Program Promotes Healthy Habits In Kids
By COSHANDRA DILLARD
Rosa Trejo, 3, and Juan Trejo, 4, are at healthy weights and pediatricians at St. Paul Children's Medical Clinic want to make sure they stay that way. At the very least, they want to give them, and their parents, the tools to learn healthy behaviors.
Since the children have been seen at the clinic, their parents are heeding the advice of doctors. Physicians practice 5-2-1-0 as outlined by the American Academy of Pediatrics. It emphasizes five servings of fruits and vegetables; two hours or less of screen time; one hour of physical activity; and zero sweetened beverages.
They recently also have begun a program, Ready. Set. StartSmart. The program provides parents with written nutrition and activity information to help stem the tide of obesity at home.
"I'm making better choices with food," said Juan Trejo, father of Rosa and Juan through a translator.
Their mother, Maria Pineda, acknowledged that the education has been helpful. She wants to address obesity now.
"Once they become heavy it's hard for them to do sports," she said, also through a translator. "I try to keep them active.
Childhood obesity, while it's been a relatively new conversation, has been realized by physicians for years. They've seen the steady increase in weight in children since 1980, as well as the chronic diseases that sometimes accompany it.
Dr. Valerie Smith, who has participated in the statewide program, Be Our Voice, estimates that 40 percent of school age Texas children are overweight or obese.
At St. Paul Children's Clinic, Dr. Smith sees numerous children who are overweight or obese -- about 60 percent of her patients.
These children are screened for diabetes, high cholesterol and blood pressure as well as for liver damage.
"It's a huge issue," she said. "I don't care about a number on a scale for kids as much as what it means for the child's health."
Rather than using body mass index to determine healthy weight, doctors go by a weight-for-growth chart, which examines which percent of the reference population the child would equal or exceed. An overweight child is in the 85th to 95th percent percentile and obese children are above the 98th percentile.
Children who are overweight or obese are at risk for type 2 diabetes, worsened asthma, orthopedic problems, depression and anxiety.
Tyler pediatrician Dr. Barbara Huggins established the Ready. Set. StartSmart a few years ago.
"She was concerned about childhood obesity before it was anyone's headline," Dr. Smith said.
Core messages, such as limiting sugary beverages, creating healthy connections between food and behavior, and allowing unstructured play, are targeted at children under 5. The program is also translated into Spanish.
"We know that for a long time that 70 percent of 3-year-olds who are overweight or obese will become overweight or obese adults ... These weight patterns really do track toward adulthood.
"There has been so much emphasis on changing adult behaviors and even in older children to reduce obesity. If we can start right behaviors, the right eating practices, then we've given our children a much better chance to grow up to be healthy adults."
Dr. Smith said the program works to change family dynamics and behavior, emphasizing sharing family meals. It also encourages neutral, positive attitudes toward healthy foods.
"So much of eating, so much of our diet is partly a social aspect," Dr. Smith said.
Dr. Smith said a message that must be reached to mothers, long before they give birth is the benefits of breastfeeding. Unstructured play outdoors is also critical.
"Getting kids outside is one of the best things you can do for their overall health," she said. "It's good for vitamin D because you're getting a little bit of sun exposure. It's good for their muscle development, their gross motor skill development. Unstructured play and time outside is really important to have that experience early on. Those kids are going to be more active as they get older."
Some old-school trains of thought may be hard to change, which is why recommendations are written, and the implications of unhealthy choices are explained. One of these old habits is the "clean plate" rule. Dr. Smith said people today have a habit of eating everything on their plate, regardless if they are full, simply because they were trained to do it as a child.
"We want to help keep that internal thermostat that tells us 'I'm full' fully calibrated in kids," she said. "That's not to say that you let a kid eat two bites at dinner because that's all they want to eat and then give them dessert afterward."
Much of a child's introduction to food comes from television commercials and other advertisements. As result, there is a lot of needless snacking.
"It's not something you use as a pastime because you're bored and it's not something you do because you have to," Dr. Smith said. "Those snacks should be viewed as mini-meals. It's not a bag of gold fish or a bag of chips. A snack includes a fruit or vegetable and some sort of protein, whether that's string cheese or yogurt, peanut butter on an apple. The protein is going to help fill them until their next meal."
Dr. Smith understands that social determinants can create an obstacle in the quest to practice healthy behaviors. She said it'll take the efforts of the entire community to overcome them.
"This is not an issue that can be fixed in these four walls," Dr. Smith said. "It really has to be a community committed to having safe, accessible places for children to play, having families have access to fresh fruits and vegetables and healthy foods.
She added, "All of those things have to be a priority from a government standpoint and a citizen standpoint. Sometimes (people) feel like they don't have a voice. They do have power in speaking up."
The clinic will survey parents six months, then 12 months after starting the program to track its effectiveness.
At a glance
• The Ready. Set. StartSmart program is an effort to reach children and parents to prevent obesity.
• About 60 percent of children seen at St. Paul Children's Clinic are overweight or obese.
• Changing how parents view food and creating positive attitudes toward healthy foods can prevent childhood obesity, doctors say.
• Unstructured outside play is encouraged in young children.
• Abandoning some old-school trains of thought, such as filling a bottle with cereal or introducing solid food too soon could have harmful effects on children's health.
• Doctors believe it is easier to promote healthy eating patterns and encourage activity in young children than to change behaviors as an adult.