Preparing Healthy Food For Kids

Interviewed by Melissa Moniz
Wednesday - September 03, 2008
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Dr. Cristeta Ancog
Pediatrician, Kaiser Permanente Hawaii

How long have been practicing?

19 years.

What do you see as the most concerning issues with children right now?

Obesity is probably No. 1. Kids are just getting more and more overweight, and we’re seeing a lot of complications with the overweight that we never used to see before.

Why do you think childhood obesity is such a big problem and why should parents be concerned?

We know that the kids who are overweight tend to grow up to be overweight. We’re also seeing a lot more kids with diabetes, which is due to being over-weight. When I was in my residency I was never trained to deal with Type 2 diabetes (which used to be called adult onset diabetes), which is the kind of diabetes that you see when you’re overweight. Now that’s the main type that we’re seeing with kids who are overweight. Pediatricians have had to learn how to take care of these diseases that only used to be seen in adults. We’re also seeing high blood pressure problems and hip problems, which are all from being overweight. It’s a very big issue health wise.

What factors are attributing to the rise in childhood obesity?

Fast food. People are busy. People don’t cook as much, so there’s a lot more eating out. And we know when people eat out the portions are bigger so they tend to overeat and it’s usually higher in fat. The second issue is that kids are not getting as much exercise. They are glued to the TV and Game Boy, and there’s not as much physical education in school anymore. And things are just not as safe as it used to be. When we were growing up we would be playing outside on the streets, but people don’t feel they can let their kids out to roam and play in the neighborhood anymore.

Medical assistant Tylette Hun, Dr. Cristeta Ancog, registered dietician Justin Miyashiro and behavioral medicine specialist Alisa Au
Medical assistant Tylette Hun, Dr. Cristeta Ancog, registered dietician Justin Miyashiro and behavioral medicine specialist Alisa Au talks to a teen about healthy food choices, exercise and emotions impacting healthy living

What tips can you give parents to help keep their child’s weight at a healthy level?

We try to teach the parents to feed their children healthy food when the kids are young. We also try to teach parents not use food as a reward. So when babies are crying, parents shouldn’t just give them a bottle to soothe them because they may grow up into adults who eat when under stress. We also advise parents not to push children to finish eating everything on their plate because that leads to overeating. And then we also try to keep the children active. Go do fun things with the family, such as playing, walking, going to the beach. As the children get older we try to teach portion sizes, limiting fat content and especially limiting juice. Everyone feels juice is really healthy, but it’s not - it’s just sugar water.

Do you see the problem is more the quality or the quantity of food?

It’s definitely a combination.

Can you discuss nurture versus nature a little bit, and how much of childhood obesity is genetic and how much is lifestyle?

We know that genetics plays a huge part in it. So if you have a parent who is obese, you have a 50 percent chance of being obese yourself. If you’ve got diabetes in your family, that also increases your risk. But we’re also finding kids who don’t have diabetes in their family who are developing diabetes because they are overweight. Sometimes it’s hard to tell if the parents are overweight because they have unhealthy lifestyles, which would make it not so much a genetic thing. The studies truly have shown that genetics play a large part, but you can’t just say I’ll be overweight because that’s what my genes are. You still have control over what you eat and how much exercise you get and can do things to keep yourself healthy. You can be the 50 percent that doesn’t become obese.

Can you talk about what is being done to help with childhood obesity?

The state and Hawaii Academy of Pediatrics have come out with an obesity tool kit for the providers in the state to use. It’s a guide so that everyone is giving the same message, and Kaiser has incorporated that into our program as well. We wanted to be consistent with everyone and have the same message. At Kaiser we make sure we’re systematically identifying all of these kids, so we’re measuring them from age 2. We’re also working on a program where we will refer all overweight and obese children to a dietician to work with them. We work in an integrated system where dieticians are part of our team and a visit to them is a covered benefit.

What’s the percentage of overweight children in Hawaii?

Hawaii has a 30 percent rate of overweight and obese children.

Should parents force their children to eat healthy foods they don’t like?

We know that sometimes you have to feed a child something 15-20 times before they like it. So keep giving it to them. Encourage them to keep trying. Try to have fruits and vegetables with every meal. And if parents eat it, the kids will tend to eat it.

And the rule that we tend to stick to is that it’s the parents job to provide healthy food on the table and it’s the child’s job to decide what to eat and how much to eat. But you can require them to do what I call a ‘no thank you bite,’ where they have to take a bite and actually swallow it. If they don’t like it, they don’t have to eat the rest of it. If they come back hungry an hour later you can reheat dinner leftovers, but not a snack.


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