Sunday January 15, 2012
By MAJORIE CHIEW
An expert in innovative approaches for the prevention and treatment of obesity spills the beans on what really makes children obese, and shares tips for healthier living.
IN view of the increasing incidence of obesity in children worldwide, parents should monitor what their children are eating.
“It’s easy for children to overeat energy-dense foods,” warns Dr Adam Drewnowski, director of the Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, US.
Knowing the right foods to feed children can help curb weight gain and obesity. For example, don’t underestimate a small bar of chocolate, says Dr Drewnowski.
“Believe it or not, a calling card-size chocolate bar can pack up to 200 kcal per gram (a dieter’s nightmare). If you can pack 200 to 250 kcal into this space (of a calling card), don’t do it. With the energy density, it’s very easy to overeat,” he warns.
A healthy option would be to feed children fresh fruits or fruit juices.
“For fresh fruits or beverages, the energy density is 0.5 kcal per gram, and for cooked rice, it’s 1 kcal per gram,” he says. “It’s not the beverage, the milk, the fruits, the vegetables, and the salads. It’s very energy-dense foods (that can cause obesity) and children like those a lot,” says Dr Drewnowski in an interview with Star2 after a talk, Eating Right: Nutrition and Balanced Diet For A Healthy Lifestyle at a recent workshop in Kuala Lumpur.
The workshop had been put together to encourage “a physically active nation for a healthier living” and was organised by the Olympic Council of Malaysia and Coca-Cola.
What to eat?
In deciding what to eat or drink, people make complex trade offs that involve food taste, cost, convenience, health and variety.
“Taste, the chief influence on food choice, combines the sensations of taste, texture and aroma,” observes Dr Drewnowski. “Sweetness is viewed as a positive attribute linked to nutritive value. Children and pregnant women reject bitter tastes as potentially toxic,” he adds.
Generally, energy density and palatability are linked.
According to Dr Drewnowski, sweet foods are preferred because they are energy-dense. Energy-dense foods containing some combination of fat, sugar and salt are the object of food cravings, whereas fruits, vegetables and even beverages are not.
In addition, energy dense grains, sweets and fats not only taste good but are also inexpensive.
In contrast, he says, many of the recommended more healthful foods, including lean meats, seafood and fresh vegetables and fruits can cost more.
Taking note of this can help parents make wiser and healthier choices for their children.
Low energy-dense foods
Children can grow to like low energy-dense foods, provided they are sweet.
Dr Drewnowski notes: “Grapes, watermelon and mango would not give nearly the same calories as cookies, candies or potato chips. Even though the portion size may look big, they have lower calories.”
Parents, he advises, should say “No” to starches, fried/deep-fried and fatty foods.
“Go with fruits, vegetables, soups and beverages as opposed to energy-dense cakes or candies,” he reiterates.
“Fizzy drinks can be sweet, but you can dilute them. Or make like a syrup and add fizzy water to control the amount of sugar. Portion control and exercise can also bring weight down,” Dr Drewnowski adds.
Losing weight effectively
Physical activity is a great way to help in weight control. There are many ways to incorporate physical activity into our lives. For example, in Seattle today, many people (teenagers too) are walking in shopping malls.
Other options? “Take the stairs or have a soup or a salad,” Dr Drewnowski advises as a way to lose weight.
On a suggestion by Harvard University professor and child obesity expert Dr David Ludwig (on July 12 last year) that severely obese children with life-threatening diseases be removed from their parents, Dr Drewnowski replys: “It’s shocking. Oh no, it’s too drastic. There’s such a thing as family. Ultimately, that’s not something that can be done for everybody. Children should not be separated from their parents. It’s a terrible idea.”
Anyway, Dr Ludwig, who shared his opinion in the Journal of the American Medical Association, sparked outrage among families and professionals across the US.
And what does Dr Drewnowski think of obese children in China who are sent to “exercise” camps to lose excess weight?
“Children in the US are sent to exercise in summer camps. But it’s a voluntary family decision; not the government’s decision,” he said.
Such exercise camps (to get children to lose weight) are “viable”, but he addd, “It costs (parents) money!”
Dr Drewnowski notes that school authorities in the US have removed two things from the curriculum.
“There are no longer physical activity and home economics (home science) in schools any more for 10 or 20 years. The focus of schools is on reading, writing and arithmetics, and it’s about achievement,” he says.
According to him, that shouldn’t be the case if we want to seriously tackle the issue of obesity.
Raising healthier children
There are many ways that parents can help control the weight of their children. For instance, by cooking at home, one can enjoy a healthy, nutritious diet that doesn’t cost much.
“If you can’t cook, you can’t go to the market and pick out fruits and vegetables. If you want to eat nutritious food at low cost, you have to be able to cook. Otherwise you go to fastfood outlets or restaurants and it’s expensive,” says Dr Drewnowski.
“These days, some busy people don’t know how to cook, including some mothers. It’s the grandmother who’s cooking. So, bring back the grandmother and physical activity in schools!” he adds.
Dr Drewnowski says “a nutrition curriculum for younger children” that teaches children what to eat should be in place. However, too often, schools are blamed for selling junk food and for childhood obesity. But the problem of childhood obesity doesn’t rest on schools alone.
“You’ve to have data looking at what per cent of daily calories come from schools. Data from the US show that calories are coming from supermarkets, not schools.
“You can’t put the blame on schools because (generally, children only take) one meal (at recess) in school.”
Reasons for obesity
Obesity is a complex social economic issue. “Obesity is related to social economic position, status, resources, income, and health. And it goes beyond future choices,” Drewnowski observes.
A study in Seattle found that the difference in obesity rates depends on which supermarket people shop at. “People who shop at expensive supermarkets are likely to be less overweight. They want value for their food and would spend the least amount of money as possible,” he said.
The study also finds that obesity is tied to more than food choices. According to Dr Drewnowski, in Seattle, the average rate of obesity is 20%. In some areas, the obesity rate can be as low as 5%, and in others, as high as 30%.
In small areas within Seattle, obesity has gone from 5% to 30%. And, it’s related to how much money people have. “The lower income groups buy calorically-charged energy-dense food. It’s an economic decision,” Dr Drewnowski says.
In Malaysia, China, Vietnam, Brazil, the overweight problem is in urban areas, not the rural ones. But the situation, he predicts, will change as Malaysia becomes richer. Obesity could become an issue of the lower income group too.
In Brazil, the obesity rate is higher among the rural than urban population. “In Sao Paulo (the largest city in Brazil) and Rio (or Rio de Janeiro, the second largest city of Brazil), obesity is a problem of the urban poor,” he notes.
Assuring equal access to healthful foods is paramount to a healthier lifestyle. In some US neighbourhoods classified as “food deserts” by the US Department of Agriculture, access to stores selling such foods can be limited and their availability and quality can be low.
Consumer diet habits are thus shaped by individual preferences, habits and by the food environment. Social and economic factors have a major impact on consumer food purchasing patterns and diet choice,” Dr Drewnowski notes.
“Showing consumers how all foods and beverages can fit within a healthy diet is one strategy for improving diet quality. Identifying affordable nutrient-dense foods within each food group is another,” he says.
Hence, the ultimate goal of public health nutrition, Dr Drewnowski states, is “helping consumers construct balanced, healthful diets.”
Getting the energy without overeating