As we begin the new year, many people are making resolutions to lose weight. It is important to be at a healthy weight and most of us struggle to be there. One thing we have to make sure we do is to stay away from fad diets, miracle pills, and insane exercise regimens. Most of these impact our heart and can cause serous long term damage. This essay focused on childhood obesity but the guidelines about portion and proper diet cut across all ages. Please pay particular attention to the section on carbs and protein about one-third of the way through.
Obesity in children is a growing concern for parents, doctors, and society. Being obese is about more than wearing a larger pant size. One is considered to be obese when their body mass index (BMI) is at least 30%, and this leads to dangerous health complications (Cochran, 2007). An obese person can expect to experience respiratory and cardiovascular problems, liver disease, PCOS (polycystic ovarian syndrome) or other fertility difficulties, joint discomfort, or type 2 diabetes (Lee, n.d.). One of the issues today is that as more and more children become obese, they are also developing type 2 diabetes. The intent of this paper is to show that there is a correlation between the rise in childhood obesity and the increase of children developing type 2 diabetes.
An overweight child does not necessarily lead to an overweight adult. This is partly due to the fact that as the body goes through the changes of adolescence, the rate of the metabolism fluctuates (Burniat, Lassau & Cole, 2002). However, many obese adults were overweight children, probably due to food and exercise choices made for them as a child (Burniat, Lassau & Cole). As they got older their metabolism slowed down, but they did not make changes to their diet, resulting in weight gain. One misconception about families who are overweight is that there must be a genetic link so it is out of their control, but this may not be true. It is more likely that the family is overweight because they share the same eating and exercise habits (Edelman, 2008).
It is estimated that 30% of children ages 2-19 measure into the category of obese- a number that is triple the obesity rate in 1980 (Cochran, 2007). The problem has become so serious that the government has become involved, developing a program called The President’s Challenge. This is a physical fitness test that includes a walk/run, curls-ups, pull-ups, shuttle run, and v-sit-reach (www.presidentschallenge.org). More recently, some states, including California, have used The President’s Challenge as a guideline for mandatory student fitness tests. California specifically issues them to fifth, seventh and ninth graders (http://www.cde.ca.gov/ta/tg/pf/ ).The goal with these tests is to measure a child’s ability, as well as encourage daily physical activity. Even though the physical fitness tests were made mandatory in the 90’s, obesity in children has continued to rise. Some states have taken it further by removing vending machines from the schools, or replacing the chips and soda with water and healthy alternatives.
How are these children getting so large? While there is a biological factor, nutrition is the main contributor (Burniat, Lassau & Cole, 2002). Studies show that even though there has been a reduction in whole milk consumption, there has been an increase in animal protein intake, and also a steady decline in vegetable consumption (Burniat, Lassau & Cole). Put plainly, children are eating fewer vegetables, and more meat and dairy. One of the problems is that even though our society is fixated with low-fat, non-fat, lower calorie foods, children continue to gain weight. It is believed that children need the whole milk, full fat, high-carbohydrate foods because that is where their bodies pull their energy from (Burniat, Lassau & Cole). This does not mean fatty cheeseburgers and bowls of ice cream, but the natural fats found in milk, nuts, and vegetables like the avocado.
Carbohydrates get a bad rap because when we don’t work it off through exercise it turns into sugar, but people don’t realize this glucose is what your body uses to get energy (American Diabetes Association, 2000). Children are constantly in motion, so their body uses the carbohydrates, and burns through it faster than an adult’s. When adults try to change a child’s diet by introducing a low-fat, high animal protein diet, they are changing the way their body breaks down and uses food. You are removing their energy source, which encourages inactivity (Burniat, Lassau & Cole, 2002). Even overweight infants showed a higher intake of protein, and lower intakes of fat and carbohydrates than their thinner, healthier counterparts, indicating that the main cause of obesity in young children is too much protein (Burniat, Lassau & Cole).
It is believed that these low-fat, high protein diets in infancy are resulting in high plasma-inulin-like growth factor-1 (IGF-1) concentrations, which causes an increase in muscle mass, and suppresses human growth hormone. (Burniat, Lassau & Cole, 2002). Unfortunately, it can also lead to fat depositing in the abdominal area, which creates a strain on the cardiovascular system (Burniat, Lassau & Cole). This same study concludes that the high animal protein diet that leads to IGF-1 plays a role in the development of metabolic disorders, including insulin resistance (Burniat, Lassau & Cole).
Nutrition goes beyond eating right at meal time. Many children (and adults) partake in binge eating- consuming large amounts of food in a short period (Burniat, Lassau & Cole, 2002). Not just snacking mindlessly as they watch television, although they do plenty of that as well, binge eating occurs when the person feels depressed (Burniat, Lassau & Cole). They have learned to use food to fill an emotional void. This is most likely a learned behavior from their parents, who may have offered cookies for a boo-boo, or ice cream for a broken heart. Many obese children who prefer fatty foods have parents who also eat fatty foods, and are simply modeling the behavior of their parents (Burniat, Lassau & Cole). The more fatty, high- protein food they eat, the less energy they have, and they are therefore less likely to participate in vigorous physical activity.
As mentioned above, type 2 diabetes can be a risk factor of obesity, and as more and more children are becoming obese, more of them are being diagnosed with type 2 diabetes (Cochran, 2007). There is a difference between type 1 and type 2 diabetes. Type 1 was previously called Juvenile Diabetes, because most cases were diagnosed while the patient was a child, but anyone can be diagnosed with it at any age (Edelman, 2008). Type 1 diabetes is an autoimmune disease in which the pancreas stops producing insulin, requiring lifelong insulin injections, or the use of an insulin pump (Edelman). Type 2 diabetes is when the body becomes insulin resistant, a result of an intake of high calorie, high fat, and high sugar foods, and as such can often be reversed through proper diet and exercise (Edelman). Many people with type 2 diabetes wind up in the vicious circle of needing to control their weight to control their diabetes, but the health complications from the disease prevent them from exercising.
Most children with type 2 diabetes are diagnosed about the time they reach puberty (Barnett & Sudhesh, 2009). During adolescence, there is a 30% reduction in insulin production, which is normally counteracted by an increase of growth hormone, but if the hormones have been suppressed by IGF-1, therefore creating more body fat, then the body may be more sensitive to insulin (Barnett & Sudhesh). Since puberty involves many hormonal changes, and a well-balanced diet helps to counteract these changes by providing the body with the necessary vitamins and nutrients, this could explain the high instances of children with poor eating habits being diagnosed with type 2 diabetes during this time. The graph below shows the number of children developing diabetes from 2002 - 2005 by age group.
< 10 years 10–19 years
NHW=non-Hispanic whites; NHB=non-Hispanic blacks; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians
(CDC, 2011)
Some of the dangers of type 2 diabetes parallel those of obesity: stroke, heart disease, high blood pressure, and neuropathy (American Diabetes Association, 2000). But diabetes has its own risks. A diabetic has a more difficult time recovering from seemingly benign cuts and scrapes because they carry a higher risk of infection, and because they are at greater risk for cataracts and glaucoma, they can become blind as they age (American Diabetes Association). Many diabetics also suffer from kidney disease, or die from ketoacidosis (DKA), a condition that occurs when the body starts using fat for energy instead of glucose from carbohydrates (American Diabetes Association).
So what can we do to help our children? We must adjust our children’s diet to their changing developmental needs. The best way to do this is by helping them to maintain a well-balanced diet. The World Health Organization (WHO) recommends breast milk for infants for at least 24 months, adding in fruits and vegetables at around 6 months of age (WHO, 2007). As infants turn into toddlers, whole fat milk and whole fruits and vegetables (not juices, sugary fruit snacks, etc.) can be introduced- and remember that a child’s stomach is not a large as an adult’s (http://www.ccfc.ca.gov/Help/ntp.asp). This is where learning about portion control comes into play. (As a general rule, a child’s stomach is about the size of his/her fist.) Don’t offer the sugary stuff -or even better, don’t buy it at all. If it’s not available, they can’t eat it. Offer two healthy choices like grapes or an orange, instead of grapes or chips. The Mayo Clinic recommends the following protein/carbohydrate guidelines for toddlers:
Ages 2 to 3: Girls and boys
Calories
|
1,000 to 1,400, depending on growth and activity level
|
Protein
|
5 to 20% of daily calories (13 to 50 grams for 1,000 daily calories)
|
Carbohydrates
|
45 to 65% of daily calories (113 to 163 grams for 1,000 daily calories)
|
Total fat
|
30 to 40% of daily calories (33 to 44 grams for 1,000 daily calories)
|
Sodium
|
1,000 milligrams a day
|
Fiber
|
19 grams a day
|
Calcium
|
500 milligrams a day
|
(Mayo Clinic, 2009)
As a child’s rate of growth slows down, adjust their diet accordingly. Around puberty, there is another spike in hormonal and growth development, and this will again require another change in diet. Since the nutritional demands begin to differentiate around this time for males and females, the diet of one child will not be the same as another’s. Caloric intake varies depending on rate of growth, but the carbohydrate/protein ratio generally remains the same; about 4:1 (Mayo Clinic, 2009). As we enter adulthood, men need more fiber than women, although it is important in controlling cholesterol and sugar levels, as well as the digestive tract for everyone (Mayo Clinic, 2011). Most of your protein should come in the form of plant protein (beans, lentils, soy, etc.), seafood should come in second with a recommendation of twice a week, and a lean cut of meat should make up the least amount (Mayo Clinic, 2011).
Finally, we need to focus on daily physical activity. Children used to play outside, every day, until dusk, but now, most children spend an average of 23 hours a week watching television (Burniat, Lassau & Cole, 2002). Combine this with 35 hours a week at school, and we have children who are sitting for up to 58 hours per week. Some complain that the lack of exercise is a societal issue, due to the rapid growth of urban communities, and reduction in safe places to play (Dalton, 2004). However, with the advances in technology, we can dance to hip hop music videos in our living rooms, either with a DVD or gaming system. We can choose to park farther away from the store, instead of right up front. Anything we can do to increase our daily activity would be beneficial. Regardless of whether we work out at a gym, or walk a few extra yards to the store, our energy intake needs to reflect our energy output (Burniat, Lassau & Cole). We should not be eating the same amount of food as a cyclist during the Tour de France if we are simply watching it on television.
Since high fat, high animal protein diets lead to obesity, and type 2 diabetes is a result of obesity, parents can keep their children from a lifetime of health issues by demonstrating proper nutrition and daily physical activity. Children rely on their parents to buy food, and by buying healthy and eating healthy in front of them, parents not only have better control over what their children eat, but also more control over their child's health.
American Diabetes Association (2000). Type 2 Diabetes in Children and Ad o l e s c e n t Diabetic Journal, Retrieved from http://care.diabetesjournals.org/content/23/3/381.full.pdf
Barnett, T., & Sudhesh, K. (2009). Obesity and Diabetes, Second Edition. Hoboken, NJ, USA: Wiley.
Burniat, W., Lassau, I., & Cole, T. J. (2002). Child and Adolescent Obesity: Causes and Consequences, Prevention and Management. West Nyack, NY, USA: Cambridge University Press .
CDC (Centers for Disease Control), (2011). New cases of diagnosed diabetes among people younger than 20 years of age, United States, 2002–2005, 2011 National Diabetes Fact Sheet, Retrieved from http://www.cdc.gov/diabetes/pubs/estimates11.htm#3
Cochran, W., Md. (2007). Pediatric Obesity FAQs, Hamilton, On, Can: B.C. Decker.
Dalton, S., (2004). Our Overweight Children: What Parents, Schools, and Communities Can Do to Control the Fatness Epidemic, Ewing, NJ, USA: University of California Press
Edelman, S. Md. (2008). What is the Difference Between type 1 and type 2 Diabetes? Retrieved from http://abcnews.go.com/Health/DiabetesOverview/story?id=3843306
Lee, R., Md. (n.d.). Risk factors of being overweight or obese and what you can do, Texas Obesity Research Center, Retrieved from http://hhp.uh.edu/obesity/docs/Risk-factors-of-being-overweight-or-obese_12.10.10.pdf
Mayo Clinic, (2011). Healthy diet: End the guesswork with these nutrition guidelines, Retrieved from http://www.mayoclinic.com/health/healthy-diet/NU00200
Mayo Clinic, (2009). Nutrition for kids: Guidelines for a healthy diet, Retrieved from http://www.mayoclinic.com/health/nutrition-for-kids/NU00606
WHO (World Health Organization), (2007). What is the recommended food for children in their very early years?, Retrieved from http://www.who.int/features/qa/57/en/
