Good food, bad food and calorie counting? What kids really need to learn.

Nutrition education in schools worries me. My sentiments have been echoed

on the Academy for Eating Disorders list serve and among peers from SCAN--the Academy for Nutrition and Dietetics (AND) subgroup populated by progressive thinkers.

A very different path.

To change the direction of how kids are being taught, I've written this piece. Share this locally, in your schools, and virtually. Use it, and use it fully, including my name, please. Thanks for spreading the word and working for change.

Good food, bad food and calorie counting? What kids really need to learn.

By Lori Lieberman, RD, MPH, CDE, LDN

In an attempt to tackle the “obesity epidemic” kids, educators and parents often receive well-intentioned but potentially harmful messages to manage eating. (1)Calorie-counting apps and black and white messages about what’s healthy to eat can be problematic. Kids, parents and educators need practical, realistic strategies to add to their toolbox. Help kids learn to self-regulate their food intake utilizing current knowledge on eating behaviors and the food environment and know the damage of deprivation-based diet approaches.

One size does not fit all!

We are educating the masses—kids of all sizes and weights, including those who are sedentary and those with very high needs given their size, needs for growth and for sports—and kids with personality traits who tend to be very literal, anxious or perfectionistic. Consequentially, food messages should be presented to serve all without harm.

Good food/bad food

Nutrition messages need to shift from the ineffective ‘good’ versus ‘bad’ nutrients and foods, to factors that impact the ability to self-regulate intake. Directing individuals to restrict their fat intake can backfire. (2) Labeling sugar as ‘bad’ and setting calorie budgets fails to control weight in long term. (3) Evidence shows that perceiving a scarcity of food and deprivation from restrained eating creates greater problems (4) and contributes to eating disorder development. (5)

Calorie counting 

Calorie counting is ineffective in the long run and conflicts with utilizing hunger and fullness—essential for managing energy balance. It fails to teach kids about major obstacles to changing eating—eating behaviors and environment. Counting calories has little positive impact on improving eating habits and weight. (3,6,7)In one study kids who began dieting had a significantly higher likelihood of developing a serious eating disorder. (5)

Portions 

Portions are also not one-size fits all. Current materials (1) refer to appropriate snack sizes but for underweight kids, competitive athletes, and those simply with higher needs, these may be inadequate. Many teens require more than the current campaign’s recommended single serving of most snacks and greater than the 100 calories encouraged as ‘moderate’.

Sit, structure, separate, sense. 

Let’s shift the focus to what works—a mindfulness approach addressing simple, achievable eating behaviors. (8,9)

Address these key behaviors to improve intake and portioning of food, applicable to all children and adults.

• Sit in the kitchen or designated eating space, at a table or counter when eating.
• Structure the day to include 3 balanced meals and snacks. Include an early breakfast and be prepared—keep snacks available and give kids a chance to eat when they need to. Encourage delaying not forbidding ‘seconds’, allowing time to sense fullness. Allow eating later when hunger is present.
• Separate eating from distractions, like TV, phone, homework, computer; distracted eating increases intake. Separate food from sight; keep food off the counters to prevent triggering eating.
• Separate food from its package! 
• Plate it.
• Use your senses. 
• See, smell, feel, hear and taste your food—whether it’s a cookie or cantaloupe. You’ll be more satisfied when you really pay attention to and enjoy what you’re eating.

Encourage positive additions and messages to support a healthy diet.

• Include 3 or more cups of milk, yogurt or milk alternative (such as soy milk) for protein, calcium and vitamin D.
• Choose fruit frequently. 
• Select from fresh, frozen, canned in juice. Don’t forget dried fruit—a convenient, satisfying, nutrient and fiber rich snack.
• Vary the Vegetables: shred them, steam them, sauté them, dip them, puree them into soups or smoothies. 
• Get them in all colors. Include more than a cup a day.
• Get real! Choose more foods that are processed less, including nuts and seeds, beans, whole grains and fresh fish/meats.

Let’s spread a sensible, more sensitive message to promote health among school age kids of various sizes and needs. Advocate for diversity of foods to normalize intake for a diet rich in nutrients and adequate in calories. Let’s focus on learning to encourage portions that fit the individual’s needs by integrating both mindfulness and environmental strategies. And let’s accept that normal eating includes having foods at times simply because they taste good.

Citations

1.http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm281746.htm

2. Wansink, Brian, and Pierre Chandon. Can “low-fat” nutrition labels lead to obesity? .Journal of marketing research 43.4 (2006): 605-617.

3. Lowe MR, Doshi SD, Katterman SN, Feig EH. Dieting and restrained eating as prospective predictors of weight gain. Frontiers in Psychology 2013;4:577.

4. Mullainathan, S, Shafir, E. Scarcity.New York::Times Books, 20135. Lowe, M. R., Thomas, J. G., Safer, D. L. and Butryn, M. L. (2007), The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa. Int. J. Eat. Disord., 40: 640–644. doi: 10.1002/eat.204056.

6. Downs, Julie S., et al. "Supplementing menu labeling with calorie recommendations to test for facilitation effects." American journal of public health 103.9 (2013): 1604-1609.

7. Ely, Alice V., et al. "Differential reward response to palatable food cues in past and current dieters: A fMRI study." Obesity 22.5 (2014): E38-E45.

8. Beshara, Monica, Amanda D.Hutchinson, and Carlene Wilson. "Does mindfulness matter? Everyday mindfulness, mindful eating and self-reported serving size of energy dense foods among a sample of South Australian adults." Appetite 67 (2013): 25-29

9. http://www.nutritionj.com/content/10/1/9  Supporting Intuitive eating section, Linda Bacon

The Google diet. No need to keep searching.

I've seen it first hand. And I'm certain that if you were to experience it first hand, that you'd be sold too. This is no testimonial for quick weight loss, nor for the latest cleanse. And I haven't lost my mind. And yes, I've already eaten my breakfast, and had my coffee--so my thinking is quite clear.

It's time to open our eyes to what Google already knows about being healthy and fit. And to apply those lesson plans to our schools--and to our selves. I'm talking about the Google diet: Google's approach to food and eating, to feeding it's many employees, that's super smart. It seems strikingly crafted, based on the research on keeping us healthy--and happy. I had no plans to blog on this, but after visiting a couple of Google offices I just had to share. Because we can all get some answers from Google.

So what's so impressive about the Google diet?

Snacking: from portions to placement

Google likes snacking. So yes, already I'm sold. There are snack stations at various sites throughout Google buildings, with several notable features: there are m & m's, and there are organic bars; there's dried fruit and fresh fruit (much of it local no doubt) and nuts and yogurts.  Take your pick. Yes, there are desirable snack options that encourage Googlers (employees) to snack. Because we all need to snack for energy, for clarity, for productivity. Or we get tired. And cranky. And impulsive when we finally get our hands on food. Or, we miss our opportunity to eat when hungry, and for some, interest in eating is lost.

There are very mini cups--the folded paper ones like what you get pills in at the hospital--and there are cereal size bowls, too. Need just a few peanut m & m's? Portion them into a mini cup and acknowledge you're eating them. And they'll look like much more, and appear more satisfying, than if served in a cereal bowl. (see Brian Wansink's work on this.) Googlers might even be encouraged to choose the more wholesome choices by placing them at eye level--just as supermarkets stock Fruit Loops at toddler height. 

And those snack areas? They are separate from work areas. We all need to have a time out for eating, separate from our other activities. And by keeping them separate, Googlers aren't prompted to eat them just because of the visual stimulus. Rather, they have to decide to go and get a snack because, I suspect, they're hungry. 

In contrast to Google,  our schools, specifically Middle and High schools, pretend that kids no longer need to eat between meals. They expect them to function well and not be irritable, in spite of drops in their blood sugar and falling energy levels. Yes, growing kids certainly need snacks between meals.

Yet teens are at the mercy of individual teachers to possibly break the rules to allow snacking in their classrooms; or, they must get permission when medically necessary to eat at the nurse's office. Sometimes kids need to sneak food in between classes--often the easiest option. Yup, nothing like encouraging our kids to start sneaking food.

Moderation

In schools, the curriculum speaks of good versus bad foods--although admittedly in slightly more opaque terms (see my last post). Fruits, vegetables and low fat foods--they're the good stuff, while fats and sugars--they're viewed as bad. It reminds me of the unsuccessful DARE drug education program taught in US schools, the program which had my middle schooler at the time appalled that I would dare to drink a glass of Cabernet with dinner. 

Not a Google dessert, but it could have been.

At Google it's about moderation. At the cafeteria, foods are labeled using the traffic signal approach: best choices get a green light, to be eaten freely; yellow, more caution with frequency and amounts, and red lights urge awareness that these shouldn't be eaten too often. (Think creamy clam chowder or fatty meat dishes.) But note that red light items are still served, and balance is the take home message. I can't say how effective the traffic light system actually is, but I surely like that they're not encouraging fat free or low calorie foods, nor displaying calorie counts in their cafeteria. Our schools, in contrast direct our kids to calorie count hoping that that awareness will solve the 'obesity epidemic'. 

I almost forgot to tell you about the desserts! They're served every day--but the portions seem rather reasonable. And they weren't placed at the start of the lunch line where diners are sure to grab it first thing--that's where the salad was displayed. Rather, it was somewhere in the center if I remember correctly--I had to search for it actually. And knowing there's no shortage of desserts being served each week surely must prevent Googlers from hoarding their desserts. No doubt they trust that it'll be there. And they can eat just as much as they need, because tomorrow will bring another dessert. (see Halloween post about this)

It's gotta taste good 

Ok. I realize that Google employs Michelin star chefs to prepare delicious food for their employees. But can't we even serve more desirable fruits and fruit salads in our schools? Can't we stir fry some tasty veggies to be more appealing for kids to want to eat? Can't we serve mini cookies with lunch--to teach balance and moderation? And can't we allow ourselves to eat foods we truly enjoy?

Support movement

Biking or walking to work? You get rewarded! Yup, in Google's case, financially. Bike to school and you might be sent home. Seriously. It happened to a patient of mine in MA. And you'd be lucky if there were a place to store your bike! In US schools, the move has been to reduce physical education. At Google it has been to add spin classes and yoga. Something needs to change in our communities to support more movement.

Consider these Google diet lessons

• We all need opportunities to snack, when we're hungry. 
• Be strategic in your placement of food in your environment--we don't need it shouting to us, but it needs to be available for when we want it.
• Food should taste good, and we all need permission to eat what we like--in portions appropriate for our individual need.
• Dessert are not just for birthdays and holidays.
• Incentives for movement encourage movement. 
• Foods aren't simplistically good and bad nor are we good nor bad for eating them.

Thanks for reading! Comments welcome!

Start counting your calories boys and girls!

Should they start weighing and measuring
everything they eat?

This scares me. Really it does. The US government, the FDA more specifically, has decided to encourage kids and their educators and families—i.e. everyone—to start tracking their calories, because, you know, doesn’t that solve the ‘obesity epidemic’? Well, no, it doesn’t—and it may cause more harm than good.

Their stated goal is to get kids and families to start reading labels and think more about what and how much they eat. Innocent enough, right? Well I don’t think so. Maybe I’m biased because I see far too many kids and adults, stuck in their heads with too much information; they spend time calorie counting, and limit their choices to single portions of foods because that’s what the label says is the ‘right’ amount. They allow the label to define their personal need, as if serving size was one-size-fits-all, when really it’s designed to provide information about nutritional value per serving, based on “usual” portions. They’ve lost their intuitive sense of how to regulate their intake.

What’s wrong with this campaign?

Let’s start with the messages in this campaign, and then you decide how helpful the guidance is. Here are a few highlights, shown indented.

The end of childhood.

Keep track of the calories you eat throughout the day. To find out what your “target” calories per day are, visit www.choosemyplate.gov .

Should kids really be tracking their calories, as if simply knowing their magic number would make everything all right? Calorie calculators are far from accurate, and don’t take into account a fair assessment of muscle mass which increases calorie requirement. They fail to adjust for individual variation in caloric need, aside for activity level. Larger sized body? You’ll get prompted with a CDC message that you’re at a high BMI and can choose to move to a ‘healthier’ weight—with no assessment of risk factors, and without regard to whether this has historically been a healthy place for you (based on your growth curves, if you’re a child, or your weight history, if you’re an adult).

I tried it out, for the sake of this piece. Where are the fats, I wondered? The sweets? Where’s the healthy, balanced diet? Exchanges from all food groups are included except for the oils and fats (fats may be components of foods in each category, but there was no place for added fats like healthy oils)—despite acknowledging separately that they provide essential nutrients. 

They do identify a calorie level for what’s called empty calories—which I was pleased to see—but they don't include it as part of my daily meal plan! Surely they need to be included—because forbidding them will only lead to deprivation and preoccupation with getting them. Omitting them surely sends a message—that they are bad, and kids and adults will feel bad including them.

The impact on real kids

This might be just what Dan needs to meet his nutritional needs.

Dan decided to become a vegetarian last year, along with a family member because he cares about animals. Fine enough, as far as I’m concerned. But then his high school health teacher (using the FDA curriculum) directed him and his classmates—regardless of their size—to reduce their fat and sugar intake and choose foods lower in calories. You know, because of the ‘obesity epidemic’.

Problem is, Dan was thin from the start. And his intake was limited enough. And being tall, and active, resulted in inappropriate weight loss, during a time that weight gain is appropriate and necessary to support growth and development. Guidance from a respected figure like your high school teacher seems like a logical thing to follow—especially when it’s coming from the US government’s program.  Yet Dan is one of many, many kids I’ve seen negatively impacted by the direction of their health or science teacher.

Are you eating  just for calories?

Kids, like adults, eat for all kinds of reasons—because they’re stressed or anxious, because they’re tired, because they’re procrastinating getting their work done and because their friends are snacking, to name a few. Just telling them ‘here’s how much to eat’ fails to acknowledge the many obstacles to ‘Just doing it’. What if we taught them how to moderate portions and how to manage stress, arming them with alternative coping skills?

If you consume more calories than you burn, you gain weight.

I’m tired of weight gain being framed as a negative. Yes, they’ll gain weight! Isn’t that what growing kids are supposed to be doing?

400 calories or more per serving is high; 100 calories per serving is moderate

Yes, so what? The teenage athletes or kids in super growth modes might need closer to the high end than the low for calories per snack.

Consider stuffing a pita or wrapping a low-fat whole grain tortilla as a lower-fat alternative to some breads.

Why lower fat alternative? And how many breads are high fat anyway—unless we’re talking about croissants, which we don’t typically refer to as bread! And why pull out fat as a problem nutrient to be watched? There’s no shortage of evidence that low fat diets  have failed us in our attempt to control weight.

Read the Label to see which foods are lower in nutrients to get less of — then replace one high-fat or high-calorie item you would have ordered with one that has lower calories or fat.

Again, why villainize fats? Maybe portions to meet individual’s needs would be more appropriate to address.

Choose foods with less sugar.

For the record, you should know that a glass of milk—plain, unsweetened milk (yes, even organic and even more so fat free) contains a decent amount of sugar. Natural sugar, called lactose, that hasn’t been linked to disease development nor to obesity. And dried fruit? And fresh—if it had a label?  All are also high in sugar and need not be avoided. Perhaps this needs to be clarified in their materials.

Nuts and dried fruits can make great snacks because they often contain nutrients to get more of – as long as you follow the serving size!

Does that mean kids need to limit their portion to ¼ cup—even of their calorie needs are high?

Why this needs to change

I worry about the impact on our kids.

Dieting is one precipitator of eating disorders; a significant percentage of those struggling with an eating disorder started off with what seemed like an innocent diet. And we surely don’t need to increase this population.

Kids need enough calories to support growth. Weight loss is generally not indicated in kids.

General educators are not skilled enough to nuance the recommendations individually, and may have their own nutrition and diet baggage, so to speak. The teacher educating kids to calorie count who perhaps is also on Atkins is not the person I’d want influencing my children’s eating.

I certainly support nutrition education in schools. But I’d like to see a different type of education.

Imagine this

What if we taught this in schools instead? (adapted from Drop the Diet, Lieberman and Sangster link):

• Eat breakfast within a half hour of waking.
• Include 3 meals and 2-3 snacks daily, at a minimum. Avoid going more than 3 ½ - 4 hours without eating (during waking hours, of course).
• Avoid compensating for a less-than-stellar day of eating; consider a clean slate, forgiving yourself for less-than-ideal eating.
• Shut the TV and the electronics when eating, and work on eating mindfully. 
• Keep all food in the kitchen—not the TV room, not the bedroom.
• Use your senses; smell, see, feel, hear and taste your food, and truly enjoy eating.
• Beware of false fullness from drinking lots of water or non-caloric beverages, or eating large volume of low calorie foods.
• Ask yourself  “Am I hungry?” Consider other means to satisfy those other eating triggers when you aren’t hungry.
• Clean up the environment. Keep foods off the counter to prevent them from calling to you. But eat foods you enjoy when you do need to eat. Then use the strategies above to manage portions.

As for the adults impacted by this campaign, be aware that at best, approximately 1 in 5 people who intentionally lose weight successfully keep it off for more than a year—and few studies track outcomes beyond this point. But maintaining lost weight should not be the sole measure of success. Weight suppression data identifies the risks that maintaining a weight below one’s highest weight creates.

Let’s not be short sighted and worsen one problem in an attempt to improve the health of our kids. There really is a better way.

Role modeling with the Lean Cuisine diet. Who needs the reality check?

Adorable, yet strikingly painful. 

                              (If a video doesn't appear above, click here)

Young, school age children, sharing their observations about their moms’ and their dads’ eating. These are strictly their observations, without judgement— except for the stink of some of the cleansing pepper drinks they refer to. The contrast made by Lean Cuisine is that eating their frozen dinners as a strategy for weight loss—that is normal!

Well isn't it? Not unless you are a 4'8 woman, non-competitive athlete. To have one of your main meals of the day, your lunch or dinner, coming in under 300 calories is hardly adequate for most anyone. Yes, even though it does contain some carbs. And the suggestion that it, in itself, is a meal, an adequate meal, is quite problematic. Who do you blame when you are left feeling hungry after this meager intake? No one but yourself, no doubt. Calling it an appropriate meal replacement is misleading, unless you add a glass of milk, a fruit, a salad with some oil and vinegar or nuts, for instance.

We know all the Lean Cuisine eaters in this YouTube video have families, including kids—young, impressionable, school age kids. So let's think for a moment about dinner time in these homes. "Here, sweetie, you can eat the chicken dinner I made for the family, I'll just eat my (inadequate, 300 calorie) frozen meal. You know, because I need to lose weight." Or "You deserve to eat this great tasting meal I've made, but not me—I'm too fat!" Or maybe, "Why don't we all live on Lean Cuisines, so you can have control over your portions too; because I don't really trust that I or you can manage when there is more than a limited amount of food in front of me!"

Fast-forward several years and let’s imagine these innocent kids as adolescents. Do they feel entitled to eat an adequate plate of food? Or do they, like many a patient I've heard from, feel limited by the messages they heard from their parents (yes, parents, because dads put forth much of the same diet shtick so to speak). Like Dana, she may struggle to ever eat more than half a sandwich—that's how much her mother allowed herself. And like Allie, she might be counting her calories, limiting them to the boxed frozen dinner amount that her mom thought was right.

What do these kids end up taking from this? That their frozen-diet-dinner-dependent moms are the sane ones, as the video implies? Or that their moms and dads (and maybe them, too, when they’re grown ups) dislike their bodies, and certainly can't trust themselves, their ability to eat enough, their body's signals, their ability for their body to be forgiving if they ate a bit too much one day. They learn that normal family dinners are things other people can have, but not them. This is just the price they have to pay to lose weight.

Are you stuck in this place? 

Are you the adult child of such a dieter, who never learned to trust her own eating? Or simply struggling as of late, desperately dieting, relying on prepackaged foods and calorie-restricted meals? Consider cooking--see the recommendations made by "Thursday's patient" to ease the process, or check out Food to Eat for more support, with its 25 recipes in an easy to manage format, justifying the merits of each dish and its nutrient content. Serving sizes are suggested, but are by no means restrictive. Suggestions to enhance the meals are provided, along with sections to help you get out of your own way--to change your perspective about food and respond to your needs. And check out the links below, including sample recipes.

Kudos to Lean Cuisine for pointing out how crazy our culture is, with moms and dads filled with body loathing following all sorts of nonsensical diets. If only they can see that their video stopped short of pointing out the irony of their own product.

http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html

http://dropitandeat.blogspot.com/2011/03/normal-eating-taken-too-far.html

http://dropitandeat.blogspot.com/2011/02/who-or-what-decides-how-much-you-eat.html

http://dropitandeat.blogspot.com/2010/11/honor-thy-hunger-and-thy-fullness.html

And from Food to Eat: 

http://dropitandeat.blogspot.com/2010/11/pecan-pumpkin-pancakes-you-can-feel.html

http://dropitandeat.blogspot.com/2010/10/how-to-cook-healthy-meal-before-eating.html