents encouraged kids to eat their fruits and vegetables. Now that two-thirds of American adults are overweight, we’re putting extra emphasis on fruits and veggies. They are naturally low in sugar and fat. They also provide us with a great source of essential vitamins, minerals and phytochemicals, substances in plants that protect us from diseases.

For people watching their weight, fruits and vegetables are loaded with fiber which makes us fill full faster, and digest our food more efficiently. Take beans for example. Kidney beans and chickpeas are also great sources of protein, which allows them to be used as a substitute for meat.

Parents, it’s important to serve a variety of vegetables. For example, dark-green leafy vegetables like spinach, romaine lettuce and broccoli provide us with vitamins and minerals that you won’t get in other vegetables. If you have a picky eater who doesn’t like vegetables, offer him or her lots of options. A child who doesn’t like regular green beans might eat them barely steamed, served with a dip, or marinated in fat free dressing and served cold. Children also enjoy stir-fried vegetables prepared in a wok.

Stir Fry Recipe

Use a small amount of oil, half cup of water, a half cup of half soy sauce, about a tablespoon of corn starch and what ever vegetables you like. Mix your water, soy sauce and corn starch. Put the oil in the skillet or wok. When the oil is hot, add vegetables. Add water, soy sauce and corn starch mixture when veggies are near the consistency you like; cooked more or less. Allow to finish cooking. Serve hot.

You can also disguise vegetables in casseroles and in soups. Some kids would even prefer getting their veggies from vegetable drinks which is fine.

Keep in mind, the food pyramid encourages you to eat 3 to 5 servings of vegetables each day. A serving could be a cup of raw leafy vegetables or a half cup of cooked or chopped raw vegetables for older children and adults. In addition to vegetables, we should eat 2 to 4 servings of fruit each day.

A serving can be a medium apple, a banana “or” an orange. It can be a half cup of chopped, cooked or canned fruit or a hand-full of dried fruit. Fresh fruits are packed with vitamins. However, canned fruit, packed in its natural juice, frozen, and dried fruit can be almost as good. Canned, frozen and dried fruit will have a longer shelf life. It’s also often cheaper. Frozen fruit can be added to cooking such as in muffins and pancakes, while canned or dried fruit can make a quick and convenient “to-go” snack.

Parents you can also use juice as one of your serving of fruit. It is often used as a fruit substitute for breakfast. But beware, much of what’s advertised as fruit juice is only five or ten-percent juice. Look for 100 percent juice.

Try to avoid those aides, punches and other beverages that are loaded with sugar, especially if your child is battling a weight problem. And, when you buy 100 percent juice, you should limit the amount your children drink. Even though it’s very nutritious; it is still high in calories. Encourage your children to drink water with meals and to quench their thirst throughout the day. And, remember, as long as the children are filling up on fruits and vegetables, they are avoiding the temptation of chips, cookies, ice cream and other snacks that may be high in sugar and fat.

Exercise Physiologist — Melinda Sothern, Ph.D.

Children can tone up or tighten their muscles through weight and strength training. The benefits of strength training include improved strength and endurance, lower blood pressure, higher resistance to diseases, a lower risk of bone and joint disorders, especially back problems, and an improved self-image. The best way to tone up is through weight lifting or using the limbs to lift other parts of the body. This should be done at least once or twice a week. Children should not begin lifting weights until they are at least six or seven years old.

Parents you have to be careful in working with your children. Some boys and girls may be tempted to use weights that are too heavy for them. Strenuous lifting, pushing, jarring and pulling can cause injuries to growing bones and developing joints. You should talk with your child’s physician about the appropriate weight for his or her size and body type.

Generally speaking, the child should begin by lifting a one pound weight in each hand.

Lifting Weights

• Children, you should grip the weight handles “lightly” to prevent an increase in blood pressure.
• Keep the rest of your body still while focusing on a particular area.
• The stomach should always be sucked in.
• It’s important to fully extend and contract your muscles without locking the joints.
• You should breathe normally...using a two-to-four -second count to lift and lower the weights.
• It’s important to rest from one to two minutes between each set of eight to twelve repetitions.

Once you have learned to lift weights properly, you should not increase the amount of weight you train with, until you can do 12 continuous reps in perfect form. You should only increase the amount of weight you lift by one to two pound intervals. Not only is it good for you to lift weights, but you should also practice simply lifting a limb or other part of the body to strengthen the muscles in that area.

Leg Extensions

• For example, you can strengthen your quads by sitting in a chair with your arms at your sides.
• Bend your knees at a ninety-degree angle with your feet flat on the floor, and your lower back flattened.
• Slowly extend both legs from the knees, while keeping your upper legs stationary for two to four seconds.
• You should not lift your hips or extend your legs fully until your upper front thigh muscles are completely contracted.
• Do not lock the knees. And, keep your ankles and feet relaxed.
• Take about four seconds to return to the starting position.

This should be done eight to twelve times.

Leg Curls

Leg Curls are good for “strengthening” your back thigh muscles and “stretching” your front thigh muscles.

• Stand up straight with your stomach muscles tightened and your hips and knees slightly bent.
• Hold on to a chair or something for support. Slowly raise the heel of one foot toward the back of your hip for a count of two to four seconds.
• Keep your upper leg and knee stationary.
• Then gently squeeze your heal toward the back of your upper leg, fully contracting the upper back thigh muscle. Slowly return to the starting position....making sure you don’t lock your knees.

Repeat this routine for eight to twelve times on each leg.

Low Row

To work the upper back, try the low-row exercise.

• Sit upright, leaning straight forward from the hips. Keep your back straight and your shoulders down.
• Then pull your shoulders back. Pull an exercise band to the upper abdomen over a period of two to four seconds.
• If you don’t have an exercise band, simply squeeze your shoulder blades together.
• Then take two to four seconds to return to the starting position, keeping the back stationary.
• You should do eight to 12 repetitions of this exercise.

Crunches

Crunches are great to tighten your abdominal muscles.

Y

• ou should 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.
• You should 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 and shoulders forward.
• You “should” look up at the ceiling, keeping your head relaxed in your hands. On the count of two, return to the starting position.

Do ten to twelve of these movements.

Modified Pushups

Modified pushups are great for working your chest muscles.

• To do them, you should stand two to three feet from a wall, a sturdy table or chair....
  Place your feet slightly apart.
• Then lean forward at a 45-degree angle, using your hands to brace yourself against the surface.
• Slowly, bend your elbows and lower your chest until your face comes close to touching the surface.
• Now push with your hands, extending your arms, and return to the original position.
• Keep your head in line with your body. Keep your legs straight and extended throughout the exercise.

Repeat this sequence eight to 12 times.

Parents, these exercises are great for both children who are overweight and those who aren’t. Other ways for children to tone up include normal play, climbing trees, swinging on monkey bars, carefully jumping on a trampoline, swinging on a swing set, skipping rope, playing hopscotch, participating in gymnastics, dancing and learning martial arts.

• 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 6 •

Pediatrician — Stewart Gordon, MD

Children sometimes endure traumatic emotional experiences because of their weight. Brandie Hunt underwent verbal abuse because of her weight. But, now Brandie is reaping the benefits of tackling her weight problems.

At the tender age of 9, Brandie had to learn how to live with being taunted about her weight. The mean and ugly treatment lingered throughout high school. “They would walk behind me in the hall and they would make noises. They would make elephant noises. They would make hippo noises. When I would get on the bus, people would scream, oh, the bus is going to fall over. The bus is going to fall over. It was one thing after the other. The more they made fun of me the more I would eat and the bigger I would get. It was just a vicious, vicious cycle.”

Brandie believes her problems began when her dad didn’t understand the difference between child and adult size portions, and insisted she eat everything on her plate. Her unhealthy relationship with food got worse as she got older. “If something would upset me I would go to the pantry. If we had a bag of Doritos, I’d go get the Doritos and I’d go sit in my room and turn on the T.V. and I’d eat the whole bag of Doritos instead of sharing my feelings, instead of sitting down and talking with my mom. As I got older it became Oreos and milk, cold double-stuffed Oreos and milk. If my boyfriend had broken up with me, I’d go to the store and get a bag of Oreos, get the milk and eat Oreos, the whole bag.”

As Brandie gained weight, so did her parents. Her mother would often help her finish up over-sized plates of food. The excess weight caused Brandie a lot of discomfort in her physical education classes. “They wanted you to run. I couldn’t run. The teachers didn’t like it. We had the president’s physical fitness awards. And, you had to do sit-ups. I couldn’t lift my shoulders off the ground.”

Brandie survived elementary, middle and high school, despite being bullied, and having very few friends. But, tragedy continued to follow her. She lost her father to kidney failure that was apparently related to his type one diabetes. And, then came more bad news for Brandie. Only one year after her father’s death, she was diagnosed with Type Two Diabetes. She was only 19-years-old. “I balled like a baby. That was the worse news anybody could give me.” Brandie consulted with her physician and a registered dietitian about losing the weight, but her efforts were short lived. By the time she was 23, 5-foot-3 Brandie had climbed to 245 pounds. Her doctor, Endocrinologist Joel Silverberg tripled her medication. “The reason her medication was increased was to reduce her risk of complications associated with diabetes, including heart disease, circulation problems, eye and kidney problems, 10 and 20 years down the road.” Like many diabetes suffers, Brandie still felt fine and she hadn’t allowed her weight to interfere with her career aspirations. By then, she was a nurse surrounded by other health care professional. They offered Brandie a world of support in conquering her problem. She also sought professional help from registered dietitian, Davie Frick. Within a year, Brandie lost 70 pounds and is still losing weight. The young nurse credits Davie with giving her all of the information and support she needed, when she needed it. She says Davie accepted her as she was, and only wanted to help. However, Davie gives Brandie all the credit. “She got up in the morning ad she ate right and she exercised. It’s just you making up your mind. And, every person is different in that aspect as far as what it takes. And, with Brandie, she just decided to get her life together at that point.”

Brandie’s doctor, Joel Silverberg wants her to lose another 25 pounds by simply eating healthy and exercising. And, she’s optimistic that will get her off medication she has been taking for seven years, medication she feared she would be taking for life. Her doctor likes her chances. “With exercise and weight loss, we reverse a condition called insulin resistance which is a factor in most patients. If she continues on that path, she won’t have to take the medication, but she will always have that monster in her closet. If the weight gain came back, the insulin resistance and diabetes would come back.”

Parents, these are not the kinds of risks you want your children saddled with as they grow older. They may not have diabetes. In fact, they may not suffer any ailments at all. But, they are certainly at risk. Remember any movement helps.

Federal health officials and those of us working in local clinics and hospitals are watching some very disturbing trends. Two-thirds of our adult population is already overweight. And, if we can’t break this cycle, most of our children will be overweight in a few decades. Take a look at the map from 1991 provided by the Centers for Disease Control. The darkest blue indicates that from 15 to 19-percent of the population in those states was obese. The lighter blue shows that from 10 to 14 percent of the population was obese. And the lightest blue indicates that less then 10 percent of the population was severely overweight.

There was no data available for the states in white.

Now lets see what happens 11 years later in 2002.

There is an alarming situation for the three states in red. More than 25 percent of the population is obese. The tan indicates that from 20 to 25-percent of the population is obese in more than half of our states. And, at least 15-percent of the population is obese in all the rest of the states.



Psychologist — Denise Sellers, Ph.D.

Many of you are making plans and working toward living a healthier lifestyle. But, some of you parents may feel unsure about how far you should go in encouraging your children to stick with the program. Generally speaking, the more personal responsibility you give your children, the faster they will understand their role in attaining and maintaining their physical well-being.

This means letting go enough to allow them to master their program themselves. The sooner the child can “set” and “abide by” his or her own limits, the better. It’s important that you as parents “not” take control of your child’s actions. Remember, you are the coach, not the controller. If the child has a bad week, don’t blame yourself. Rather, help lead her back on course. In the same vein, you can’t take credit when the child reaches her goal. It’s entirely her accomplishment. As is true of any coach, when the team drops the ball, it’s not the coach’s fault. And, when the team scores, it wasn’t the coach who threw the winning ball. That said, there are many issues that come along with independence.

Coping with failure

We all become familiar at one point or another with the features of failure. When your child doesn’t reach a goal, it’s important to work with her to access the situation realistically by evaluating her goals. Was the goal too difficult? Was there something going on in the child’s life that made the goal difficult to attain? Take a look at the big picture. Never look at the child as a failure and move forward by establishing new, easier goals.

Though I’ve told you, the child has to ultimately be responsible for sticking with the program; you as parent have to set restrictions.

Restrictions

If things aren’t progressing the way you hoped, the time will come when you should reflect on the household rules you made and whether or not you enforced them. It’s up to you as parents to initiate, model and monitor the restrictions.

Positive reinforcement

I want to stress the importance of positive reinforcement. When was the last time you said something positive to your child. When did you say something negative? I’ll bet you could have rephrased the negative comment to make it affirming, upbeat and encouraging. That’s something we all need to work on as parents.

Healthy choices

Your children will always have an easier time taking on responsibility and becoming more independent when they know they have healthy choices available to them. Remind children of their options. For example, let them know they can rake the leaves, vacuum the carpet or spend half and hour riding their bike. Or you may want to let children know they can’t have ice cream for dessert, but there is an array of other choices that are also sweet as well as delicious...things like strawberries, sugar-free and fat-free yogurt and watermelon. Having choices in every aspect of the program strengthens everyone’s commitment and sense of control.

Both parents and children, as you embark on changing your lifestyle, you need to be prepared.

Backsliding

There will be times when you backslide, but to different degrees. I have a list of definitions to help you deal with those situations.

• First, there are lapses or slips. Your child may engage in an old, unhealthy behavior once during a typical week, eating a fast food meal for example, or spending an entire day on the couch. If this happens, remember, this can be a planned treat.
• Then there is the relapse. Your child allows unhealthy behavior to surface three times within a single week. It’s time to become a little concerned.
• And, then there is the collapse. An unhealthy behavior happens every day of the week. It could either involve eating unhealthy food or failing to exercise.

The relapses are definite areas of concern. During these times, you need to sit down with a pen and paper and list the things that you can control that may have contributed to the relapse or collapse. Maybe you didn’t limit television time. Or maybe you slipped yourself and bought some unhealthy snacks.

Then, you need to list changes you can make at home to promote maintaining healthy habits.

Remember parents. It won’t do much good to make these lists if you don’t follow through on the changes you need to make. And, finally parents, and children...by now, you know I believe in making lists...writing things down.

Differences between normal and overweight people

I have some comparisons between things overweight and normal weight people do. This list will give you some things to think about, observe and hopefully change. First the things overweight people do:

• skip breakfast
• sit at desks all day
• snack too much on junk food
• always take the elevators or escalators
• walk around with drinks or food
• feel physically tired at the end of the day
• head for the sofa and t.v. to relax
• eat a large dinner late in the evening
• over-exert during rare exercise sessions
• eat midnight snacks
• stand impatiently at traffic lights and bus stops
• drink soft drinks when thirsty
• stand impatiently in store lines
• sit in one position for hours
• eat fast food three or four times a week

That’s while normal weight people

• eat a healthy breakfast
• get up every thirty minutes for two or three minutes of moderate activity
• schedule mid-morning and mid-afternoon snacks that are healthy for them
  take the stairs
• eat at the dinner table
• go for a walk or ride a bike to reduce stress and unwind
• eat a moderate dinner in the evening
• exercise moderately most days of the week
• sleep soundly because of a regular exercise schedule that helps reduce stress
• shift weight from side to side at traffic lights and bus stops
• drink water when thirsty
• do toe raises or shuffle their heels forward while waiting in store lines
• feel hungry when they wake up
• stretch at their desk frequently
• eat fast food only once every couple of weeks

Parents, it takes time and determination to go from an unhealthy to a healthy lifestyle, but, the rewards are worth it. Occasionally, children will become defiant or depressed while trying to make the transition from one lifestyle to the other. If you detect this behavior I suggest you contact a professional.

Registered Dietitian — Heidi Schumacher

Parents, you should teach your children that all three meals are essential in maintaining a healthy lifestyle. And, better yet, make a habit of preparing all three meals for the whole family.

Children often see their parents skip breakfast because you “don’t leave enough time” to eat in the morning. Some parents even think skipping meals will help them eat less and lose weight. Skipping meals, especially breakfast, is similar to asking your car to run without gasoline. Eating throughout the day is important to keep both your body and mind functioning properly. People who skip meals actually find it harder to lose weight than those who eat frequent small meals and snacks. Our bodies need us to “break the fast” in the morning.

Going long periods without eating such as sleeping all night and then skipping breakfast, and possibly even lunch, negatively affects our metabolism. It causes our bodies to actually slow down and burn less calories. The result is that we don’t lose weight and may even gain unwanted pounds.

Skipping meals can also make us eat far too much when we finally do eat. We tend to overeat or load up on high calorie snacks to hold us until our next meal. Studies also show that children who eat breakfast do better in school!

A healthy breakfast

A healthy breakfast should include protein such as eggs or egg substitutes, low fat cheese, peanut butter, low fat milk or yogurt.

You should also have a complex carbohydrate, such as bread, grains and cereal. When shopping for cereals, make sure you compare sugar and fiber content, looking for no more than 5 grams of fat and 15 grams of fiber. Oats is a great cereal for meeting this requirement.

Other healthy breakfast meals include low fat cheese toast, peanut butter on a bagel, fruit and skim milk, and an egg with whole wheat toast.

Breakfast does not have to consist of traditional breakfast foods. Eat a turkey sandwich or peanut butter and jelly sandwich on whole wheat bread.

Either will provide you a complex carbohydrate and a protein. Try an English muffin with ricotta cheese and salsa or a tortilla with beans and low fat cheese.

If there just isn’t time to sit-down for breakfast or you have a child who just doesn’t seem to get going in the morning, consider some breakfast meals that you can take with you. A bag of dry cereal or a low fat breakfast bar might work, or a small bagel or English muffin with peanut butter. You could also hand him a small carton of juice or a smoothie made with skim milk or yogurt and fruit to get in a serving of fruit.

Sometimes parents it’s helpful to prepare a pitcher of fruit beverages to have stashed in the refrigerator to grab on the run. Be creative! And remember your kids will probably do what they see you do. Sharing breakfast is a great time to not only eat together, but also give your kids some encouragement for the rest of the day.

Exercise Physiologist — Melinda Sothern, Ph.D.

Parents, it’s important to make sure your children are comfortable with what ever body type they inherited from you. And, body type is hereditary. While specific training can alter some aspects of your shape and posture, it can’t change everything. This means, some children may never appear as lean as others with different genetic profiles. However, they can always work to stay in good shape.

Some kids have denser, heavier muscles and bones. Their muscles are composed of more thick fibers called “fast twitch” that can generate lots of power over a short period of time. They have fewer “slow twitch” type fibers which generate less force, but can go for long periods. Their body types are better designed for activities requiring strength and power such as football, baseball, martial arts, boxing, wrestling, weight lifting, shot put, discus, long jump, ice skating, ice hockey, water polo, sprinting events in track and field, swimming, springboard diving, gymnastics and tumbling.

Others have a more average type frame. They will have about an equal amount of fast twitch and slow twitch muscle fibers. These people tend to do well in all types of middle-distance and moderate-intensity activities such as swimming, dancing, or brisk walking. They are also well suited for individual sports; martial arts, tennis, archery, bowling, sailing, golf, softball, hiking, snorkeling, scuba diving, water skiing and middle-distance field events.

Some children have body types that are more suited to do long distance events such as basketball, soccer, football, ice hockey, field hockey, track and field, long distance runs, pole vaulting, marathons and triathlons. Note, these are moderate to vigorous intensity exercises that take long durations of time. That’s because children with this body type have more slow-twitch fibers. It is important for kids to do all kinds of exercise, no matter what their body type. Keep in mind that all activity burns calories and improves overall health.

And, parents, children may need your encouragement in some areas. They will naturally gravitate to the sport that is more inline with their body type. For example, girls with large frames and heavy bones are more likely to excel in sports requiring strength and endurance such as volleyball, baseball and basketball. That’s while boys with small frames will do well in martial arts, gymnastics and soccer. It’s fine for kids to have their favorites. But, you should expose them to as many activities as possible, in settings that are both nurturing and inviting.

As your children get settled into an exercise routine, it’s easy for them to get bored. That’s when you may want to steer them toward cross-training. There are four basic types of cross training.

Cross-Training

• Continuous cross-training is a regimen where you alternate endurance activities such as jogging and swimming. You do them at a consistent pace, at a specified period of time, from three to five times per week.
• For interval cross training, the child gravitates among a variety activities, with periods of rest in between them. For example, the child may run very hard for one lap, walk easily for two laps, jog moderately for one lap, run very hard for one lap, and so on. The rate of intensity varies from very high to very low.
• Fartlek cross-training is a more casual version of interval training, that’s typically done outdoors and on roads and trails. Children casually decide which routine they want to pursue based on how they feel at the time, or the lay of the land. They may run up a hill for ten minutes, walk on a level surface for five minutes, slowly jog downhill on flat land for 15 minutes, or whatever they feel like doing.
  Circuit cross-training includes both strength and endurance exercises. Children move from one station to another, alternating between strength exercises like stomach crunches, to aerobic exercises like marching or running in place.

Parents you want to encourage your children to experiment with all these forms of exercise to see what works for them. See which programs appear too challenging, which ones leave your children feeling happy or sad; whether they sweat too profusely or their ankles, knees, or other joints hurt. Respond to the trouble areas, shortening programs, giving children more time to rest, more water.

The amount of sleep a child gets can also be a major factor in how well he or she handles an exercise routine. Once your child is settled into a formal exercise routine, he or she will often be challenged to stay on course. Trips to visit relatives during the holidays or summer vacations will interfere with your schedule. Plan stops at play grounds or parks in advance. If you are staying in a hotel with a pool, take advantage of it. Ask about exercise rooms. Take trips to zoos that will force you get out and do some enjoyable walking. If it’s a winter trip, try to get in some skiing, sledding or even just get out and build a snowman. If your children complain about having to stay active, remind them that they will feel sluggish if they do not exercise while on vacation. And, it will be much harder for them to get back into their routine when they get back home.