Healthy Food & Healthy Living by Dr. Ayala

Childhood obesity, an app for that too?

The prevalence of childhood obesity is truly alarming: One fifth of American kids are obese.

When an adult is obese their doctor might recommend a weight loss diet. Their health professional’s advice will be just a drop in the bucket of counsel: Weight loss plans of all stripes materialize from every bookshelf, digital screen and food outlet. Weight loss is a 72 billion industry, which in and of itself might suggest that we don’t yet have a reliable solution – most weight loss plans work to a certain degree when people reduce caloric intake, and ultimately have miserable long term success rates in avoiding weight regain.

Should the same approach be used for kids?

A few weeks ago WW, previously known as Weight Watchers, launched an app called Kurbo, intended to help kids (as young as 8 years old) and teens “reach a healthy weight”. It tracks food intake, physical activity and weight loss. The app categorizes foods into Green (fruits and veggies), Yellow (bread and pasta) and Red (candy, soda and French fries), encouraging kids to eat according to the traffic light system, and asking them to select a goal, such as ‘lose weight,’ ‘feel better in my clothes,’ ‘make parents happy’, ‘boost my confidence’ and ‘eat healthier.’ For a fee, it will set kids up with coaches. The app follows a previous encroachment into young audiences: Last summer WW offered free membership to teens aged 13-17.

The newly launched app was met with widespread criticism from consumers and dietitians, and a petition in change.org has collected tens of thousands of signatures. Why the outrage?

Should kids diet? What are the risks?

Kids and teens, unlike adults, are growing, and caloric restriction, if not done carefully, may interfere with their growth and development.

Another concern is the link between food restriction and eating disorders, which are extremely prevalent among teens, and are in fact the third most common chronic condition in teens – right after obesity and asthma. Although eating disorders usually appear in teens who are not overweight or obese, quite often, teens who try to lose weight develop eating disorders.

The American Academy of Pediatrics issued a clinical report several years ago in which it reviews the studies and states that dieting – caloric restriction with the goal of weight loss – is a risk factor for eating disorders, and, un-intuitively perhaps, to obesity. Pediatricians are advised to discourage dieting.

So, if dieting is counter-productive and risky what should health professionals and parents do? The obesity, nutrition and eating disorder experts writing the paper suggest an integrated family-based and lifestyle approach (emphasis is mine):

“An integrated approach to the prevention of obesity and EDs [eating disorder] focuses less on weight and more on healthy family-based lifestyle modification that can be sustained. Pediatricians can encourage parents to be healthy role models and supportively manage the food environment by creating easy accessibility to healthy foods (eg, fruits, vegetables, whole grains, beans and other legumes, and water) and by limiting the availability of sweetened beverages, including those containing artificial sweeteners, and other foods containing refined carbohydrates.”

Leaving it to the kids?

Early prevention and intervention – before habits of overeating set in – is key, but when it comes to obesity treatment proven successful plans are hard to find, and most success is short lived. A 2017 Chochrane review estimated that childhood interventions that included diet, physical activity and/or lifestyle changes achieved only a very small, short-term reduction in BMI.

A recent analysis in Obesity Reviews looked at 182 nutrition-related randomized trials in kids aged 2-11 years for successful interventions. Only 14 trials were effective in reducing body weight, the results in these were small (but still encouraging), and those successful trials centered on environmental changes, such as water fountain installations at school and cafeteria menu changes.

Childhood obesity has tripled in the last three decades. The epidemic’s cause is multifactorial, but I don’t think kids of the 70’s liked candy and soda any less than today’s kids. They certainly needed much less self control – they didn’t live in an obesogenic environment in which the default is to gain weight, one on in which junk- and fast-food is endlessly available and tirelessly marketed to them wherever they go.

We owe it to our kids to fight this fight for them and with them. The last thing they need is more of time alone on an app.

Dr. Ayala

How to get babies to love their veggies

Parents know how important vegetables are to their kids’ health, yet only 1 in 10 kids eat enough of them, leading to another worrying statistic: Only 1 in 10 US adults eat enough fruits and veggies to support good heath. How do you create good vegetable-eating habits? How do you get kids to like vegetables and eat them out of choice, without a struggle?

All habits are easier to form earlier in life, but that’s even more pertinent when it comes to food preferences. Generally, a baby’s first 20 months are the time he or she is most open to new flavors and textures – bear in mind that babies are fed nothing but milk until age 4-6 months. Acceptance of new foods diminishes after that, food neophobia peaks at age 5 years, after which interest in new food usually recovers.

So how do you take advantage of this window to get kids into broccoli, tomatoes and spinach?

A new review, published in the journal Appetite, collected all 46 relevant scientific studies on promoting intake of vegetables in kids under 3 years of age. Among these there were 25 interventional studies and 21 observational ones.

Strategies that work

Repeated exposure

There were 27 studies exposing babies to the same vegetable repeatedly, for 8-10 repeats. All 21 experimental studies find that recurrent exposure increases intake, usually by at least about an ounce a day, and that the younger the baby, the greater the increase in veggie consumption. The 6 observational studies confirm the same trends. Some of these studies had up to 6-month follow up, demonstrating that repeated exposure let to a stable increase in veggie consumption.

How many exposures are needed to change a baby’s initial aversion? Some studies showed an effect already at the third exposure, and by the eighth exposure about 70 percent of babies liked a veggie they previously disliked.

Variety

Exposure to a variety of veggies seems to increase veggie intake in young kids in the 15 studies examining this strategy. When variety is piled on to repeated exposure the advantages are magnified.

Start early

Mom’s diet during pregnancy and after birth if she’s breastfeeding may expose her baby to the flavor of veggies very early, well before they eat their first mashed carrot. All the observational studies reviewed in this paper support a relationship between breastfeeding and veggie acceptance.

As to the age in which babies were fed their first veggies, this seems to have just a small effect on veggie affection, hardly detectable when the kids are 4 years old, so no rush  feeding eggplants to a 4-month-old.

Visual exposure 

Does showing a picture of a veggie in a book increase a baby’s affinity to the veggie? Four studies investigated this question and suggest that exposing babies to unfamiliar veggies through books, play and touch moves them to try that veggie.

Setting an example

Parents who eat vegetables in the presence of their kids tend to have kids that eat vegetables. Three observational studies in this review confirm that setting a good example of eating and enjoying vegetables is associated with higher frequency and intake in their young kids.

Things that don’t seem to work

Acclimatizing to a veggie’s taste

Parents may combine a veggie that their kid doesn’t readily want with a flavor they like, for instance, sugar can be added to green beans, masking its flavor. Although young kids initially prefer a sweetened veggie puree or a high calorie veggie soup the effect doesn’t last.

Bottom line

Repeated exposure to a variety of veggies and fruit is the most effective way to get babies and young kids to eat them. This method is the most proven scientifically, and makes intuitive sense – we’re all subject to the persuasive power of repetition, that’s why we’re served the same messages and ads again and again.

Don’t give up!

Serve veggies in a positive, calm, no pressure way – another clear takeaway from other research is that pressuring kids to eat is counterproductive and it certainly isn’t fun for anyone involved. It also follows common sense that better-tasting, nicely prepared veggies will be better liked.

Dr. Ayala