Thursday, July 31, 2008

How to get yourself to exercise when you are tired.

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.

Wednesday, July 30, 2008

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

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!

Sunday, July 27, 2008

But I only ate half the sandwich...

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.

Friday, July 25, 2008

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

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.

Wednesday, July 23, 2008

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.

Monday, July 21, 2008

Dr. Dolgoff's Lighter Weigh- at home

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.

Sunday, July 20, 2008

Parents must speak up!

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.

Thursday, July 17, 2008

Child Obesity and Diabetes

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.

Tuesday, July 15, 2008

Medical Risks of Child Obesity- Focus on Heart Disease

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
Liver Disease
Gall Bladder DiseaseSeveral Kinds of Cancer
Other Musculoskeletal Problems
Sleep Apnea
Infertility in Women
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.

Monday, July 14, 2008

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.

Saturday, July 12, 2008

Apple Fries Update

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.

Thursday, July 10, 2008

Children on Cholesterol Meds- My Thoughts

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.

Wednesday, July 9, 2008

Children on Cholesterol Meds?

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.

Tuesday, July 8, 2008

Shocked at Chili's

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.

Friday, July 4, 2008

Eating for sport

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.

Wednesday, July 2, 2008

Early sign of pre-diabetes

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.

Tuesday, July 1, 2008

Apple fries

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.