Saturday, May 31, 2008

One hamburger just isn't enough!

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.

Friday, May 30, 2008

Is baseball considered exercise?

I have many patients tell me that their children exercise every day for an hour or more each time. When I first started my practice, I was thrilled that I had such active patients. But upon closer exam, I realized that my definition of exercise is very different from most other people's. You are truly exercising when your heart is racing, your face is bright red, you are sweating, and you are slightly uncomfortable. Standing in the outfield, waiting for a fly ball, is NOT exercise. Many of my patients tell me that they stop exercising when they feel slightly short of breath. But that is when real exercise usually begins. If you can have a conversation, you are not truly exercising. The AAP (American Academy of Pediatrics) recommends 60 minutes of active exercise most days of the week. Their definition of active exercise is the same as mine. While I would love my patients to exercise as much as official recommendations call for, I would be happy with 45 minutes of active exercise at least 4 days a week. So make sure that your child is truly exercising when they are "exercising".

Tuesday, May 27, 2008

Chicken Pizza?

I thought I would share a healthy dinner option. My kids love chicken parmigiana but I don't love all the calories and fat. So I make a healthier version. I take chicken breasts and bake them until mostly cooked. I then cover with a light tomato sauce and fat free cheese and continue baking until the chicken is cooked through and the cheese is melted. I call it "chicken pizza" and my kids think it is delicious. Another (slightly more fattening) version uses shake 'n bake to coat the chicken before baking. Serve either version with a small side dish of whole wheat pasta and a vegetable. Delicious!

Monday, May 26, 2008

Where do you keep the butter?

I hope you all enjoyed your Memorial Day weekend. Mine was wonderful... lots of fun with family and lots of barbeques. I had a another family over on Sunday night and my friend and I were in the kitchen, preparing the food, when she asked me, "Where do you keep the butter?". I answered, "I don't keep butter in the house". She looked at me like I was crazy. "What do you mean you don't keep butter in the house?" To me, it seemed perfectly reasonable. "Why would I keep something in the house that I don't want my children to eat? If it isn't in the house, there is no way my husband or nanny can give it to them. And butter is not something that is necessary. So I don't buy it". My friend looked at me and said, "Hmm. that's smart". And I thought, "Yes it is". So I figured I would pass the tip along.

Thursday, May 22, 2008

A Reader's Question... Picky Eater

I received the following question from a reader:

Dr. Dolgoff,
My five year old son is a very picky eater. He will only eat chicken nuggets and french fries. His doctor told me he is overweight but I can't get him to eat any healthy foods or vegetables. What can I do?

Thank you for sending in your question. I hear this all of the time. Parents of toddlers are often worried that their children aren't eating enough. Few parents understand the normal eating patterns of a toddler. It is normal for a toddler to eat one good meal and then just pick for the rest of the day. It is also normal for a child to only want to eat a small number of different foods. As long as these are healthy choices, it doesn't really matter. It is a problem, however, if a child will only eat unhealthy foods.
Your son is five years old so he can only eat the foods that you give him. This puts you at an advantage over parents of older picky eaters. Simply refuse to give him chicken nuggets and french fries. Tell him that he needs to eat something healthier. Then give him a healthy choice (that children usually like). Do not give in to his tantrums. As a parent, it is your responsibility to teach your child to eat healthy foods. Sometimes it takes ten tastes before a child will accept certain foods. Don't give up. If your child refuses to eat, that is okay. But don't give him unhealthy food instead. Your child won't starve if he misses a meal or two. Eventually, when he is hungry enough, he will eat your healthy meal. As for vegetables, aim for a "two bite" rule. Your child must try two bites of a healthy food but does not have to eat the rest. After enough tries, he just may learn to enjoy it.

Please keep your questions coming. You can also let me know if you have any comments about my advice on this question.

Tuesday, May 20, 2008

Limit those 100 calorie packs!


I am a big fan of the 100 calorie pack. I mean, who doesn't love them? I am the type of person who can eat one pack and be satisfied. Then again, I can often eat one small chocolate and be happy. The issue is when people eat more than one pack. Or when they eat one pack in the morning, one in the afternoon, and one at night. By the end of the day, they have eaten 300 calories of junk. In my opinion, 100 calorie packs should be limited to once a day. That way you can have your sweet treat without going overboard.

Monday, May 19, 2008

Not all broccoli is healthy!

Okay- so maybe that title is a little sensationalizing- is that even a word? But I am always surprised when people assume vegetables are healthy no matter how they are prepared. One of the nurses in my office told me that a pharmaceutical rep had brought lunch to the office. I never eat at those lunches because they are always insanely unhealthy. But the nurse said to me, "You are going to like it today because it's healthy. There is broccoli." That sounded good to me so I went into the lunch room and saw a tray of chicken with broccoli from a Chinese takeout place. You could see the pools of oil in the tray. I had to laugh- in no way was this dish healthy. In fact, Chinese food is one of the most fattening foods to eat because of all the oil used to cook it. But it just highlighted the fact that many intelligent people don't think about how their food is prepared; they solely look at the nutritional value of the food in the uncooked state. You have to think about what was used to make the food. Was it fried in oil? Is it covered in cheese sauce? Is it topped with butter? If so, it isn't healthy.

Please feel free to ask me questions via the comments. I know you guys are all reading this because I get the numbers reported to me. So ask away. I would love to answer.

Sunday, May 18, 2008

Overweight children and TV

Studies show that the more television a child watches, the more likely that child is to be heavy. Each additional hour of TV watching (on a consistent basis) directly increases the likelihood of that child being overweight. Having a TV in the bedroom raises this risk even further. Children who have TVs in the bedroom watch an extra hour of TV each day (and their parents don't even know about it). It is not clear if watching a lot of TV causes a child to be overweight or if overweight children tend to watch a lot of TV (because perhaps they don't feel as comfortable playing sports or doing other more active activities). One study lowered the weight of the children involved simply by decreasing their TV time. Practically any other activity burns more calories. An interesting finding is that a child's resting metabolic rate might be LOWER while watching TV than when staring blankly at a wall. This may be due to the fact that people fidget less when watching TV or that they get into an almost trance-like state while watching TV. Eating in front of the TV also leads to weight gain. Who among us hasn't been engrossed in a show, only to realize that suddenly half a bag of chips have disappeared! People eat many more calories while watching TV because they aren't paying attention to their food or to their body's response to the food. Commercials also prompt children to crave unhealthy foods. The average child sees 40,000 commercials each year- mostly for high fat, high calorie foods. Just watching a food commercial can cause a child to be hungry. So- what can a parent do? LIMIT TV TIME! The American Academy of Pediatrics recommends less than one or two hours of TV each day. If you are not home to monitor, you can buy a TV device that limits children's TV time. The parent programs how much time each child is allowed to watch TV; a child must enter their code to turn the TV on. Once the maximum allottment is reached, the TV is turned off and cannot be turned on again until the next day (or until the parent resets it). Also, never let your children eat in front of the TV. And do not put a TV in your child's bedroom. Parents must monitor their children's TV watching- both in terms of time and content. A TV should never be a babysitter!

Saturday, May 17, 2008

New Study on Causes of Obesity

A new study states that exposure in the womb to some common chemicals may cause a person to become obese. These chemicals include those used to make many products, such as plastic bottles and pizza box liners. Scientists exposed mice to tiny amounts of these chemicals during development and found that these mice were heavier than mice not exposed to these chemicals.
"One of the problems we are finding is we don't know where all these chemicals are," said Suzanne Fenton, a research biologist at the U.S. Environmental Protection Agency, whose research focused on perfluorooctanoic acid. "The chemicals appear to disrupt the endocrine system by altering gene and metabolic function involved in weight gain", said Bruce Blumberg, a University of California biologist. "The result is the offspring store fat cells more efficiently, which makes them gain weight."
It is important to note that this study has not been done in humans and therefore may not be applicable. It is interesting, however. This may be why some children are heavy, despite seeming to eat similar foods to thinner kids and despite having a normal metabolism. Are some people programmed to become obese even before birth? It is possible.
If true, it does not mean that such individuals are destined to a lifetime of obesity. They just may have a more difficult time losing weight, although weight loss would still be possible. We cannot and should not simply "give up" in light of these new findings. It may be helpful to gain some understanding as to why our children are heavy, but it doesn't change the treatment options. These children should be taught healthy nutrition and exercise from an early age to prevent the further accumulation of fat cells.

Wednesday, May 14, 2008

Healthy Food Costs More...

It is a fact that healthy food is more expensive than junk food. In fact, a study from the University of Washington looked at the price of eating a 2,000 calorie diet if it consisted solely of junk (~$3.50) versus if it consisted solely of healthful food (~$36.30). What a difference! The disparity is likely because healthy food is perishable whereas junk food can lasts years. But when it comes down to it, there are plenty of other ways to save money. We should not scrimp on the foods we serve our children (or the foods we ourselves eat). I was guilty of this today. I went to a local shop (Kitchen Cabaret). I saw an energy bar for $2.00 and some fresh pineapple for $6.00. I thought to myself, "I am not spending that much on a quick snack" and so I bought the energy bar. But later in the day, as I was talking to a patient about this very subject, I realized that I had broken one of my own rules. Don't look to save money at the expense of your health. It's not worth it. And now the 200 calories of the energy bar are weighing heavily on me- ha, ha!

Tuesday, May 13, 2008

Do not become your child's short order cook

We had low fat (97%) hot dogs for dinner tonight. Actually, I should say that I had low fat (97%) hot dogs for dinner. Even though this is usually one of my children's favorite dinners, tonight they protested. My son wanted me to make him peanut butter and jelly instead. I refused, even though it would have been much easier to give in. Children must eat the healthy dinner that is served to them (as long as it is something they usually like). It is not acceptable for children to insist on eating different foods from the rest of the family. I may have made a different decision if we were eating salmon, since I know my son dislikes salmon. But these are hot dogs! Parents are not short order cooks. Parents can (and should) control their children's food intake- even if it isn't easy. Insist that your children eat healthy foods and they will learn to like them. Remember, it takes 5 - 10 experiences with some foods before children will begin to enjoy them. In this case, however, my son was just trying to be difficult. I did not allow him to take over; I did not make him PB&J. I simply told him that we were having hot dogs for dinner and if he didn't want to eat them, he didn't have to. When he gets hungry enough, I am sure he will settle for the hot dogs. I will let you know what happens. How would you have handled the situation?

Monday, May 12, 2008

School Lunch

I am so frustrated with our schools. How can the institutions we trust with our children make such unhealthy choices for them? I saw two patients today who each loved to buy hot school lunch each day. I explained to each of them that school lunches are beyond unhealthy. My nutrition system divides food into green light (Go!), yellow light (Slow!), and red light (Uh Oh!) categories based on their caloric/nutritive values. Almost every school lunch served contains at least one red light food. Some even count as two or more! Each child gets two red lights to use each week. There is no way to eat school hot lunch each day and lose weight. I advised both patients to bring lunch instead of buying. I also gave them the option of buying other lunch options such as sandwiches or salads. One patient opted to bring lunch each day. The other refused to give in and bought hot lunch each day. Other than that, they both follow the plan. The patient that brought lunch lost about 2 pounds this week. The other patient gained half a pound. The bottom line is that school lunches are not compatible with a healthy diet. It is sad, but true. I tell patients that love school lunch to pick their favorite lunch each week and use it as one of their reds. There is no food that is completely off limits. But school lunch every day is too fattening... I urge you all to consider these thoughts when planning your child's lunches.

By the way- please post comments... I have been hearing that you guys are reading the posts but not writing. Write something and let me know you are out there!

Sunday, May 11, 2008

Happy Mother's Day!

Happy Mother's Day! I hope everybody is enjoying this special day. I had a wonderful time with my family. I did notice, however, that every celebration centered around food- and not healthy food. I started the day with brunch at IHOP. As a "treat", my children shared strawberry pancakes (pancakes covered with strawberry syrup and drowned in whipped cream and syrup). My son, Zachary, and I went to get haircuts where our hairdresser gave him a lollipop. He was very sweet and got one to give to his sister when we got home. Then we went to our family's Mother's Day party. Our hosts had bowls of M&Ms placed all around the house. You can imagine how my children were all over them. Even I was unable to monitor and curb the chocolate intake. The meal was served: mini pizzas, chicken nuggets, and French fries for the kids. After the meal, I saw that the kids were all congregated around the M&Ms again. By the time dessert was served, I had lost all control. My son immediately went to the chocolate cake. My daughter looked at all of the desserts and asked for fruit. I was elated. But when we got her to the kid's table and she saw everybody eating cake, she began to cry for her own cake. After my son's first slice of cake, he asked for another. I immediately told him that he had eaten enough junk for the day and that he would get a bellyache if he ate anymore. My mother immediately butted in. "Joanna, it's a special day. Can't he just have one more piece of cake?" I said, "No- he has had enough" but my husband piped in, "C'mon. It's Mother's Day". I couldn't win. Zachary had a second piece of cake. And then, you guessed it, "Mommy, I want a cookie". I said no and again Doug said, "Well- he didn't finish the second piece of cake". Despite my protests, my husband handed him a cookie. I will note that he took one bite and then put it down.

What a frustration! It just is not healthy for children to eat this way. I guarantee that children growing up in the '70s did not eat three pieces of cake. I am sure that mothers back then were not bullied into allowing their children to overdose on chocolate. How has this society gotten so out of control? How has three slices of cake become the norm. And it is not just Mother's Day. It seems there is always an excuse for this kind of behavior. Mother's Day, Father's Day, Memorial Day, Fourth of July, Labor Day, etc. And then there is mommy's birthday, daddy's birthday, grandma's birthday- and everybody else in the family. Don't forget about all of their friend's birthdays. It really doesn't end.

Children will keep on getting heavier and heavier unless we take a stand. This binge eating is not acceptable. We must be stronger for our children's sake. It isn't easy- even I fail from time to time. But we can't give up the struggle.

Friday, May 9, 2008

The Healthy Shelf

Children love to make independent choices, however their choices are not always (or usually) the healthiest. A good way to give your child some autonomy over his/her diet is to create a "Healthy Shelf". Take all of the healthy snacks from your kitchen and put them in a place that your child can get to. Then when your child is hungry, he/she can pick anything they would like from the available (healthy) choices. You can also make a "Healthy Shelf" in the refrigerator. Mine is filled with low fat yogurt, low fat cheese, fruit, and cut veggies. Another benefit is that you don't have to get up everytime your child is hungry (which in my house is all of the time!)

Thursday, May 8, 2008

When the family doesn't work together...

How can a child learn healthy eating habits when his/her parents aren't modeling the desired behaviors? I see many parents who are distressed about their child's diet and weight but seem unwilling to make appropriate changes themselves. That type of attitude will never work. The entire family needs to make changes. You can't expect a child not to eat chips when he sees his father sitting in front of the TV with an open bag. I find this with my own family. My husband and I took our children out for lunch last weekend and I ordered grilled cheese (made without any butter or oil) and sliced cucumber (instead of fries) for the children. My husband then proceeded to order a bacon cheeseburger with fries. What?? I knew exactly what would happen. My children wound up eating most of my husband's food. It is very difficult to teach your children to eat well when some members of the family are not. This is especially difficult when one sibling is heavy and the other is thin. Parents routinely tell me that they can't expect their thin child to forgo dessert simply because their other child is heavy. I strongly urge these parents to treat both siblings the same way. It is not fair to allow one child to eat things that the other is not allowed. It sets up bad feelings for everybody involved. Besides, nobody should be eating unhealthy foods on a regular basis. When starting a child on a weight loss program, the entire family must be prepared to make changes.
More tomorrow...