The new American Academy of Pediatrics guidelines for childhood obesity have shifted from a “watchful waiting” method to “early and aggressive treatment.” Coverage of the guidelines in the Washington Post, the New York Times, and other reputable news outlets have readily accepted this new depiction of childhood obesity as a disorder in need of immediate, aggressive intervention and has given little or no attention to what has been proven to help keep kids healthy — a nutritious diet and healthy lifestyle habits.
There is a middle road between the American Academy of Pediatrics’ old-fashioned hands-off attitude and today’s rush to treat with surgery and drugs. The approach that has been shown to reduce overweight and obesity and resolve Type 2 diabetes is diet. Of course, preventing obesity in young people is key, and diet also plays a crucial role here.
According to a study in the American Journal of Clinical Nutrition, a diet rich in vegetables, fruits, legumes, and whole grains improves childhood obesity. This epidemic increases the risk of type 2 diabetes and heart disease. Decades of research show that this type of healthful, plant-based eating can help prevent, improve, and even reverse type 2 diabetes. The American Diabetes Association even endorses a plant-based diet.
A low-fat, plant-based diet also lowers the risk of heart disease in obese children by improving their weight, blood pressure, and cholesterol levels, according to a Cleveland Clinic Study. That’s critical as obese children show evidence of significant heart disease beginning at age 8. And half of U.S. children and adolescents do not have ideal cholesterol levels, with 25 percent in the clinically high range.
Studies and research aside, I have seen firsthand in my pediatric practice the difference diet and lifestyle modifications that can make for children who are concerned about being overweight.
Some key tips I share with parents so that their children learn to eat well are:
Teach children the value of good nutrition. Parents, guardians, and teachers can work with children to understand that food is a fuel for health and fitness rather than a comfort, friend, enemy, or boredom reliever.
Have healthful foods readily available for snacking. For example, hummus and crackers, whole grain bagels and peanut butter, granola with strawberries and non-dairy yogurt, or a fresh and frozen fruit smoothie. Limit the quantities and availability of highly processed foods and sugary beverages.
Help children learn to listen to natural hunger and fullness cues rather than focusing on “cleaning plates.” Help children learn to pay attention to natural internal signals to keep from overeating. If a child does not want to finish his or her meal now, the plate can be wrapped and saved for later.
Engage children in the food preparation process. Gardening, picking berries, apples, or other produce at farms, grocery shopping trips, or visiting the local farmers market can spark an interest in healthful foods. Also, invite children to participate in menu planning as well as cooking.
Children continue to grow and develop into their early 20s, so they can’t afford to shortchange nutrients. For this reason, I do not typically restrict my patients’ calorie intake. However, switching out empty-calorie foods like highly processed snacks with healthful options ensures growing kids get everything they need.
In their coverage of these new childhood obesity guidelines, some reporters have rightfully pointed out that there is unequal access to the types of healthful foods that I describe. Right now, we have an opportunity to address this disparity. Our federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recently announced proposed changes to the WIC food allotments, significantly increasing the amount and variety of vegetables and fruits and expanding whole grain options.
If history is any judge, these changes will improve the health of those who use WIC benefits. A 2017 study in the American Journal of Preventive Medicine looked at what happened when WIC was revised in 2009 to include foods such as whole-grain breads and cereals and fruits and vegetables. There were significant decreases in purchases of calories, sodium, and total fat and increases in purchases of fruits and vegetables with no added sugar, fats, or salt. Childhood obesity also declined for WIC participants after these changes were made, according to a study in JAMA Pediatrics.
While diet is not a panacea, the mention of prevention and dietary interventions that work to help resolve childhood obesity should be a part of any reporting on this important topic.
Paul Porras is a pediatrician.
