Nestle Tollhouse Cookies

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Nestle Tollhouse chocolate chip cookies... Boy do I love them. In fact, I simply cannot control myself when they are around. For this reason, I have never baked them with my children. So you can imagine my horror when my husband decided that he just HAD to bake them with the kids today. At first I protested. But then I thought about it. It is okay to bake cookies every once in a while. But how could I do that without going crazy? And without my kids binging on cookies for the next few days.

Doug came home with the cookie dough. I have never seen such a big roll of cookie dough. He saw me look at it and said, "I had the choice of the one that made 17 cookies or this one that made 32 cookies. And this one was only a dollar or so more expensive!" Hmmm... my husband fell into the 'super size me' trap. Yes, it may make more sense from an economic standpoint. But we do not need to eat 32 cookies- regardless of the price.

But then Doug said something that made a lot of sense. "I just figured we would make a few cookies for today and freeze the rest of the cookie dough until we decide to bake them again."

What a great idea! We didn't have to make all the cookies at one time. Instead, we made a small tray of cookies with just enough for each of us to have three or four (not at one sitting but over the next day or so). And we just stuck the rest in the freezer. We were all happy, indulging in the most delicious cookies. But we were not overdoing it. And I know that if we had made all the cookies, they would be gone in a few days (or until I got sick of the kids eating them and just threw them out in the trash). And that really would not have made economic sense!

Ha! As I sit here typing this, I realize that I should divide the rest into three or four small bags before it freezes so I can just take out another small portion when we want to bake again- without having to defrost the whole thing. I think I will go do that right now!

Healthy Fettuccine Alfredo

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My family has discovered a healthy way to eat Fettuccine Alfredo. We found a packet of Alfredo Sauce mix from Knorr's at our local supermarket. There are 180 calories and 4.5 grams of fat in the entire package (which served our entire family). The directions call for butter/margarine and milk but we didn't follow them. Instead, we mixed the packet with skim milk and omitted the buter/margarine completely. I will admit that the sauce was slightly thin- but it was delicious. We served the sauce over whole wheat fettuccine. My children went crazy for it. My daughter said, "Mommy, I love this!" My son proclaimed, "This is my new favorite dinner!" I was thrilled- although I did warn them that we would NEVER order the dish in a restaurant because the restaurant version is so unhealthy. Try it and let me know what you think!

Let's go nuts!

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Nuts are an extremely healthy snack for kids because they contain the healthy type of fat: monounsaturated fat. Monounsaturated fats actually don't raise 'bad' cholesterol but do raise 'good' cholesterol. The fiber in nuts helps to keep you full and the high fat level helps to keep you satisfied. Nuts have been shown to be part of a healthy diet. They can even decrease your risk of heart disease! Of course, you want to watch your portion size because nuts do contain calories. But if you keep your intake at a moderate level, they are a great snack.

Great nuts to snack on include:

peanuts (which are actually legumes but have similar a nutrient profile to nuts)
walnuts
almonds
pistacio nuts
macadamia nuts
cashews
pecans

One other caution about nuts: they should not be given to children under the age of two years. If you have a strong family history of nut/peanut allergy, wait until your children are three years before you introduce them. You also want to watch your children as they eat nuts as they can be a choking hazard. Children should be sitting down while eating nuts.

Enjoy!

Thanksgiving Dinner

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Well, the Thanksgiving weekend is finally over! How did you all do? Did you follow my 'Holiday Tips?' My family did- and we survived Thanksgiving without any extra pounds (or cholesterol).

I gave my kids a snack before heading out to my Aunt's house. When we got to the party, I let my kids eat a few appetizers and then encouraged them to leave the den with the food. Instead, I set up some activities in the next room. We started dinner with a salad. Then, when the main course was served, my husband and I made plates for both kids. I started their plates with a nice serving of white meat turkey and some broccoli. Then I added two tablespoons of mashed potatoes and a medium serving of candied yams. I avoided the stuffing because it is very caloric and while my kids like it, they don't love it.

After dinner, the kids ran to play while the adults helped clear the table. Then, dessert was served. Each child got to pick their dessert of choice. One serving and they were done.

We definitely had a happy Thanksgiving! Hope you did too.

Back from Disney World

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Hi everybody! I am back from my vacation and my blogging hiatus. We took the kids to Disney World and we all had a blast. I was actually very impressed with Disney, in terms of nutrition. Of course, they had the junk food. But they also had healthy options. In fact, they had a fruit and vegetable cart in the middle of the Magic Kingdom! And to my delight, there was a line waiting for fruit. (This was actually one of the very few lines we saw at Disney! The place was empty.) Also, all of the restaurant/cafeterias had kids' meals which came with a main course and a choice of two of the following: grapes, apple slices, carrot sticks, or applesauce. None of the kids' meals included french fries. Fries were available for an additional charge. What a great idea! Why not make the fruit and veggies the standard- with an option of fries, rather than making fries the standard with the option of fruit/veggies. I think Disney has it right. Hopefully other companies will follow suit!

Subway

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I had a great meeting with Subway today. The Subway people are intent on providing healthy choices for children. Lanette, the official Subway Registered Dietician, went over the menu, pointing out all the healthy options. They are offering kids' meals with a choice of mini-sandwich with baked potato chips, low-fat yogurt, or apple slices. They also offer bottled water, juice, or low-fat milk for a beverage. They are proud that they do NOT include a cookie with the meal (although they do include a toy). The Chief Marketing Officer told a story about going to McDonald's and ordering apple slices. The server placed the apple slices and a container of caramel on his tray. He said, "No thanks. I don't want the caramel," and the server said, "But it all comes together." "Why," he asked. "Aren't apples naturally sweet enough?" It seems that McDonalds insists on making everything more caloric than it needs to be. Subway does not. Subway is also spending money promoting children's health issues. Jared was also at this meeting. What a nice guy. He has started his own foundation to increase awareness about childhood obesity. He goes to schools all over the country, warning kids not to make the same mistakes that he made.

I can honestly say that I endorse Subway and its products. Parents can be sure that Subway will provide a fast, inexpensive, HEALTHY meal for their children.

How to teach your children to enjoy fresh herbs in their food.

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Herbs add lots of taste to food without adding lots of calories. But most of my patients tell me that their children refuse to eat anything with 'clumps' of green in it. They are missing out on a very low-calorie way to make their food taste better. Read on to see how I handled introducing my children to herbs in their food.

The other night, I was eating a dinner of chicken and barley. The chef had used a bunch of different herbs in the seasoning. I didn't know which herbs they were- but they smelled and tasted great. My kids were examining my plate, as usual. "Mommy, I want some rice," my daughter told me. I let her try the barley and she liked it. "This type of rice is called barley," I explained. "What's this?" my son asked, pointing to a dark green leaf on my plate. "That's a seasoning, a type of herb," I informed him. He wrinkled up his nose. I told him, "It smells and tastes great. And it's healthy!" He looked at me skeptically. "I want to smell it," he said. So I held the leaf up to his nose and he inhaled the aroma. "It smells good," he said.

Now- you have to realize that my mother has an herb garden and has always let him smell and taste the different herbs. We had conditioned him to the idea of herbs.

"It tastes great, too," I said. He agreed to try it. "Wow, it does taste pretty good." I replied, "It makes my chicken taste extra fresh and extra delicious." "Cool," was his reply.

Let's analyze this a little more closely.

The first step is to introduce your kids to herbs from a young age. Plant a small pot of parsley and mint. Let your child watch it grow. Water it together. Pick leaves, smell them, and taste them. Teach your children that these herbs make food taste better and are very healthy. Then, when they encounter them in restaurants (or even at home), they are used to the idea of 'leaves' in food.

Secondly, let them see you enjoying foods with herbs. Zachary was skeptical until I told him that it makes food taste great. It was a stress-free environment. I don't think it would have been as successful if I have put a plate of chicken with herbs on his plate. But since it was on my plate, he knew that he didn't have to eat it if he didn't want to. Plus, everything tastes better from mommy's plate!

I also think it helps to let them smell the herbs. Our smell sense is closely related to our taste sense. He smelled it and recognized that it smelled just like the herbs he grows with Grandma.

Finally, ask them to taste it. Just be sure to act very positively about it. Don't say, "Taste it. You don't have to eat more if you hate it." That implies that you think there is a good chance he is going to hate it. Instead, say "Taste it. I just know you are going to love it as much as mommy does!" It puts a more positive spin on the food.

Good luck!

Why don't I exercise more often?

My patients often tell me that they want to exercise. They have no problem starting an exercise regimen. Yet they are unable to continue with an exercise regimen. "I always have such good intentions," they tell me. "I even plan when I want to exercise. But then something always comes up and it just doesn't happen."

How can we handle this? The bottom line is that exercise is essential. Planning is definitely the first step but you have to follow through. Consider it an appointment. You wouldn't just bail on a doctor's appointment or a piano lesson. So don't bail on your exercise. If you have a calendar, write it down. Don't accept any excuse to cancel.

Another idea is to exercise with a friend. If you can't actually exercise with a friend, at least pick an 'exercise buddy' to keep you on track. Make a deal with a friend that you will report to each other with your exercise progress. It is psychologically more difficult to skip an exercise session if you know you have to report to somebody.

You can also come up with a reward for yourself for perfect exercise attendance. For example, treat yourself to a manicure if you work out four days this week. Or ask your parents if you can stay up a half hour later for each day that you exercise.

Don't let excuses derail your exercise plans. Stick to your program and you will see great results.

How was Halloween?

Hopefully, we are all coming out of our Halloween chocolate-induced comas. Now it's time to reflect on the holiday. How did it go? Did your children eat every piece of candy in sight? Or were they able to moderate their intake?

I'll be honest... my plan backfired. Throughout the year, I monitor my kids' junk intake but I have a sweet spot (ha!) for Halloween. So, as in the past, I told my children they could eat as much candy as they wanted. In the past, they ate a decent amount and then decided they were finished. This method allowed my children some unrestricted candy intake- but I was there to make sure it didn't go overboard. And in the past, I didn't have to intervene.

This year was different.

My son didn't stop eating chocolate. I broke my first rule by not leaving enough time for my children to eat a healthy snack before leaving the house. So we went trick-or-treating on an empty stomach. And we went before dinner so they were hungry.

By the time we got back home, I was in a bind. Naively, I had told my son that he could eat as much candy as he wanted. But I realized that I didn't really mean it. I was getting nauseous as I watched him eating chocolate after chocolate. My husband and in-laws actually intervened. We were all aware of the irony of them telling me that I was giving the kids too much chocolate. Luckily, they played my usual role of the 'bad guy' and made him stop eating. But I learned my lesson. There will be different rules next Halloween.

Hmmm... maybe I need to read my own newsletters a little more closely!

Happy Halloween. And don't forget to vote on Tuesday.

Newsday's Article on School Lunches

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The recent articles in Newsday about school lunches were interesting. Schools need to make money (or at least not lose money) on food sales. The sad truth is that the healthier the meal, the fewer kids want to buy it. One statistic showed that schools make up to half their profits on the sale of chips and cookies. At a recent PTA meeting in my district, the moms told me that their kids have been complaining about the pizza. They said that the children no longer wanted to buy lunch on 'pizza Fridays'. This change occurred at the same time the school began serving whole wheat pizza with low-fat cheese. I don't know how to solve this dilemma. Perhaps as parents we need to convince our children that healthier food is better for our bodies, even if it doesn't taste as good. My experience has shown me that school officials are more than happy to make these healthy changes. It is the parents (and the children) who are hampering the process. Parents want school lunches that their children will eat. And children don't want to eat the healthier options. At our PTA meeting, the parents will asking for the old (more fattening) pizza instead of the healthier pizza. Personally, I tell my kids that they need to eat the healthier food. I don't really give them a choice. If they don't like the school option, they can bring a healthy lunch from home. But then the school loses money. It is a hard situation.

Desperate Housewives

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I recently read an US Weekly article about the overweight child actress, Madison de la Garza, on Desperate Housewives. Critics fear that the actress's self-esteem will suffer from being ridiculed on television. I certainly feel bad for that little girl. It's one thing for an adult to decide to be the butt of a joke on TV; it is something else for parents or an agent to decide that. At one point in the show, Gaby is driving the car and making her daughter, Juanita (played by de la Garza) run after her- for exercise. Every time Juanita gets close, Gaby drives a little further. It's so degrading. The producers claim that they arrange the shooting schedule so Madison doesn't see the jokes about her being filmed. But at the end of the article, they talk about the actress watching the episodes with her family. So obviously she realizes that she is being made fun of. Child obesity is serious. And the show is making it into a joke. A fat joke. I really don't approve.

Nutrient Rich Foods Index

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Adam Drewnowski, PhD, has an interesting proposition. He wrote an article for the Nutrition Reviews magazine, in which he discusses his proposed Nutrient Rich Foods Index. He wants to rank foods based on their nutrient content. Foods with unhealthy nutrients would be lowly ranked. Foods with healthy nutrients would be highly ranked. Dr. Drewnowski would like all food packages to be labeled with the foods nutrient foods index so consumers would know which foods are healthiest.

In theory, it sounds like a good idea. I am assuming that higher calorie foods and higher fat foods will be given lower ratings. We definitely need something to help consumers make better choices. Perhaps this will be it!

I will keep you posted on any developments!

Trans-Fat Free

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The FDA is allowing nutrition packaging to mislead us. A patient brought in some delicious Fiber One muffins the other day. She also brought the box so she could show me how healthy these muffins were. As we looked at the nutrition label, she said, "I used all the mix but made one quarter the number of muffins because otherwise the muffins wind up way too small." So to be accurate, we would have to multiply everything on the nutrition label by four to get an accurate assessment of what we had eaten. I looked at the front of the box. It said, "Trans-fat free" in big letters. I then looked at the nutrition label. Trans fat: 0 g. But then I looked at the ingredient list and there it was- PARTIALLY HYDROGENATED SOYBEAN AND/OR COTTONSEED OIL. Wait a minute... a partially hydrogenated oil is a trans fat. How can they advertise that it is trans fat-free when there is a trans fat in the ingredient list?

Let's look at this more closely:

Serving size: 1 muffin Serving we actually ate: equivalent to 4 muffins
Calories: 190 Calories we ate: 760
Total fat: 3 g Total fat we ate: 12 g
Trans fat: 0 g Trans fat we ate: WE DON'T KNOW!!!

How is it that we don't know how much trans fat we ate? Because a product can be advertised as 'trans fat-free' if it has less than half a gram of trans fat per serving. But we ate four servings! So we may have eaten up to 2 g of trans fat, which is a large amount.

Beware of hidden trans fats! Always look for hydrogenated or partially oils on the ingredient list. If they are on the list, the product contains trans fats so be aware of the serving size.

By the way- I wouldn't eat those muffins again!

When you slip up...

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What should you do when you lose control? You have been eating healthy foods with proper portion sizes and then... boom... you go crazy. Maybe you drank a glass of wine or two. Maybe you hit the dessert platter with a vengeance. All you know is that you didn't do well. Now what?

The mistake that many people make is thinking, "Okay, I blew the day (or the week) and no matter what I do now, I can't recover from it. I may as well eat the rest of this cake. I will get back on track tomorrow (or next week).

No, no, no! That is the worst thing you can do. The moment you catch yourself, get right back to your good habits. Even if your 'slip' was 2000 calories worth, it is still better than a 3,000 calorie slip. Don't fall into that trap. Immediately get back to your good habits and a slip won't turn into a neverending slide.

What is an ideal weight?

I think our society is very confused about ideal weight. Your ideal weight is NOT the weight at which you could model on the cover of Sport's Illustrated Swimsuit Issue. It is ironic that a society so obsessed with looking emaciated is also so overweight.

My program is targeted to overweight children and teens. A child whose belly does not look completely flat in a bikini is NOT an overweight child. I often have parents (almost exclusively size 0 parents) bringing in their gorgeous, curvy teens, complaining that they are 'fat'. Some will lament that their daughters gained twenty pounds in a year but are unfazed when I point out that they also grew five inches during that time. Children are supposed to gain weight and girls bodies change as they grow and mature. A woman's body is supposed to have curves and yes, some flesh. As mothers, we need to teach our children to love their bodies. Overweight children must lose weight to prevent serious health complications. Yet even those children can be taught to think positively about their bodies. I always frame these discussions by explaining that even though a child looks great, his/her weight can be harming his/her health. Weight loss should be for health, not for bikinis.

Moms, if your child is truly overweight, it is essential to get some help. But please don't chastize your daughters for turning into the women they are destined to become.

Indulging with thought

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I am usually a very healthy eater. But every now and again, cravings strike. When I first sense a craving coming on, I sit with it. Very often, it passes. Last night, it did not pass. In fact, I felt it growing stronger and stronger. And since I usually am able to wait them out, when my cravings get that strong, I indulge. I know that if I do not indulge these cravings, they will overwhelm me. I would estimate that I give in like this every three or four months. Last night, I indulged.

Doug, my husband, is very familiar with these cycles. All I have to do is look at him and say, "It's time" and he says to the kids, "C'mon guys, we're going to Friendly's." My Friendly's decadence is always the same. I am actually embarrassed to write it... but I want to be honest with everybody. I order fried clams with well-done French fries and then a Reese's Peanut Butter Cup Sundae. DELICIOUS!!

But I did feast with thought. The clams were incredible but the French fries were just good. I was not going to waste calories on good so I pushed them to the side of my plate and decided not to eat them. Had the fries been amazing, I would have eaten them. I ate the clams slowly, really tasting each bite. I noticed the sensations on my tongue and paid attention to the crunch. I got most of the way through the clams and felt myself getting full. So I stopped eating. I did not want to get too full to enjoy the ice cream. I ordered my sundae with extra fudge and extra peanut butter sauce because if I was going to do it, I was going to do it right! It was incredible. But halfway through, I realized that I was getting too full. And I hate that stuffed feeling. I felt so conflicted. I so rarely eat like this and I didn't want to stop eating. But I knew that I would regret it if I overdid it. So I put my spoon down. And I stopped eating. And that was that. I really enjoyed myself. And I woke up this morning ready to enjoy the healthy fare I usually eat.

It was interesting to watch my children at Friendly's. I watch what they eat carefully but they do have junky food in moderation. They were thrilled to be at Friendly's. Zachary said, "Daddy, I can order anything I want... even chicken nuggets and French fries." But when our meals came, Zachary and Danielle each ate only half of their order. And they did the same with their sundaes. They ate half and then told me that they were full. I was very proud. They indulged the same way that I did. They ate what they wanted and stopped when they were full.

Like my mom always says, "Everything in moderation, including moderation!"

Watch Joanna Dolgoff, MD on WABC Eyewitness News

Click here to watch Joanna Dolgoff, MD on WABC on Eyewitness News.

http://abclocal.go.com/wabc/story?section=news&id=6431034

The Greenvale School Gets Even Healthier!

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I had the opportunity to meet with a head administrator and the head of nutrition at the Greenvale School. I would first like to thank them for welcoming me so warmly. They were very cooperative and listened carefully to my suggestions. It is great to see our schools take such an interest in our children's health. Some suggestions they are considering include offering fruit every morning with their morning snack, serving fat-free salad dressing, using reduced-fat cheese products, and offering reduced-calorie whole wheat bread. I can't wait to see the changes!

Let me know if you would like me to talk to your child's school!

Do we really need to drink 6-8 cups of water a day?

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Do we really need to drink 6-8 (eight ounce) cups of water a day? Contrary to what you might hear from many 'diet experts', there are no conclusive scientific studies proving that 6-8 cups of water a day promotes health.

Some weight loss programs advise people to drink 6-8 glasses of water a day so they don't confuse hunger and thirst. Dehydration can definitely be misinterpreted as hunger, but it doesn't require that much water to prevent dehydration. 4 glasses of water a day should be sufficient. Any intake above that will not have much effect.

Some programs claim that drinking 6-8 cups of water a day will decrease headaches, flush toxins, and clear skin. These maladies may be caused by dehydration, but as I previously wrote, 4 glasses of water a day should be sufficient to prevent dehydration and therefore prevent these problems.

One study from Germany maintained that drinking 6-8 cups of water daily caused an increase in metabolic rate. Looking more closely at the data, scientists realized that this increase in metabolic rate was so minimal that it was insignificant.

So- don't worry about chugging water all day. But don't let yourself get dehydrated, either. Four eight ounce glasses of water a day should be sufficient. And don't forget that caffeine is a diuretic. You must drink an extra cup of water for each cup of caffeinated beverage you ingest!

Not all frozen yogurt is created equal!

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There seems to be some confusion about frozen yogurt and ice cream.

In my program, low-fat frozen yogurt is generally a green light food. But Ben & Jerry's low fat yogurt is a yellow light food. Why? Because Ben & Jerry's yogurt is a 'premium' frozen yogurt, which means that it has a lot more calories than your basic low-fat frozen yogurt. The same is true for ice cream. Premium ice creams, like Haagen Dazs, contain many more calories than regular ice cream.

Many people aren't aware of the large difference in calories between regular frozen yogurt (or ice cream) and premium brands. So be aware when you are indulging. You may be getting more than you bargained for!

How to survive a holiday dinner.

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The Jewish Holidays are here again. Those of you who celebrate them know what that means- LOTS OF FOOD! How can you enjoy this holiday (or any holiday) without gaining weight? It is a struggle, especially if you have family pushing unhealthy dishes on you.

I will share my survival strategy. I pick my favorite unhealthy dish and make sure that I eat a reasonable portion of it. Knowing that I will be able to indulge in something wonderful makes it easier to pass on the less-wonderful, but still tasty, dishes.

I love noodle kugel. My grandmother used to make the best kugel and although nobody's can compare to hers, I still do love it! So I will be eating noodle kugel at my Rosh Hashana dinner. I will not, however, be eating brisket this year. I really enjoy brisket, but not as much as noodle kugel. So I will resist the the brisket in an effort to keep my calorie intake in control. I will also pass on the other fattening foods and concentrate on the (few) healthy options available. I will have turkey and vegetables with my noodle kugel.

The same goes for dessert. Offer to bring fruit salad to your dinner, even if the host doesn't ask you to. This way you can ensure that there will be a healthy dessert option. Don't waste calories on desserts that you can eat any time. So pass on those store-bought brownies and cookies. Instead, opt for the desserts you don't often get to eat. I am going to have a (small) piece of my Aunt Robin's famous brownies. They are decadent and she doesn't make them often. And I will enjoy every bite!

L' Shana Tovah!

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Write to me!

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I just want to let you know that I welcome all of your questions and comments. I can see that you are reading my blog- so write to me! I promise to write back.

My child MUST eat McDonalds!?!

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As shocking as this may be, some mothers are insisting that their children be allowed to eat McDonalds for lunch during school. The Roslyn Middle School principal told the district Health and Safety Committee that each day at lunch, many mothers drive to the school to drop off fast food for their children to eat at lunchtime. What? I can't imagine being so insistent that my child eat something so unhealthy for lunch that I would stop what I am doing during the day, drive to a fast food restaurant, wait on line, and then drive the food to school. And for what? So my child wouldn't have to eat a turkey sandwich for lunch?

The Middle School will be sending home a note explaining that parents may not drop off store-bought lunches in the middle of the day. But what I think is more concerning is that these parents don't realize how harmful this food is for their children. It's one thing to bring a child to Burger King as a treat (although I don't actually do this with my kids). But it's quite another to make sure that this food is a staple of their diet and to go through so much effort to make sure they have constant access to it.

Moms- regardless of the changes made in our school lunch system, nothing beats a brown bag lunch. When you make your child's lunch, you are in complete control of what they are eating. Let's bring back the turkey sandwich.

My ideal school lunch: 2 slices of reduced-calorie whole wheat bread
6 slices of turkey breast, 5 slices of roast beef, OR 4 slices of ham
1 slice of fat-free cheese

1 yogurt or 1 piece of string cheese

100 calorie pack of something yummy

water or crystal light

Roslyn School District

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I had a great day yesterday. I was invited to attend a Health and Safety Committee meeting for the Roslyn School District. Various topics were discussed, including the nutritional value of the foods served in the school cafeterias. I was thrilled to discover that the district had hired somebody to revamp the school lunch offerings. She has already made major strides, including serving whole wheat thin crust pizza made with 2% reduced fat cheese (instead of regular pizza). She also had all the school district deep fryers recycled into scrap metal, since she refuses to allow anything deep fried to be served in Roslyn schools. But what made me even happier was the fact that she (and the entire district, including the Superintendent) were completely open to hearing my suggestions. In fact, we have scheduled a meeting to go through the food choices from start to finish! It is fabulous that our schools are starting to take our children's health more seriously.

There is something that you all can do... please call your school board representatives and your PTA presidents and let them know that you are concerned about the foods offered at your local school. I have been learning a lot about how the school systems work. It seems that it is almost impossible to get anything accomplished without the support of the parents and the PTA. So please make sure that your community leaders know how strongly you feel about this issue! Get involved! Our children need all of our help to ensure their safe futures.

McDonald's does it again

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Well... McDonald's has done it again. Have you guys seen their new ads for the 'third of a pounder' hamburger? What happened- our children weren't getting heavy enough with the quarter pounder so they decided to increase the serving size? Were that many people leaving McDonald's hungry? I'm sorry but nobody should be eating such a large serving size. It's no wonder that the patients in my office have no concept of how much they should eat. When I show them a model of a portion of pasta, they are shocked. They ask, 'how come I am given five times that amount when I go to a restaurant?" Unfortunately, I have no answer for them.

Parents- please be aware of how much your children are eating, especially in restaurants. It is best to order one dish for two children to split, especially with pasta. Restaurant portions are so large and we don't want our children to become accustomed to eating an entire restaurant plate. Get them used to sharing from an early age. Make sure your children understand that restaurant portions are very inflated.

I'm back!

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Hi everybody! I'm sorry for the blogging hiatus but I have been very busy. My practice has undergone lots of changes.

First- we have a new name. We are now called 'Dr. Dolgoff's Weigh: Child and Adolescent Weight Management Program. The change was due to trademark stuff.

Second- we have a new location. We are now at 216 Willis Avenue in Roslyn Heights, N.Y. We now have a suite of offices all to ourself! It feels so great to have so much more space.

Third- my practice have grown. We now have a fabulous Registered Dietician, Lori Palma and a great Social Worker, Danna Gordon. And Marianne Belziti is our incredible Patient Coordinator.

Our new website is www.drweigh.com.

You can reach us at our new e-mail addresses:

Joanna Dolgoff, MD jdmd@drweigh.com
Lori Palma, RD lprd@drweigh.com
Danna Gordon, SW dgsw@drweigh.com
Marianne Belziti mb@drweigh.com

Our phone number is still 516-801-0022. Feel free to reach out to us at anytime!

I'm in the same boat!

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Last Thursday night, I was preparing for a presentation I am giving on 'How To Feed Your Picky Eater'. I was putting together all my tips for parents when I realized it was time for dinner. My nanny had prepared steak (a lean cut trimmed of all fat), mashed potatoes (without butter, milk, or oil) and string beans. Zachary immediately began to throw himself around. "I HATE STEAK!" he screamed. "I WANT TO EAT PIZZA. I AM NOT GOING TO EAT STEAK!" I explained to him that we had eaten pizza the day before at a party and today we eating something else. He would not budge. It was as though I were being tested... was I really prepared to give a lecture about what to do with a picky eater? We would soon find out. I put my foot down. "You will eat what Katie made or you will go hungry. I know that you love mashed potatoes and you need to learn to eat more than just pizza." Zachary told me he would not eat anything and I said that was fine with me. Dinner was served and placed in front of him. Danielle, of course, sat smiling and saying, "Mommy, I love this meal! I'm a good girl, right?" "Yes," I said. "You are a good girl." Danielle and I began to eat and Zachary just sat there. "Can I have peanut butter and jelly?" he asked. "That's healthy." I explained that even though PB&J is healthy, he had to learn to eat with the family. Eventually he took a bite of the potatoes... and then a bite of meat. He ate half the plate by the time dinner was over. At the end of the meal, he asked, "Can we have pizza tomorrow?" I told him I would think about it.

All in all, it was a successful meal. I think I passed the test!

A nice family outing...

I want to suggest a great family activity. My husband and I take our kids hiking on many Sundays. We love to explore new areas and spend time together, doing something active. It shows our kids how much we value exercise. In fact, my husband and I spend most Friday evenings (our date night) either hiking or biking. We can use the time to chat about nothing or talk about bigger issues. Then we head to a local restaurant for dinner- just the two of us. It is a tradition that we both cherish. And it is great for our children to see how much we look forward to going out and working up a sweat. They are always begging to come with us. That's why our Sundays are so special. They get to join in with us- and learn how much fun exercise can be. Our friends joke with us... "So- hiked any mountains recently?" And we usually respond, "Actually, we did!"

Cholesterol medicine promotes donuts?

I was walking in my office and saw the funniest thing: a box of munchkins with a sticker promoting a new cholesterol drup. A drug rep had brought it to the office? What kind of message is that sending? Some things are too ridiculous for words.

Are mozzarella sticks healthy?

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I was at a party yesterday and my son took a mozzarella stick from a waiter and asked me, "Mommy, is this healthy?" I had to laugh. "No, sweetheart. It is definitely not healthy." But it was helpful to hear him ask me that. It reminded me that we are not born knowing what to eat. It really is something that has to be learned. We can't assume that our bodies will make the correct choices. I was also glad that my son knew enough to ask. Many children wouldn't care. Of course, after I told him that they were very unhealthy, he informed me that he wanted to eat them anyway. I responded that it was his body and he could make unhealthy choices if he wanted to. In the end, he ate two bites of it and he was done.

Everything in Moderation, Including Moderation

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A patient came into my office last week, extremely upset. She had been following the plan perfectly for a month and had lost an incredible six pounds already. But she went to a party this week and, according to the patient, 'totally blew it'. She was practically in tears. After calming her down, we discussed the party in more detail. Although she was out of 'red lights', she ate two large cookies. I asked her if they tasted good. She looked at me in surprise. "Yes," she said. "They were delicious." So I told her the only thing I was upset about was that she was feeling guilty about it. I explained that healthy eating is a lifestyle change- not a short term deal. In order to keep this up for the long term, we have to allow ourselves some wiggle room. Nobody can be perfect all of the time- and even if we could, what fun would that be? I am a realist. If we aim for perfection, we are guaranteed to fail. I told my patient that I am proud that she ate two cookies and then immediately returned to her healthy eating. That is the key to success. As my mother always says, 'Everything in moderation, including moderation'.

By the way- she lost two more pounds last week, despite eating the cookies. She was shocked and thrilled- and so was I.

Healthy IHOP

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I had a very pleasant surprise this past weekend. As I mentioned last week, Danielle's birthday was this weekend. She got to pick the restaurant for her birthday breakfast and wanted IHOP. So to IHOP we went. And there on the menu- IHOP's healthy breakfasts for kids. They had a few options, all under 600 calories and 15 grams of fat. Still a lot of calories but I am very impressed with the effort. I ordered my kids the 'fruit face'- a buttermilk pancake decorated with a fruit face, small amount of whipped cream, and strawberry yogurt to use to decorate. They LOVED it- and even left a large amount of the pancake over. I have to say that I will definitely be back at IHOP in the near future!

A delicious and healthy side dish... YUM!

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I made the most delicious side dish the other day. I took a small sweet potato and baked it in the oven for 45 minutes at 400 degrees. I didn't wrap it in tin foil or anything- just sat it on the rack. When I took it out of the oven, I cut it in half and sprayed it with I Can't Believe It's Not Butter spray. Then I added cinnamon and Splenda and mashed the insides up. I can't believe how good it was. The skin was crisp and the inside was warm and soft. The ICBINB spray, cinnamon, and Splenda made it taste like dessert. My kids loved it! And it was so easy.

Just thought I would share... Enjoy!

The Olympics... Sponsored by McDonald's???

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Like many of you, my husband and I have been enjoying the Olympics. I love to watch the athletes move- their muscles are so well-defined and beautiful. But I had to laugh when I saw the commercial with the Olympic athletes talking about McDonald's. How often do you think they actually eat that kind of food? Probably never. What kind of a message is this sending to our children? They see these icons promoting that kind of garbage and think that it is okay to eat. They get the message that it is part of a healthy diet. I expect more of these Olympic athletes. It is disappointing to see them selling out like that. I would love to see them race/compete after eating a Big Mac and large fries.

Also- a follow-up to my post about the birthday party. There were sixteen three year-olds. Two of them asked for a second mini-cupcake and one asked for a third (but only licked the icing off of each one). And I offered seconds three or four times! So it seems that serving smaller portion sizes really did lead to fewer calories consumed. Try it at your child's next in-class birthday celebration!

Birthday parties in school

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As those of you who know me already know, I am against parents bringing unhealthy treats for the class to celebrate their child's birthday. Our children are exposed to so much fattening temptation and there is no need for us to make it worse. I can't tell you how many children have cried in my office because they are trying to lose weight and are faced with 'birthday cupcakes' weekly. On the one hand, they want to be good but it is hard to resist when all the other kids are scarfing them down. Why do we need to celebrate with fattening food? Wouldn't birthday watermelon suffice

I believe that a parent has the right to send whatever they want to for their own child. Let the parent give the birthday child a birthday cupcake. But it is not right for a parent to give somebody else's child a food that his/her parent may not allow.

Okay- so that is what I believe. But that is not the rule and all the parents bring in birthday treats. It is now my daughter's birthday. What do I do?

This is a real issue and besides being a pediatrician/child weight specialist, I am also a mommy. Do I really want to be the only one to bring in fruit? It's one thing if that is the rule; it is quite another thing to have the whole class annoyed that Danielle's mommy didn't bring cupcakes. I wish that wouldn't be the case, but I know it would be. And how would Danielle feel?

I have been struggling with this for days. Here is the solution I came up with. Instead of making large or even regular size cupcakes, Danielle and I made mini-cupcakes and I used applesauce in place of half of the oil. There are 17 children in her camp class and we made 40 mini-cupcakes. I plan to serve each child one cupcake but they can have more if they want more. Psychologically, the children are more likely to eat one mini- cupcake and be satisfied than they are to eat half of a larger cupcake, even though they would be eating the same amount. I am very curious to see how many of the three year olds go back for seconds. By doing this, I feel like I am not being completely hypocritical (just slightly!) Everything is okay in moderation and there is nothing wrong with eating a mini-cupcake. Thirty years ago, they were probably considered regular-sized cupcakes.

So- it will be an interesting experiment. I will let you all know how it turns out. I am also interested in hearing your thoughts about all of this.

Now I've seen it all...

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Now I have seen it all... I went out for dinner in the city last night to celebrate my father-in-law's birthday. We went to a great restaurant called Fresco di Scotto. The waiter began to recite the daily specials and I thought I misheard him. "Excuse me," I said. "Can you repeat the last appetizer, please." He said, "Sure. We are serving fried tomatoes." Fried tomatoes??? Are they kidding? Are we frying everything these days? I've heard of the movie- but I didn't think people actually ate them. What's next? Fried lettuce? Will we destroy every healthy food by deep-frying it? Soon there will be no healthy options left. Fried baby formula, anyone?

How can my child be overweight? He doesn't eat much junk food.

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Almost all of my patients tell me that they don't understand why their child is heavy when he/she doesn't eat much junk food. "He has a pretty healthy diet. We almost never eat fast food. Why is he overweight?"

The answer is easy... portion sizes.

Almost everybody overestimates portion sizes. Think back to the 1950s. Most dinners consisted of meat and potatoes yet people were much thinner. Why? Because they ate much less than we eat now. One serving of a piece is chicken or meat is the size of a deck of cards or the size of the palm of your hand minus fingers. How often do you really eat that little? But back in the day, that was standard and people didn't starve to death. A serving of pasta is about one cup (depending on age). Yet when you order pasta in a restaurant, you are often served four cups or more! Even if you only eat half of your dish, you have still eaten twice as much as necessary.

We need to reset our understanding of normal serving sizes. I don't suggest you do it all at once. If you suddenly cut your servings to ideal serving sizes, you will feel starving. What I do suggest is gradually decreasing your serving sizes. If you normally eat two cups of pasta with your meal, decrease to one and a half cups for a week and then decrease to one cup. Do the same with your protein. If you are feeling hungry, add more vegetables. If you do it slowly, you won't notice the change as much. But you will notice the scale moving down!

Have a Lighter Weigh Day!

How to get yourself to exercise when you are tired.

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Sometimes it takes a lot of motivation to get yourself to exercise. You know you should do it, but you are so comfortable on the couch. Or you have so much on your to-do list and think that you don't have the time. Believe me- I've been there. So how do I get myself moving? I tell myself that I am only going to exercise for 15 minutes. And who doesn't have 15 minutes to spare? I make myself put on my sneakers, thinking that I can do anything for just 15 minutes. And nine times out of ten, I am so into the workout at 15 minutes that I continue for my usual hour. But there are definitely days when, after those 15 minutes of torture, I turn around and head inside my house. And that's okay too.

The Most Effective Way To Get Your Child To Love Exercise...

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Studies conclusively show that there is one thing parents can do to get their children to exercise- and that is to exercise themselves. Children of active parents are much more likely to be active than children of more sedentary parents. Let your children see that you enjoy exercise. And if you don't love to break a sweat? Fake it... You don't want your children to think of exercise as a chore or a burden. It should be fun. If you don't like to run, find other activities that you do enjoy.

My husband and I love to go for long bike rides together. We hop on our bikes (with helmets, of course) and explore nearby neighborhoods. It is great exercise and great 'alone' time for us. Now that our children are getting older, they beg to come riding with us. So now we often go to a local park and ride bicycles as a family. You have no idea how cute our two year old looks on her tricycle! Sometimes Doug and I will rollerblade or run while our children ride. Zachary (our five year old) loves to have races- I run while he rides his bike. No matter how fast I run (and believe me, I am competitive enough that I try to win with all my might), he always wins. It is wonderful for his self-confidence.

I love to run- and the kids also want to try to run with me. So when I come back from a long run, I will take the kids and we will all run around the block together. They tend to tire out quickly, but I love the fact that they see running with mommy as a treat. Zachary used to run half a block with me and now he runs two blocks. As he gets older, that distance will keep increasing until my own running buddy!

Truthfully, I used to hate exercise. I never exercised in high school. When I got to college, one of my roommates was an all-national lacrosse and field hockey player- (hi Lisa!). She was my exercise inspiration. I began to exercise to become as lean as she was. She would take me running and I would curse the entire time. She even took me to the lacrosse field- but when she saw my awkward attempts at holding the lacrosse stick, she quickly dropped that idea and we went back to running. At first, I didn't like to run. Then I met two girls (hi Kara and Jessica!) who were aerobics instructors (while still attending Princeton). They took me to a few aerobics classes and I fell in love. I loved the camaraderie of the class, the pulsating loud music, and the feeling of my heart racing in my chest. I took more and more classes- and eventually became an instructor myself. Once I was in better shape, Lisa and I gave running another try- and I loved it. I can't thank these girls enough. By observing them, I learned that exercise could be fun- exactly like what I am asking you to do for your children. These girls have remained my life-long friends and were all bridesmaids at my wedding. To this day, they are some of my closest confidantes.

The bottom line is that children need to see that you value exercise and think of it as fun. If they see you moaning and groaning every time you put your sneakers on, they will not want to try it themselves. Even worse, if they see you lying on the couch and not exercising, they will learn that exercise is not important enough to even try. So go lace up those sneakers and get moving!

But I only ate half the sandwich...

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It is interesting how serving size really does influence our perception of how much we are eating.

We were upstate this weekend and ordered sandwiches from a new restaurant. I got my favorite (turkey, ham, lettuce, tomato, onion, and honey mustard). When the food arrived, we could not believe the size of thesandwiches! Each one was a huge hero. I picked up half of my sandwich and began to eat. Three quarters of the way through, I was no longer hungry. Yet I found myself continuing to eat because it was "only half of the sandwich so it shouldn't be too much". Mid-bite, I stopped myself, hearing my own voice in my head. How many times have I counseled patients to stop eating as soon as they were full, regardless of how much was left on the plate? How many times have I observed that when served larger portions, people almost always tend to eat more than they need to? I asked myself to put the sandwich down and not let myself fall into the same trap that plagues children (and adults) throughout the country.

So what happened? I put the sandwich down... and then picked it up and finished it. I can't tell you why- I just felt the unfinished piece calling to me. I wish I could say that I was strong enough to resist the temptation- but I was not.

Now I have to try to learn from it. I have known for a while that I don't feel full until I clean my plate. No matter how hard I try, it is very difficult for me to leave food on my plate. So over the last six months, I have made some changes. I switched from dinner-sized plates to salad plates so I trick myself into thinking I am eating more than I am actually eating. I serve myself very small helpings, knowing that I can always go back for more. At a restaurant, I call over the waiter the moment I feel full so I don't have the opportunity to pick at my plate. I usually ask him to wrap it up so I can eat it (or what usually happens- leave it in my fridge until it is barely recognizable and then throw it out) another day. I am famous at my local frozen yogurt store for ordering a small non-fat cone and asking them to give me 'much less' than the normal small serving. Again- I know that if they give it to me, I will eat it- and their smalls are super big!

So what can I do with this sandwich? I can cut the half in half before I start eating and only put one piece on my plate or I can make myself IMMEDIATELY throw the rest of the sandwich in the garbage as soon as I feel full. I will let you know what happens the next time we order from that restaurant.

East Hills, N.Y. is a healthy place to live!

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I am proud of East Hills, N.Y. If every town took the steps that East Hills is taking to ensure its children's health, America might be able to pull itself out of this child obesity epidemic.

I was frustrated with the lack of healthy food choices offered at our local pool. After one brief discussion with Mayor Koblenz, the situation was immediately rectified! Plans were already underway to turn the pool lunch cafe over to new management. Just days later, I received a phone call from Jim Zanfardino, owner of Delicacies, a wonderful deli in the town of Roslyn. Delicacies is taking over the lunch cafe and Jim asked to meet with me to set up a healthy menu for the children and adults of East Hills. I then received a phone call from the Mayor himself, making sure that Jim had called me.

Today's meeting was so refreshing. Delicacies Deli was open to every one of my healthy suggestions! They are set to offer grilled cheese sandwiches made with reduced-calorie, whole wheat bread and low-fat cheese, prepared without butter or oil, along with a list of MANY other healthy lunch choices. Delicacies will also offer sliced cucumber, fresh fruit, baked potato chips, and pretzels as side dishes. Desserts will include no sugar added fudgsicles and sugar-free ice pops.

I hope that East Hills can serve as a model for other areas. As Delicacies owner, Jim, put it "it isn't that hard to offer healthy options." So why aren't other delis, pools, and towns taking the time to change their menus? I am not sure. Hopefully, word will get out about the healthy changes at East Hills, prompting others to follow suit.

I want to give my thanks and appreciation to Mayor Michael Koblenz and Delicacies Deli.

I hope that residents of this area will let them know that their committment to our children's health is greatly appreciated. Residents of other communities should talk to their community leaders about what they can do to make healthy changes.

Does 'kid-friendly' mean 'fattening'?

It seems that the phrase 'kid-friendly' has come to mean 'fattening'. When did this happen?

I was on the phone with the owner of a local day camp today, discussing the camp's meal plan. Before I could get into the subject, the owner informed me that the camp had to serve 'kid-friendly' food and was unwilling to change the menu. (* In the owner's defense, the camp does offer healthy options in addition to the less healthy hot lunches. This particular camp does a good job of accommodating campers- so this is not meant to lash out at this owner at all.)

What struck me was his choice of words- as if there were no way to offer healthy 'kid-friendly' foods. Are there healthy 'kid-friendly' foods? You certainly wouldn't think so from looking at children's menus at restaurants. By constantly offering children chicken nuggets and french fries as options, aren't we turning these unhealthy meals into 'kids' meals'?

Why can't we come up with some healthy foods that children like? Or turn some of the less healthy foods into healthier foods by making small tweaks- for example, serving low-fat or fat-free cheese on grilled cheese sandwiches and grilling them without butter. Why can't Burger King's 'apple fries' become the next child food staple? How about replacing fried chicken nuggets with grilled chicken nuggets- serving them with barbeque sauce or some other sauce to keep the taste alive?

What if we changed the way we think about food altogether? We could suggest that fried foods are 'adult' foods, only appropriate for children in small doses. Why are these foods all that different from cigarettes? Cigarettes have terrible medical consequences- just like fatty foods. Cigarettes are addictive- just like fatty foods. And cigarettes provide a quick 'high'- just like these fatty foods. Can we reshape our thinking to recategorize these foods? Sure they taste great (like cigarettes supposedly feel great)- but they are certainly not great for us. Maybe this analogy is a stretch- but it does make a certain point.

I do know that children (and many adults) will turn to these unhealthy foods if they are offered. Children are too young to understand the consequences of their decisions. Parents must be the ones to realize that their food choices impact their children's health.

We need to redefine 'kid-friendly' foods because it is not 'friendly' to offer our children foods that can harm them.

Dr. Dolgoff's Lighter Weigh- at home

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NBC News featured my child and adolescent weight management program nationally last week and the response has been incredible. I am receiving calls and e-mails from all over the country. So I have come up with Dr. Dolgoff's Lighter Weigh- at home version. Consultations are done via telephone and features include a personalized nutrition plan personally devised by me, weekly 25-minute phone consultations, e-mail questions answered at no additional charge, monthly live chats, weekly e-newsletters, a Dr. Dolgoff-recommended scale, and my rewards program (stickers and prizes for progress).

I was all set to start- until my attorney told me that I may need to be licensed in each individual state before I am able to start counseling out-of-state patients. So please be patient while I look into this matter. I promise to get back to you all as soon as possible.

Thanks for your patience!

Joanna Dolgoff, M.D.

Parents must speak up!

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It has been a very hot weekend here in New York and like many parents, I have spent the weekend at the local pool club. And like most local pool clubs, the snack bar area only serves junk. I looked at the menu and had a difficult time finding something healthy that the average child would want to eat. Sure they had salads (with full-fat dressings)- but few children will eat salad for lunch. Our pool club has a no strict substitutions policy so I couldn't even make their "healthy" wrap sandwich into a "healthy" lunch. At about 300 calories just for the wrap itself, wraps are not healthy at all. And the wrap sandwiches at our pool come with full-fat cheese and mayonnaise. The children's menu is typical- pizza, chicken nuggets and fries, and grilled cheese (glistening from all the butter and oil) with fries.

Snack time is no better. Snack choices are regular potato chips, ices, ice cream, and a $7 small fruit salad. Would it kill them to throw in some pretzels or a healthy granola bar? Even a 100-calorie pack of something would be great.

Today I had enough. I cornered our local Mayor (who runs our pool club) and told him how unhappy I was with the choices offered. To my surprise, he was very amenable to my suggestions. He agreed to have me sit down with the snack bar manager to give my recommendations. Just like that- no arguing, no nagging.

Maybe if every parent spoke up, we could make some change. Let's all give it a try. Make sure the owners of your local pools, restaurants, and other eating establishments know that we want (we demand) healthy options for our children.

Child Obesity and Diabetes

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Obesity is a major risk factor for the development of diabetes.

Type II diabetes used to be called “Adult Onset” diabetes. The name has recently changed to Type II diabetes due to the large number of children developing what used to be an exclusively adult problem. Not long ago, nearly all childhood diabestes was Type I. Now nearly half are Type II. Being overweight is the single strongest risk factor for Type II diabetes.

Let me explain how obesity causes Type II diabetes. Insulin is produced by the pancreas and helps control blood sugar. When you eat, starch is broken down into simple sugars that enter the bloodstream. Sugar causes the release of insulin. Some sugar is used immediately as energy. Insulin takes the excess sugar out of the blood and helps store it in body tissues such as the liver where it can be converted to fat.

Insulin does not work as well in the obese. This is called “insulin resistance”. The body responds to insulin resistance by making more insulin. Increased insulin is not good for the body. Insulin causes increased salt retention and increased constriction of blood vessels, leading to high blood pressure. Insulin also causes the formation of LDL (bad cholesterol) and the breakdown of HDL (good cholesterol).

When insulin resistance first develops, sugar levels are kept under control by the compensatory production of increased insulin. Eventually, the body can no longer compensate and can’t keep sugar levels under control. Blood sugar levels rise and the patient develops type II diabetes.

Health risks of Type II diabetes include kidney failure, blindness, heart disease, and peripheral vascular disease. An adult diagnosed with Type II diabetes may require kidney dialysis or develop a heart attack at age 60 or 70. Ateen diagnosed with Type II diabetes may develop these problems in their 30s or 40s.

Type II diabetes that develops during childhood or adolescence is extremely dangerous. The only way to prevent the development of Type II diabetes is WEIGHT LOSS.

Medical Risks of Child Obesity- Focus on Heart Disease

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No previous U.S. generation has raised children likely to have a shorter life expectancy than its parents. Epidemiologists at the CDC predict that obesity will soon overtake smoking as the nation's leading cause of preventable death. In the last two decades, doctors have been finding cases of what used to be "adult" diseases in overweight teenagers and children as young as age 6. New research indicates that childhood obesity itself may shorten one's life span, even if that person is not obese as an adult. It is imperative to recognize and treat childhood overweight as soon as possible in order to maximize life span.

Medical complications of obesity include:

Coronary Artery Disease
Congestive Heart Failure
Type II Diabetes Mellitus
High Blood Pressure
High Cholesterol
Stroke
Liver Disease
Gall Bladder DiseaseSeveral Kinds of Cancer
Osteoarthritis
Other Musculoskeletal Problems
Asthma
Sleep Apnea
Infertility in Women
Depression
Other Psychiatric Illnesses


Heart disease is the #1 killer of men and women in the United States. Chief risk factors include overweight, inactivity, hypertension, diabetes, high cholesterol, and smoking. A Harvard study of individuals age 13-18, followed over 50 years, showed that obese boys were twice as likely to die from heart disease versus normal weight boys. Obesity that develops in childhood or adolescence causes a greater risk of early death than obesity that starts in adulthood. Autopsies of children who have died in accidents have shown abnormal fatty changes in the hearts of overweight children as young as 5 years old. It is clear that heart disease can begin at a very early age. According to the American Heart Association, a heart-healthy diet from an early age lowers cholesterol and, if continued, decreases the risk of coronary artery disease in adulthood.

Injecting insulin while eating McDonald's

My children and I stopped at McDonald's for breakfast this morning. We were on the road traveling back home from a weekend away and were stopped in major traffic. The kids were starving and there was nothing else in sight. We each had an Egg McMuffin(at 300 calories each). Not a great breakfast but also not terrible. We finished it off by sharing a fruit, walnut, and yogurt salad.

But I couldn't believe what I saw in that McDonald's. There was a morbidly obese couple eating next to us. They each had ordered two breakfast sandwiches and hash browns. Before eating, the woman pulled out a syringe (of what I am assuming was insulin) and gave herself an injection.

What will it take for some of us to realize that being obese has terrible health consequences? The fact that she needed insulin was not enough to get this woman to stop eating McDonald's. I understand that I don't know the full story of this woman's life, and perhaps she usually eats healthy and was caught in a tough situation, like my family was. But this woman is not alone. Looking around McDonald's, there were many obese families. Something in our society really needs to change before we all eat ourselves to death.

Apple Fries Update

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We stopped at a reststop on our way upstate today because my daughter had to use the bathroom. When my husband returned from taking her, I noticed he had a Burger King bag in his hands. My first instinct was to get annoyed. I said, "Doug, you know I don't like you or the kids to eat that junk". He smiled and pulled out two orders of apple fries. "I knew you wanted to see what these looked like". He was right. I threw out the empty bag and handed the kids the "fries". They were so excited. "Mommy- these look like French fries", my son giggled. They really did. I tried one and they were fresh, crisp, and yummy. My children ate them all and gave them a thumbs up. What a great idea! (By the way, I threw the low fat caramel dipping sauce away with the bag, figuring it wasn't necessary- but I looked at the nutrition label first and the sauce only had 35 calories. Not necessary- but not too bad. I am impressed with Burger King's ingenuity and I hope they continue to introduce other healthy, fun options for kids.

Children on Cholesterol Meds- My Thoughts

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I am torn about this issue. On the one hand, we cannot just sit back and watch our children eat themselves to death. One out of every three children is overweight and at risk for medical problems due to their health. There are more children with high cholesterol than ever before. Children are now commonly developing diseases that used to be exclusively adult diseases. The CDC says this generation will be the first generation in history to die younger than their parents- all due to their increased weight and all the problems that go with it. An overweight adult with high cholesterol and diabetes may have a heart attack in their 60s- but a child who develops these illnesses may have a heart attack in their 30s. We must do whatever we can to prevent some of these diseases. How can we not try a medicine that seems to be safe and effective?

At the same time, we must also realize that there are no studies of the long term effects of these medications and there is no hard data that lowering cholesterol by using these drugs will definitively lower the risk of heart disease. So I can understand why some are hesitant.

My bottom line opinion: we must give nutritional and exercise changes a really strong effort first. As the AAP recommends, parents should seek the expertise of a child weight management physician. If that truly does not lower the cholesterol, I think we should give the medications. I think we are obligated to try whatever we can. We know that children with high cholesterol are at severe risk of medical problems and we don't know that the medicines will do any harm... There is no clear-cut answer, and I would love to hear your arguments either way.

Thanks for reading.

Children on Cholesterol Meds?

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The American Academy of Pediatrics came out with some controversial guidelines this week. I will summarize them for you:

1) All children should follow a healthy diet, including low-fat dairy products for all children older than 2 years. Reduced fat dairy products should also be used in children age 12 months to 2 years who have a family history of overweight, high cholesterol levels, or heart disease and in children age 12 months to 2 years who themselves are overweight.

2) Children and teens with a higher risk of heart disease and with high LDL ("bad cholesterol") levels include NUTRITIONAL COUNSELING, diet changes, and increased physical activity.

3) Children with a family history of high cholesterol or early heart disease, children whose family history is unknown, and children with other risk factors such as overweight, high blood pressure, cigarette smoking, or diabetes, should have their cholesterol levels tested with a fasting blood test between the ages of 2 and 10. Children with normal values should be rechecked every 3 to 5 years.
If lipid levels are high, weight management treatment should begin (NUTRITIONAL COUNSELING) and increased physical activity.
Children age 8 years and older who have an EXTREMELY high LDL level should consider cholesterol-lowering medications.

Let me explain why this is so controversial.

1) We don't know the long term side effects of these medications in children.
2) We don't know for sure that these medications will decrease the incidence of heart disease in children. Cholesterol increases the risk of heart disease and the medications do lower cholesterol- but do they actually decrease the risk of heart disease?

We do know that to date, these medications are safe in adults. We do know that in middle-aged men with high cholesterol, these medications decrease the risk of heart disease. Evidence does not clearly show that they decrease the risk of heart disease in women and there have been no studies in children.

So the question is: if diet and exercise are not enough, should we try these medications in children and hope they do more good than harm, or do we let these children continue to have dangerously high cholesterol levels? Pediatricians are very divided on this issue.

Before I share my thoughts, I would like to hear some of yours.

Shocked at Chili's

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I was at Chili's the other day and was completely shocked at what I saw. I cannot believe the size of the lunch plates... and I cannot believe how unhealthy the food is. I observed families (some heavy, some not) digging into plates of bacon cheeseburgers, french fries, and nachos- without giving it a second thought. There didn't seem to be any hesitation about eating these foods that are filled with trans fats, saturated fats, calories, and cholesterol. I watched an 8-year old eat an entire plate of mozzarella sticks- as an appetizer! How could a parent allow their child to eat like that? Even the salads are nightmares.

I ordered shrimp fajitas and asked for unmarinated shrimp. I also asked if the entire dish could be cooked without butter or oil (or as little as possible). I asked for lettuce leaves instead of tortillas and extra guacamole instead of sour cream. When the dish was brought to the table, it was glistening with oil. I asked the server and she said, "We didn't use oil to cook it but the vegetables are premarinated in an oil sauce". PREMARINATED IN AN OIL SAUCE? Even veggies have to be full of oil. I guess it was my fault for eating at a restaurant like that. It just shows you that there are tons of secret ways restaurants stick oil and other unhealthy items into the food. Next time I will order a grilled chicken breast (with Buffalo dipping sauce on the side for an extra kick), a dry baked potato, and some steamed veggies (with no oil). Let's hope that works out better.

The bottom line- beware of eating at restaurants like this. Really quiz your server about what is in your dish. And don't be afraid to ask for substitutions.

Eating for sport

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The Nathan's hot dog eating contest pretty much sums up everything that is wrong with our country. Eating has become our new national sport. I couldn't believe that ESPN was covering this spectacle. I was so nauseous watching these people shoving hot dogs into their mouths, in front of hundreds of screaming "fans". Would people have the same enthusiasm watching an alocoholic drink himself into a stupor or watching a smoker attempt to smoke as many cigarettes as possible in as short a time as possible? No- because we understand that drinking too much and smoking too much are dangerous to our health. Yet overeating is just as dangerous- and much more common. As a nation, we have failed to realize this scary fact. So we continue to encourage each other to keep eating- in fact, at times we even cheer each other on, pretending that there is nothing to worry about. But there is a lot to worry about. And until we realize that, the obesity epidemic will continue.

Early sign of pre-diabetes

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There is a little-known very obvious sign of pre-diabetes often seen in overweight children; it is called acanthosis nigricans. Acanthosis nigricans is a darkening and thickening of the skin found in skin folds and creases; it is most obvious in the back of the neck, just underneath the hairline.
Acanthosis nigricans is one of the first things that I look for when examining an overweight patient. Acanthosis nigricans is usually seen with conditions that increase insulin levels, such as type 2 diabetes or being overweight. High insulin levels can trigger activity in skin cells, resulting in this dark, thick, velvety skin. Acanthosis nigricans can also be caused by medicines such as human growth hormone and oral contraceptives (aka "the pill"). There is no specific treatment for acanthosis nigricans, although weight loss may decrease its appearance. I always check fasting glucose and insulin levels to make sure that the patient has not yet developed diabetes. Acanthosis nigricans is a sign that a patient's weight is starting to affect his/her health. It should be a wake-up call that weight loss is needed immediately to prevent the development of diabetes. If your child is overweight, be sure to check their neck and make sure that they do not have this sign of "hyperinsulinemia" (higher than normal insulin levels). The absence of acanthosis nigricans, however, does not mean that your child does not have pre-diabetes or diabetes. Any overweight child should have their fasting glucose and insulin levels checked as a precaution.

Apple fries

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I just read that Burger King will soon begin selling "apple fries" which are raw apple slices cut in the shape of French fries, served with a low fat caramel dipping sauce. I think it is a great option. I like the idea that they are shaped like fries because although they obviously won't taste like fries, they do simulate the experience of eating a fry- which is important. I hope that fast food restaurants keep coming up with healthier options. I don't understand why they can't use leaner meat for the burgers. And why do they have to fry them in so much oil? Hopefully, they are learning that people will pay for healthier fare. I believe that since restaurant chains are now required to print nutrition info on the menu, people will be much less likely to eat such unhealthy food. It is a lot harder to eat a Whopper when you see that it has 680 calories and 40 grams of fat. I am hoping that these restaurants will look for new ways to make their food healthier so they can show better numbers on the menus. At least this is a start.

If you offer it, they will eat it...

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I went to lunch this weekend with one of my friends and all children. I ordered my diner usual for the kids- grilled cheese sandwiches made without any butter, oil, or mayo and sliced cucumber instead of fries. My girlfriend laughed at me, claiming that her son (18 months old)would never go for that. She ordered him chicken fingers and fries. The food came and initially my children said, "Mommy, why can't we have fries?" and I said, "Because they aren't healthy". They accepted that and began to eat their lunch. At some point, my friend's son reached his hand into my daughter's plate and grabbed a cucumber. I watched him munch happily on the crisp vegetable. To prove my point, I ordered another side of cucumber and placed it in front of him. To his mother's surprise, he began to eat the cucumber, only occasionally stopping for some fries. I explained to my friend that children will eat the veggies if they are offered to them- especially if you start at a young age. She has now vowed to order cucumber instead of fries. I think the lesson here is that you shouldn't just assume that your child "won't" eat something. Try- and keep trying. Always offer healthy choices to your kids. You will be surprised how often they will eat them.

Salads are not (always) healthy!

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Many people mistakenly believe that if a meal contains lettuce, it is automatically healthy. Salads are often some of the more fattening items on the menu. I laugh when people order a caesar salad because they are "on a diet". A caesar salad is beyond fattening. And a taco salad is never a healthy choice; you know your salad is unhealthy when it contains anything fried or is topped with sour cream. Even just a plain salad with regular salad dressing can sabotage your diet. Salad dressing has lots of calories and fat. Blue cheese and caesar salad dressings are the worst- they have about 76 calories and 8 grams of fat per tablespoon. And most people use much more than 1 Tbsp when dressing their salads. Other regular salad dressings have about 55 calories and 6 grams of fat per tablespoon. Light salad dressings have about 30 calories and 1.5 grams of fat per tablespoon and fat-free salad dressings have about 20 calories per tablespoon. Regardless of the type of dressing, be careful of serving sizes!!!

A patient's family recently told me that prior to coming to see me, they had been trying to lose weight on their own. They like to go to Burger King for the convenience- so they had begun to order salads to help them lose weight. They typically ordered a crispy chicken salad- and topped it with a packet of croutons and two packets of the light italian dressing. This "diet" meal contains 710 calories and 45 grams of fat! I told them that if they had eaten a small burger and small fries, they would have SAVED themselves 190 calories and 20 grams of fat!

Be very careful when eating salad. Try to use a small amount of a fat-free or low fat dressing- or better yet, learn to enjoy salads with just a splash of balsamic vinegar!

Does caffeine stunt growth?

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It is a widely held belief that caffeine stunts growth, but there are no scientific studies to support this claim. However, caffeine is generally not recommended for children because it can cause many side effects such as upset stomach, jitteriness, nervousness, headaches, difficulty concentrating, insomnia, increased heart rate, increased blood pressure, and dehydration. Because children are smaller than adults, it takes much less caffeine to cause these effects in a child.

I often see children on the line at Starbucks- ordering Decaf drinks and thinking they are safe. All decaffeinated coffee has some caffeine (just less than regular). Starbucks decaf coffee has especially high levels of caffeine. In my opinion, parents should not give their children caffeine.

"Mommy, why did you tell the waiter not to bring any fries?"

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I took my children out to lunch today and ordered their lunch "without fries". My five-year old son got upset. "Mommy, how come you told the waiter not to bring any fries?" I looked him in the eyes and said, "Because fries are not good for your heart and I want your heart to be as healthy as possible". He looked at me and said, "Oh". End of discussion. Sometimes it is as easy as that.

What is the best cold treat during summer?

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What is the best cold treat during summer?

ice cream, premium: 1/2 cup = 266 cal, 17 grams of fat

ice cream, regular: 1/2 cup = 145 cal, 7.9 grams of fat

ice cream, light: 1/2 cup = 100 cal, 3.5 grams of fat

ice cream, no sugar added: 1/2 cup = 80 cal, 4 grams of fat

sorbet: 1/2 cup = 130 cal, 0 grams of fat

sherbet: 1/2 cup = 110 cal, 1.5 grams of fat

frozen yogurt, soft serve: 1/2 cup = 117 cal, 4 grams of fat

frozen yogurt, low fat: 1/2 cup = 150 cal, 4.5 grams of fat

frozen yogurt, fat-free: 1/2 cup = 100 cal, 0 grams of fat

frozen yogurt, premium, lowfat: 1/2 cup = 190 cal, 0 grams of fat

frozen yogurt, premium: 1/2 cup = 220 cal, 4.5 grams of fat


Enjoy summer!

Fast food's convenience is so tempting... Don't Give In!

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My daughter and I were shopping at Target the other day when I realized it was lunchtime. It was 12:30 and I only had an hour to run all my errands and pick my son up at school at 1:30. There was no way I was going to be able to stop to eat and get everything done. As I rushed out of Target, I noticed a Pizza Hut stand. How easy would it be to just stop and pick up some pizza? I would be able to get everything done and be on time. It was very tempting. But I knew that was not a healthy option and I would regret it later. There is no errand that is more important than healthy eating. So I picked up Danielle and we left. We stopped for sushi (our favorite healthy lunch), ran some of the errands, picked up my son, and then finished the errands. There was a way to get everything done without sacrificing our health!

TV and obesity- advice for parents

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What can a parent do to help their child?

1) LIMIT TV TIME!

The AAP recommends fewer than 2 hours of TV per day. Parents seem to believe that their children will not agree to these limits- but elementary and middle school children can usually be persuaded to cut down on TV.

2) HELP YOUR CHILD MAKE A LIST OF OTHER ACTIVITIES TO DO INSTEAD OF WATCHING TV.

Have your child make a pie chart of what they do with their spare time and tell them the doctor says more than 2 hours of TV a day is unhealthy. Then fill in the pie chart with other activities. They can even interview a grandparent or great-grandparent about what they used to do before they had TV. Make trying new activities into a game.

3) DO NOT ALLOW YOUR CHILD TO EAT IN FRONT OF THE TV.

Children (and adults) do not realize how many calories they consume when they watch TV. Don’t eat while distracted.

4) TEACH YOUR CHILD THE PURPOSE OF COMMERCIALS.

Explain that companies who produce unhealthy foods are trying to make money by tempting children with their commercials.

5) DO NOT PUT A TV IN YOUR CHILD’S BEDROOM.

When you put a TV in your child’s bedroom, you immediately lose control of how much your child is watching and also of what your child is watching.

6) MONTIOR YOUR CHILD’S TV USE.

The parent has to be responsible and has to be aware of how much TV a child is watching. A TV should not be a babysitter.

TV and obesity

TV, video games, and computer use are contributing to the rise of childhood obesity. Before these inventions became so popular, children used to run outside to play. Now, more often than not, our kids are content to sit on the couch with the remote (and a bag of chips).

Studies have proven that children who watch a lot of TV are more likely to be obese. A study published in Lancet in 2004 followed 1000 children born in 1972 or 1973 over the course of 26 years. Almost 50% of the individuals who consistently watched 3 or more hours of TV per day were overweight. Only 25% of the individuals who consistently watched less than 1 hour of TV were overweight. The more hours of TV a child consistently watched, the more likely that child was to be overweight.

Putting a TV in a child’s bedroom raises the risk of obesity even further. A 2002 study from Columbia University revealed that preschoolers with a TV in their bedroom were 31% more likely to be overweight than those children without a TV in their bedroom. A TV in the bedroom instantly adds about an hour of increased TV time per day. It is impossible to tell what is cause and what is effect. Does watching TV make a child overweight or does being overweight cause a child to watch a lot of TV? It is not clear.

Chubby children are often teased in school and left out when children are picking teams in gym class. They tend to have some discomfort in their knees and ankles when running. They become embarrassed that they can’t keep up with the other children and tend to turn to more sedentary activities, such as watching TV and eating. This causes more weight gain which makes the situation even worse. The overweight child starts to avoid sports altogether and further increases TV and computer time. Eventually the child becomes obese and unable to do even simple activities, such as walking.

TV causes weight gain in many different ways. Most important, children are inactive while watching TV. And the average child sees 40,000 commercials a year- mostly for high calorie and high fat foods. Companies spend so much money on these child-targeted commercials because they work! They prompt children to crave these unhealthy foods.
How many of you remember seeing commercials for fruits, vegetables, or whole grains? These healthy foods are rarely promoted on TV because they are not usually branded items and don’t turn out the same profits.

And who hasn’t experienced the mindless eating that occurs during TV viewing? We are all guilty of this from time to time. A child gets so engrossed in the program that he doesn’t realize he have eaten the entire bag of chips. During the week, children tend to consume 18% of their total daily calories while watching TV. On weekends, children consume 26% of their daily calories while watching TV.

New studies indicate that children’s resting metabolic rates are lower while watching TV than they are when sitting still, staring at a wall, without the TV on. This means that they are burning fewer calories during this time. It is not clear why this occurs, but it may be because they fidget less while watching or because they get into a trance-like state.

Read more tomorrow to learn specific strategies to prevent the TV from causing weight gain in your child.

Fat-free sugar-free chocolate pudding

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Another yummy snack... I promise to post more tomorrow.

Sugar-Free Jello and Fat-Free Cool Whip

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I have just rediscovered this wonderful dessert- and now my kids are enjoying it too. They just love to see the scoop of the "whipped cream" on top of the colorful jello. They have no idea that it is a very low calorie dessert- they just see it as a treat. Try it yourself with your kids. There are so many different flavors so every day can be something new. Enjoy!

It isn't easy...

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It isn't easy to limit your children's junk food. I am so often sabotaged. Today we took the kids to the pool club. I had spoken to the owner of the cafe during the week and asked him to add some healthy options to the menu. He agreed to add a "grilled cheese light" item which is two slices of whole wheat bread with three slices of Alpine Lace reduced fat cheese made without any butter, oil, or mayo. So I ordered that for my daughter- and purposely didn't order any fries for her. I also ordered some fruit salad to start so we could all fill up on the healthy stuff. Well, our food came and I realized that all my friends had ordered chicken fingers and fries for their children. So of course Danielle immediately started crying that she wanted french fries. How could I deny her what all of her friends were eating. I usually do that but I really didn't have the energy. So I let her have a few fries. We finished eating- but our friends had left over some chicken fingers. Next thing I know, I turn around and Danielle is chomping on a fried, greasy, left-over chicken nugget. So much for all my efforts to make this a healthy meal.

Will kids eat carrots with hummus?

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We had friends over for a barbeque tonight and I put out a nice spread of food. I had a vegetable platter of baby carrots, bell peppers, and baby tomatoes with a hummus dip. I also prepared a fruit tray of pineapple, watermelon, oranges, grapes, and cherries. I could not keep my kids away from the table. Surprisingly, they spent a lot of time around the veggies- particularly the carrots and the hummus. I am sure that if I had other junk food on the table (chips, cookies, crackers), then my kids would have been eating that stuff. But since I kept all the options healthy, they took advantage of what was there. Try it the next time you have guests over; just put out healthy fruits and vegetables and see what happens. I bet (after some initial grumbling)you will be pleasantly surprised.

Are turkey burgers really that healthy?

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I was at a barbeque tonight and noticed many people making a very common mistake. The hosts were serving hamburgers and turkey burgers. The hamburgers were made from 93% fat-free ground beef and the turkey burgers were regular turkey burgers. All of the women chose the turkey burgers because they were "dieting". What they didn't know was that turkey burgers have more fat and more calories than 93% fat-free ground beef. In fact, even all white meat turkey burgers have more fat than 93% fat-free ground beef. I counsel all of my patients about the benefits of this extra lean meat. It is so yummy and also healthy. So I enjoyed my burger while the other women suffered through their turkey burgers! It is not often that the tastier food is also the healthier choice!

Fast food causes heart disease!

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Everybody knows that fast food isn't healthy but few realize exactly how unhealthy it truly is.
Children who commonly eat fast foods have the same risk of developing clogged arteries as an adult five times their age. Can you imagine a 10 year old with the same risk of a future heart attack as a fifty year old man? It is astounding.

Fast food also plays a large role in the development of obesity. Children are eating more and more fast food these days. And while it is great that fast food restaurants are offering healthier options, kids are not choosing them. A recent study found that teens served a fast food lunch ate about 1650 calories during that meal- more than 60% of their daily requirement.

Children eat about 187 extra calories on days that they eat fast food. They also eat more fat and sugar and less fiber, milk, fruit, and vegetables. Over the course of a year, an extra 187 calories a day = 68,255 calories per year or 17 extra pounds of fat. Granted, most children don’t eat fast food DAILY- but even eating fast food once a week would cause a child to gain 2 ½ pounds in a year. And those 2 ½ pounds can add up quickly.

Fast food should not be a regular part of a healthy diet. As a (very) occasional treat, it may be okay. But it should not be a daily (or even weekly) option.

Friendly's should be illegal!

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In a moment of weakness, my husband and I decided to take the children to Friendly's for ice cream. When I was younger and ordered a sundae, I was served a scoop of ice cream, some hot fudge, whipped cream, and a cherry. That is not what my children received. They got THREE scoops of ice cream with hot fudge, M&Ms, sprinkles, fluff, caramel, oreos, and every other type of topping that you could imagine. No wonder children these days are getting heavier. Luckily, my kids had a few bites and were done. I wish I could say the same for myself. Somehow I found myself eating my entire sundae and finishing everybody else's. I try to watch what I eat but I fell into the trap of thinking, "Well, I already ruined today so I may as well really enjoy it". It is such flawed thinking. Allowing myself a treat was okay- but indulging in everybody else's because I had already deviated from my normal plan- was just silly.

One hamburger just isn't enough!

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My mother told me a very funny story at dinner last night- (by the way, happy 37th anniversary mom and dad). My mother has always made quarter pound hamburgers (of 93% fat-free ground beef, of course) for dinner and my father always eats two burgers on one bun. So last week, my mother simply made him one half pound burger. Well, my father went crazy. "One hamburger just isn't enough for me!" he complained. "I am a grown man and I need to eat two burgers (at least)." My mother tried to explain that eating one half pound burger was the same as eating two quarter pound burgers, but my father would not be satisfied. He was used to seeing two hamburgers on his plate and so he needed that visual in order to feel full. It just goes to show that your appetite can so easily be misled. That is why I recommend eating on smaller plates because it tricks your mind into thinking you are eating more food. I also recommend cutting food into pieces so that you feel like you are eating more. My family all laughed at my father's silliness but the truth is we all fall prey to those feelings. I told my mom that next she should try serving my dad two smaller hamburgers and see if he notices. It may just be that he needs to eat two burgers- regardless of the size.