How should doctors manage overweight kids?

KEN RESNICOW ANSWERS: “Thirty to 40 percent of American kids are overweight. Pediatricians keep telling us they don’t know what to do—they don’t believe what’s out there works. So we’re attempting to give them some new counseling skills. Through the American Medical Association and the American Academy of Pediatrics, we’ve put together a series of guidelines on pediatric obesity prevention and treatment, and we’re testing those guidelines in a randomized trial of 36 pediatric practices throughout the country. The guidelines are available on the AMA and AAP websites, and we’ve also produced a three-disk DVD on the use of motivational interviewing for pediatric obesity.

“A key aspect of our guidelines is to calculate body-mass index, or BMI, for all patients on a yearly basis, beginning at age two. BMI is an objective physiologic measure that’s unbiased—unlike diet and activity. Next, we encourage physicians to work with parents to identify behavioral targets for the family. Typically this will involve reducing sweetened beverages, fast food, portion size, and TV/screen time. On average, we’d like to move kids’ BMI from the 95th to the 92nd percentile. That’s important because the medical consequences of obesity tend to cluster at the high end of the BMI spectrum. So moving kids even three percentile points will have clinical significance.

“If our intervention works, this could be one of those few studies you do in a lifetime whose outcomes really change clinical practice. ” Ken Resnicow, professor of health behavior and health education, and co-investigator Matthew Davis, associate professor of pediatrics and communicable diseases, associate professor of internal medicine, and professor of public policy, are in year two of a five-year study of pediatric obesity funded by the National Heart, Lung, and Blood Institute.

Can we get kids to eat locally grown fruits and vegetables?

BETTY IZUMI ANSWERS: “Yes, and farm-to-school programs are an important part of that effort. These emerged in the U.S. in the mid-1990s as a way to increase children’s access to fresh fruits and vegetables and to provide new market opportunities for small and midsized farmers. Today there are more than 2,000 such progams across the country.

“I recently completed a study of seven different farm-to-school programs in the upper Midwest and Northeast. Findings from my research suggest these programs succeed on a number of levels.

“First, kids like locally grown food when it’s sourced directly from a farmer or a regionally based produce distributor. It’s fresher, tastes better, and comes in more varieties than the food you typically get from distributors that are more national in scale and scope.

“Secondly, locally grown food is often cheaper than food that’s shipped in from long distances.

“Third, teachers can design classroom lessons, activities, and field trips around locally grown foods, and these experiences can have a positive impact on kids’ diets. One school that I studied received a delivery of purple potatoes, and the teachers incorporated those into the curriculum. They talked about the nutritional content of the potatoes and showed what happened when they became French fries. They encouraged the children to try the potatoes roasted. Where there’s an extensive educational component, kids are more likely to eat new foods. Studies of school gardens in California show that children who have an opportunity to grow their own food are more likely to be willing to try it.

“The relationship with local farmers is also important. When farmers come into a cafeteria and do taste tests with kids, or just walk the halls so that the kids see who’s bringing the apples to school—or even when a school simply puts apples in a basket with the farmer’s name on it—the symbolic meaning of the food changes. Kids think the farmer is cool and therefore the food is cool, and they eat it.

Caroline's Lunchbox Blog“Farm-to-school programs have real potential to benefit kids, farmers, and communities, so it’s important that we find ways to strengthen these efforts.” Betty Izumi, a research fellow with the Kellogg Health Scholars Program at UM SPH and author of the Caroline's Lunchbox food blog, studies ways that physical and social environments affect risk factors for cardiovascular disease. She holds a Ph.D. from Michigan State University’s College of Agriculture and Natural Resources; her doctoral dissertation was on farm-to-school programs.

Food Allergies

As many as 25 percent of the children in the U.S. who have a life-threatening food allergy will experience their first allergic reaction away from home. Usually it happens in a childcare setting or at school, says pediatric allergist Harvey Leo, who is directing a three-year study of food allergies in childcare settings for the UM Center for Managing Chronic Disease.

It’s a serious problem, because six percent of U.S. children currently have life-threatening food allergies—most often to eggs, milk, or peanuts and tree nuts—and the numbers are growing. Ten or 20 years ago, a food-allergic child was a rarity. But now, Leo says, “you may have several food-allergic children in a classroom of 20 kids being fed and managed by childcare workers who have no medical background, where a mistake could be serious.” The situation is a source of anxiety for both childcare workers and parents, and “it needs to be addressed systemwide at the community level.”

Leo and his research team are assessing the anxiety levels of workers and parents of children enrolled in the UM’s eight child-care systems and conducting educational sessions with both groups about food allergies. The researchers want to devise a systematic approach to the care of allergic children in childcare settings, so that the children are safe but not socially or developmentally isolated. Ultimately, the researchers hope to develop an approach that can be implemented throughout the UM childcare system and serve as a model for other programs, such as Head Start and community childcare centers.

10 Ways to Improve a Child’s Diet

  1. Offer a variety of healthy foods.
  2. Let children decide whether and how much to eat.
  3. Offer new fruits and veggies many times and in different ways.
  4. Offer at least one food a child likes at each food occasion.
  5. If a child rejects a prepared meal, don’t offer to prepare alternate foods. Instead, let him or her choose from healthy snacks and foods later in the day.
  6. Offer children healthy snacks, like sliced fruits and veggies, and limit the availability of unhealthy snacks, like potato chips and candy. But don’t overtly restrict visible sweets and high-fat snacks if they happen to be available—research shows that overt restriction can increase a child’s preference for that food.
  7. Food should not be used as a reward for good behavior.
  8. Set family rules for meal and snack times (e.g. regular meal and snack times, kids stay seated while eating, no TV or phones, kids engage in pleasant conversation). Children thrive in a structured environment.
  9. Model healthful eating. Kids learn eating behaviors from those around them.
  10. Keep healthy foods easily available.

SPH alumna Melissa Reznar, MPH ’02, a doctoral student in community nutrition at Michigan State University, compiled these tips, which are drawn from literature in her field. Reznar’s research lab studies the influence of parent-child communication on children’s food preferences.