Childhood Obesity

The examination of lifestyle on health has long been examined.  Healthful diet and physical activity have been shown to decrease risk of all cause mortality.  Even among those aged 70-90, the use of a Mediterranean diet and healthful lifestyle has been show to have a 50% decrease in the rate of all causes and cause specific mortality.  Diet and physical activity affect health at all stages of life.  This crisis is now more pronounced due to the affects of poor diet and lack of physical activity that characterizes much of our youth.  According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the last 30 years.  Overweight and obesity is a definition that receives much criticism.  Advising a parent on the status of their child’s weight is a difficult situation for many providers.  Labeling a child may result in a real or perceived stigma associated with such a diagnosis. 

So what is the intervention?  I would make the same recommendation to the parent’s of an overweight/obese child that I would make to a parent seeking health information for long term disease prevention.

1)      Parent/Adult is responsible for what meals/snacks will be available as options

2)      Child is responsible for making food choices and activity choices based on the options made available.

3)      Parent is responsible for role modeling positive health behaviors such as healthful diet and physical activity.

In its simplest form unintentional weight gain is a result of an energy imbalance.  Not all calories are created equal but at the core of weight management - overall calories is a major focus.  High sugar, high salt, high fat foods result in larger food portions as well as more calorie intake.  Energy balance is attained by reducing calories consumed in the form of food/drink as well as increasing calories utilized thru increased physical activity. 

If this sounds like work and a troublesome endeavor, then you are right.  Healthful changes do take work.  They require time, planning and commitment.  Most children are not concerned with the long term health risks of poor diet and inadequate physical activity.  Issues such as diabetes, high blood pressure and/or other chronic illnesses are not a part of the young child or adolescent’s sense of mortality.  Energy levels, the fit of clothes, keeping up with their peers have a further reaching impact.  Children and adolescents will often clearly indicate when they are ready to open the discussion of developing their own specific plan for addressing desired weight loss.  Motivation for change on the part of the child and/or adolescent may take longer than what might be desired on the part of the health care provider.  The adults – as the individuals responsible for food purchasing, food preparation – have a larger responsibility when it comes to the day to day interventions that promote healthful lifestyle changes.  A helpful site on how to role model healthful lifestyle choices can be found at www.myplate.gov under their 10 tips series. 

The Vanity Size

My ability to still fit into traditionally small sizes has been misleading.  And when I find a pair of pants that rates me a desirable size, I stock up on the size which I call the Vanity Size.  So this weekend as I got into a small wet suite for a rafting trip I was not prepared for how my less than slim self was going to look on photographs.  This was not a pretty event.  Increased social activities, dealing with a tragic loss to our family, financial uncertainty, work demands, desire for higher education, the less than ideal gym schedule (a trade off for the sweet price) that occurs during school breaks have all resulted in barriers to meeting my health focused goals.  Addressing obstacles is now more important than focusing on knowledge.  I had to spend a little time today focused on addressing those obstacles.

Obstacles:
1)  Gym not open in the morning (my preferred workout time).
2)  Social activities mean more opportunities to snack on unhealthful foods.
3)  Housework poses a huge distraction when working out at home.

How to address the obstacles includes cognitive restructuring.  While the gym hours are not convenient, this is definitely a short term issue as after the holiday weekend- normal hours will resume.  In the meantime, I do have a treadmill and exercise bike trainer at home that I can utilize.  So while dinner is cooking, I can exercise and watch some TV.  Music would make the workout a higher intensity but with my current lack of motivation, the focus is on the quantity (time and frequency) of my workouts and not on the quality (intensity/pace).  I also set up an exercise date with a friend which is a great way to keep me on track.

I just resisted an ice cream snack at lunch time despite its accessibility and the soaring temperatures outside.  I did that not as a form of self denial but because, having looked at my week in advance I knew that I would have some special treats during an upcoming social activity. 

The final obstacle is a great "food stopper".  A food stopper is an activity that can be used to distract us from grazing/snacking or other eating patterns that do not serve as a response to hunger and our body's nutritional needs.  On evenings that I am more productive a home, I graze less since boredom is one of my identified food triggers.

I might have to look at the picture of myself in a wet suit off and on throughout this process but it is a true reminder that sizes on labels aren't necessarily a good indicator of the physical changes our bodies undergo.

Progress- NOT PERFECTION

So the weekend was filled with various celebrations which included three birthdays, Mothers' Day, time out of town and less physical activity.  While the cake decorating was a success, the time involved with preparing for each of the activities and the more than six hours spend driving meant that I didn't focus on my healthful eating and activity priorities.  But there was progress.  Progress - NOT PERFECTION. 

Focusing on perfection can often be a set back as it doesn't allow for an acceptable level of flexibility.  I didn't go to the gym but I did walk the dog four miles.  I didn't eat my packed lunch (I am SOOOOOOOO tired of chicken enchiladas) but I did exercise portion control as I enjoyed a meal with a friend.  We are often not alone in the types of changes we may want to accomplish.  Find others to check in with on a routine basis.  Or find others to work with towards healthful changes.  This strategy is not only a form of a support system it is a system of accountability.  I have enlisted several friends to whom I can be accountable.  Some are colleagues whom I see regularly at work, others are friends with whom I socialize – this means less gaps.  For home, I am focusing on changing my routine.  No more eating in front of the TV.  Each of my meals is to be enjoyed mindfully while sitting at my dining room table.

New Rules:

1)      Focus on Progress NOT PERFECTION

2)      Become Accountable

3)      Eat mindfully

Tour of the Gila

This weekend's 5 mile hike ended up being a bit more of an adventure than previously planned.  I got a group together to hike Signal Peak in Pinos Altos and while the trails were open as usual, the road to the trail was closed to motorized vehicles so the walk to the trail head (reportedly 4 miles) ended up being over 6 miles one way.  Thank goodness for packed lunches and lots of water.  It was an absolutely beautiful day to be out hiking and a great example of persevering for better wellbeing.  Dealing with barriers to change is a reality when making healthful lifestyle choices.

Barriers:
Time (2 hrs drive time each way)
Weather (the May heat of the southwest)
Road Block (literally a road block not allowing cars to pass to the trail head due to the Tour of the Gila bike races)

With each barrier it would have been easy to throw in the towel and perhaps decide to go visit local businesses and have a nice lunch rather than put in the extra footwork.  Trust me, while the first six miles were great- I definitely felt the effects of the last few miles.  While some individuals even made it a round trip of 15 miles, everyone got a great day in the beautiful outdoors.  Dealing with barriers comes down to problem solving.  Be realistic about your barriers and once you've thought of all the reasons it won't work- think of at least one strategy to make it work.  Is there a time of day that works best for you?  You may find less distractions and more success by getting your activity into your routine earlier in the day.  Doing several shorter activity sessions may be another strategy.  Time is probably the most common barrier reported but it's really about determining our priorities.  How much time do you spend sedentary doing things such as watching television, sitting in front of the computer or other sedentary tasks?  Maybe it's time to stop planning and start doing.

I am happy to report 1.2 pounds additional weight loss and tomorrow will be another weight in day.

Fairly Good Start

I have gotten my burst of motivation in the form of really planning some meals that I enjoy.  Being reasonable with my meals helped me save money while I was out of town this weekend.  There is a misconception that eating in a healthful manner costs more money.  But here is my experience.

1) Eating healthy actually saves money
2) Taking time to be physically active saves money
3) Eating for enjoyment helps meal time be more fun

Eating Healthy Actually Saves Money
This works in more than one way and can include saving money thru purchasing less food overall, going with lower cost unprocessed food options, eating foods within their natural season.  I have spent $10-20 on a cart full of fresh fruits and vegetables every 2-3 weeks.  I have the advantage of having a dehydrator that I pilfered from my mother’s stash of handy kitchen gadgets which helped me with managing the 10 pounds of onions I purchased for less than a dollar.  Even counting the fruits and vegetable that ended up feeding the animals and compost, that's still a pretty great deal.  I could have avoided discarding any fruits and vegetable by investing in a deep freeze or caning items but I haven't gotten organized enough to get shelf stable systems in place in my household.  I have also saved money by making my own Greek style yogurt (<30 cents per serving versus $1.20 per serving) and by making homemade bread.  Take a look at your purchases to decide which items would save you the most money and how you can make those healthier options.

Taking Time to be Physically Active Saves Money
Physical activity can be a great distraction.  Rather than giving in to eating out for dinner (which wasn't in line with my eating or budget plans) I went swimming after work.  I can also use physical activity as a low cost entertainment.  Many might find that they pay a monthly membership to a gym that they do not utilize.  I have a low cost annual membership that averages less than $20 per month.  If I only go to the pool THREE times then I've already come out ahead on my budget but the cost is low enough that I can still enjoy going hiking or riding my bicycle as my activity.  For some, a pay as you go option is more practical but for others, the act of paying for membership encourages them to be active and get their money's worth.  When I'm getting a craving that isn't a result of hunger, going for a walk not only benefits my weight but it gets my dog outside for some fun and it helps me avoid the distractions (such as shopping) that cost money.

Eating for Enjoyment
Today I enjoyed homemade tuna salad chock full of radishes, cucumber, tarragon and light mayo added for creaminess.  I find "diet" concepts to be a bit boring when they have a repetitive plan.  I like the options, yes they require more decision making but for me it makes it fun to have a plan with a lot of variety.  The greatest lesson I obtained from mindful eating exercises was that taking my time to eat with all of my senses (smell, sight, touch, taste.....) makes a meal more enjoyable.  If I don't want my senses involved then it's probably not a meal that I'm enjoying.  I had a win today with getting my diet drink and water rather than eating while I was socializing today.  I'm not usually a fan of carbonated beverages but that they had Dt. Dr. Pepper as an option rather than other diet drinks, it did make me feel a bit more included in the meal and it didn't throw my plan off balance.  Socializing isn't a free for all and should be planned into your calorie allowance.

So tonight, in order to make up for sleeping in today it will be running on the treadmill as part of my half marathon training followed by a swim because the swim is just what the dietitian ordered on a hot day.  So I can add more weight loss to the half pound lost in the last few days.  If you're not impressed then you may not understand healthful weight loss.