Pediatric Fitness

Pediatric Fitness

Pediatric Fitness: How We Can Work Together to Help Kids

To examine the impact and cost of obesity within the U.S., HBO and the Institute of Medicine, in association with the National Institutes of Health and the Centers for Disease Control, created a four-part documentary series titled, "The Weight the Nation."

Part three of the series, "Children in Crisis" features the UW Health Pediatric Fitness Clinic and highlights two of the patients and their families.

Watch Part 3: Children in Crisis

A Discussion with the Staff of the Pediatric Fitness Clinic

During a recent community screening of the documentary, staff from the Pediatric Fitness Clinic, including Dr. Alexandra Adams, Dr. Blaise Nemeth and nutritionist Cassie VanDerwall answered attendees questions about helping kids make healthy choices, and maintain an active lifestyle. Highlights from the evening's discussion are below.

How Do We Know if Our Child Has a Weight Problem? And, What Do We Do About It?

Fluctuations in weight are natural as children grow. However, if your child is over the 85th percentile for body mass index, or BMI, the reality is he or she is probably not going to grow out of it.

Weight issues can occur at any age, even as toddlers. But, if you're at a well-child check and the BMI is high for your child's age, that should be a call to action.

It's critical to remember that it's not just a kid issue, and it's not an issue of blame. It takes commitment from everyone in the child's life to try and do something about it.

How to Talk to Your Child About Weight

It's important to frame the conversation in terms of the family. "I think in our family we're eating too many desserts," for example, or, "I think we should be more active as a family." And ask the child how they're feeling about their activity level, or what they're eating. Often kids are more aware than we give them credit for.

Also, encourage kids to be thoughtful about why and what they're eating. Are they bored? Thirsty? And how do they feel after they've eaten particular foods? Encourage an awareness of the how's and why's of eating.

How to Make Changes

It's unrealistic to suggest drastic changes to lifestyle or eating habits. Instead, consider what's currently in your kitchen cupboards and figure out - are there healthier alternatives out there?

Also, remember that as parents, children look to you as role models. The biggest impact on children's habits comes from watching the adults in their lives. They learn by example. If you want to limit kids' soda consumption, it's best to keep soda out of the house and limit your own consumption of it.

As the "nutritional gatekeepers" for the home, parents can make a significant difference just by opting to have healthier options available. And take time to be active as a family. Go for a walk after dinner. Take a hike, play in the snow. Just get active together.

The Issue of School Lunches

For some kids, school lunches is the only meal of the day. Historically, school lunches had a higher caloric value for just that reason. But, if you're not satisfied with the meals available at school, there are a few things you can do.

Teach your kids that healthy foods can be satisfying and continue introducing your kids to fruits and vegetables. This one can be tough because it requires a lot of patience. Some experts suggest that it takes 15-20 times to introduce a new food and another 15-20 until a child will actually eat it. That's almost like a year's worth of effort trying to get your kids to eat the peas you're serving with dinner.

Look over the school menus together and identify the healthier food options available during the week. If possible, consider supplementing school lunches with food from home. Perhaps it's a mix of bringing lunch from home three times a week and eating school lunches on days when there are healthier options available.

And find balance. If the lunch on a given day is less than your standards, then make sure breakfast and dinner are healthy options.

Are There Tips for Getting Kids To Eat Healthy Foods?

The first step is to figure out where your kids are at from a developmental perspective. Older kids may respond better to learning the facts and statistics about what an unhealthy lifestyle can do to their future health. Younger kids won't be able to quite grasp that kind of long-term thinking, so you need to bring the conversation to their level.

Look around and see where kids are eating - school, sports practices, grandparents houses, friends? Where are they consuming most of their foods and can you help them identify ways to make healthy choices?

Have someone other than you, their parent, have the conversation. There's no doubt it can be frustrating to have your child say, "So-and-so told me this!" when you've been saying it all along. But in the end, what really matters is that they're hearing the message.

Limit the junk food available in the house and make sure you have healthier options available.

Consider having a garden and letting the kids plant and tend their own plants. You might be surprised at how enthusiastic they'll be about vegetables when they've grown them.

Consider alternatives. Your teen doesn't like breakfast? Try making a healthy breakfast smoothie that can be taken to-go. Not a fan of cereal? Make it a PB&J on whole grain bread with a glass of milk. Work together to find something that works.

How Much Should We Eat? And, What is the Caloric Intake Kids Should Be Getting?

Rather than looking at how much soda you're consuming in a day, it's easier to look at how often. When asked to self-report, people on average underestimate the amount of food they've consumed. So, look at patterns of how often you consume chips or drink soda, for example.

My Plate is a very useful tool because it provides an easy framework to determine how much of a particular food type you should be consuming.

It's difficult to figure out how much a 1/2 cup of pasta is in order to determine whether you've had a full serving. My Plate divides the plate so that 1/4 should be a lean protein, 1/2 a whole grain, and 1/2 should be filled with fruits and vegetables. is a great resource to learn more.

Caloric intake varies based on age, gender and activity level. Teenage girls, for example require anywhere from 1,600 - 2,000 calories per day, while teenage boys need 1,8000-3,000. It's best to consult with your child's primary care provider to determine what's best for your child's health.

A Word About Water

Kids often mistake thirst for hunger. At school they may be limited to just the water fountain throughout the day and when they come home, eat because they think they're hungry when in fact they're dehydrated. If possible encourage kids to carry a water bottle in the backpack. And kids should aim for eight 8-ounce glasses of water a day.

What's Causing Early Puberty?

The onset of puberty is early in kids who are obese, but research is still out on what the exact causes are. Whether it's Bovine Growth Hormone or BPA, there's not enough evidence at this point to determine how our endocrine systems are being affected. Parents need to make their own choices about what's comfortable for them. Avoiding BPA, or r-GBH is really a personal decision at this point.

How Can We Eat Healthy When Food is All Around Us?

There's no doubt there's a prevelance of food in our daily lives. Whether it's at church, through the workplaces or at school it seems like we can literally eat our way through the entire day. But there are a few tips you can try to help navigate a tempting landscape.

  • Make sure you have a full stomach before you go to a place you know there'll be tempting foods, like church or even a holiday party.
  • Be aware of what you're eating and ask yourself, are you really hungry or just eating because it's available?
  • Stick with the appropriate quantity of food. One small slice of cake is okay, but don't negotiate one small slice of cake and one cookie in lieu of one large piece of cake.
  • Eat mindfully. Quiet the environment down at dinner so you can focus on what you're eating and pay attention to how it smells and tastes.
  • Teach kids to use a scale to identify how full they are. On a scale of 1-5, how hungry are you? For little kids you could even make it fun - are you as hungry as a mouse or a bear? Some experts suggest stopping before you feel full since it can take a little bit for the brain to catch up to the stomach.

What's With All the Sugar?

If you stop to read food labels, you'll may just be surprised to see how much sugar is in the foods we eat, even ones that are so-called, "healthy." So what should we aim for in our day?

It's important to limit the amount of added sugars in your daily diet. And they can hide in many different forms.  When you read the label, look for words ending in "-ose" like maltose or sucrose. And other forms include high fructose corn syrup, molasses, cane sugar, syrup, honey or fruit juice concentrates.

Adult men should limit their sugar consumption to 9 teaspoons per day (or 37.5g), while adult women should limit their consumption to 6 teaspoons (or 25 grams) per day.

Preschoolers should only consume about 4 teaspoons of added sugar, while elementary school kids the recommendation is around 3 teaspoons. Teenagers are generally between 5-8 teaspoons. Stop to consider that one 12-ounce can of soda has 12 teaspoons, so with that one drink, teen are already consuming twice the daily amount. And that's just one soda.

While sugar-sweetened beverages like soda or juice are major culprits, added sugars can be found in a variety of foods like bread, breakfast cereals (even ones the purport to be healthy), and even condiments like mayonaise and ketchup.

What Can We Do?

Watching a compelling documentary like "Children in Crisis" can leave anyone, but especially parents, feeling overwhelmed and even to a degree, helpless. There are important things to remember.

Dr. Alex Adams reminds us that this is an "everybody issue." We all have a part and a responsibility and it's important to do our best.

For Dr. Nemeth, physical activity throughout our day is critical. While the conveniences of modern life have made that challenging, we need to find ways to bring it back into our daily routine.

Cassie reminds us that health starts at home, and it doesn't have to be major. Pick just one thing you can change and make that change. Then next week or next month, pick another thing and before you know it, you'll have made major changes by taking one step at a time.