Experts help families fight fat
A child obesity study published earlier this year in the New England Journal of Medicine found that children who were obese or overweight by kindergarten typically remained that way into eighth grade. Austin doctors and dietitians are seeing some of that trend here, as well as other nutrition challenges.
Dr. Kimberly Avila Edwards, a pediatrician at Austin Regional Clinic who was previously at the Texas Center for the Prevention and Treatment of Childhood Obesity at Dell Children’s Medical Center, says she and other pediatricians are doing a lot more talking to parents about healthy eating habits in recent years. They talk about nutrition and activity in terms of numbers — 9-5-2-1-0: Nine hours of sleep a night, five daily servings of fruits and vegetables, two hours or less of screen time (including video games, computer, iPads), at least one hour of physical activity a day and zero sugar-added drinks (including juice, sports drinks, sodas, sweetened waters).
She says dietitians have become vital parts of the team effort of helping kids and families be healthier for both the kids who are overweight and kids who are considered failure-to-thrive or underweight.
Amy Eschberger, a pediatric dietitian at Specially for Children, has seen a lot of kids come through the practice at both ends of the spectrum. For the kids who are struggling with their weight, it can be more than just the pounds. They might be carrying around excess fat on their livers as well as be at-risk or already have Type 2 diabetes.
Hope van der Heijden, the clinical nutrition manager at
Dell Children’s Medical Center, says recently she has seen more children diagnosed with Type 2 diabetes. She and other dietitians help families begin a new way of eating before they leave the hospital. “It’s a life-altering diagnosis,” she says. “When we talk to the patient, we talk to them about healthy eating and portion control. Weight loss is a very delicate topic.”
Gastroenterologists rely on dietitians to get to the nuts-and-bolts of a patient’s diet. Patients benefit from a face-to-face interaction with a dietitian, says Dr. Anees Siddiqui, a pediatric gastroenterolo- gist at Specially for Children. “It’s difficult to create lasting change based on an educational fact sheet.” Often a dietitian will ask the family to do a 72-hour calorie count to know what the child is eating and how much. Dietitians involve the whole family because children don’t really control what food items get brought into the house. “(Change) begins with every family member,” Siddiqui says.
There’s a division of responsibility when it comes to healthy eating, van der Heijden says. Parents should be in charge of what their children are eating, and children should be in charge of how much so they can be in touch with hunger cues and know when to stop.
Parents also should model healthy eating habits. Changing habits is easier when children are younger before the teen rebellion years hit.
Dietitians also help children with malnutrition as well as specific diseases such as celiac or inflammatory bowel disease or food allergies or intolerances, constipation and other digestion problems that might change how a child can eat.
One of the new things doctors and dietitians have seen recently are families who are putting their children on a restrictive diet such as paleolithic or gluten-free when there is no medical reason to do so.
“A lot of folks have strong beliefs,” Siddiqui says, but he asks parents to do a cost-benefit analysis before putting children on a restrictive diet. Some of the risks he points to are bone strength and growth and ability to concentrate. There also can be some psychological and behavioral ramifications with not eating what your friends eat, he says.