1 June 2011

Finding it hard to keep your children at a healthy weight? A consultant dietitian gives JENNIFER JACOBS some practical tips

KIDS are getting fatter and increasingly unhealthy. According to the National Health and Morbidity Survey done in 2006, 5.4 per cent of our children were overweight. This included 6.8 per cent of kids between 6 and 8, and 6.4 per cent between ages 4 and 6.

“The numbers don’t look too bad but what is alarming is the trend. It’s all on the rise,” says consultant dietitian Indra Balaratnam.

She explains that contrary to popular belief, a chubby child is not necessarily a well-nourished one. Many times, the heavier child has loaded up on empty carbohydrates that can be a source of energy but not of nutrients. So these seemingly healthy children are actually suffering from a micro-nutrient deficiency. And if they lead sedentary lifestyles, the energy is stored as fat, leading to problems such as diabetes and hypertension later on.

In light of the growing obesity and related health problems as well as the rising price of sugar worldwide, the Health Ministry embarked on a sugar reduction campaign last year. It was found that the average Malaysian consumed 24 teaspoons of sugar a day. According to the World Health Organisation, children between the ages of 2 and 8 are supposed to consume no more than five to six teaspoons of added sugar a day while an adult is supposed to consume no more than 10 teaspoons. This has led to local food companies striving to reduce the sugar in their offerings, especially those aimed at children. The latest to do so is New Zealand-based dairy company Fonterra, which has just launched Anmum Essential Tanpa Gula Tambahan, a growing up milk with no added sugar.

The problem, as always, starts at home. Most parents are not aware of what their children are consuming and where the sugar is coming from. While they may shop responsibly and load their refrigerators with healthy food or snacks, there is no guarantee that their children are availing themselves of these options.

And, if they eat out a lot, they usually have no idea what goes into the food. It’s not just the usual suspects such as fast food outlets. Seemingly innocuous stall food such as tom yam soup can be swimming in sugar and what makes it deadlier is that the sweetness is masked by a barrage of other tastes. Indra says the most common cause of obesity in children is, not surprisingly, parental over-indulgence.

“Many parents don’t want to rock the boat. They fear the backlash if they start denying their kids food that they know may not be healthy for them. Most cave as soon as the kids start to whine or throw a tantrum. When you want to change any behaviour, you have to ride out the wave. And don’t worry, the wave won’t last forever.” She does not advocate extreme measures such as telling the busy mother to quit her job to stay home and cook nutritious meals for her kids. Nor does she suggest they try to be superwomen and do it all themselves. But she does recommend a series of strategies to firstly increase awareness of what the children are consuming and then to gently “find new favourites” that are healthier and more nutritious. The key is to get the whole family on board.

Identify the problem It’s important to find out what the child eats in a typical day. When identifying the problem, she says, it is important not to assign blame or find a scapegoat. Fault-finding may make you feel better but it does not address the problem at hand. The water’s been spilt and it’s time to mop it up.

Find new favourites For every food item removed from the diet, it is important to replace it with something else. “When you remove something, you need to replace it with an alternative so the variety is still there. If you keep taking things out without replacing them, what used to be paradise has suddenly turned into the Sahara. Ultimately it won’t be sustainable.” How do we do this? “For example, a child likes sweet drinks. But now that fizzy drinks and sugary cordials are out, replace them with chocolate milk, probiotic drinks or the 100 per cent fruit juices with no sugar added. Even better, take the child shopping and let them pick what they want. You set the boundaries, but within those boundaries you allow them to choose their own flavours. When they have had a hand in choosing the food, they will be more eager to consume it.” Reduce, don’t deprive Parents who are too strict about their children’s diet usually find it counterproductive in the long-run. “Don’t be too extreme in depriving them of a favourite food. At some point your children will encounter the contraband and go wild. In fact, as they will probably load up like little addicts when they do because they know they will have to go back to ‘prison’ where their supply will be cut off.” If a child likes chocolate, for example, and wants it in candy bars, it is possible for the parents to give them chocolate in milk instead. This way, they still get the chocolate flavour, but with vitamins and nutrients present in milk. Mealtimes are not battlegrounds The fast food outlets do not nag children to eat their burgers and fries. They just make themselves so appealing that all the kids want to flock there. Similarly, if healthy food is presented in an appealing way, parents can get their children to consume it more willingly. And don’t underestimate your child’s intelligence. Tell them the truth about the food and the nutritional benefits.

Don’t use food to reward Many parents use chocolate, ice-cream and fast foods as a reward. Not only is this unhealthy but it positions the unhealthy alternatives as food to be strived for. Indra suggests that instead of “rewarding” the kids with food of any kind, the parents reward their children with quality time. “So turn off that Blackberry, stop checking your email and spend a solid hour with your child playing card or board games. They will enjoy it as much, if not more than the chocolate.” Don’t put down your child In an attempt to get kids to make healthy food choices, many parents employ negative reinforcement such as criticising them, or putting them down. Not only is this strategy not effective but it undermines the child’s confidence resulting in a whole new set of issues to deal with later. “One mother told her child in front of me, ‘You’d better listen to this auntie. She’s here to teach you how to get thin. Otherwise, I’m telling you, you’re never going to get married’. The child was only 9 and I don’t think the mother even realised what she was saying or how negative she sounded,” cautions Indra.

Setting the lead Parents have to be willing to look into their own diets and regulate their sugar intake. Indra says that sometimes, in suggesting dietary changes, she encounters the greatest resistance from the food preparers themselves, that is, the mothers, who like a certain food and are reluctant to give it up, pointing out that it doesn’t affect her other children in the same way and she doesn’t want to deprive them. This sends the wrong message to the child. And it detracts from the seriousness of the message. What’s sauce for the goose should be sauce for the gander.

Cook smart, not hard While a working mother or father should not be expected to cook fresh meals every day, they can cook a large meal and freeze part of it in containers to be heated up over the course of a week. “Then all you need to do is make the rice and stir fry a vegetable and you have a tasty meal in a short time.” Make time for play These days, parents fill their children’s days with “enrichment” classes, which are supposed to account for outdoor activity, but which effectively take all the fun out of leisure time, or playing. “When I ask a parent what activity their child is involved in, they are likely to tell me about how they send her to this coach or that coach. So what’s supposed to be a play session has become an enrichment class.

“If you want to send them for tennis lessons or swimming lessons, fine. But don’t let that be your definition of activity.” In the interests of safety, she says, it is advisable for a parent to be present if the kids go to the playground. But here too, they can be creative. “If you live in a condo, take turns with the other parents to watch over the kids. Find a support system, whether it is your extended family or your neighbours. You don’t need to go it alone.” Read food labels “Our labelling laws are not the best, so food manufacturers who add more sugar, salt and fat can fly under the radar. Even so, there is still information you can get from the label. Look out for words ending in ‘ose’ because that means it is some kind of sugar. Look also for corn syrup solids, glucose syrup solids, honey, brown sugar, treacle, molasses, gula melaka, sobitol and xylitol. And remember that ingredients are listed in a descending order. So if one of these ingredients are high up on the list, it means a high concentration of sugar.”

This article was published in www.nst.com.my on 4 April 2011.