The Biggest Loser

Like adults, children require the correct mix of good foods and enough exercise to stay healthy and maintain a good weight. Whereas once this was easy as children were more likely to walk to school, play with neighbourhood children after school and get exercise at recess and lunchtime, changes in our society have meant that the opportunities for exercise have been reduced. At the same time, there has been an increase in the amount of time spent in front of television and computer screens and an increase in the abundance of junk food available.

All together, this means that your job as a parent has become a little harder as you have to make a more conscious effort to provide your children with the opportunities for exercise and make sure they are making the right choices about food.

When it comes to establishing good patterns of health for our children, we have to remember that growing bodies need the right kind of energy to help their bodies and brains develop. Food contains many important nutrients (see the section to explain the importance of the major nutrients, especially for growing children). It is vitally important to ensure that our children eat the right type of foods, including protein, fat, carbohydrates and fibre, because otherwise their growth and their ability to learn will be impaired.

Multivitamins are not a quick fix as there is no evidence that vitamin and mineral supplements improve academic performance. We do know though that breakfast eaters have better food patterns and nutrient intakes than those who skip breakfast. They also have better brain function when it comes to memory and test grades compared to those who do not eat breakfast, so make sure your kids eat breakfast every day.

Many factors influence a child’s growth. These include genetic, family, social and medical factors as well as their environment. To grow at the expected rate a child must be healthy and have access to an adequate amount of nutritious food. Most of the time this goes according to plan and between birth and turning 18 years of age, a child’s body weight will have increased about 20-fold.

While most infants double their birth weight by about 4 to 6 months of age, this slows down dramatically between the ages of 1 and 2 years with a healthy toddler gaining only about 2.5 kilograms a year and from then on roughly 2 kilograms per year until the onset of puberty at around age eleven. Girls stop growing at around 16 years of age and boys about 18 years, though there are lots of variations, which usually follow family patterns.

Nutrient needs correspond with changes in the growth rate, so this makes infants and teenagers particularly vulnerable. This also puts the pressure on parents and those involved in providing regular care to make food and drinks available that will ensure nutritional adequacy and optimise the health and wellbeing of young people.

Appropriate growth is an indicator of health and nutritional status. Comparing a child’s growth to a reference chart that covers the healthy growth trajectories for children is a way of keeping an eye on things to ensure your child or adolescent continues to grow within the healthy weight range. Regularly measuring height and weight in your children and plotting these on a growth chart means that you can monitor their pattern of growth over time. Most Australian children are given an infant health record at birth that contains growth charts to assist you in monitoring their growth over time.

The growth charts consist of a series of ‘percentile curves’ and by selecting the right chart for gender, height, weight or the one for Body Mass Index, you can check which line your child’s growth falls on and how this changes over time. The percentile lines rank the position of a child compared to the rest of the reference population and tell you where your child is, compared to other boys and girls of the same age.

Although measurements at a single time point can be plotted on a growth chart, they do not provide adequate information about the child‘s growth pattern over time. When plotted correctly, a series of accurate measurements can be used to identify and evaluate patterns of growth. They do need to be interpreted with caution and the height and weight of the parents need to be considered before assuming there is a health or nutrition concern.

The key to plotting your child‘s growth is to start by taking accurate weight and height measurements. Weigh children in light clothing using accurate scales. Try to measure them at roughly the same time of day, such as first thing after breakfast. For height, make sure the child stands with their heels against a wall and then looks straight ahead so the top of their head is in a flat plane. You can also do this by putting your thumbs under their ears and gently lifting their jaw. Put a ruler on the top of their head and measure from where it touches the wall down to the ground. You will find this easier if you have an adult helper.

Next, choose the right growth chart for the measurements taken and then plot the measurement using their exact age on the day the measurements were taken, to the nearest month. If you need help, ask your GP or nurse at the child health clinic.

Any changes in a child‘s weight need to be interpreted with caution, especially at puberty as growth can vary considerably between individuals. But if you think that your child may be overweight, the first step is to make an appointment for your child with your GP. It is useful to take along any history of growth measurements so that your doctor can see if your child is tracking normally or if your child has shifted to a different track.

For children and adolescents the focus should be on ensuring they consume most of their food and drink from the basic or ‘core’ food groups listed in the How to Eat Well section, and on limiting the amounts of the non-core or ‘extras’ consumed daily. Extras are high in kilojoules and rarely provide many of the essential vitamins, minerals or much fibre.

Currently in Australia well over one-third of a child or adolescent’s daily kilojoules come from non-core or extra foods. This means that it is now common for kids to be missing out on the foods that are high in the nutrients they need to grow and develop optimally.

If parents do not make it a top priority to ensure most of the foods available to their kids are healthy and to limit junk food, then the kids just don’t stand a chance.

‘You are what you eat‘ is a familiar catch cry. However, recent studies suggest that what you drink may be just as, or even more, important. Analysis of the dietary patterns of 18,000 people in the 1994–1998 Continuing Survey of Food Intakes in the USA showed that those who drank more milk had significantly greater intakes of essential nutrients. For children in particular, consumption of milk is strongly related to calcium intake. The one catch is that to keep the total saturated fat intake low you have to select low-fat milks.

In another study of children aged 1–5 years, milk intake decreased as juice, soft drink and other sweetened beverages increased. The researchers demonstrated that those with the highest intakes of all sweetened drinks had food intakes of the lowest overall quality. This shows a dangerous pattern: drinking more sweetened beverages displaces eating important nutrient-dense foods.

As for fizzy drinks: soft drink intake today equates to about 300 millilitres per day per person or just over 2 litres each per week. A high intake of soft drinks is associated with a greater risk of weight gain and obesity with a number of studies showing an association between soft-drink consumption and excess energy intake. There is a consistent relationship between consumption of sugar-added beverages and weight gain. Those who drink the most soft drink gain the most weight. The good news is that replacing soft drink with water or artificially sweetened soft drinks results in weight loss and this has been shown in both adults and adolescents.

The key message is that to optimise your child‘s and your own health, choose water and reduced-fat milk. If you need the fizz of a soft drink, choose diet or artificially sweetened versions. And, as for juice, limit that to just half a cup per day.

Parents are the most important influence on their children: they control the majority of their children’s time, set expectations and lead by example. Do not underestimate your power as a parent to set your child on the right path to healthy living.

As the number one role model for your children and family, there are some things to focus on in your modelling role. Kids need to see their parents:

A parent’s role is to buy healthy food and to present it to their child at designated meal and snack times. It’s the child’s role to try the food and to choose how much of that food to eat. They may sometimes choose to eat no food; if this is the case, ignore this behaviour and offer nothing else until the next snack or meal time – don’t worry, your child will not starve.

Make your job easier by planning your meals ahead of time and shop with the aid of a shopping list (for a sample list you can photocopy). If you often feel victim to your child‘s ‘pester power‘ try to shop without them. Or you may find it easier to have fresh fruit and vegetables home-delivered to ensure you are getting the best pick of produce.

Use the recipes in this book to select healthy meals. Once you get the hang of healthy cooking, you will find it easy to adapt other favourite recipes to be healthier (see also the section on making over recipes). Master some quick and easy favourites for those nights when time is tight. Another option is to cook large batches on the weekends and freeze small portions for later meals.

A key to setting your children on the right path to healthy eating is to get them involved in cooking. This will increase their interest in food and help them later in life when they are responsible for cooking for themselves.

If possible, move dinner time to earlier in the evening to avoid the constant nagging from hungry, cranky children and to avoid letting them snack before dinner.

Food that is eaten out of the house is just as important as that which is served in it. Buy a lunchbox for every member of the family and pack it the night before with healthy foods for the day at school or work. for some ideas on what to pack in the lunchbox.

Il_9781742735979_TXT_0056_001 Most adults admit they have bought food products for children as a result of ‘pester power’.

Il_9781742735979_TXT_0056_002 While almost all adults believe that it is important for children to have breakfast to encourage learning, on any day 15 per cent of children are skipping breakfast.

Il_9781742735979_TXT_0056_003 In Australia, 10 per cent of meals are prepared out of the home and 6 per cent are eaten out of the home. Some 4 per cent are purchased outside and eaten in the home.

Il_9781742735979_TXT_0056_004 Half of all dinners are consumed while watching television.

Il_9781742735979_TXT_0056_005 Two out of every five kids in Australia would like to be more involved in meal preparation. While this is more prevalent in girls than boys, almost one in three boys would also like to be more involved in meal preparation.

FAMILY WEIGHT RULES

1 Put the emphasis on making small positive daily changes that you can live with. Remember small changes make a big difference over a month, a year and a lifetime.

2 Never comment on your own, or a family member’s body, unless you are saying something positive. For example, ‘Your eyes look pretty when you wear that colour’. This takes the emphasis off weight. Be careful what you say around children about your own body. They are listening to every word.

3 Adopt positive attitudes towards food by focusing on efforts to try healthy foods. For example, say ‘I like the way you tried that zucchini’. Choose to ignore the behaviour of family members who refuse to try specific foods. We need a ratio of positive comments to negatives of about nine to one.

4 Have a daily routine and consistent boundaries as these help everyone know what to expect and to feel protected.

5 Eat together at the table with the television turned off every night. Eat the evening meal as early as is practical.

6 Try a variety of healthy foods over the week, but do not become the short-order cook making special dishes every night to cater for every individual taste.

7 Be reassured that healthy children will not starve themselves. Encourage them to eat from the healthy foods on offer and to stop eating when they are comfortably full.

8 Prioritise activity and have fun trying to be physically active as a family. You might like to set up a family activity routine where straight after dinner you go for a walk, kick a ball around, put on a dancing DVD or Wii Fit.

9 Limit the number of televisions at home to just one or two and remove all televisions and computers from bedrooms as they are associated with being an unhealthy weight.

10 Acknowledge that every family is unique and different things work for different families.

11 Build support into family life so you can keep up the healthy lifestyle long-term. Get the grandparents involved and ask them to treat the children to a fruit platter, rather than a bag of lollies or take the kids for a trip to the park rather than to a fast food outlet so they associate the outdoors with fun.

12 Think about adopting a healthy lifestyle as an investment in your children’s future and in your own (healthy) retirement. Start today. It may be too late to start tomorrow.

Whether they are aware of it or not, fathers have a powerful and positive influence on the overall health and wellbeing of their children. Research has demonstrated that active and engaged fathering is positively associated with children’s intellectual ability, educational outcomes, psychological health and social behaviour. This influence extends to young adulthood. The bottom line is that fathers matter! Involved fathers who care about their children, and spend quality time with them, give their children the best chance to lead successful and rewarding lives.

The influence of fathers clearly extends to the eating and physical activity behaviours of their children. Fathers need to make a concerted effort to demonstrate the healthy lifestyle behaviours and attitudes that they want to see their children adopt as they grow up. As both a role model and catalyst, fathers have a critical role in helping their children develop good eating habits and positive attitudes to physical activity.

Fathers who are active and who engage with their children in games and activities are more likely to have children who are also physically active and enthusiastic about participating in physical activity both now and in the future. The way fathers play with their children also has an important impact on a child’s emotional and social development. Fathers are more likely to play with their children in a stimulating and ‘rougher’ way than their mothers. This type of play teaches children how to control their feelings and behaviour.

Fathers who model good-eating habits in the home, such as eating a variety of fruit, vegetables, wholegrains and low-fat foods and drinking water rather than soft drinks or alcohol, are more likely to have children who also eat a variety of healthy foods.

There is a well known parenting phrase that is particularly relevant for fathers – children spell love as TIME. Importantly, the nature of the time is more important than the amount of time. Mere physical presence alone does not count as good parenting: sitting down to read the paper and supervise the children while they play outside is not quality time in the eyes of children. Fathers need to make time to play actively with their children.

Fathers can use physical activity and exercise as well as the purchase, preparation and cooking of healthy foods as the opportunity to interact with their children in an enjoyable way. If you add to this eating together as a family, dads will soon become more sensitive to the needs and interests of their children and, crucially, the children will recognise they are important to their father. Children have a tremendous and innate desire to connect with their fathers, and the benefits are shared.

Father–child fun emphasises active and physical pursuits which are often more valuable than passive activities for children’s physical and psychological development. Daily physical play with children can take the form of backyard games, bike riding together, or playing sports.

Fathers can positively impact their children’s eating patterns and set them up for a lifetime of healthy eating by demonstrating a number of healthy eating behaviours. The first step is for them to start the day by preparing and enjoying a healthy breakfast with their children. Research has shown that eating breakfast not only assists in maintaining a healthy body weight, but improves a child’s ability to concentrate and perform at school.

And if fathers are shown packing and taking a healthy lunchbox to work, children are much more likely to accept that a healthy lunchbox is normal for them as well.

Sitting down with the family at dinner time and eating the foods on offer, including meats, salad and vegetables, and potato, rice or pasta will normalise healthy eating. Sitting down for dinner also provides a fantastic opportunity to engage with children and provide guidance by discussing the trials, tribulations and achievements of their day.

To appreciate the impact a father has on a child’s eating just think about how often you hear of an obscure eating behaviour of a father that gets adopted by their child as well.

Parents make eating and exercise decisions in the interest of their child’s health but can forget to do it themselves. Parents need to be as healthy as their children to keep up with them and respond in an appropriate, loving and energetic way.

A father who returns home from work, slumps on the lounge and asks their child to get them a beer is not what a child wants. Use their desire for an active father to help you get fitter and healthier yourself.

Play actively with your child – even young children benefit from ‘rough-housing‘.

Undertake activities that you enjoy so your child can see that it is normal for people to be active.

Demonstrate your child‘s importance in your life by spending quality time with them.

Getting to a healthy weight for you and your family means you have to take a stand and be tough when it comes to making decisions about what to feed your family. Parents are the gate keepers of the family’s food supply. Kids can only eat the food that is made available to them – if it is not there, they can’t eat it. Simple as that.

Even teenagers who have their own money still consume most of their food from the household food supply as it’s free. Stay strong and say ‘no’ to junk food, including soft drinks. Shop for the foods you want your children to feed to their children (your grandchildren) in the future. To grow healthy children you have to purchase, cook and offer them healthy food.

Help your kids distinguish between basic foods essential for health and those that are highly processed, contain limited nutrients and should only be consumed on special occasions. Involve them in buying and cooking food or ask a grandparent to involve them in growing fruit and vegetables. Take them to a farmer’s market or visit a farm, market garden or orchard. Help them make the connection that fresh food you prepare yourself tastes better than highly processed foods.

To establish healthy eating habits at your place, you need food rules. Keep in mind that children do not need to eat as much food as adults, while very active teenagers, especially boys, may need more. Do not force them to finish meals, especially if they are overweight, as their body already has more than it requires.

To help making it easier to achieve a healthy food intake aligned with the Australian Dietary Guidelines and recommendations for healthy eating follow the healthy food tips on the facing page. And remember that change takes time to become habit. Start by making one or two changes to your family‘s diet, then gradually add more.

HEALTHY FOOD TIPS FOR FAMILIES

1 Swap full-fat milk, yoghurt and cheese to reduced-fat or skim varieties.

2 Swap sweetened beverages to water or reduced-fat or skim milk.

3 Serve potato without fat, which means swap hot chips and fries to mashed, boiled or homemade chips without using fat.

4 Buy the leanest meat you can afford and trim off all visible fat.

5 Use low-fat cooking techniques (see for more information about low-fat cooking techniques).

6 Swap high-fat cereal-based foods and snacks, such as the ones that come in multi-bags, biscuits, cakes, pastries and crisps to lower fat choices, such as raisin bread, low-fat yoghurt, fresh fruit, air-popped popcorn or packaged snacks containing fewer than 400 kilojoules per serve.

7 Limit ‘extras’ to an agreed number per week and when that limit is reached, there are no more until next week.

8 When first offering vegetables to your children, start with ones that are not bitter. Try beans, beetroot, carrots, corn, eggplant, lettuce, onion, peas, pumpkin, sweet potato, spinach and tomato.

9 Mask the bitter taste of broccoli and cauliflower with a low-fat cheese sauce. Stir 1 heaped teaspoon of cornflour into ½ cup skim milk. Place in a small saucepan over low heat and when almost to the boil stir in an extra-light processed cheese slice and stir briskly until it thickens.

10 Neutralise the taste of bitter vegetables with other ingredients. Black pepper contains ‘piperine’, a food chemical that neutralises pungent flavours, so try a twist of freshly ground black pepper on vegetables known to be bitter.

11 Camouflage vegetables by hiding them in casseroles, stews or grating them into rissoles, meatballs and patties.

12 Cut down the ‘stewed’ smell by cooking vegetables for as short a time as possible. Use a microwave or a large saucepan with the water boiling well before you drop them into it to cook. This will reduce the release of sulphur gas, which is responsible for that unpleasant smell.

13 Cook vegetables using a range of herbs and spices. Add them to a stir-fry with onion, garlic and ginger or make a dressing of olive oil, balsamic vinegar and black pepper to pour over them after cooking.

14 Never give up! Offer little tastes on a regular basis. Praise all efforts to try them.

Parents can help their children lose weight, but it helps if you know the facts and fallacies about overweight children so you know what impact you can have.

I can't do anything about my child being overweight because it is determined by genes.

About 40 to 50 per cent of your child‘s risk of becoming overweight is set by the genes they inherit from their parents. But this is just the risk factor – your actions can override this. There are a number of genes that make it easier to gain weight – if your child has inherited a few of these genes, it means he or she is more prone to weight gain, especially if they live an unhealthy lifestyle. Therefore, it is more important for you to set in place a healthy lifestyle, offer healthy food and encourage physical activity than it is for others.

Overweight children become overweight teenagers and then overweight adults. There is a greater risk if one or both parents are overweight or obese. The good news is that children are more likely to successfully maintain weight loss than their parent, if given the chance of getting to a healthy weight, so your actions to help your child now have a good chance of sticking.

Excess weight in childhood is associated with problems. The most harmful are those of discrimination, bias and stigmatisation. Even when unintentional, it occurs due to treatment by other children as well as by adults, and children find this harder to deal with than adults. Young people who are overweight or obese during their later teenage years are less likely to be successful in employment, in getting promotions and in finding a partner, compared to those of a healthy weight. The older an overweight child becomes, the more likely they are to suffer the adverse health consequences associated with excess weight, such as disease. By developing good habits in your child now, you can help your child escape the overweight cycle.

If I restrict what my child eats and drinks they will develop an eating disorder.

The aim is not to provide a restrictive environment for your child but a positive one where there is lots of good, healthy food available for them to eat when they are hungry. Don’t make it hard for your child by stocking junk food that you don’t allow them to eat. Switch the whole family over to a pattern of healthy eating and you will all enjoy the benefits of good health.

Children who are overweight tend to have accelerated growth and changing their food habits and moderating the foods they are offered does not usually restrict their height growth, but will slow down their rate of weight gain. Monitoring their height and weight on the growth charts roughly every 3 to 6 months will let you monitor their overall growth. See for more information about tracking your child‘s growth.

Children do not need to be put on kilojoule-controlled diets. Follow the tips in this book to change the family food habits and they will grow into their weight over time. The exception may be a very overweight child or teenager and in this situation seek more advice from your GP and an Accredited Practising Dietitian (APD).