Attacking childhood obesity in the home begins with planning meals that are low in fat, sugar, and calories, and then careful grocery shopping. It calls for a lifestyle change for parents and caregivers who are cooking the meals.
In the midst of busy schedules, work and school responsibilities, and parenting and home chores, monitoring what children eat can seem a daunting task.
"A lot of moms get started and then give up. They are so busy. To monitor a kid's intake is hard," says Sharla Cook, registered dietitian with the Lucas County Women, Infants and Children (WIC) program. "If the parents can set limits such as have kids ask for a snack, this helps to monitor what they are eating. Don't give them free rein of the kitchen. It's setting limits."
One mother who didn't give up is Lisa Lewis of Toledo, who has been successfully cooking and serving healthy meals for more than three years.
When Ms. Lewis realized that her 18-month-old son, D'Angelo, was overweight she changed the way she cooked, and made lifestyle changes that helped him grow into his weight. (He went from 32 pounds at age 1 to 46 pounds at age 4.) Healthy cooking and meal planning involved her four older children as well.
"My youngest child was heavy. When he was born, he was nearly 10 pounds. I nursed him for 18 months. When I stopped, I thought he would slim down," says Ms. Lewis, who was involved with the WIC program, which surveys what children are eating. "The dietitians noted that he was having too much juice. We cut back on the juice."
She made other changes. "I made specific times for eating for the whole family," she says. Sometimes one of the kids would say "I don't want to eat now." But she held firm to breakfast at 8 a.m., lunch at 11:30 a.m., and dinner at 6:30 p.m. The children are now ages 16, 15, 11, 8, and 4.
She cut out eating between meals, except for a 3:30 p.m. snack, which now fits into D'Angelo's preschool schedule and is the time the other children come home from school. "On weekends, I stick with the patterns they have at school," Ms. Lewis says. She also serves age-appropriate portions for each child.
For dinner, "we all sit down together," she says. "Before bed, they can have a half piece of fruit or a glass of milk. I make a nice filling dinner with all four food groups and a dessert. Sometimes it's homemade apple cake, fruit cobbler, or maybe once a month, a piece of cake."
The secret to her success: "I seldom fry. I bake and use the slow cooker."
Her biggest challenge: "Telling [D'Angelo] 'no.' I have to say 'no' about candy, chocolate, and sweets. The kids can't go in the refrigerator without permission," she says. If they did, she wouldn't be able to keep track of what they eat.
The children help in the kitchen. "It's a family affair," Ms. Lewis says. "My 8-year-old, D.J., loves to pick green beans and [he and] my 11-year-old, DeLise, help the most." Ivory, 15, also loves to help.
Ms. Lewis has developed a shopping method that allows each child to pick or plan a meal. "We all go to the grocery store together," Ms. Lewis says. "We go once a week. I cook four or five nights a week. My oldest daughter, Allie, cooks one night. That's our 'cheat meal,' which is sometimes chili dogs or hamburgers" - higher-calorie foods that she doesn't usually prepare.
Although it is not unusual for babies to be overweight, parents and caregivers may introduce solid foods in ways that help children develop healthy eating patterns and avoid obesity.
As compared to breast-fed babies, "the percentage of overweight babies is higher with bottle-fed babies," says Mrs. Cook, the dietitian. "You can force-feed bottle-fed babies."
Check to see how much the baby should be drinking based on his or her weight. "Babies have the need to suck for comfort," Mrs. Cook says. "It's easier to keep a baby quiet by giving them a bottle. They can tend to overeat when bottle-fed."
As you add baby foods, notice when the baby doesn't want any more to eat, she advises. Don't force the baby to finish.
"We encourage babies to get off the bottle at one year and to switch to a cup," Mrs. Cook says. "They may not eat as well with too many bottles."
"We tell moms not to force babies to eat. Between ages 2 and 4, they often eat one good meal per day. Don't use food as a reward. Moms are in charge."
Dietitians try to analyze what parents and caregivers can do when a baby is overweight. With overweight children, weight reduction is not the goal. "They are still growing and they can grow into that weight," Mrs. Cook says. "Our first goal is to get them to keep the same weight over three months."
Debbie Verkin-Siebert, a pediatric nutritionist and dietitian at Mercy Children's Hospital, agrees. "Weight loss is not desirable for a rapidly growing child," she says. "As children grow, their weight is supposed to go up."
She recommends that parents not overemphasize the problem. "Do not make the child a new topic of discussion in the family," she says. "Don't single them out especially within the family."
The whole family can adopt a more healthy lifestyle. "Try to improve the choices available," says Mrs. Verkin-Siebert. "Children influence what a family purchases. Parents need to take control, not in a rigid sense, but they have the ultimate decision for the school-age child."
Whether the student takes a lunch or buys it, plan on healthy lunches. School lunches are designed to provide the recommended nutrients based on USDA guidelines. "Get a menu for the week and decide what days the child will purchase lunch at school," Mrs. Verkin-Siebert advises.
After-school snacks should be nutritious. For students involved in sports and for those still growing, a snack such as a peanut butter roll-up or a ham and cheese sandwich can be eaten on the way to an activity.
Based on team practices and other extracurricular activities, the family meal may be as late as 7 or 8 p.m. "It's not when the meal is served; it has to do with quality," Mrs. Verkin-Siebert says. "Parents feel like they don't have much structure. If there's no planning, you have to make a decision about what to have for dinner on the way to the practice or event.
"With the chaotic nature of meal planning, the biggest thing is for parents to realize they don't have to be stuck in the kitchen. Cook extra food on Sunday. Keep home-baked turkey breast in the refrigerator and warm it up. It takes planning."
A detailed food history with children includes the family's habits. "The first thing we look at is beverage consumption," Mrs. Verkin-Siebert says. "Pop has replaced milk, especially as a child gets older. Second, we try to eliminate noncaloric beverages. We try to dissuade diet pop, which contains phosphates, which can cause a leaching (draining) of calcium from bones." Encourage adequate low-fat milk consumption for children of any age.
Cooking methods are important. "How many products are convenience foods? Does the family prepare from scratch? It's important not to add additional fat to foods if preparing convenience items," Mrs. Verkin-Siebert says. Choose leaner meats, and cook with olive oil.
"If your family eats out every night, cut back to four nights a week," she advises. "Look at the children's menu and if it seems too high in fat, then it is. Choose from the low-fat 'lighter' menu. Look at overall total calories. Look at portion sizes. If you have fries, split them."
Teenagers represent a unique population. It is difficult to get them to change their eating habits. They have more income and more independent time than younger children at home.
Involve teenagers in food shopping and preparation as Ms. Lewis does to establish healthy meals with the teens' input.
Make family favorites such as chicken nuggets and macaroni and cheese with lower-fat recipes such as the ones on this page. In place of fried chicken, bake chicken or use a slow cooker with recipes such as Slow-Cooker Chicken.
Everyone agrees that exercise is as important as healthy meals. "I make sure D'Angelo plays," Ms. Lewis says. "We go to COSI, Walbridge Park, the zoo. I make certain the kids get exercise."
For more information:
●American Heart Association's Meals in Minutes (Clarkson & Potter, $26.95).
●The American Heart Assocation's Kids Cookbook (Clarkson & Potter, out of print, $16).
●Secrets of Feeding a Healthy Family by Ellyn Satter, R.D. (Kelcy Press, $16.95).
●Underage and Overweight by Francis Berg, M.S. (Hatherleigh, $24.95).
●The Mom's Guide to Meal Makeovers by Janice Newell Bisseck & Liz Weiss (Broadway, $15.95).