Healthy food as medicine
I think in the beginning, if you’re not used to thinking about preparing food and thinking about food choices in the way that we’re recommending, then it probably does seem like it costs more and requires more time to cook and eat healthily. You do have to be more thoughtful when you’re shopping and look at the labels for sugars and carbohydrates. But eating vegetables doesn’t mean that you have to do anything fancy; you can use frozen vegetables, and that doesn’t take very much time. As far as the cost goes, yes, fresh vegetables are a little more expensive, but not any more expensive than a meal at a fast food restaurant, so you have to put it all into perspective. And I think if you look at healthy food as medicine, then it’s not really expensive at all. If your child got diabetes, you’d never think of not giving them the medicine that they needed to get better. If your child is overweight, it’s the same thing: you need to give him the food that’s going to make him better, and eating healthy is what that is.
Colleen Kochman, RN, MSN, PNP
Major health risk: Diabetes
A major health risk that we currently see is type 2 diabetes, which we now find in adolescents. Before, we didn’t see it until adulthood, but now we see it in adolescents too because we have such an epidemic of overweight in this country. Overweight can cause bone and joint problems as well, because if the body has to carry around that extra weight, that’s more pressure on the musculoskeletal system. Later on in life overweight can cause problems with the heart, because once again you’re carrying around extra weight, which can put pressure on the heart and cause clogging of the arteries. It can affect fertility later on in life, and in fact many teenage girls have something called PCOS, which causes a lack of menses or very irregular menses. Sometimes I talk to families about the complications of diabetes. I’ll talk to kids about how unpleasant it might be to have to prick yourself several times a day to test your blood sugar, or in some cases, to have to take shots of insulin every day, and then later on in life have circulation problems. It’s not a very pretty picture, and sometimes it’s scary enough to get parents thinking about using healthy food as a medicine to prevent these diseases.
Colleen Kochman, RN, MSN, PNP
Convenience and healthy foods
It does take more planning to be able to eat more fruits and vegetables and more whole grains. You have to spend more time in the produce section, and then if you buy fruits and vegetables and leave them in the fridge in their packages they’re not going to get eaten. But if you take those apples and wash them and put them in a bowl on the table then they’re going to get grabbed. If you take those carrots or cucumbers and wash and peel them and chop them up, then they’re going to get eaten as snacks. The problem with the convenience foods is just that– the convenience part has already been done. Pretzels are already in a bag that just needs to be ripped open, and the same with potato chips and crackers– those types of things. But there are a lot of healthy types of convenience foods out there if you look for them. Cheese sticks are a really quick and easy thing to rip open and have. You can get baby carrots that are already peeled and cut up and ready to be eaten, and you can get cottage cheese that comes in little snack packs that break off and you can throw into a lunch. The same is true of the light, low sugar yogurts. Frozen fruits and vegetables that are already cut up are just as nutritious as fresh ones. So there are definitely time saving foods out there that can be used to help you to eat a healthy diet.
I just think that people think that those aren’t out there, and so they fall back on, “Oh, it’s too difficult to do that.” And that primarily comes down to the way foods are marketed: so many of the unhealthy foods are things that you just rip open and that you can sit on the couch and eat. But you can also sit on the couch and eat an apple. I mean, you can’t get any more convenient than a piece of fruit– it’s already in its package, it doesn’t need to be refrigerated, and it’s ready to go.
I think people have this misconception about what’s convenient. A lot of the counseling sessions in the clinic focus on changing those misconceptions to the knowledge that healthy eating can be easy, it can be quick, and it doesn’t have to be really time consuming. As far as price is concerned, you can buy different produce based on what’s on sale or just what’s in season, because those items tend to be cheaper. Yes, a large bag of potato chips is only $1.79, but a large bag of potato chips isn’t going to fill you up, so you’re going to end up eating more frequently and eating more of those chips overall, when you could have gotten a pound of apples for $1.79, which would have made you feel a lot fuller. So there’s a deception there, because since unhealthy processed foods aren’t filling anyway, you need to eat more of them, which ends up being more expensive. I think there have been some studies where it has been shown that healthy eating ends up meaning a difference of only about $5 to $10 per grocery shop. A lot of people think it’s double the cost, but it’s not.
Kelly Sinclair, Clinical Nutritionist
Costs of healthy and unhealthy foods
Calorie for calorie, fresh fruits and vegetables do cost more than some poor quality, highly processed foods, at least in the short term, although the long term costs of having an unhealthful diet are quite another story. However, some of the apparent short term cost savings can be deceptive. Many families spend far more than they would imagine on fast food, soft drinks, sugary breakfast cereals and other junk foods. Many families can change from this way of eating to a natural, healthful diet, sometimes even saving money in the process, but this does require some time and planning. Buying foods in bulk and preparing them at home can be cheaper than eating out, even compared to fast food.
David Ludwig, MD, PhD Director, Obesity Program
Ebb and flow of weight loss
Everybody in the family must be working together. If you have a parent helping you with this it makes an enormous difference. Families come to clinic once a month or once every two months, so they really need to have that support at home [between visits]. It is difficult to tell a child that they have gained weight, but that’s just part of the ebb and flow of weight loss, and the ebb and flow of learning to change eating patterns. This is not something that happens overnight.
Frequently, if someone hits a stressor in their life– say a grandparent died or there was a divorce a child may revert to turning to food for comfort, so then you’ll see an increase in weight. It’s great if they keep their appointments and come back during those times, so that you can see that pattern and address something before it becomes more of a problem, and so you can discuss why it’s happening. But their worth is not linked to their weight; it’s not the end of the world, and they can do something to get back on track again.
I’ve even had some kids who have been doing really well and are able to make some quick changes to their diet and lose some weight, but then they pushed their appointments a little further out and I didn’t see them for a while, and they came back having gained weight. Frequently it’s because they got a little overconfident; they saw that they were losing weight and thought “I’ve lost weight; this really worked. Now I can go back to the way I used to eat, and I don’t have to worry about it.” And when they go back to their old eating habits the weight just comes right back on again. So I try to stress to them that this is a lifestyle change; you’re making this change for your lifetime. This isn’t a quick fix. Usually, after addressing that, these families get back on track again.
Kelly Sinclair, Clinical Nutritionist
How children learn about food
For countless generations, children have learned what, how and when to eat from the people who have their best interests at heart: their parents. The main classroom for these lessons was the family dinner. Unfortunately, the family meal has become an endangered species. Meals away from home are the norm, and children spend countless hours in front of the TV. Today, many children learn more about food from TV commercials than from anywhere else, and of course, the main goal of food ads is to sell products, not promote the health of children. A typical child in the US sees 10,000 food commercials each year, overwhelmingly for high calorie, poor quality products such as fast food, soft drinks and sugary breakfast cereals. So it shouldn’t be surprising that TV viewing is strongly linked to childhood obesity. Some food companies and media outlets have recently announced campaigns to address the childhood obesity epidemic. However, the most effective way to deal with the unhealthful effects of advertising is for parents to turn off the TV and spend more time with their kids, both at the dinner table and physically active outdoors. My advice for parents is:
Turn off the TV, or at a minimum, limit commercial TV viewing to one hour per day.
Encourage and model a healthful diet: Increase fresh and natural rather than processed and packaged foods; reduce or eliminate fast food and sugary sodas; increase fruits and vegetables; and have a family meal together at least once each day.
Encourage and model an active lifestyle: fun family recreational activities, sports, or simply long walks most days of the week.
David Ludwig, MD, PhD Director, Obesity Program
Practical advice on choosing foods
I talk to families about healthy ordering at fast food restaurants. Sometimes with the older kids, I’ll also say “Watch this,” and we do an internet search for grocery stores in Dorchester or Roxbury versus fast food restaurants. So many little flags pop up for the fast food restaurant locations that you can barely see the land, but there are only three or four grocery stores. So access is an issue. We talk about the corner store a lot as well, because in Boston the corner store is where kids go. We talk about ways for parents to say, “Okay, instead of buying the $1.00 bag of chips, buy the $.25 bag.” It’s not bad to want or eat those foods, but let’s try to figure out ways to have them less frequently, so that it becomes a special treat rather than an expectation. But sometimes financially I think that it is really challenging, and I don’t know that there is any quick, easy solution.
Jennifer Rein, MSW Social Worker and Clinical Coordinator
Problems with watching TV
I always ask families about how much TV children are watching in a day. I like to say that three things happen when you watch TV. Number one, of course you’re not moving your body, so you’re not burning off any calories that you’re taking in. Number two, many people are so focused on watching TV that they sit with a bowl of food and put food in their mouth and don’t even realize that they’re eating. And number three, what do they advertise on TV? Food! So even if you weren’t hungry to begin with, all of those messages about food and junk food might make you start wanting to have some food or go out and get some. And of course video games are sedentary. The surgeon general recommends an hour of physical activity a day, and by that I mean getting your heart beating fast. A lot of our kids, unfortunately, aren’t even doing that.
Colleen Kochman, RN, MSN, PNP
Television and Activity Level
Television watching is the one factor that is strongly associated with obesity. Interestingly, video games and computer usage are not. So I talk about how families can reduce TV time specifically, and how they can increase other activities. I encourage the use of a pedometer, I encourage people to walk as much as they can, and I encourage errands with the family. If they’re close to the store, I encourage them to walk to the store on Saturday and feel what it used to be like to carry groceries home. The other thing that I do, which I think is really strong actually, is to model that behavior. So that I know what it’s like to walk, I walk to and from work without taking the T on nicer days. Then I tell them what it feels like to walk. I carry my own groceries, so I can tell them what that’s like. I model the behavior.
Jan Hangen, Clinical Nutritionist