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

Burning through the calories: where the carbs fit for weight management

Are you hyper focusing on the nutrients that are 'safe' to eat?

Processed foods are bad, toxic even. Breads, even so-called wheat breads, must be avoided. Other starches aren’t great for you either—but those whole grains seem a little better. And forget sugar, because you know all the horror stories about what sugar does.  Best to avoid it all; it’s much safer that way.

That’s what Dave thinks, and he’s not alone. He's an underweight young man, unhealthily thin. Yes, most sources of carbs are a problem for him. In fact, most fats are also a problem for him. He selects only foods he perceives as super-foods—super healthy choices chock full of nutrients; he’s not contaminating his body with any of that other junk. He reads a lot, but never the full research paper, because, I mean, who does? Anyway, if it’s in print, then it must be true, right?

Start to look at the big picture.

No, not correct. Even all the hype about sugar and its negative impact on health pulls from studies showing high intakes—25% of total calories, to be specific. That’s a lot of sugar. And that’s quite different than including a couple of mint Milanos or Lindt chocolates for instance, in the midst of a healthy, balanced diet. But why all the fuss, you ask? Who needs processed carbs anyway?

An RDA for chocolates?

It’s like this. There’s no daily requirement for processed foods—that’s for certain. But creating long lists of foods to avoid creates another set of health issues, both mental and physical. Deprivation, for one, creates rebound overeating, so setting rigid rules about all the foods you can’t eat becomes an issue. Further, avoiding large categories of foods as Dave does leaves fewer fuel sources and nutrients to meet your needs. A diet of vegetables and lean protein and a bit of fruit will likely leave you low energy—carbohydrate stores are our go-to for fuel; yes there’s a reason why Marathoners have a pasta dinner before their event.  Food rules are challenging to adhere to and lead to increased preoccupation with food and eating.

It’s worse if your needs are high, like if you are in the process of restoring weight from a low place. Truly, metabolic rate dramatically increases to well above what others of the same height (but who weren’t restricting and now re-feeding) experience. So the feeling of fatigue may result, and if you’re wondering why your strength is lost, this could be why. Or if you are a growing teen, restricting what you can eat may add to your problems—it’s challenging to meet your needs to restore normal growth when there’s lots you choose not to eat.

Burn, baby burn

Take a step back and try to look at your
assumptions a bit differently.

It's hard to negotiate with irrational thoughts. And the media's messages villainizing most anything that tastes good hardly help. So I’ll turn to my fireplace analogy to help him (and you) see carbs as just another fuel.

Let's say you have a fireplace. You could burn logs of pine or oak or maple. Burning each log type generates heat, turns to ashes in the end, regardless of which you started with.

Should it matter to you which type of log or fuel you use? Well you might have a preference for the scent of pine or maple, let's say. But from a fuel standpoint, it doesn't much matter. That is, as long as the total amount of wood is equivalent. It's just like food and its building blocks. You could burn carbs or protein or fats that you eat and yield energy—our heat equivalent here. And as long as the total amount of fuel or calories is the same, your body hardly cares where the fuel source came from—from a weight standpoint. You may have a preference for the taste of chicken or of nuts, and some foods may be more satiating (think whole grains or balanced meals including protein); and a varied diet will help meet your nutrient needs over time. But if the calories are the same, they will generate about the same amount of energy.

That's sweetened chai tea with real milk to go with our
carb-based snack.

But substitute some twigs and the fire dies down fast. Rice cakes, for instance, just won't sustain the energy. You could swap newspaper for the logs. But you'd need a ton of it to heat your house in winter. Yes, just like if you chose only light products or large volume but low calorie dense foods like broths or salads with little substance to them.

So what can I do now?

Stoke your fire with items that are pleasant. I love the scent of burning pine, personally, and I enjoy a good piece of pastry when I need the fuel. There are times those whole grains are just what I'm yearning, and they'll likely take a bit more time to process, and thus burn, than just white rice. But brown sushi just doesn't seem right.  And favoring protein and eating lots of it simply because you heard it’s good for you is no advantage for long-term weight management.

A healthy body requires getting enough. Not just total calories, but satisfaction, from a wide range of foods and nutrients. Isn’t it time you free yourself from the unnecessary food rules?

From the Land of Oz: Hillary's Hyman and Detox Diets

Wouldn't you just love to find a cure for your struggles?

Hyman's suggestion that my diet is the reason for my

MS is beyond insulting.

Let’s give a round of applause ladies and gentleman to Dr. Mark Hyman for finding the answer to all of our weight loss troubles! Dr. Mark Hyman’s Book, The Blood Sugar Solution 10-Day Detox Diet: Activate Your Body's Natural Ability to Burn Fat and Lose Weight Fast, is a New York Times bestseller. His book is a guided weight loss and detox program that claims to be the solution in preventing disease, losing weight and reducing insulin levels in just 10 days. His book provides meal plans, recipes, shopping lists, recommended medications, supplements, and more. Written by an MD, there must be truth to his detox diet claims, right?

About that M.D. credential

A Medical Doctor, meaning “teacher of medicine” is an honorable profession that rightfully holds esteem in society. Often times, when you are diagnosed with a condition, such as Type 2 Diabetes, you see a team of clinicians with varying credentials. Understanding what an MD, RD, NP, RN, PA or PhD are and their scope of practice is important to know and understand when it comes to your treatment plan.

In a nutshell, a doctor (MD), assesses the condition, forms a plan and treats the condition. An MD has extensive education in anatomy, biology, physiology, and chemistry and is an expert on injuries, diseases and drug therapy. That being said, a doctor (as well as an NP, RN and PA) has very little education in nutrition and is far from qualified as an expert in nutrition. Unless a doctor is an RD (Registered Dietitian) or has an advanced degree in nutritional science (think PhD), they should not proclaim themselves nutrition experts. Similarly, an RD, an expert in nutrition and dietetics should not prescribe medicine or formulate a plan for surgery as this is outside their scope of practice.

The Tell Tale Signs

So, how do you know if these self-proclaimed “wholistic” MD’s (as Dr. Hyman calls himself) have gone too far? Well, Dr. Mark Hyman produced a perfect example for us to explore.

There are no shortcuts to getting healthy and fit.

The first sign of quackery is the guaranteed “quick fix” that we all secretly want. We hate to be the bearer of bad news, but anytime a doctor (yes, that includes Dr. Oz), or medical professional for that matter, guarantees over 7 lbs of weight loss in 2 weeks without vigorous physical activity, then you may want to assess whether their techniques are safe and can be maintained for the long-term. For reference, the Academy of Nutrition and Dietetics, considers healthy weight loss of ½ -2 lbs. per week with a balanced/portioned diet and regular vigorous physical activity. Even this guidance is quite controversial, as the long term data gives little support that that lost weight is maintainable. Dieting leads to deprivation and long term struggles with rebound over eating and weight gain.

In one of the first pages of Dr. Hyman’s book, he catches eager readers by telling a story of Janet, a 48 year old woman who lost 11 pounds in 10 days by eliminating fish, gluten, dairy, sugar, all grains, beans and legumes, all processed foods, all refined vegetable oils, alcohol and caffeine. Is it not obvious? Of course she lost a ton of weight in a short amount of time, virtually every food group was eliminated! But successful weight management needs to address thoughts and behaviors, so that dietary changes can be maintained. Rigid rules will only lead to failure.  Haven’t we all seen this?

You, on a diet.

The second sign of “wait, this book or treatment plan is a crock” is the all mighty powerful “DETOX”.  According to Dr. Hyman, virtually all foods lead to weight gain and illness, so a 10 day detox is warranted to get rid of decades of food toxins and promote weight loss. Makes sense, right? Well, no. The problem with this, is that our body naturally detoxifies itself. The liver, kidneys and colon filter out toxins and bacteria in the body. Therefore, eliminating essential foods and nutrients for a body cleanse/detox does not make sense at all. The last thing we need is to narrow our selection of foods for no good reason!

What happened to 'an apple a day keeps the doctor away?'

Eliminating whole categories of foods from your diet for weight loss is just absurd. It is not realistic to think you can survive a diet that is limited in variety and nutrients without serious consequences—low energy, increased thoughts and preoccupation, nutritional deficiencies, to name a few. It is also not realistic to think that you will continue to have an abundance of weight loss post “detox” as behavior and dietary changes do not magically occur in 10 days. Further, rebound overeating results from deprivation. This, combined with slowed metabolic rate from your body perceiving starvation will only result in weight regain. 

What Is The Magic Pill?

You're really gonna give these up? Until you lose weight? 

Then what?

We challenge you to realize that there is no cookie-cutter way to treat chronic conditions such as obesity, diabetes and inflammatory conditions as Dr. Hyman suggests. Standards of practice and research-proven methods exist to guide people toward health. And there is individual variation in our calorie and nutrient needs and healthy weight ranges. Self-help/”wholistic”/detox “treatment plans” are damaging—they don’t take into consideration these individual needs nor consider the impact on a person’s medical status as a whole. They offer false hope that if you just follow (this most un-followable plan) you will cure your ills and be happy. 

We challenge you to do your research, recognize what the credentials mean and be cautious of the quackery rules of advice. And by you, we include very intelligent readers who might've been pulled into believing this misinformation--like Bill and Hillary Clinton, who endorse Hyman's sensational promises.

Avoid triggering and false messages from shows like Dr. Oz and books like Dr. Hyman’s. And if it sounds too good to be true, it probably is!

This piece was written primarily by my awesome intern, Lakisha Dubar--with direction and editing by yours truly. Please share your thoughts with us! As always, thanks for reading, and sorry for the long wait--I had to travel to San Francisco for these photos!

Healthier Kids With Frosted Flakes. Balancing Sugar And BMI.

Tony the Tiger of Kellogg's Frosted Flakes fame

Ban Aunt Jemima? That’s just fine. Her image is not politically correct (and I’ve always preferred homemade pancakes and real maple syrup anyway). Joe Camel, as cigarette promoter, I am glad became extinct. But must we bury Betty Crocker before her time, just because her baked goods are high sugar? And Tony the Tiger, who I grew up believing was GREAAAAT, in spite of the sugar coating on his Frosted Flakes? And Toucan Sam of Fruit Loop fame? Must we part with them all, desperate to halt the obesity epidemic, to take control of our kids’ climbing BMIs?

I’m reacting to the recent NY Times article on the government’s plan for voluntary principles for food manufacturers, regarding advertising products to children. (http://nyti.ms/lxO60F) Make foods healthier or stop advertising them to kids, is the message. “The guidelines call for foods that are advertised to children to meet two basic requirements. They would have to include certain healthful ingredients, like whole grains, fresh fruits and vegetables, or low-fat milk. And they could not contain unhealthful amounts of sugar, saturated fat, trans fat and salt.”

Is a sugar limit really the best way to control our kids' obesity?

Scott Faber, representing food makers, said that “…ads for packaged foods on television shows aimed at children 2 to 11 had dropped significantly since 2004, and that the ads more often showed healthier types of foods.” Yet based on CDC data, obesity rates among kids nearly tripled since 1980, and continues to climb http://1.usa.gov/kmdWbN .

Hmmm, something just doesn’t add up. Maybe it’s not the ads that are the problem, but the number of hours sitting around watching TV and playing video games that’s an issue!

Guess how much sugar is in 1 Tbsp?

But what if we did limit these useless foods being fed to our kids? Seems harmless enough. I mean, what harm is there in not having these items around, of omitting them from our kids’ diets?

Not so fast. Before we ban all things deemed unhealthy and we start setting criteria for labeling foods as healthy enough to be advertised to kids, consider the consequences. Here’s what I fear will happen: 

Inadvertently, we will stigmatize foods as good versus bad. And the last thing we need is more black and white rules. They make no sense, and they certainly don’t resolve the issues for a culture struggling with making peace with food and an inability to manage weight.

1 gram more sugar than in a serving of Frosted Flakes, and figs are
first ingredient. Should we restrict exposure to kids?
Let's think twice before we set absurd guidelines!

Take Jane, an adolescent who came to see me 2 weeks ago for weight management. Referred by her pediatrician, accompanied by her mother, I learned some interesting things in our one-hour session. This articulate 15 year old described the “perfect” home environment. Mom cooks nightly, providing the healthiest of meals. Full of vegetables and whole grains, containing lean protein, her dinners were nothing short of wholesome. Second portions were never an issue, as Jane didn’t care much for the foods that were served. But she made the most of it.

When asked if she liked baked goods and ice cream Jane replied shyly that she did—but that she never had them at home. These were banned as unhealthy. The result is that Jane eats more than her share of these items whenever she has the opportunity—when she is out with friends, or at a party— regardless of how hungry she is. It is “now or never” thinking.

It’s like the Halloween candy phenomena (http://bit.ly/bjTtFT). Restricting these items fails to achieve the intended goal and as I’ve seen, makes for an unhealthy relationship with food.

Now I’m a parent, too. And while my kids are way past the age where I can control their food choices, I do recall that time. So what did I do when confronted with their request to eat what their peers were eating (and what was being advertised to them on TV and at eye level at the supermarket)? How did I balance my need to provide a healthy diet, while minimizing conflict around food? And, maintain a healthy relationship with eating?

The only one allowed to snack in the living room.

I didn’t restrict their ad exposure, although I limited TV time so that they would use their bodies to be active and their minds to create through reading and play. There were no TVs in their bedrooms, and all meals and snacks were eaten at the kitchen or dining room table. The only one in our home who could eat his snack in his den was my dog, Mica, who would grab his biscuit and eat it in his bed. No such luck for the kids, though.

But when they did view television ads, I’d make a point of educating them to be critical thinkers. I would share with them that high sugar cereal may be called a healthy breakfast, but it’s like eating candy for breakfast. We’d discuss how perhaps that cereal would make a good sweet snack to have with a glass of milk, instead of eating cookies, if they preferred. Or I would point out how they were being tricked by the ad’s information, teaching them to be more critical viewers of the media and to not be manipulated by savvy messages and messengers.

 

When they were young, I’d offer the high sugar cereal as a mix in with a healthier, lower sugar cereal choice. For instance, Frosted Flakes mixed in with corn flakes, or a small serving of Fruit Loops mixed in with Cheerios. This achieved many goals. It minimized conflict and prevented categorizing foods as acceptable and forbidden. And, it kept their intake rather healthy, despite inclusion of small amounts of sweetened items. And now as adults, I see them choosing lower sugar, healthier selections. And stopping when they’ve had enough to eat, even of such favorites as white flour, fiber-less bagels.

1/4 c. has more than twice the sugar than 3/4 c of
Frosted Flakes. Should we ban them? 

What about the idea of allowing food manufacturers to target kids if their product were healthier? Specifically, if it had 8 grams or less of sugar, or contained a certain level of whole grains or capped the sodium content? Good intentions, but here’s what I fear. If it were limited to 8 grams of sugar as proposed, that eliminates much added fruit (including raisins) in the cereal. Yes, fruit is naturally high in sugar (24 grams in ¼ cup of raisins), and there’s nothing wrong with including it generously in your diet! And I can imagine that foods will be filled with diet sweeteners, as a means to lower the evil sugar content. I suspect most parents may not want to be pumping their kids with diet products throughout the day.

Chocolate chip cookies would hardly fit, based on the planned guidelines. But should they be eliminated from our diet? If you’ve read enough of the posts on this blog you certainly know where I stand on this.

Yes, this is from the raisin container. 100% natural raisins.

Kids, like adults, need to learn balance. They need to appreciate it as they get older and become independent. They need to learn that while a food itself may not be nutritionally rich, it’s important to have enjoyment from what we eat, regardless of where you are on the BMI chart! A food may not be so balanced by itself (for instance, it may be relatively high in sodium), but as part of a meal it may fit just fine. Perhaps what can change is that kids (and their parents) will consider their portion of pizza, but won’t eliminate it because of its high salt and low fiber content. Rather, they’ll include a glass of low fat milk at the meal and serve some veggies with it.

I write this post as both a mother, and as an RD—one who sees obese kids, and eating disordered children and adults. Let’s be careful to not replace one health epidemic, obesity, with disordered eating.

What was your experience as a child? And how do you approach this issue with your kids? Comments welcome!