Childhood Obesity:Part 3

Provided Courtesy of Nutrition411.com

Adapted with permission of Lucille Beseler, MS, RD, LDUpdated by Nutrition411.com staff Review Date 6/13 K-0529

What Works? Traffic Light Diet

• Food groups: – Fruits and

vegetables– Grains– Milk and dairy– Protein– Other

• Color code:– Green foods—foods

containing <20 calories/serving

– Yellow foods—major diet staples

– Red foods—high in fat and simple carbohydrate

• Calorie intake is controlled and determined—average 900 to 1200 calories• Families are provided with food reference guide

that lists foods, color code, and food group• Family goals—stay within prescribed calorie

range and eat no more than five red foods/week• Other components include self-monitoring,

behavior modification, and contracting

Traffic Light Diet (cont’d)

• Use of the Traffic Light Diet, as part of a multicomponent weight-loss treatment program:– Associated with short- and long-term weight

loss in children 6 to 12 years of age

Traffic Light Diet (cont’d)

• High-glycemic index foods produce a large increase in postprandial blood glucose and play a role in appetite regulation• In adults, a high-glycemic index diet is

linked to central adiposity• Studies suggest that children on a low-

glycemic diet are less hungry, which results in the consumption of fewer calories

What Works? Low-Glycemic Load Diet

• Use of a low-glycemic diet is effective for:– Modest weight loss in adolescents– Possibly for long-term weight loss in

adolescents

Low-Glycemic Load Diet (cont’d)

Source: Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS. A reduced-glycemic load diet in treatment of adolescent obesity. Arch Pediatr Adolesc Med. 2003;157(8):773-779.

Glycemic Index of Foods• Low-GI foods: <55• Medium-GI foods: 55-70• High-GI Foods: 70

Low-Glycemic Load Diet (cont’d)

Protein-Modified Fast Diet • No sufficient evidence is available to

suggest that high-protein, low-carbohydrate, very-low-calorie diets result in greater long-term weight loss in children, as compared to a balanced macronutrient diet

Nutrition Treatment: What Works?

Pharmacological and surgical treatments

• Sibutramine and orlistat studies:– Both produce modest weight loss in adults at

approximately 3% to 8%– Drug therapy does not address lifestyle, physical

activity, and behavioral changes, which all are necessary to produce healthy weight loss

• Bariatric surgery—the last resort for severely obese adolescents

Nutrition Treatment: What Works? (cont’d)

Source: Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360(9331):473-482.

All interventions culturally adapted• Understand cultural beliefs• Adopt culturally acceptable and

appropriate words to teach

Nutrition Treatment: What Works? (cont’d)

Stein K. Cultural literacy in health care. J Am Diet Assoc. 2004;104(11):1657-1659.

• Provide healthy foods• Encourage breakfast• Review lunch menus with day

care/preschool or caregivers• Eat meals as a family• Get kids to help in the kitchen:– Even young children can help with simple tasks

• Strive for appropriate portions for the entire family

Advising Parents: Easy Tips on What to Do

What’s safe for growing children?• Give eating specifics if necessary• Cut back on fat—visible fat and invisible

fat• Cut back on sugar—especially from juice

and snacks (offer water instead of juice or soda and healthy snacks)

• Encourage whole grains, such as brown rice, whole-wheat pasta, whole-wheat bread, and whole-grain cereals

Easy Tips on What to Do (cont’d)

• Recommend that the family cut back on fast food to one time per week:– Help family establish eating-out rules

• Provide amount and calorie parameter for daily snacks—100-calorie snacks• Explain that the family should have:– Five fruits and vegetables each day– Nutrient-dense beverages, such as milk* – Lean meat, poultry, low-fat cheese, and fish

Easy Tips on What to Do (cont’d)

*If body mass index is >85th percentile, change to lower fat milk.

Environment• Structured eating in approved places:– Not in car—no dashboard dining– Not alone in their rooms

• Eat family meals• Prevent grazing throughout the day:– Rules for snacks—asking permission or providing

an allowable snack box

Easy Tips on What to Do (cont’d)

• Fast-food companies offer lunches in many day-care centers/preschools:– Fast-food lunch for a toddler can provide 50% of

the day’s calories– Busy parents often opt for their toddlers to eat

the center’s lunchthe center’s lunch• Day-care centers/preschools often have

many snacks and unlimited juice• Day-care centers/preschools should

incorporate standard practice of feeding:– Parents should serve as nutrition advocates for

their children Source: Fox MK, Pac S, Devaney B, Jankowski. Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc. 2004;104(suppl 1):s22-s30.

Teach Parents to Become Advocates

PreventionPrevention

Prevention is easier than treatment

Health care professionals should:• Teach good nutrition to families and

children right from the start• Take advantage of the many teachable

moments for parents during their child’s 1st year of life, stressing the importance of nutrition

• Review growth charts with parents at each visit

• Offer nutrition tips at each visit

Childhood Obesity

Worst foods for kids• Prepackaged lunches• Instant-flavored noodles• Hot dogs• Fruit leather• Toaster pastry• Cereal with candy • Candy (sticky or hard)• Doughnuts• Snack cakes• Soda pop• Fruit-flavored drinks• Coffee/tea

Best food for kids• Yogurt• Sweet potatoes• Broccoli• Wheat bread• Whole-grain cereal• Beans• Milk• Cantaloupe• Bananas• Eggs• Tomatoes• Fish

Sources: Bazarte M, Beseler L. Nurturing With Nutrition. Gulfstream, FL: DMI Publications; 2001. Family Nutrition Center Web site. www.nutritionandfamily.com. Accessed June 14, 2013.

Worst and Best Foods for Kids

• Help make the prevention of childhood obesity a national health priority:

– Through parent education—prevention is the best cure

– By taking a leadership role in this initiative

Treatment for Childhood Obesity