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Prevention of Obesity

Susan R. Johnson MD, FAAP, 3/10/2000 (rev 11/29/12)

By the time I reached 6th grade, I was probably 25 to 30 pounds overweight for my height. My pediatrician placed me on lots of calorie restricted diets all of which didn't work. I even tried the high fat/ high protein diet that is now back in vogue. All of this dieting just made me focus more on food. By 7th grade I had become a walking dictionary for the amount of calories in just about every type of food. As a young teenager, all of this emphasis on losing weight made me think that what I looked like on the outside was more important than who I was on the inside.

Childhood is the time for prevention of obesity. Health habits are not yet well established and recommendations to improve nutrition and increase the level of physical activity are more easily made when a child is young and eager to learn and before the child has become overweight. The FAMILY is the key for change since children's preferences for foods, level of physical activity, coping strategies in response to stress, and even communication styles are closely related to those they see modeled by their parents and other significant people in their life. In addition, the warmth and presence provided by an involved family and their extended community protect children from feeling powerless and alone.

Here are a few things that we can do right now to improve everyone's health and well-being:


I. To improve nutrition and foster healthy eating habits:

1) Eat more organic/biodynamic, fresh fruits and vegetables and less junk foods (like those foods containing mostly sugar, high fructose corn syrup, and partially hydrogenated (trans) fats). High sugary foods like sodas, pastas, and white breads cause too much sugar to enter the bloodstream too quickly and thereby overstimulate the pancreas to release too much of the hormone, insulin, into our blood. Excessive insulin pulls too much sugar (glucose) out of the blood stream and into our cells. The resulting drop in our blood sugar level can then trigger a reactive hypoglycemia, a low blood sugar level, with symptoms of dizziness, irritability, and fatigue (in children one sees temper tantrums and meltdowns). Low blood sugar stimulates increased cortisol production by the adrenal glands which causes the formation and accumulation of tryglycerides (extra fat) in the body. Therefore it is the over-secretion of insulin that leads to the accumulation of fat in the body. Genetic and epigenetic factors may determine an individuals sensitivity to sugar and the amount of insulin released by the pancreas in response to sugar.

Good quality fats and proteins do not stimulate much, if any, secretion of insulin by the pancreas. Complex carbohydrates, such as fresh vegetables and fruits, only stimulate a little insulin release because they have fiber and are more slowly digested. Therefore the sugar in these foods more slowly enters the bloodstream. when we are more physically active, we decrease our need and secretion of insulin in response to sugar. On the other hand, poor quality fats such as trans fats and partially hydrogenated oils that result when cooking in corn oil make our cells more insulin resistant so more insulin is needed in response to sugar.

2) Consume good quality fats and proteins like organic eggs, avocados, wild salmon, presoaked/slow roasted almonds and walnuts, green pumpkin seeds, sunflower seeds, raw cheeses, and yoghurt and kefir made from organic raw milk. Organic raw whole milk is considered more healthy than nonfat milk because the fat contains minerals and the enzymes and beneficial bacteria haven't been destroyed by heating (pasteurization). Non-organic, homogenized, ultra-pasturized whole milk is the worst milk to buy because the enzymes have been inactivated by heat (making it very hard to breakdown the milk protein-casein), the fat globules have been disrupted by homogenization, Vitamin B 12 has been inactivated,and pesticides and hormones are contained in the fat. Homemade almond milk also provides an excellent source of protein and fat in addition to being a good source of calcium and magnesium.

3) Choose to eat grass fed beef from cows that are allowed to graze in pastures. Choose organically fed chickens and turkeys that are allowed to roam free in sunshine and not confined in indoor cages or wooden structures without windows.

4) Read the book, Gut and Psychology Syndrome by Natasha Campbell-McBride. Fat accumulation also results from Candida overgrowth in the intestine and having a "leaky" intestinal lining. We often can't lose the excess fat in our body until we heal our intestinal lining and restore the good intestinal bacteria by eating fermented vegetables, yogurt, and probiotics. Avoiding foods high in sugar and refined carbohydrates like breads and pastas (that are body quickly converts to sugar) will help eliminate the candida or unhealthy yeast organisms in our intestine and body.

5) If not getting enough omega 3 fatty acids in your diet then consider taking Nordic Natural's Arctic D cod liver oil (1/2 tsp/day for 3 to 5 year old children and 1 tsp/day for children 6 years and older). Flax seed oil can be given to infants that are no longer breast-feeding and toddlers less than 3 years old.

6) Encourage three regular meals plus 2 healthy snacks every day. If children constantly snack, then they never experiences hunger between meals and do not learn to eat in response to their own hunger cues. Eating sugar filled snacks all the time chronically stimulates the secretion of insulin from the pancreas, and therefore, the accumulation of more fat in the body. Skipping meals tells the body that food is scarce, and the body will then lower its metabolic rate and not burn as many calories. Avoid unscheduled snacks, which teach a child to eat in response to many different feelings such as boredom, loneliness, frustration, anger, and sadness instead of only hunger. Children need to learn that food only solves the problem of hunger and never resolves these other feelings.

7) Avoid discussions about eating or food during meals. Mealtime should be enjoyable and a chance for the family to share in each other's day. Discussions about food at the table will make mealtime a battleground and an unpleasant experience for all.

8) Children need to learn how to recognize their own internal cues of hunger and to eat only when hungry. Children need to decide if they are going to eat and how much (from what is served on their plate) they are going to eat at each meal. Parents are in charge of the kinds of foods that are served and the timing of meals. If a parent is always telling a child how much to eat, then the child learns to respond to the parent's needs and not to the needs of his or her own body.

9) Be sure children get plenty of sleep at night. If we do not get enough sleep, our adrenal glands will secrete excess cortisol and cause the accumulation of more fat. In addition, if we do not get adequate sleep, especially the sleep before midnight, our liver can not store adequate amounts of sugar to supply energy for the brain. Normally the liver would store sugar as glycogen starting mid-afternoon and continue storing sugar as glycogen until 3 AM. After 3 AM, the liver would slowly breakdown the glycogen to proved the brain with a steady flow of glucose for the entire day. If the liver does not store enough glycogen during the night, then we wake up feeling tired and craving sugar. When we eat lots of sugar we again cause our pancreas to over-secrete insulin and our body will accumulate more fat.


II. To increase the activity level of the entire family:

1) Decrease the amount of time watching television, videos, and playing on the computer. TV encourages all of us to be passive and inactive and the commercials promote junk foods. TV, videos, and computer games directly activate the stress nervous system and cause our body to secrete cortisol from the adrenal glands and accumulate fat. Finally, all of these screens keep us from communicating heart to heart with each other and distract us so we don't develop other interests and hobbies.

2) Encourage continuous aerobic activities like biking, hiking, walking, swimming, or dancing for 45 minutes, 3 to 5 times per week. Physical exercise is a wonderful way to release stress and it converts fat to muscle and increases the body's metabolic rate. Regular exercise also speeds up the metabolism and allows children and adults to eat more without gaining weight. It also decreases the bodies need for insulin when consuming sugary foods.

3) Encourage little bits of activity throughout the day such as taking the stairs instead of the elevator and parking farther away from our destination so we walk more.

4) Encourage out children to do chores for at least 30 minutes per day. Chores are a wonderful source of exercise. Children also feel valued and part of the family when they do chores.

5) Change family activities and even holidays so they are not just centered around food. For example, it would be healthier for everyone to play a family baseball game on Thanksgiving instead of just eating. We could take a walk to the park instead of a drive to the ice cream parlor. We could take a family walk together at night to talk instead of talking over a second helping of dessert at the dinner table.


III. To improve the communication and expression of feelings in the family:

1) Avoid making food the main symbol of nurturing and love in our family. Food often becomes the main way we reward and nurture ourselves and our children. Work on fostering unconditional love in the family rather than conditional love. Be fully present. Children need the warmth of our full presence otherwise they will generate their own warmth by physically adding fat.

2) Improve our ways of communicating with each other and learn to speak up about our feelings. Feelings that are not verbally expressed or resolved often lead to overeating as a way to cope. We need to help each other recognize what moods trigger eating and explore other ways of dealing with our moods, such as talking about our feelings, problem-solving, and exercising. We need to teach children that eating only resolves the feeling of hunger and can't offer any long-term solutions for the feelings of anger, sadness, loneliness or boredom.

3) Seek the help and support from friends, relatives, ministers, physicians, or counselors if problems like alcohol use, drug use, depression, or constant arguing are interfering with your families ability to relate and be present with each other, share feelings and needs, make requests, and find solutions.


IV. To serve as role models to our children:

1) Be physically active, eat nutritious foods and get plenty of sleep at night.

2) Be good communicators and talk about feelings. We also need to reduce multitasking and be more present to the moment. Our children need our full attention (heart, mind, and physical presence). They need to be filled-up with our presence. Sometimes we only are there physically with our children while our hearts and minds are somewhere else. Children feel this disconnect from us and sometimes use food as a way to comfort themselves and fill in the gap.

3) Avoid criticizing our own body shape or our children's body. Otherwise, we teach our children that bodies are something to be ashamed of. Our children then start believing that the way their body looks on the outside is more important then the kind of person they are on the inside.

4) Discourage jokes and laughter aimed at people that are overweight. This reinforces our society's messages to children that being fat means more than just being overweight, and it supports all the negative stereotypes associated with being overweight.

5) Finally, teach our children that "All bodies (regardless of size or shape) are good bodies".


V. With respect to weight loss goals:

1) Overweight children and growing teens can often maintain their weight to achieve their weight goal. By maintaining their weight, children can lose up to five pounds for every inch they grow in height.

2) It is important that adults, teenagers, and children never try to lose more than 1/2 to 1 pound per week; otherwise they may lose protein or muscle instead of just extra fat. Rapid weight loss in a child can also suppress their growth and lead to vitamin deficiencies.

3) Parents and children that are trying to lose weight need to weigh themselves only once a week. Our weight can fluctuate anywhere from 1 to 4 pounds during a single day because of water gains and loses. A consistent loss of weight over a weeks time represents loss of fat. Having a child (or adult) use a scale to weigh themselves should be viewed simply as a way for that child (or adult) to learn about their bodies. Weighing the body each week teaches us how much we can eat and how active we need to be in order to either maintain our weight or lose 1/2 to one pound per week.

4) Weight goals can be made, but rewards and praise should be given for accomplishing changes in nutrition, activity level, or problem-solving and not for weight loss. Focusing on weight and attaching rewards to weight loss will increase battles around food and heighten a child's preoccupation with weight and eating. Many feel that it is the preoccupation with weight and dieting that has led to the increase in disordered eating among our children.

Finally, all of our bodies are beautiful and serve as a vessel for our Spirit. It is our task to love them and take care of them as best we can.


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YouandYourChildsHealth.org is a library of health information about raising children and creating a healthier family life. This Living Book also contains personal stories about the joys and triumphs, as well as the struggles and challenges, we face as parents. It is made freely available as a public service.

© Susan R. Johnson, M.D., F.A.A.P.
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