Dr. Lisa Belisle: Let Food Be Your Medicine: Tips for Feeding the Family

By Lisa M. Belisle, MD, MPH, Medical Advisor, Raising Readers

Summer 2005, Raising Readers Issue Brief

For most Maine families, the summer means time spent outside. My family is no different.With a baseball player, a softball player and softball coach in our household, many a June evening finds us at the local fields. While we always try to eat before we go, the snack bar often proves especially tempting for the children at dinnertime. Fortunately, along with the requisite hotdogs and ice cream sandwiches, our Little League also makes sure to stock green apples and bottled water. Ever mindful of their budding bodies, I make every effort to cajole the kids into choosing the latter over the former. This may mean that I have to agree to the occasional ‘sweet treat,’ but at least they are getting a consistent message about healthy choices.

Pediatric providers have long recognized the importance of good nutrition. We begin our emphasis on this crucial topic as early as the prenatal visit, and carry it through to our adolescent wellchild visits. In some respects, we may feel as if we are fighting a losing battle. Despite our efforts, children in Maine are becoming increasingly obese. Fifteen percent of kindergarteners were overweight in 2002; an additional 21% were at risk for becoming overweight. These numbers are especially frightening with the known link between obesity and diseases such as diabetes, hypertension and heart disease. Being overweight can set a child up for a lifetime of problems.

The role of the pediatric provider is not to get discouraged by the obesity problem in our state, but to take action. Studies have shown that patients and their families really do listen to what health care providers have to say. The Maine Center for Public Health, and organizations such as the Maine Chapter of the American Academy of Pediatrics (AAP) recognize this, and have formed the Maine Youth Overweight Collaborative (MYOC). The goal of the MYOC is to bring community organizations together with primary care and specialty practitioners to find ways of “improving the management of overweight youth.” Currently in the pilot phase, the MYOC hopes to provide practical tools for this to medical practices across the state.

In addition to dealing effectively with the needs of overweight youth, medical practices should strive to prevent this problem from occurring in the first place. The AAP and other organizations currently advocate yearly monitoring of BMI and obesity-associated disease risk factors. Practitioners also need to continue to offer solid anticipatory guidance on nutrition. This begins with encouraging breastfeeding (especially in the first year), and continues with reviewing the correct ages for introducing solids and potentially allergenic foods such as nuts, citrus and shellfish. As children grow, parents can be educated on appropriate serving sizes, and the importance of offering a varied diet. It may be helpful to direct parents of children over the age of 2 to www.MyPyramid.gov, where they can create an individualized eating plan for their child’s age and activity level. Optimally, of course, children should have the highest activity level possible, by decreasing time spent in front of the television, and increasing time spent engaged in physical pursuits (or simply playing outside!). Other tips for families include:

Strive for a diet rich in fruits, vegetables and whole grains, with appropriate amounts of low-fat milk, lean meats, poultry, fish, beans, eggs and nuts (if tolerated).
Begin the day with a breakfast of foods comprised of high-quality proteins, carbohydrates and fats
Fruit does not equal fruit juice, which should be limited due to its high sugar and caloric content,
Consume foods rich in Omega-3-fatty acids (such as cold-water fish, flaxseed, nuts, dark green leafy vegetables and soybeans) , which are good for brain as well as body development,
Limit intake of fish that has been shown to have a high mercury content (for more information download the “Healthy Fish, Healthy Family” pocket guide at www.psr.org).
Emphasize foods that are less processed and packaged; minimize foods made with white flour, sugar, added salt, preservatives and trans-fatty acids,
Consider organic foods—they are less likely to be contaminated with pesticides, hormones and other contaminants, the long term health impact of which are unknown (for a wallet guide to pesticides in produce, visit www.foodnews.org).

What children eat can be as important as the setting in which they do so. Eating is a social event, and helping children create positive associations with the right types of food can make them more likely to eat them in the future. Older children also benefit from having some control over their menus. Suggest to parents that they:

Give children a few healthy possibilities (“Do you want carrots or corn with dinner tonight?”), instead of making mealtime a battleground,
Plan, shop, grow foods for and cook meals together, using kid-friendly cookbooks such as Mollie Katzen’s Honest Pretzels, and magazines such as Eating Well and Cooking Light,
Eat as a family at least twice a week, which gives children a chance to socialize, learn manners, and appreciate the importance of the food being served,
Have school-aged children bring lunch from home, if school choices are not optimal (for ideas, see www.laptoplunches.com),
Make healthy snacks (such as fruits and vegetables) easily accessible,
Avoid sodas, take-out and fast food, but
Allow occasional fast food meals, while emphasizing a healthier repast through sharing portions, choosing salads instead of ‘nuggets,’ fruit instead of fries, and milk or water instead of soda,
Get fresh produce through summer farm share programs (see www.csacenter.org) or farmers markets (www.local harvest.com), which are available to WIC recipients through the Farmers’ Market Nutrition Program at 1-800-437-9300,
Set an example for kids, by making healthy food and lifestyle choices as parents.

Obviously it would be impossible to discuss all of these things in one visit—topics can be addressed as time permits. The discussion should be tailored to the family, and relevant resources explored. For children who are struggling with weight or poor decision-making around food, consider a nutritionist referral.

There are a myriad of patient education tools available (see Resources). Try to be sure you have the appropriate tools for your population—some written information has a relatively high literacy level. If patients do not have home access to the World Wide Web, refer them to the local library for Internet access. Encourage parents to read books about healthy foods and behaviors, and have them available in your waiting room. The Family Nutrition Program at Kansas State University has actually developed a list of children’s books and food-related lessons, which can be found at www.humec.ksu.edu/fnp/bib.html. For other ideas see Books about Food and Eating.

The father of modern medicine, Hippocrates exhorted his patients to “Let food be your medicine.” More than twentyfour hundred years later, there remains no better advice. As a pediatric provider, you can help your patients to see the value of good nutrition. Then maybe one day they will ask for apples at the snack bar.

With research assistance from Kate Bartley.

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RESOURCES:

Guide to Your Child’s Nutrition by the American Academy of Pediatrics (Villard, 1999).

American Dietetic Association

American Academy of Pediatrics

American Academy of Family Physicians

Maine Center for Public Health

U.S. Department of Health and Human Services

U.S. Department of Agriculture

U.S.D.A. Dietary Guidelines for Americans

BOOKS ABOUT FOOD AND EATING

ABC Yummy, by Lisa Jahn-Clough, Walter Lorraine Books, 1997.