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We stopped at a reststop on our way upstate today because my daughter had to use the bathroom. When my husband returned from taking her, I noticed he had a Burger King bag in his hands. My first instinct was to get annoyed. I said, “Doug, you know I don’t like you or the kids to eat that junk”. He smiled and pulled out two orders of apple fries. “I knew you wanted to see what these looked like”. He was right. I threw out the empty bag and handed the kids the “fries”. They were so excited. “Mommy- these look like French fries”, my son giggled. They really did. I tried one and they were fresh, crisp, and yummy. My children ate them all and gave them a thumbs up. What a great idea! (By the way, I threw the low fat caramel dipping sauce away with the bag, figuring it wasn’t necessary- but I looked at the nutrition label first and the sauce only had 35 calories. Not necessary- but not too bad. I am impressed with Burger King’s ingenuity and I hope they continue to introduce other healthy, fun options for kids.

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I am torn about this issue. On the one hand, we cannot just sit back and watch our children eat themselves to death. One out of every three children is overweight and at risk for medical problems due to their health. There are more children with high cholesterol than ever before. Children are now commonly developing diseases that used to be exclusively adult diseases. The CDC says this generation will be the first generation in history to die younger than their parents- all due to their increased weight and all the problems that go with it. An overweight adult with high cholesterol and diabetes may have a heart attack in their 60s- but a child who develops these illnesses may have a heart attack in their 30s. We must do whatever we can to prevent some of these diseases. How can we not try a medicine that seems to be safe and effective?

At the same time, we must also realize that there are no studies of the long term effects of these medications and there is no hard data that lowering cholesterol by using these drugs will definitively lower the risk of heart disease. So I can understand why some are hesitant.

My bottom line opinion: we must give nutritional and exercise changes a really strong effort first. As the AAP recommends, parents should seek the expertise of a child weight management physician. If that truly does not lower the cholesterol, I think we should give the medications. I think we are obligated to try whatever we can. We know that children with high cholesterol are at severe risk of medical problems and we don’t know that the medicines will do any harm… There is no clear-cut answer, and I would love to hear your arguments either way.

Thanks for reading.

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The American Academy of Pediatrics came out with some controversial guidelines this week. I will summarize them for you:

1) All children should follow a healthy diet, including low-fat dairy products for all children older than 2 years. Reduced fat dairy products should also be used in children age 12 months to 2 years who have a family history of overweight, high cholesterol levels, or heart disease and in children age 12 months to 2 years who themselves are overweight.

2) Children and teens with a higher risk of heart disease and with high LDL (“bad cholesterol”) levels include NUTRITIONAL COUNSELING, diet changes, and increased physical activity.

3) Children with a family history of high cholesterol or early heart disease, children whose family history is unknown, and children with other risk factors such as overweight, high blood pressure, cigarette smoking, or diabetes, should have their cholesterol levels tested with a fasting blood test between the ages of 2 and 10. Children with normal values should be rechecked every 3 to 5 years.
If lipid levels are high, weight management treatment should begin (NUTRITIONAL COUNSELING) and increased physical activity.
Children age 8 years and older who have an EXTREMELY high LDL level should consider cholesterol-lowering medications.

Let me explain why this is so controversial.

1) We don’t know the long term side effects of these medications in children.
2) We don’t know for sure that these medications will decrease the incidence of heart disease in children. Cholesterol increases the risk of heart disease and the medications do lower cholesterol- but do they actually decrease the risk of heart disease?

We do know that to date, these medications are safe in adults. We do know that in middle-aged men with high cholesterol, these medications decrease the risk of heart disease. Evidence does not clearly show that they decrease the risk of heart disease in women and there have been no studies in children.

So the question is: if diet and exercise are not enough, should we try these medications in children and hope they do more good than harm, or do we let these children continue to have dangerously high cholesterol levels? Pediatricians are very divided on this issue.

Before I share my thoughts, I would like to hear some of yours.

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I was at Chili’s the other day and was completely shocked at what I saw. I cannot believe the size of the lunch plates… and I cannot believe how unhealthy the food is. I observed families (some heavy, some not) digging into plates of bacon cheeseburgers, french fries, and nachos- without giving it a second thought. There didn’t seem to be any hesitation about eating these foods that are filled with trans fats, saturated fats, calories, and cholesterol. I watched an 8-year old eat an entire plate of mozzarella sticks- as an appetizer! How could a parent allow their child to eat like that? Even the salads are nightmares.

I ordered shrimp fajitas and asked for unmarinated shrimp. I also asked if the entire dish could be cooked without butter or oil (or as little as possible). I asked for lettuce leaves instead of tortillas and extra guacamole instead of sour cream. When the dish was brought to the table, it was glistening with oil. I asked the server and she said, “We didn’t use oil to cook it but the vegetables are premarinated in an oil sauce”. PREMARINATED IN AN OIL SAUCE? Even veggies have to be full of oil. I guess it was my fault for eating at a restaurant like that. It just shows you that there are tons of secret ways restaurants stick oil and other unhealthy items into the food. Next time I will order a grilled chicken breast (with Buffalo dipping sauce on the side for an extra kick), a dry baked potato, and some steamed veggies (with no oil). Let’s hope that works out better.

The bottom line- beware of eating at restaurants like this. Really quiz your server about what is in your dish. And don’t be afraid to ask for substitutions.

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The Nathan’s hot dog eating contest pretty much sums up everything that is wrong with our country. Eating has become our new national sport. I couldn’t believe that ESPN was covering this spectacle. I was so nauseous watching these people shoving hot dogs into their mouths, in front of hundreds of screaming “fans”. Would people have the same enthusiasm watching an alocoholic drink himself into a stupor or watching a smoker attempt to smoke as many cigarettes as possible in as short a time as possible? No- because we understand that drinking too much and smoking too much are dangerous to our health. Yet overeating is just as dangerous- and much more common. As a nation, we have failed to realize this scary fact. So we continue to encourage each other to keep eating- in fact, at times we even cheer each other on, pretending that there is nothing to worry about. But there is a lot to worry about. And until we realize that, the obesity epidemic will continue.

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There is a little-known very obvious sign of pre-diabetes often seen in overweight children; it is called acanthosis nigricans. Acanthosis nigricans is a darkening and thickening of the skin found in skin folds and creases; it is most obvious in the back of the neck, just underneath the hairline.
Acanthosis nigricans is one of the first things that I look for when examining an overweight patient. Acanthosis nigricans is usually seen with conditions that increase insulin levels, such as type 2 diabetes or being overweight. High insulin levels can trigger activity in skin cells, resulting in this dark, thick, velvety skin. Acanthosis nigricans can also be caused by medicines such as human growth hormone and oral contraceptives (aka “the pill”). There is no specific treatment for acanthosis nigricans, although weight loss may decrease its appearance. I always check fasting glucose and insulin levels to make sure that the patient has not yet developed diabetes. Acanthosis nigricans is a sign that a patient’s weight is starting to affect his/her health. It should be a wake-up call that weight loss is needed immediately to prevent the development of diabetes. If your child is overweight, be sure to check their neck and make sure that they do not have this sign of “hyperinsulinemia” (higher than normal insulin levels). The absence of acanthosis nigricans, however, does not mean that your child does not have pre-diabetes or diabetes. Any overweight child should have their fasting glucose and insulin levels checked as a precaution.

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I just read that Burger King will soon begin selling “apple fries” which are raw apple slices cut in the shape of French fries, served with a low fat caramel dipping sauce. I think it is a great option. I like the idea that they are shaped like fries because although they obviously won’t taste like fries, they do simulate the experience of eating a fry- which is important. I hope that fast food restaurants keep coming up with healthier options. I don’t understand why they can’t use leaner meat for the burgers. And why do they have to fry them in so much oil? Hopefully, they are learning that people will pay for healthier fare. I believe that since restaurant chains are now required to print nutrition info on the menu, people will be much less likely to eat such unhealthy food. It is a lot harder to eat a Whopper when you see that it has 680 calories and 40 grams of fat. I am hoping that these restaurants will look for new ways to make their food healthier so they can show better numbers on the menus. At least this is a start.

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