A Diet For The New Year

 And Beyond

By Jeff Cersonsky, MD, FAAP

“My pediatrician suggested that my daughter lose weight. What do you think of those ‘lo-carb’ diets?”

This is a good opportunity to look into your child’s nutrition and make sure that her diet is what it should be. I’ve formed some solid educated opinions about children’s nutrition. I’m not a nutritionist, but after 25 years in pediatrics, I feel there are some important issues brought up by today’s question to address:

Obesity: First, a healthy perspective is essential.

Our sons don’t need to look like steroid-enhanced athletes; our daughters don’t need to look like skeletal celebrities. Our children need to have healthy bodies, which means a healthy weight. Body Mass Index (BMI) is a scientific, objective measure that indicates whether a child’s weight for age and height is appropriate. Your pediatrician can calculate BMI or parents can do so themselves as follows: Using a calculator, body mass index is equal to Body Weight (in pounds) divided by Height (in inches) divided again by the Height, then multiplied by 703. The accompanying charts (from www.keepkidshealthy.com/welcome/bmicalculator.html) show the normal body mass indexes for children. For instance, a 3-year-old girl should have a BMI less than 18.3. A 10-year-old boy should have a BMI less than 22.

Dieting: I hesitate to condone any dieting by my patients. The main trouble with diets is that they end. What I counsel my patients to do is to adopt a healthful, balanced way of eating that will last a lifetime, not the finite amount of time it takes to shed some pounds. A healthy eating plan for children needs to take into account the lifestyle of kids. Children still need to be children, and function in the school and social world they live in. For the child under 10, it is mostly the parents’ responsibility to supervise their nutrition. For the child 10 and up, they have to take an active part in planning a healthy diet or it will not work.

Lo-carb Diets: To put it simply, these diets are simply NOT for children. Children who try them will end up eating too much fat, and may not get enough carbohydrates to properly concentrate at school, or to maintain their energy levels. This is not a balanced diet by any means and is not a model for lifelong healthy eating, which is our goal.

Proper Nutrition: Good nutrition has more to it than maintaining a good weight. Nutrition’s a separate topic altogether, but here are some pointers: Children need to get 5–8 servings of fruits and vegetables a day, with 2–3 servings of fish, meat, or eggs, and the equivalent of 12 ounces of milk products. The vegetables should be a mixture of legumes (beans), green leafy vegetables, and yellow vegetables (including orange vegetables and spinach, but not corn — corn is a grain, not a vegetable). Foods should be naturally nonfat or low-fat wherever possible, but beware of sugar substituting for oil. Breads, cereals, and pasta should be whole grain and high in fiber. Sweets should be kept to a minimum, and that minimum will vary depending on the child. My parents used to tell me that sweets would ruin my dinner. The truth is that simple sugars actually increase hunger and calorie intake because they bounce the blood sugar up then down, creating more hunger. So, not only do they add “empty calories,” but they result in more intake of other calories by the child.

What do I mean that the minimum quantity of sweets would vary from child to child? The truth is that every child has a different metabolic rate and requires a different number of calories to maintain a good weight. Some children can only have one or two desserts a week, where others can have a small treat every day. Every child, however, should learn what a reasonable quantity is. Three (or even two) scoops of ice cream are unnecessary to enjoy the experience. One will do.

Exercise: Exercise is terribly important for a child’s health. Exercise must be combined with a healthy, low-calorie diet to have the desired impact on weight control. Good, vigorous play every day, together with a healthy, balanced diet, is the best prescription.

Growing into a Weight: Children have a terrific advantage over adults in that they are still growing. I will frequently advise a parent of an overweight child that we need to find an eating pattern that will not necessarily lose weight, but rather will allow the child to grow into their weight. For instance, a 6-year-old girl who is 45 inches tall, and 60 pounds (giving a BMI of 20.8) who grows three inches in a year without gaining weight will reduce her BMI to 18.3, which is in the normal range. Even when I recommend weight loss, I recommend no more than 10 pounds per three months, no matter how high the weight.

So what do I recommend for children with a weight problem? Keeping the above in mind, the process is simple to describe and not too difficult to apply. First, keep an accurate diet diary of everything a child eats. Many children are getting extra calories in snacks they barely know they are eating. After a week, go over the diary either by yourselves or with the help of a professional. Look for areas where quantities can be reduced, substitutions can be made, and overall calories can be reduced. Because, despite all the new diets and fads, it’s calories which are the biggest determinant of weight control.

For instance, instead of having the pure sugar of maple syrup on your pancakes in the morning, try some fresh fruit. Instead of that soda or lemonade at lunch, try drinking water, nonfat milk or 100 percent juice. Keep track of weekly or monthly weights (not daily — that can cause a child to dwell too much on his or her weight), and reevaluate the written diary of foods on a regular basis. Make it a family affair (most overweight children have one or more overweight parents) and try to make it fun!