Parent Resources – Obesity


Some families think that preparing healthier food can be more expensive for families.  In some ways the exact opposite is true!  Here are five ways that you can save money at the grocery store while preparing healthier meals for your kids:


1) Get organized with a list. Figure out what meals you will serve for the week and make a good list. When you go to the store then you are armed with a plan to buy on the good high-quality foods you need and no more. You also waste less time when shopping with a list.


2) Buy local. Local produce prices at farmers markets are often very reasonable. Not only does the food taste fresh, it often lasts longer because it’s been picked and quickly delivered to the market. To find a list of farmers markets in your area visit (link).


3) Buy in bulk. This means buying oats out of the bulk bins at the grocery store and not the box. Find large tubs of yogurt instead of single servings. Packaging costs extra money. Why pay for it if you are not going to eat it?


4) Buy less processed food. Processed food, for the most part, costs more. A store-bought granola bar costs 2-3 times what a homemade one does. Popsicles, granola, muffins, cookies, and soups are all examples of things I used to buy but now make. Homemade foods also mean less preservatives, additives, dyes extra salt and sweeteners.


5) Buy less store bought drinks. Juice, sports drinks, sodas and other sweetened drinks cost money and can inflate your weekly grocery bill. These drinks also add unnecessary calories without adding much nutrition.  Water out of the tap is just about free, and has zero calories! Getting kids used to drinking water and lowfat milk with mealsl is a great lifelong habit that can promote maintaining an ideal body weight.


For more tips on preparing healthy food for your family visit, a pediatrician’s nutrition website.


In 2010, the U.S. Centers for Disease Control and Prevention reports that 34% of American adults and 17% of children are “obese.” Even more staggering is that the number of adults considered “overweight” is 64% and that nearly one-third of children are at least overweight to obese. Many pediatric practices around the country are seeing growing number of overweight and obese children every year.  Below is an overview of obesity in children.  Management of obesity, especially in children and even adolescents should be a parent-driven process.  This article is meant to provide background information in order for parents to help make informed decisions,  which will help children attain a healthy lifestyle and body weight.

Risk factors for obesity in Children include:
  • Having at least one obese parent
  • Having a television in the bedroom
  • Watching television for more than 2 hours per day
  • Sedentary lifestyle
  • Poor diet (diet high in fat, sugar and processed foods)
Health Consequences of Obesity include:

Many of these problems were once thought of as medical issues of adulthood.  However, as the obesity rate rises in the pediatric population pediatricians are seeing more children and adolescents with the same obesity-related complications.  The incidence is difficult to estimate because many of these problems go undetected for years.  For instance, type 2 diabetes, a problem almost exclusively related to obesity, can be detected only by blood work. This kind of testing may not be pursued for months or years if a child feels okay. Once a problem of people over age 40, type 2 diabetes is now diagnosed in children by pediatricians and pediatric subspecialists more than ever.  Without proper diagnosis, management, and control (including weight loss), these children may face a shortened lifespan with numerous complications related to diabetes.

How to Diagnose Obesity

Body Mass Index (BMI) is the ratio of weight (in kilograms) to the square of the height (in meters).  The BMI is a way to determine the proportion of a person’s weight to their height.  As opposed to adults, in children normal BMI varies by age.  Because of this variation, the BMI is assigned a percentile score relative to other children of the same age and gender.  At each well-child visit, a child’s weight and height are measured and the BMI is easily calculated and plotted on a standardized curve.  This is generally calculated for children over the age of two years. Below is a graph from the Center for Disease Control and Prevention website. It explains how BMI is used in children.



One of the biggest contributors to the excessive amount of calories that American children consume is BEVERAGES. The average American teenager consumes in the neighborhood of 400 calories. That’s the equivalent of a four mile run! In my practice I give many of my overweight young patients a food journal to keep track of a week’s worth of eating. In talking to their families and reviewing their journals I often find that I can help them get back to a normal weight just by getting them off of sweetened beverages.


Here are some of the beverages I see kids drinking excessively.


1.Fruit juice and fruit drinks. These are loaded with calories and sugar. Even 100% juice is high in calories and low in nutrition. Consider than 8 oz. of apple juice has about 20 more calories than 8 oz of coke! What about eating an apple? It’s less calories and has fiber, which many kids diets are lacking. The American Academy of Pediatrics recommends that children from age 6 months to 6 years get no more than 4-6 oz of juice per day. I see so many  toddlers and young children in my office with sippy cups full of strangely colored fruit drinks. Ultimately these extra calories can translate into extra weight and early tooth decay.



  • Sports Drinks.  I see many families overusing these drinks for their young athletes and letting them drink them regularly at home.  Most children are not sweating enough to require the calories and electrolytes in these drinks.  As an every day drink most sports drinks are high in calories and artificial dyes. I keep one bottle of an electrolyte drink in the back of the fridge just in case one of the kids is sick and needs a rehydration drink.  These are not really a healthy choice for every day.
  • Sweetened tea.  I’m not sure why families are giving young kids caffeinated drinks anyway, and decaffeinated teas often use chemical solvents to extract caffeine.  Yuck!  Sweet tea only tastes good when there’s enough sugar to rival soda! Most prepared sweet teas have about the same number of calories too.
  • Soda. Not much to say about his except your “nutrients per calorie” is just about ZERO.  Regularly ingesting that much sugar puts strain on the pancreas, which can ultimately lead to diabetes. At my house soda is a “special occasion drink” but definitely not an everyday drink.


So what’s wrong with water?  It’s free, for the most part.  It’s ZERO calories and frees up some calories for us to eat foods with real nutrition.  Water does not promote tooth decay. It’s good for us, and it’s what humans are meant to drink!


Families say to me, “But my kids don’t LIKE water!”  Just like many things, with time and patience kids WILL adjust.  I used to keep lots of juice boxes, orange juice and lemonade in the fridge to share with friends.  I have slowly phased those products out over the past few years.  In terms of drinks, I now buy milk and that’s about it.  Three amazing things have happened after I made that decision.


  • My kids drink water.
  • My kids LIKE to drink water
  • I spend less money at the grocery store. This money now can be put in my pocket or used for other healthful changes like more organic produce and local farmed raised meats. Two small packs of juice boxes plus one carton of orange juice per week was costing me almost 500 per year!!


One thing parents can do to get kids off the sugary beverage train is STOP BUYING THESE PRODUCTS.  If parents bring sweet drinks into their homes, just expect that kids will drink them.  It’s up to adults to set an example and not buy these drinks regularly.  Phasing drinks out slowly may help the transition  (cutting juice with water at first, or limiting sugary beverages to once a day or a few times a week).  But ultimately parents need to get on board, shop differently, and start drinking water themselves. In my opinion, drinking water is one of the best habits parents can teach their kids.


To get more ideas on raising children who have healthy eating habits, visit, a pediatrician’s nutrition website run by The Doctor Yum Project, a Virginia non-profit organization.


1 – Have a great lunch box that both you and your child likes.  Bento box-style systems with one lid that is easy to clean can help organize different food groups easily.  Also have a small thermos which you can use for occasional hot items like soups and stews.


2 – Keep things exciting and appealing by using many colors.  Lunch will look interesting and have many different types of nutrients. Try different dips like hummus and yogurt dressing for veggies. Occasionally pack a homemade sweet treat that is packed with nutrition.


3 – Leftovers from the day before can be enjoyed for lunch the next day.  Make life easy and let one meal do double duty.  Foods like soups and stews can be packed in  a thermos. Make Sunday’s leftover pancakes into a pancake sandwich on Monday.


4 – Have plenty of options stocked in your pantry and freezer so you do not always have to rely on fresh foods.  For example, dried fruits like raisins can substitute for fresh. Keeping a bag of frozen edamame means you always can pack something green.  Keep canned tuna in case you run out of lunch meat. Have options so you can always pack a great lunch in a pinch.


5 – Don’t be afraid to pack something new.  Exposure to a variety of different foods is what grows an adventurous eater.  When packing something new for kids, make sure your other lunch box compartments are filled with things they like. That way they will not feel too hungry if they don’t like a new food initially.


6 –  If your child does not love something new that you have tried, don’t be afraid to pack it again.  Research shows that it takes 6-10 exposures to a new food before a child may accept it (some researches say as many as 15 exposures). A recent study showed that 94% of parents give up on a food before they reach five tries! Kids are less likely to be adventurous, healthy eaters if parents do not persist in exposing them to good nutrition.

7 – Try keeping your packed lunch as “waste free” as possible.  If you find a great lunch box, you will not need throw-aways like sandwich bags.  Find cloth napkins in fun patterns.  The kids will love them and you will be showing them how to take care of the planet!


8 – Try packing seasonal items.  Seasonal local foods are fresher and taste better. Packing more seasonally means that kids get to try different foods each month.


9 –  Don’t forget calcium!  Kids have growing bones and need plenty of calcium. If your child does not consume dairy products, have options on hand that are calcium-fortified like fortified juices and cereals.


10 –  Keep kids engaged and interested in their lunches. Ask them to help with choosing, preparing, and packing lunch items. They are more likely to enjoy food when they are involved.


For more ideas on packing healthy lunches visit a pediatrician’s nutrition website,


The food industry has targeted kids with clever marketing, advertising and fancy packaging of highly processed foods made with artificial ingredients that make children sick.  Pediatricians are seeing more children with diet-related illnesses daily.  We as parents can fight back by perfecting the skill of saying  “no” at the grocery store.  Saying “no” to a child can be difficult. It goes against parents’ instincts to keep their children happy and comfortable. However, in some instances it is necessary to say “no”, even though it may bring on feelings discomfort and frustration in children.  This paradox is one that parents should embrace:  saying “no” can be the greatest show of LOVE. When it comes to raising a healthy eater, it is imperative that parents learn to say “no” at the grocery store.

Let’s face it.  Grocery shopping with children is tough enough.  The kids may be tired, hungry, and bored while we drag them down aisle after aisle. Now add in the temptation of highly attractive but unhealthy processed food, and it can be easy to break down and give in.  Saying “no” does not have to sting.  It can be done with warmth, love and compassion. Saying “no” may also create a “teachable” moment, in which kids can come away having learned a lesson about healthy eating.


First, put yourself in the position of a child.  Children are bombarded by advertising and lured by smart, attractive packaging.  Groceries stores also are set up to tempt them into asking for unhealthy food.  Children like what they see, and do not know any better. They do not know that highly processed, colorful, fun-shaped foods with their artificial sweeteners, preservatives and dyes, can cause them a myriad of health issues later (or not so much later) in life. It’s a parent’s job to say no, and to protect them from the dangerous consequences of these artificial foods.


Here are some artful ways of saying “no”, while keeping your kids health in mind:


Say “no” but offer an alternative. For instance you might say, “Those cookies look nice, but I think I have a recipe for something almost like that, and it will be a lot healthier. Maybe we can make them together.”


Offer an explanation, and create a “teachable moment”. For instance you might say, “I don’t buy those kind of fruit snacks because they have dye in them that gives them bright colors.  Some people can get really sick from those dyes.  Can I show you on the label?” The child may then see that the “no” comes with a good reason, and that you are looking out for them.


Try to time your shopping after a healthy meal. Hungry kids (and parents) are much more likely to give into the pressures and temptations of unhealthy snack foods and treats while roaming the aisles.


Lay ground rules early, so you do not have to say no so much. For instance, you may establish a rule that you don’t buy candy from the checkout aisles at the grocery store. kids know that I do not buy candy in the check out aisles.   At first it may take a lot of repetition of saying something like, “Sorry, we don’t buy candy near the cash register.”  Once the rule is understood, they may stop asking for unhealthy options.


Offer a small treat for cooperating at the grocery store. Preferably this would not be a food item. Once you are changing the way you shop, you may offer a small trinket for a child who is helpful and cooperative.


Make a list. Start off the shopping trip by laying down rules that you are buying what’s on the list and not much else.  Making a list saves time (and money, too!)


Teach your kids how to spot unhealthy food. This works great for kids who can read and can be shown how to navigate a food label. For example, teach them to spot certain unhealthy preservatives or foods with high fructose corn syrup.  Training them to be a partner in your efforts may empower them to help you make good food choices.


For more ideas on raising children with healthy eating habits, visit, a pediatrician’s nutrition website.


In the summer of 2011, the USDA did away with the old “Food Pyramid”, replacing it with the new “Choose My Plate” recommendations. The USDA presented a simple attractive graphic that even kids can understand. Along with the simplified graphic they also include some other highlights:


  • enjoy food but eat less
  • avoid oversized portions
  • make half your plate fruits and vegetables
  • drink water instead of sugary drinks
  • switch to fat-free or low-fat (1%) milk
  • compare sodium in foods
  • Make at least half your grains whole grains.

What is great about the new USDA guidelines:

1. There is flexibility. The ratios are not set in stone. There is some room to tailor the plate to the individual.

2. This plate provides a visual, which shows the importance of fruits and vegetables which together should fill half the plate. Many parents get stuck on trying to fill kids with carbohydrates and worrying about protein. Those sections are usually easy. Most kids in America eat twice the protein that they need, and overemphasizing carbohydrates is largely what has created an obesity epidemic. Parents should be doing their best to get the left half of the plate full of as many types of plant foods as kids will accept.

3. The recommendation stresses avoidance of sugary beverages. Too many children drink too many calories. Sweet drinks like sports beverages, juice, sweet tea, and soda are contributing to the crisis of overweight kids. What’s wrong with drinking water? Nothing, says the USDA!

4. Highlighting the idea of “empty calories” is key when thinking about food. The USDA says that much of the American diet consists of “empty calories”. These are the added fats and sugars that provide no nutritional benefit. So many parents think of food as fuel only. However, food is much more than that. It has vital nutrients, vitamins and minerals, which serve as medicine to keep us healthy. If parents keep that in mind, they may make more wise choices and maximize those important benefits for each calorie they feed their children.

Finally, parents should share this new USDA visual with kids that are old enough to understand. Talk about why the plate looks like it does, and strive to make your plate match the visual. For more detailed information visit the USDA website,

Here is a sample of a real life dinner using the Choose MyPlate USDA recommendations:

1)    Mixed fruits: apricots, strawberries, and blackberries 2) Herb salad with goat cheese, walnuts, and roasted beets 2) Red rice with onions, toasted almonds, and peas4) Baked tilapia 5) Glass of low fat milk.

To find easy, kid-tested recipes visit,, a pediatrician’s nutrition website.


In a quest for constant improvement of our family’s diet, I recently decided I would tackle one issue that constantly plagues us: SNACKING!

Let me first backtrack. I read a fascinating book recently called French Kids Eat Everything by Karen Le Billon.  In the book this mother describes the year she spent in her husband’s native France trying to get her two small children in touch with the French way of life.  She soon discovers that the typical North American way that kids eat just won’t do in France. The French seem to have a cultural sensibility about how to get their children eating healthy delicious food from a VERY young age.  Leek soup, beet salad, fresh bread and French cheese -no problem!  This is typical kindergarten fare at the school cafeteria.  She spends the next year trying to get her kids accustomed to the French way of eating by exposing them in a very matter-of-fact fashion to all sorts of local foods.

What I have done with my own kids is very similar to how the French teach kids about food-and my kids do eat EVERTHING!  However, our family faux-pas  is how much my kids snack.  I don’t think I’m much different from most American moms.  I carry snacks for “just in case.”  What if someone has a meltdown? What if we are stuck somewhere without food? I have a compulsion to be prepared for all of these “what if’s.”  We also have a big “Snack Basket” in our kitchen, and the kids always seem to be hitting it right before dinner (which drives me a bit nutty!)

What I learned from Le Billon’s account of her time in France is that French kids just don’t snack.  Period.  After school they have a small “meal” called le goûter. This is given to children when they get home from school, sitting down at a table. Typically it may be yogurt and fruit or bread and cheese.  Then food is put away and there is no snacking until dinner, typically at 7:00 to 7:30.  Easy as that!  What if kids get hungry? Well, hunger is a normal human sensation that kids get accustomed to, and it also helps them to eat more nutritious foods at mealtimes.  A child who is faced with broccoli at dinner is more likely to eat it if she is not full of fishy crackers and fruit snacks.

For the past month, I have instituted “no snacking” and le goûter, at my house, and I’m please to say it has worked brilliantly.  During soccer season, our heartier snacks held the kids over until after practice and the kids were much more able to eat a nutritious dinner that I served because they weren’t munching in the car on the way home.  The kids now understand the rules about snacking, and as long as the kids have plenty to do, they don’t seem to miss the snacks.

Here are some five simple rules regarding snacking for kids:

  • Small children should probably be offered a mid-morning snack and a later afternoon snack. Other than that snacks should be put away so that children are more likely to eat their meals.
  • Older children (approximately 5 year old and older) can be offered a mid- afternoon snack. Other than that, snacks should be put away so that children are more likely to eat their meals.
  • Children will probably whine at first when they are getting used to not getting snacks on demand.  It’s okay. They will get used to it.  Provide simple explanations for the change in your routine, and then don’t give in.
  • Snacks should consist of foods that one would give at meal.  Instead of “filler foods” like fish crackers, pretzels, chips, and fruit snacks which don’t offer much nutrition, try to provide a balance of fruits, veggies, whole grains and proteins.  See our “Super Snack Plate” for an example.
  • Avoid sweet drinks like juice, sports drinks, soda, or other sweetened beverages with snacks.  Water and milk are good choices for snack time. Smoothies that combine fruit, veggies, yogurt and other nutritious ingredients can work well too as a snack.

Here’s a link to Karen LeBillon’s book:  French Kids Eat Everything: How Our Family Moved to France, Cured Picky Eating, Banned Snacking, and Discovered 10 Simple Rules for Raising Happy, Healthy Eaters.

To get more ideas on feeding kids, and for more snack ideas and kid-tested recipes, visit, a pediatrician’s nutrition website.


How do you convey to relatives, especially grandparents that you don’t appreciate the sweet treats and junk food they feed your kids when they visit? A friend recently emailed me about the frustration she feels when her in-laws bring over loads of sweet treats for the holidays. She is a working mom who tries hard to make sure that her kids eat nutritious food throughout the year. However, all her efforts are put aside at Christmas time when relatives show up with boxes of junk food that the kids can’t resist. This is a common theme I see in my practice as well. Some parents of obese children might be trying hard to change their eating habits, only to feel sabotaged by grandparents who can’t seem to stop the endless supply of junk food. I sometimes suggest that parents bring these grandparents to their follow-up visits so they can hear from me how important good nutrition is.


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For more ideas on raising children to eat healthy food, or to find delicious and healthy kid-tested recipes, visit, a pediatrician’s nutrition website run by The Doctor Yum Project (a nonprofit organization in Virginia).