Read an Excerpt
Growing Up Healthy the Next Generation Way
By MARY ELLEN RENNA
Copyright © 2007
Mary Ellen Renna, M.D.
All right reserved.
Chapter One The Unhealthy Child-A New Epidemic
People around the world are exposed to more and more nutritionally deficient foods, creating an increasingly unhealthy population. We are exposed to hundreds of thousands of processed foods. Every day our children are bombarded with ads for very unhealthy foods; then they are served these foods in school, at parties, at the homes of friends, in restaurants and even in our own homes. These foods have caused an alarming increase in overweight, obesity and poor eating habits.
The obesity epidemic is frightening, especially when we look at the statistics for children. Sixteen percent of children between the ages of 6-19 are overweight, a number that has more than tripled since 1980. (See Appendix 1.) The medical community does not have an answer to this problem. But an obvious solution is to get our children off the computers and videogames and outdoors, and to teach them about healthy food choices. Some organizations and school systems are trying to address this issue and have taken the initiative by promoting physical education programs and after-school sports. There is also a trend toward establishing guidelines for offering more nutritious foods in school cafeterias. However, the process of making systemic changes that can contribute to the solution of this problem is very slow. The real key to solving the problem lies in the family. Together, parents and children need to learn how to deal with the plethora of non-nutritious foods advertised at every turn and prominently displayed in stores as well as the constant lure of videogames and computers. Parents are the role models for their children; if parents adopt a healthy lifestyle, their children will naturally follow it.
Proper nutrition and a healthier lifestyle must start at a young age. If we help children develop good habits when they are young, the possibility of decreasing future morbidity and mortality is astounding. The younger children are when they develop good habits, the more likely it is that these habits will stay with them throughout life.
Staying healthy requires goal setting, meal planning, understanding the benefits of good foods and exercise and integrating this knowledge into everyday behavior. Children cannot do this alone; they need family participation. Parents must participate with their children in this program to increase the chances of children becoming healthy adults. It is never too late to start or too early to begin; babies, children, adolescents and adults can all benefit from the healthy habits described in this program. If followed correctly, the Next Generation Fitness Program will lead to a much healthier life, one with more energy and vigor, a greater ability to learn and less risk of disease.
Research has shown that certain food nutrients have a protective effect in preventing heart disease, type II diabetes, infections, inflammation, stroke, high blood pressure, cancers and dementia. Plant-derived nutrients, also known as phytonutrients, are found in abundance in fruits, vegetables, legumes, nuts and whole grains. However, some of these nutrients are lost when food is processed. Even though over 8,000 food nutrients have been identified, we are depriving our bodies of them because so many of the foods we eat are processed. The easy availability of processed, high-fat, quick foods results in our children growing up without the benefit of the protection offered by these nutrients. This has created a generation of unhealthy children.
Children are more likely to have low blood levels of micronutrients-the minerals that our body needs, like selenium, chromium, zinc, etc.-as well as phytonutrients because children are filling themselves with non-nutrient-dense foods. These low blood levels are not life threatening, as a vitamin C deficiency might be, but they can be life altering nonetheless. Without these protective phytonutrients and micronutrients our bodies are more at risk for many diseases. A call to action has been taken by the Center for Disease Control as well as the World Health Organization, to name a few of the public health agencies that are sounding alarms. This call to action involves getting our children to eat more fruits and vegetables and to get more exercise. It has been estimated that altering one's diet and exercising regularly have the potential to decrease the rate of heart disease by 80%, type II diabetes by 90% and cancer by 30%! All we need to do is get our children exercising and eating more fruits and vegetables.
In order to fully understand the ramifications of this epidemic and just how unhealthy it is, it is important to know what is considered healthy. The dictionary definition of health is to be "sound in body" or "free from disease." Since these definitions are somewhat vague, let me explain what I consider to be a healthy child. A healthy child is one who is free from disease; has an appropriate intake of calories in the form of fruits, vegetables, legumes, lean meats and whole grains; AND expends a proper amount of energy in the form of cardiac-stimulating activity and resistance training.
As a pediatrician, I deal with children's illness and well as their health. To evaluate a child's health, of course, I examine the child. But I also always ask both the parent and the child a lot of questions to help me assess the three most important variables: the child's height and weight, the child's nutritional intake and the child's physical activity. The basic questions involve what the child is eating and what kind and how much exercise the child is getting. Although the answers I get to these questions can be both funny and sad, they also give me a window into the child's overall health-related habits. Lifestyle habits can't be solved by one talk with a child's doctor, but it is a good place to start. Assuming that a child is free from obvious disease, 80 percent of my time during a check-up is spent evaluating these three factors.
The first thing I look at during a check-up is the child's height and weight. These simple numeric values are very important in revealing the overall picture of the health of the child. These numbers can tell me whether a child has gained too much or too little weight in relationship to the increase in height. If a child gains too little weight and has not grown much in height, it usually is a sign that something more serious is going on and steps need to be taken to find the cause of the problem. Alternatively, if a child has gained too much weight, this also needs to be evaluated. All too frequently, this is the problem.
The weight and height parameters are used together to calculate the body mass index or BMI. The BMI is a ratio of weight to height and it is being used more and more frequently as a standard way to measure a healthy body weight. An adult BMI should fall between 19 kg/[m.sup.2] and 25 kg/[m.sup.2]. A BMI over 25 is defined as overweight; greater than 30 is, by definition, considered obese. A child's BMI alone cannot determine whether or not the child is overweight. Therefore, for children doctors also use standardized charts that plot BMI and age and give the results as a percentile range. The normal range is from 5-85 percent. If a child's BMI plots between the 85th percentile and the 95th percentile, the child is considered at risk for becoming overweight. Oftentimes, parents may be completely unaware that their child is at risk for becoming overweight. Once a child is above the 95th percentile, the child is officially overweight. Whether the child is at risk for overweight or officially overweight, the issue needs to be addressed during the child's check-up. But we need to avoid getting to this point. I can never overemphasize that eating healthy foods and exercising regularly will ensure a healthier future for your child.
When monitoring a child's growth and health, it is important to watch for percentile changes in the child's BMI. If a child has been at the 20th percentile for years and suddenly jumps to the 75th percentile, bells should go off. It is time to take a serious look at the child's food intake and exercise output. The same applies to the child who has had a normal BMI that suddenly falls into a much lower percentile. Although the growth percentiles for a child change, and this is a normal part of growth, when such change becomes a steady trend, it needs to be evaluated.
There are some caveats when evaluating a child's BMI. There are children who have a significant amount of muscle mass and therefore have an elevated BMI. This occurs in very muscular boys and girls as well as in body builders. These children would certainly not be considered overweight, so we need to look at another parameter-their waist circumference. A large waist circumference, along with an elevated BMI, means that the child is in the overweight category. Again there are no single numbers to define an enlarged waist circumference for children, as there are for adults (adult males should have a waist circumference less than 40 inches; females should be less than 35 inches), but there are standardized graphs that show the normal ranges for different ages. Most pediatricians are able to identify children who are overweight without the use of charts. An enlarged waist circumference is associated with an increased risk of heart disease and should set off alarms; immediate action should be taken to begin a healthier lifestyle. This applies to adults as well as children.
It is important to mention another related issue: We live in a society that places too much emphasis on what a person looks like and not enough emphasis on being healthy. Many parents who bring in their children for wellness check-ups are very worried about how their child looks. They may have noticed that their child is getting bigger; they also may have noted an increase in fat distribution throughout the child's body. Many children start to change shape just before the onset of puberty and parents naturally are concerned when any unexpected change occurs in their child. It is important to remember that a wide range of body weights are considered normal. People who eat right and exercise daily come in all different shapes and sizes. They may not fit the Hollywood definition of body beautiful, but they are certainly healthy, and that is what really counts. If my patient is eating healthy foods, taking in an adequate amount of calories, avoiding junk foods and exercising regularly, I will reassure the parent that these healthy habits will stick with the child; most likely the child will not have a problem with weight. However, follow-up is needed at regular intervals so I can continue to monitor the child.
On the other side of the spectrum, we should not presume that because some people are naturally thin, they are healthy. If your child is thin, or you as a parent are thin, your body still needs the right foods and daily physical activity to maintain good health. Filling a thin body with junk food and avoiding exercise because your weight is stable, still leaves you with an increased risk for disease. Even people who do not have a weight problem should follow a healthy nutrition plan and exercise routine, allowing for additional healthy food servings to maintain a proper weight. What a person looks like is not nearly as important as lifestyle habits.
A simple question that I ask children at each check up is, "Are you eating your fruits and vegetables everyday?" Most children will respond with a vigorous affirmative nod while the parent stands behind the child nodding no. I will then ask the child exactly what fruits and vegetables he or she is eating. At this point, many children will make a face and tell me that they don't like vegetables or say they "ate an apple last week." Most children will go on to tell me of the foods that they "tried" in the vegetable category; some will even tell me of the fruits they eat regularly. It is the rare patient who reports eating fruits AND vegetables everyday. It's not surprising that some parents are frustrated with trying to get their children to eat better. I have even had parents ask me if any child really eats what they're supposed to each day. Well, there are some children who eat the recommended daily servings of fruits and vegetables-about 20 percent in the U.S. We need to get that number closer to 100 percent!
Pediatricians have special relationships with their patients. We care for children from infancy to early adulthood and sometimes we are the only doctor they know. This can put pediatricians in a very powerful position. If we have done a good job and have built a trusting relationship, children will listen to what we tell them. In addition, since we are dealing with children, parents often seek advice about their child. I am always happy to give it. However, time is limited during doctor visits and so many things need to be accomplished. I therefore make a point of telling every parent, child and adolescent to make sure they are eating fruits and vegetables EVERY DAY. Children often will take my advice and very proudly report back to me on their newly acquired dietary habits. This is a great feeling of accomplishment for me because I know what a dramatic impact these food changes will have on their future.
Children are amazing learners and are always eager to listen. During the talks in my office with patients and their families, I also discuss how much food is an appropriate amount to eat each day. (Food quantities and portions are discussed in more detail in Chapter Six.) This often reinforces what most parents are trying to do at home. For those parents who have not been thinking about dietary habits, these talks help them become aware of the relationship between what we eat and their child's future health and the importance of food choices in our daily lives.
The benefits of daily exercise are well-documented. The reduction in heart disease, some cancers and hypertension are just a few of the diseases that we know can be prevented through regular exercise. Other benefits include improved bone density, a stronger immune system, sounder sleep, increased energy, improved coordination, increased self-esteem and improved ability to concentrate in school. In addition, daily exercise can help reduce the incidence of obesity.
When I ask my patients about exercise, the most common response often consists of a description of how the child plays on a sports team, whether soccer, baseball, football, lacrosse or other sports. The majority of teams meet twice a week, once for practice and once for the game. Not only is this too little exercise, but sports teams are not designed to get the child into the HABIT of exercise. Team sports concentrate on sport-specific skills, not lifelong exercise habits. There are children who are very involved in highly competitive sports teams and these children usually get plenty of exercise during the week. However, we still need to make sure that exercise becomes a habitual part of children's lives so that once the sport season is over, exercising does not come to a complete halt.
We can do this by teaching children how to exercise at home. Most parents don't realize that their children should be exercising at home, regardless of the extent of their sports activities. Furthermore, they are not aware that children also should be doing resistance training for maximal benefit.
Sports team activities rarely teach children about resistance training. The importance of resistance training has been overlooked because it was once thought that this type of training might be harmful for growing children. In the past, some doctors where worried that weight training could harm the growing skeleton and possibly "stunt growth." Using any type of exercise equipment inappropriately will increase anybody's chance for injury-not just children. The Next Generation Fitness exercise program uses the only natural way to resistance train: using the child's body weight as the resistance. There is no better way to build muscle and improve bone strength than to use a child's body weight as the resistant force; there is no worry about a weight being too heavy and damaging a finger or worse yet loosing a finger to the weight stack. Unfortunately, children are accidents waiting to happen when they are unsupervised in gyms. I do not recommend children using weight rooms. Resistance training is a crucial part to any exercise program and we are now aware of all the benefits to the growing muscle and skeleton. Resistance training should be an integral part of our exercise routine for maximal benefit.
Excerpted from Growing Up Healthy the Next Generation Way by MARY ELLEN RENNA Copyright © 2007 by Mary Ellen Renna, M.D.. Excerpted by permission.
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