Archive for March, 2010
Monday, March 22nd, 2010
A South Carolina woman was charged with criminal neglect when her 14 year old son reached a shocking 555 pounds. I am sure that many of you can understand the charge because the example is so egregious. But how do we know this is really the mother’s fault? And if we do decide to charge parents of obese kids with child abuse, where do we draw the line?
As a Pediatrician and Child Obesity Expert, I see a wide range of overweight children. Some patients are simply ten pounds overweight while others are more than one hundred pounds overweight. How do you decide who to charge with criminal neglect?
Many of the parents of my morbidly obese patients have been struggling (unsuccessfully) to keep their kids’ weights down. They beg. They plead. They keep junk food out of the house. They lock their refrigerators. Yet these kids still manage to gain access to food.
It is somewhat easier to protect a younger child. But even at school, a kid can overeat. All a child has to do is cry that he is hungry and the lunch aides will serve him a second (or even a third) helping. And many a heavy child has begged their thinner classmates for some of their lunch. At the many parties thrown in class (for birthdays, holidays, and “special” days), these kids try to eat as many servings as possible. Even worse, a Mom may give her daughter some money to buy a turkey sandwich and never know that she used it to buy French fries and cookies instead. Parents have very little control over what their kids are eating out of the house.
Socioeconomic factors also play a role in the development of child obesity. I will admit, my family and I ate at McDonald’s last month during a long car trip and I was shocked at how little it cost. My family of four ate for less than $15. It’s no wonder that families with little money often opt for this cheap, but unhealthy, option.
Obesity rates are also affected by environmental factors, like access to playgrounds and parks. Many families live in unsafe areas where kids can’t simply go outside to play. These children are often kept indoors for their own safety. And what do these kids do while cooped up in the house? Eat and watch television, more risk factors for weight gain. How can we blame parents for these inequities?
Some kids are genetically predisposed for obesity. While less than 10% of all cases of child obesity are due to known genetic defects, it does happen. Some individuals are deficient (or resistant to) the effects of a protein called leptin. Leptin is what tells our brain that we are full and no longer need to eat. Mice studies prove that mice with leptin defects become obese, sometimes to the point of eating themselves to death! These mice will eat until they become sick… and then they eat some more.
Some obese individuals have been found to have these same leptin defects. Clearly, obesity in these kids cannot be their parents’ fault. It is possible that genetic defects are responsible for more cases of child obesity than we realize because we haven’t yet discovered the responsible genes. I would hate to put a mother in jail or separate a family only to find out a few years later that the child suffers from a previously unheard of genetic defect. There is simply no way to know for sure whether a child is obese because of a parent’s neglect or some genetic predisposition.
This is not simply conjecture. A family in Britain was on a Social Service’s watch list, at risk for losing their children, due to their kids’ weights. Luckily, Dr. Sadaf Forooqi discovered a gene deletion that left these kids unresponsive to leptin, causing them to live in constant hunger. Dr. Forooqi spoke to authorities and Social Services dropped the investigation. Had Dr. Forooqi not made that discovery in time, this family would have been devastated for no reason!
So let’s go back to our initial example of the 555 pound South Carolina teen, Alexander Draper. His mother, Jerri Gray lost custody of her son and is being charged with criminal neglect. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity, said her lawyer, Grant Varner. Could Alexander suffer from an unknown genetic abnormality? Are we sure that he can control his hunger in a normal way? Alexander Draper hasn’t even been tested for genetic causes of obesity, according to Varner. How can we justify putting this woman in jail for something that may not be her fault? We don’t know what goes on in that house. It is possible that the problem lies within Alexander’s DNA. And how can we punish his mother for that?
Now I am not saying that all parents are blameless. It is horrifying to see parents feeding obese children unhealthy foods and parents must be responsibility for keeping their kids as healthy as possible. I am just not sure that jail is the answer.
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Tags: child abuse, child nutrition, Child Obesity, child obesity abuse, fat child, fat children, fat kids, obese child, obese children, obese kids, overweight child, overweight children, overweight kids
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Friday, March 12th, 2010
We were starting to think that Vitamin D deficiency was a thing of the past. I mean, when was the last time you met someone with rickets? But a recent study in Pediatrics showed that over six million children in the United States do not get enough Vitamin D. That is one out of every five kids! It seems that Vitamin D deficiency is more common than we thought.
Vitamin D is an important vitamin! New studies are proving that vitamin D can help prevent many diseases such as cancer, depression, diabetes, hypertension, osteoporosis, chronic fatigue, autoimmune diseases and cardiovascular disease. Other research has linked low Vitamin D levels to obesity; studies show that overweight individuals are much more likely to be Vitamin D deficient. It is not clear, however, whether increased body fat leads to Vitamin D deficiency or if low Vitamin D levels cause a person to gain weight. Is one responsible for the other? More research is needed in this area.
There are a few different ways to get vitamin D. Vitamin D may come from foods or vitamin supplements; vitamin D can also be made by the skin when it is exposed to ultraviolet rays (UV light). Fortified foods are the main dietary sources of Vitamin D as few foods naturally contain it. Although milk is fortified with vitamin D, dairy products made from milk, such as cheese and ice creams, are generally not fortified with vitamin D. Fatty fish and fish oils are natural sources of Vitamin D.
Vitamin D deficiency is often missed because there are no real symptoms associated with it. Rickets and osteomalacia (softening of the bones) are the most common signs of vitamin D deficiency but there is no way for parents to tell if their child is suffering from these illnesses. The only way to prove that your child is vitamin D deficient is by completing a blood test which screens for a particular form of vitamin D, called 25-hydroxyvitamin D (25(OH)D).
Think that name sounds complicated? Unfortunately, many doctors do too. In fact, doctors often order the wrong blood test when assessing vitamin D levels. Be sure to ask for 25(OH) D blood test not 1, 25-dihydroxy-vitamin D (aka calcitriol). With such complicated names, it is no wonder that such mistakes are made!
Vitamin D deficiency exists when 25(OH) D levels fall below 25 ng/mL. Levels may vary depending on time of year, direct sunlight exposure, skin color and vitamin D consumption. Levels should be between 50 – 80 ng/mL year-round for both children and adults.
As a doctor, I am finding more and more children with low levels of vitamin D, mainly because kids are spending less time in the sun. These days, toddlers are more often inside watching TV than playing outside. And if they are in the sun, they are lathered with sun block, which reflects the sun’s rays and decreases vitamin D formation. Obviously, sunscreen is important and should not be avoided! But it does lead to lower levels of vitamin D. Also, many toddlers do not get enough vitamin D to meet their needs since there are limited food sources of high vitamin D content.
The current recommendation is 400 IU per day in the form on of vitamin D3 (cholecalciferol). New studies are showing that higher levels may be needed to prevent the diseases discussed above. Many are now recommending 1,000 IU per day in the form of vitamin D3 (cholecalciferol). If your child doesn’t get this amount of vitamin D in his diet, you may want to consider a multivitamin that contains vitamin D.
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Tags: child diets, child nutrition, Child Obesity, diets for kids, milk, nutrition for kids, school lunch, Vitamin D, vitamin D deficiency, whole milk
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Friday, March 5th, 2010
Recently, America’s school lunch menus have been under fire and parents are becoming increasingly concerned about the state of their children’s health and well-being. Federal law, under the School Lunch Act, provides nutritional guidelines and criteria to which schools must adhere. These guidelines include the amount and type of foods the cafeteria must offer, in addition to placing limits on nutrients like saturated fat, cholesterol and sodium. Specifically, school lunches must provide 1/3 of the Recommended Daily Allowance (RDA) for protein, calcium, iron, vitamin A, vitamin C, and 1/3 of the Recommended Energy Intake (REI) for calories. In addition, the cafeteria must offer 5 components as part of a school lunch, of which three of the five must make their way onto the child’s lunch tray. These include a starch, meat (or meat substitute), fruit, vegetable and milk. There are similar guidelines for schools that serve breakfast as well. These guidelines are especially important because many children eat the majority of their meals at school.
Milk contributes a good portion of nutrients to school lunches. It is a valuable, nutrient-dense source of protein, calcium and vitamin D, all of which are important for achieving adequate nutrition and optimal growth in school-age children. However, whole milk can significantly contribute to the saturated fat and cholesterol content of a meal.
According to the American Academy of Pediatrics (AAP) whole milk and other full-fat dairy products are only appropriate for children under the age of 1-2 years old. Children under two, who are in a stage of rapid growth and brain development, have high energy and dietary fat requirements. They need the extra fat that whole milk contains.
Everybody else, however, should choosing low fat dairy products, including skim milk. In fact, the AAP states that no child over the age of two should be drinking whole milk. Skim milk is identical to whole milk in terms of nutritional value, but is markedly lower in saturated fat, cholesterol and calories. Diets high in saturated fat are associated with increased risk for obesity, heart disease and certain cancers. Saturated fat intake causes harmful buildup in the arteries and blood vessels of healthy individuals, starting in young children. It is important to begin healthy eating habits as a child and to continue making healthy choices throughout life.
A good portion of a child’s learning happens through modeling. That is, by watching their parents or other caregivers’ actions, they learn how to be an adult. This is especially important when it comes to eating: your food preferences as an adult are closely related to the foods you saw your parents eating. But what happens when your child is eating 2 out of 3 meals a day at school, plus a snack? Because they are eating so many meals outside the home or the care of their parents, kids are increasingly reliant on teachers, caregivers and cafeteria staff to guide them to make healthy choices and model healthy eating behaviors.
The fact is, the people who are responsible for serving food to or eating with your children usually receive no formal nutrition education. In most cases, a position as a preschool classroom aide or a kitchen worker requires a high school level education. Regardless, whatever their educational background, it is a common misconception for people to think that whole milk has a nutritional advantage over skim milk. It is also very common that parents encounter teachers or caregivers who have different beliefs than their own when it comes to feeding their child. Especially when you’re talking about the welfare of a child’s health, when a parent feels one way but their caregiver feels another way, this can create some tension. A well-meaning day care worker just may not be aware of or understand the reasons why full-fat milk can be dangerous, even for young children. Parents often have a difficult time getting this message across but should continue to be an advocate for their child’s health.
In situations like this, as a parent you have the right to decide what your child does and does not eat. You can stress this issue to the teacher in a polite way while still standing firm. If needed, refer them to an appropriate resource, such as www.MyPyramid.gov, the American Academy of Pediatrics, your pediatrician, or even a local dietitian for further advice on this matter. Your child’s health comes first!
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Tags: child diets, child nutrition, Child Obesity, diets for kids, milk, milk in schools, nutrition for kids, school lunch, whole milk
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