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Childhood Overweight: Favorable Food Practices

Part 2: Following the Food Guide Pyramid

Volume 8, Number 1 - January, 2004

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, Janet M. Pollard, MPH, Extension Associate-Health, and Debra B. Reed, Ph.D., RD, LD, Associate Professor and Extension Nutrition Specialist

Download PDF version of this newsletter and 8 handouts

Inside HealthHints....

• Childhood Overweight: Favorable Food Practices
• Seven Principles to Guide Extension Programs Addressing Childhood Overweight
• What, When, and How Much
• The Food Guide Pyramid and Children
• Nutrients and Calories
• The Food Guide Pyramid and Your 2 to 6 year old
• Milk
• In the News...
• Weight Loss and Children
• The Food Guide Pyramid and Your 7 to 12 year old
• Keeping Your Diet Balanced?
• The Food Guide Pyramid and Your 13 to 18 year old
• Food Servings Based on Calorie Needs/Intake
• Understanding Serving Size
• "Super-sizing" Not a "Value"
• What Counts as One Serving?
• Visual Aids
• Making Sense of Multi-ingredient Foods
• Meal Planning
• Breakfast: Starting Your Child's Day Off Right
• Snack-time
• Fruit Juices, Soft Drinks, and Other Sweetened Beverages
• Overweight and My Child
• Resource Extra!
• References

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Childhood Overweight: Favorable Food Practices

Among the most promising ways to prevent childhood overweight are encouraging physical activity (see Part 1 of this series at http://fcs.tamu.edu/health/Health_Education_ Rural_Outreach/Health_Hints/2003/sept-oct/childhood_overweight.htm) and encouraging and modeling healthful eating habits. Teaching our children to eat healthfully is crucial in fostering a healthy weight and can produce lifelong health benefits. All youth can benefit from healthy food choices and regular physical activity.

To encourage healthful eating habits, parents and care providers need to have a good understanding of childrens' food needs and be a model of healthful eating. This issue of HealthHints is designed to guide parents and care providers in teaching their children healthful eating practices.

Seven Principles to Guide Extension Programs Addressing Childhood Overweight

As we move toward taking action in the area of overweight among children, our focus will continue along the following seven principles. These can be our guide in choosing interventions with the most likelihood for success. Our focus in the next issues of HealthHints will be on principles 3 through 7 as we guide clientele in fostering healthful eating practices among the children in their care.

1. Gradually increase physical activity through active play for children and adults.
2. Decrease sedentary activities including "screen time" (TV, computer, video, etc.) at home to 2 hours or less each day.
3. Improve diet quality by following the Food Guide Pyramid for serving size and number. Discourage "super-sizing" amounts.
4. Increase fruit and vegetable intake to amounts recommended by the Food Guide Pyramid.
5. Limit sweetened beverages including soft drinks, sports drinks, imitation fruit juices, sweetened teas, agua frescas, etc.
6. Increase family meals together to improve nutrition, communication, and family connections.
7. Encourage "engaged parenting," in which parents provide children with healthy food choices and opportunities for physical activity and act as role models for these behaviors.

What, When, and How Much: A guide for good eating

To assist parents and child care providers in guiding their children's eating, we need to help them consider what to eat, when to eat, and how much to eat.

When considering what to eat, we'll look at:

• Types of food needed
• Food selection and preparation
• Healthful eating at home, school, and when eating out.

When considering when to eat, we'll look at:

• Snacking
• Family meal-time traditions/connections.

When considering how much to eat, we'll look at:

• Serving size
• Number of servings
• Multi-ingredient foods.

Within each of these categories, we'll consider the age and growth of the child.

This issue of HealthHints will focus on what children need to eat and how much they need to eat based on the recommendations of the Food Guide Pyramid.

The Food Guide Pyramid and Children: Relating the Pyramid to children's food needs

A healthy diet consists mainly of plant foods such as grains, fruits and vegetables. Animal products such as dairy foods, poultry, fish, meat, and eggs add protein and other important nutrients. Fats and sugars add unneeded calories and few nutrients to the diet (Anding, 2001).

The Food Guide Pyramid is an outline of what to eat each day. The Pyramid is made up of six groups of food, emphasizing foods from the lower five groups (i.e., the lower three sections of the pyramid):

• Fats and Sweets
• Milk, Yogurt, and Cheese group
• Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts group
• Vegetable group
• Fruit group
• Bread, Cereal, Rice, and Pasta group,

The Food Guide Pyramid is not a rigid prescription, rather a general guide that lets you choose a healthful diet that's right for you and your family. The Pyramid calls for eating a variety of foods to get the nutrients you need and, at the same time, the right amount of calories to maintain a healthy weight. This looks different for adults and children of different ages. Too many people have a diet that is top heavy on the Food Guide Pyramid, which can result in a diet that has too many calories and not enough nutrients (see Nutrients and Calories box below).

Helping parents and child care providers understand the Food Guide Pyramid will require looking at all the different aspects of the Pyramid. The Pyramid gives guidance in what to feed our children as well as how much they should be eating. The numbers of servings and serving sizes needed by the body will vary with age.

The Food Guide Pyramid has been adapted to provide more specific guidelines for children ages 2 to 6 and 7 to 12 (see Food Guide Pyramid for Young Children Ages 2-6 and Food Guide Pyramid for Children Ages 7-12 handouts). These Pyramids help differentiate the number and size of servings needed to maintain a healthy weight while intaking appropriate nutrients for these age groups. Children ages 13 and up can transition to the adult dietary guidelines by following the guidelines set on the adult Food Guide Pyramid (see Food Guide Pyramid handout).

The Food Guide Pyramid and Your 2 to 6 year old: Guiding the young child

The Food Guide Pyramid for Young Children ages 2-6 (see handout) was designed to help you teach the child by illustrating foods commonly eaten by children, showing the foods in single-serving portions when possible, and giving the food groups shorter names (see below).

According to the Pyramid, children ages 2 to 6 need the following number of servings daily from each of the five major food groups:

• Grain group* -- 6 servings
• Vegetable group -- 3 servings
• Fruit group -- 2 servings
• Milk group** -- 2 servings
• Meat group*** -- 2 servings.

* Includes bread, cereal, rice, and pasta -- especially whole grain.
** Includes milk, yogurt, and cheese
*** Includes meat, poultry, fish, dry beans, eggs, and nuts.

While children ages 4 to 6 should eat a smaller number of servings than recommended for adults, they should generally eat the same serving sizes as recommended for adults (see What Counts as a Serving box). Children ages 2 to 3 should eat the same number of servings as 4 to 6 year olds, but smaller serving sizes, about 2/3 of the recommended serving size, EXCEPT for the Milk group; children ages 2 to 3 need 2 full servings from the Milk group for healthy growth and development (United States Department of Agriculture, 1999b).

So, what does 2/3 a serving look like? A good "rule of thumb" is to serve about 1 tablespoon of each food per year of age (American Medical Association, 1997). For example, if your child is 3 years old s/he would eat 3 tablespoons of peas, 3 tablespoons chicken cut into bite-sized pieces, 3 tablespoons of unsweetened applesauce, etc. Another way to help provide your children 2/3 a normal serving is to visualize the normal serving size and then cut it into thirds -- removing one third. For example, a three ounce serving of chicken is about the size as a deck of cards or a cassette tape -- visualize cutting off a third of the deck or cassette. Remember, however, that even 2 to 3 year olds need 2 full servings from the Milk group.

While too many calories from fats and sweets are not good at any age, the message of the Food Guide Pyramid for Young Children de-emphasizes fat restriction, recognizing that some fats are necessary for early growth and development. The Dietary Guidelines for Americans suggest that fat in preschoolers' diets be gradually reduced from 34% of total calories to "no more than 30% of total calories" recommended for most people by about 5 years of age (United States Department of Agriculture, 1999a). Thirty percent calories from fat can be achieved by choosing low-fat options of foods in each food group.

Remember, the Food Guide Pyramid (whatever your age) is a guide -- not a rigid prescription. A variety of foods and healthy balance is recommended at all ages for appropriate nutrition. Overcompensating by restricting food portions too much should be avoided. Over-restricting young children's food is actually linked to overeating and weight gain (Filipic, 2003).

The Food Guide Pyramid and Your 7 to 12 year old: Changing as they grow

As children grow, so do some of their food needs. The Food Guide Pyramid for Children Ages 7-12 (see handout) uses the same food group terminology as the adult Pyramid, but alters the number of servings to better fit the growing 7 to 12 year old, and emphasizes the need to recognize appropriate serving size.

According to the USDA guidelines, children ages 7 to 12 need the following number of servings daily from each of the five major food groups:

• Bread, Cereal, Rice, and Pasta group -- 9 servings
• Vegetable group -- 4 servings
• Fruit group -- 3 servings
• Milk, Yogurt, and Cheese group -- 3 servings
• Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts group -- 2 servings.

As with adults, fats and sweets should be used sparingly, and 7 to 12 year olds should choose low-fat options often to help with calorie balance.

The Food Guide Pyramid and Your 13 to 18 year old: Teaching your teenager

Once your child reaches the teen years s/he will use the following guidelines as recommended by USDA for this age group:

• Bread, Cereal, Rice, and Pasta group -- 9 to 11 servings
• Vegetable group -- 4 to 5 servings
• Fruit group -- 3 to 4 servings
• Milk, Yogurt, and Cheese group -- 3 servings
• Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts group -- 2 servings.

Fats and sweets should be used sparingly, and low-fat options should be chosen often to help with calorie balance.

Notice that here, the Food Guide Pyramid lists a range in the number of servings for each food group (you may also see this in the Food Guide Pyramid handout attached). This range is in place because not everyone needs the same number of calories to maintain a healthy weight. Everyone needs to eat foods from each of the five major food groups to make sure s/he gets a healthy balance of nutrients, however, people of different ages, genders, and physical activity levels have different calorie needs to maintain a healthy weight. For example, a sedentary (inactive) teen may use only 2,000 calories a day, while a teen actively involved in sports may need 2,200 to 2,800 calories a day (example adapted from Anding, 2001). Note: Males generally need more calories than females.

To help determine your children's food needs, you can use the chart below as a general guideline, then create your own Family Food Servings chart using the tool provided (see attached handout).

The number of servings needed daily from each of the Pyramid's food groups depends on individual calorie needs.

• Children ages 2 to 6 years need about 1,600 calories per day.
• Most children over age 6 and teen girls need about 2,200 calories per day.
• Teen boys need about 2,800 calories per day (United States Department of Agriculture, 2002).

Remember:
Weight = Energy Intake - Energy Output (Anding, 2001). Energy, or calories, is spent whenever you do physical activity. Maintaining a healthy weight depends not only on the foods we eat, but also on the amount of energy we expend in physical activity. For ideas on physical activity for your family members, see http://fcs.tamu.edu/health/Health_Education_Rural_ Outreach/Health_Hints/2003/sept-oct/childhood_overweight.htm.

Understanding Serving Size: How much to eat

Putting one helping of pasta with spaghetti sauce or mashed potatoes with gravy on the plate equals one serving doesn't it...as long as I don't go back for a second portion?

One of the biggest misconceptions when it comes to food intake is that a "serving" is whatever amount I choose to put on my plate or whatever amount is served to me at a restaurant, regardless of whether or not the chicken fried steak is hanging over the edges of the plate, or the pancakes are stacked 10-high. In our society of "sizing up" or "super-sizing" meals, it is not difficult to understand why we might be confused about what an appropriate serving size is for ourselves and our children.

To help eliminate some of the confusion, let's talk terminology for a moment. There are two commonly used terms -- portion and serving.

"A portion is the amount of food you choose to eat. There is no standard portion size (United States Department of Agriculture, 2003h)." Placing 2 cups of pasta and 1 cup of spaghetti sauce on your plate or 1 cup of mashed potatoes with 1/2 cup of gravy could be the portion you choose to eat. These portions, however, would not be the recommended serving sizes. In fact, one half cup cooked pasta equals one serving. If you consume 2 cups of pasta at one meal, you have already consumed 4 of your daily servings from the Grain group.

"A serving is a standard amount of food, like 1 cup or 1 ounce. It is used to help give advice about how much to eat, or to identify how many calories and nutrients are in a food (United States Department of Agriculture, 2003h)." For example, the Pyramid for individuals ages 7 and up recommends 2 to 3 servings from the Meat and Beans group totalling 5 to 7 ounces in a day. Thus, one serving might be a 3 ounce chicken breast (about the size of a deck of cards) at dinner paired with 1/2 cup cooked, dry beans in a burrito eaten at lunch and 2 tablespoons of peanut butter on toast at breakfast equals the daily recommendation for the Meat and Beans group.

So, the next big questions are...

• How do I know what one serving of a food is or what it looks like?
• Do I need to start measuring everything my children and I eat?
• What about multi-ingredient foods like lasagna, casseroles, etc.? How do these count?
• Where will I find the time to make and manage food in our home?
• Even if I figure this out, my kids will never eat their vegetables!

Let me ease your mind... You don't have to count every calorie or measure every serving of food you give to each family member. Once you have a general idea what a serving looks like -- it's easier to help your family eat right. We're also going to give you good ideas for managing your time and still feeding your family healthfully in this issue, as well as some ideas on how to overcome obstacles we encounter in feeding our children in the upcoming issue of HealthHints.

Visual Aids: Helps for visualizing recommended servings

Visualizing one piece of fruit or one slice of bread as a serving isn't difficult. When asked to visualize 1/2 cup, 3/4 cup, 1 cup, 1 or 2 tablespoons, or 1 to 7 ounces of a food, however, the task may seem more complex. One way to make this task easier is to compare the amount of food in an appropriate serving to a common item or increment that can be easily visualized.

The United States Department of Agriculture/Agricultural Research Service (USDA/ARS) Children's Nutrition Research Center has prepared an excellent pictorial resource entitled Visual Aids Make 'Portion Sense' available at http://www.kidsnutrition.org/consumer/archives/portioncues.htm or use the handout provided in this issue of HealthHints for these and other helpful ideas for visualizing recommended servings.

Another way to help visualize appropriate serving sizes for your family members is to measure them once or twice. Once you have measured 1/2 cup rice, pasta, or cooked cereal onto your child's plate or into his/her bowl, you will have a general idea about what the recommended serving looks like and be better able to serve the appropriate amount the next time you serve these items. You can also try measuring out 2 tablespoons of peanut butter onto toast. Try limiting fats and oils by placing 2 tablespoons of salad dressing in a saucer next to salad or other greens; have your child dip his/her fork filled with greens into the dressing or place the dressing on top a little at a time to see how much is really needed to provide flavor. Kids love dipping finger foods, so dipping raw vegetables in small amounts of low-fat dressing, peanut butter, or other favorite sauces can be a fun snack-time idea as well.

Making Sense of Multi-ingredient Foods: Putting mixed dishes in the Pyramid

Once we form an understanding of the Food Guide Pyramid and appropriate serving sizes of single-ingredient foods, another question arises...What about multi-ingredient foods?

Does your family eat pizza, lasagna, tacos, burritos, tuna casserole, chicken pot pie, beef stir fry, chicken fried rice? The list of foods we eat with more than one ingredient could go on and on. Many foods don't fit neatly into one Pyramid group; but, you can still choose the mixed dishes you like, whether from fast food, ethnic restaurants, or your own kitchen and eat based on the Pyramid. For example, cheese pizza counts as a full or partial serving in several Pyramid groups: Grains (the crust), Milk (the cheese), and Vegetables (the tomato sauce). In a bean burrito, the tortilla counts in the Grains group, while the beans fall in the Meat and Beans group. For chicken fried rice, the chicken and any egg used would count in the Meat and Beans group, the rice goes in the Grains group, and any added vegetables would fall in the Vegetable group.

Remember, it does not have to be hard or require counting every ingredient to exact measure. Just remember to keep servings moderate. A 6" by 6" square of lasagna is much more than one serving for an adult. A 3 to 4 inch square would be more appropriate. For your young child, 2/3 that amount would be appropriate -- if your child is still hungry s/he can have more or fill up on other side dishes, but there is no need to serve too large a portion. (Note: Portion control, self-service, and the roles of parent and child will be discussed in the upcoming issue of HealthHints).

As you consider the multi-ingredient foods you eat, you can use the handout, Mixed dishes -- How do they contribute to Pyramid food groups in the resource Where do your favorite foods fit? to discover how some of your favorite foods fit into Pyramid food groups. To link to this resource go to http://www.usda.gov/cnpp/Pubs/Brochures. This excellent resource can be used in its entirety or simply print the chart on page 4 for use as a handout or activity sheet for an upcoming program. Use the lines at the bottom of the chart to "guesstimate" how some other food selections fit.

Note: County Extension agents -- This "guesstimating" idea could be a good activity to use with participants at your next related program to give them a feel for how to fit multi-ingredient foods into the Pyramid. You can also provide the sheet of recipe cards located in the handouts at the end of this issue of HealthHints. These cards can be used for their personal collection of recipes at home or as an activity during your program to "guesstimate" where foods from participants' favorite recipes fit.

Meal Planning: Mapping out meals for your family

A good way to help your family eat healthfully (and save money) is to plan ahead for meals. A little advance preparation can help you prevent those runs for non-nutritious fast food or keep your kids from filling up on nutrient-empty snacks before dinner is prepared. Meal planning and preparation can also be a time to involve your children. Children involved in meal selection and preparation are more likely to eat what they select and prepare (Center on Hunger, Poverty, and Nutrition Policy, 2003) (See more on involving your children in meal planning and preparation in the next issue of HealthHints).

Here are some meal planning tips that may help:

• Make a list of the meals for which you'll need to buy food (e.g., breakfast, lunch, dinner, snacks). Plan the week showing when you need to prepare each meal and when that meal is provided elsewhere (e.g., school, ballgame, eating out at friend's house, etc.).
• Decide what foods to serve at each of these meals. Include all items -- main entree and side dishes.
• Write down what you've decided to serve at each meal. You can also write down the ingredients needed for mixed dishes. You can use this to help make your shopping list (Adapted from Center on Hunger, Poverty, and Nutrition Policy, 2003).

Next, make a shopping list. Here are some tips to help you shop smart, select healthy foods, and save time, money, and energy:

• Use the "Healthy Shopping Checklist" (see attached handout) or create your own, then stick to it.
• Group foods on your list to match your store's layout. This will help you shop faster, more efficiently, and make it easier to remember everything.
• Shop after you've eaten. Most people tend to buy more when they are hungry.
• Leave children with a friend, relative, or sitter if needed. Try swapping childcare with another parent. Stores often place foods that children like (e.g., candy, foods with prizes, non-nutritious snack foods, etc.) where they can see and reach for them.
• Shop when you have the most time to read labels and compare prices. The following resource is an excellent tool for learning how to read and understand food labels: http://www.cfsan.fda.gov/~dms/foodlab.html.
• Try to shop just once a week. It is easier to shop smarter if you shop less often (adapted from United Stated Department of Agriculture, 2003c).
• Buy some partly prepared foods to save time later. Consider grated cheese, cut up chicken, and mixed salad greens for time-savers. Note: These foods often cost more, so you may want to compare prices.
• When making your selections, remember to include a variety of foods to get needed nutrients. Go easy on foods from the "tip" of the Pyramid -- sweets, fats, and oils. Choose smaller amounts of more costly foods. Beans cost less than other foods from the Meat group. Grains, cereals, breads, pasta, and rice tend to cost less than other foods. Your family needs the most servings from the Grain group each day.
• Stock your kitchen with a few staple items that you can make and serve in a hurry, such as:
  • Canned and dried fruit
  • Canned or frozen vegetables and beans
  • Canned meat, poultry, and fish
  • Canned soups or stews
  • Whole grain bread(s)
  • Pasta
  • Rice
  • Cheese*
  • Yogurt*
  • Crackers*
  • Cereal*
  • Frozen meals.
    *low-fat
    (Adapted from United States Department of Agriculture, 2003c, United States Department of Agriculture, 2003d).

Finally, plan ahead for meal preparation. Here are some ideas to help keep meals healthy while managing your time wisely:

• Plan to prepare one entree or side dish from scratch and use convenience or pre-prepared foods for the other parts of the meal. For example, if you make the main entree from scratch, consider canned fruit, frozen vegetables, or quick bake or ready- made whole-grain breads for side dishes. If you prepare a vegetable side dish from scratch, consider using pre-prepared items for the main entree, such as a pasta medley adding canned chicken if desired.
• Do some tasks ahead so dinner time preparation is made easier. A few hours or the day before a meal, wash and trim vegetables or make a fruit salad. Cook noodles for pasta salad or other pasta dishes. Cook lean ground meat for tacos or stuffed bell peppers.
• Pre-prepare foods of your own. Cook in advance on weekends or days off work and freeze these foods. Good food ideas for freezing include soups, stews, and casseroles.
• Double or triple the amount you make. If you make large amounts, they can be used for more than one meal. For example, you can make enough spaghetti sauce or chili to top pasta or rice today and use it to top a potato tomorrow. Organize/package the foods in meal-sized amounts to make it easy to freeze, heat, and eat.
• Make no-cook meals. No-cook meal ideas include salads with canned tuna, chicken, or beans; cold sandwiches; raw vegetables with yogurt dip. Note: Most kids love finger foods.
• Cook once for everyone. If you know your child likes plain vegetables, meat, rice, or noodles, just set some aside before adding the remainder of ingredients. This will keep you from taking time to make separate items and will provide your child with items s/he likes to eat.
• Cook a fast way. The fastest ways to cook include broiling, stir frying, or microwaving. Baking and roasting take longer, but can be done the day/night before.
• Use "quick-to-fix" meals occasionally. Try these suggestions:
  • Add canned or frozen vegetables to tomato or chicken soup;
  • Mix chopped lean ham or deli meat and cooked vegetables into macaroni and cheese;
  • Serve homemade or canned chili over a baked potato or rice.
  • Add your own "quick-to-fix" ideas to this list.
• To make breakfast a priority and keep breakfast healthy during the "early morning rush," lay out non-perishable foods the night before.
• Don't eliminate fruits and vegetables from the diet because you don't have fresh produce. Stock and use canned or frozen fruits and vegetables when you need to save time (Adapted from Reed, 1998; United States Department of Agriculture, 2003d).

Snack-time: Help your children snack smart

Children like to snack. In fact, most young children need to snack. Young children have a high need for calories to support their active play and growth relative to the small size of their stomachs; thus they need to eat more often (Robinson, 2002a). But...most of us need to re-think how we look at snacks. We need to think of snacks as a mini-meal that help provide nutrients and food energy our children need to grow play, and learn. Most children do best when they eat four to six times a day.

Here are some tips you can use to help your children snack smart:

• Keep food group snacks handy. Stock cut raw vegetables, fruit, 100% juice, peanut butter, hard-cooked eggs, low-fat milk, cheese, and yogurt. Keep fruits and vegetables in clear storage containers at eye level in your refrigerator or in a bowl on the kitchen table where they can be easily seen. You might also try clear containers for other snacks, such as crackers, dry cereal, or raisins in your pantry (note: raisins can be a choking hazard for very young children).
• Go easy on snacks with added sugars. Offer water, low-fat milk, or 100% juice. Soft drinks and other juices can crowd out vitamin- and nutrient-rich foods your child needs to grow and stay healthy (see Fruit Juice, Soft Drinks, and Other Sweetened Beverages in this issue for more information).
• Avoid strictly prohibiting certain foods. A little candy is okay once-in-awhile. Just make food group foods the usual snacks. Overly restricting foods can actually encourage tendencies toward overeating and overweight (American Medical Association, 2000).
• Use snacks to fill in nutritional gaps. If your child missed having his/her 100% juice at breakfast, offer juice or fruit at snack time.
• Keep snacks small. If your child is still hungry, s/he can ask for more. Let your child decide what's enough within reason. (Note: We will talk more about children controlling their servings in the next issue of HealthHints).
• Time snacks carefully. Have snacks two hours before meals. This will help your child be able to eat well at each meal without being filled up on snack-time foods.
• Only offer snacks to satisfy hunger. Try to skip the urge to offer snacks to quiet tears, calm a child, or reward behavior. This can lead to emotional overeating later on. Try other means to deal with emotions. If you need a reward, try stickers, pencils, special time together, hugs, etc. Note: Sometimes children will say they are hungry when they really are thirsty, want attention, or just need something to keep them busy (they're "bored"). Offer a glass of water, take a little time with your child, or provide a fun activity. Your child will let you know if s/he is really hungry.
• Snack wisely yourself. It is up to parents and care providers to act as role models. Do you snack when you're stressed or bored -- or just when you're hungry? What foods do you typically snack on -- are they food group foods or "tip" of the Pyramid choices? Remember, your children learn from watching you (adapted from United States Department of Agriculture, 2003g) .

For some Fun Snacks Ideas, see the attached handout.

Fruit Juices, Soft Drinks, and Other Sweetened Beverages

When choosing beverages for your children, choose water most of the time. Soft drink consumption among children has been linked to overweight (American Medical Association, 2003). The United States Department of Agriculture suggests a maximum of 6 tablespoons of sugar per day for someone consuming 1,600 calories (an amount typical for a 5-year-old). One 12-ounce soft drink contains about 3 tablespoons of sugar -- half the day's recommended amount (Nemours Foundation, 2003).

Additionally, a recent study finds that overweight children consume 65% more juices than their thinner peers (Bouchez, 2003). When providing juice, give only 100% juice and limit consumption to 4 to 6 ounces a day for 2 to 6 year olds and 8 to 12 ounces a day for 7 to 18 year olds (North Carolina Healthy Weight Initiative, 2003). Also, choose to offer juice at mealtimes, rather than snack time. When juice is extracted from the whole fruit (or vegetable) it reduces the fiber content and releases a type of sugar from the fruit (or vegetable) that can damage teeth, especially if given frequently (Food Standards Agency, 2003a). Thus, keeping juices to mealtime can lower chances for tooth decay (see http://fcs.tamu.edu/health/Health_Education_Rural_ Outreach/Health_Hints/2003/august/childhood_dental_health.htm for more on Early Childhood Dental Health).

Offer low-fat milk (1-2%) or preferably water between meals to family members above age two.

Overweight and My Child: The parent/provider dilemma

If you suspect your child is overweight or at risk for becoming overweight, seek help. Talk with your child's doctor or get a referral to see a registered dietician. Weight loss dieting is not a healthy approach for the growing child. Withholding food can result in negative outcomes for the child, including:

• not getting enough food energy and
• nutrients to grow properly, learn, and play
• learning to sneak food when the parent or provider is not watching
• feeling bad about him- or herself -- resulting in anger, stress, or overeating
• not learning to control how much s/he eats if someone else is always making the decisions about what's enough or pushing the child to eat less (United States Department of Agriculture, 2003b).

Just remember, all members of the family can benefit from healthy food choices and regular physical activity; so, involve all family members being cautious not to single out those who are overweight.

In this issue of HealthHints we have looked at what children need to eat, how big an appropriate serving is, and how many servings are recommended for children at differing ages and stages of growth. In the next issue of HealthHints we will explore ways to help your child eat well for his/her health and how you can facilitate this behavior as a family.

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References

• American Academy of Pediatrics (2000). What about a formal weight-loss program? [on-line]. Available: http://medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/
  ZZZB92U8W7C.html&soc=AAP&srch_typ=NAV_SERCH.
• American Medical Association (2002). Breastfed infants at lower risk of being overweight during older childhood and adolescence, but not necessarily during early childhood [on-line]. Available: http://medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_
  ContentItem/ZZZSOKPNQMC.html&soc=AMA&srch_typ=NAV_SERCH.
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• American Medical Association (2000). Special nutritional concerns: children age 6 to 12 [on-line]. Available: http://medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/
  ZZZAFLLNK9C.html&soc=AMA&srch_typ=NAV_SERCH.
• American Medical Association (2003). Television watching and soft drinks may contribute to adolescent obesity [on-line]. Available: http://medem.com/search/article_display.cfm?path=\\ TANQUERAY\M_ContentItem&mstr=/M_ContentItem/
  ZZZCUKMEEKD.html&soc=AMA&srch_typ= NAV_SERCH.
• Anding, J., Jouridine, L., Tietyen, J. (2001). Teen nutrition: it's up to you (leader lesson) [on-line]. Available: (Agents Only) http://health4u.tamu.edu/AGENTS/food_and_nutrition/fn_leaderlessons.htm.
• Berman, C & Fromer, J. Meals without Squeals: Child Care Feeding Guide and Cookbook, Bull Publishing, Palo Alto, CA, 1991, p. 180.
• Bouchez, C. (2003). Fruit juice a two-edged sword for kids [on-line]. Available: http://www.healthfinder.gov/news/newsstory.asp?docid=513011.
• Center on Hunger, Poverty, and Nutrition Policy (2003). Healthy and tasty meals for less: unit 4, Tufts University (617-627-3956).
• Dannon Institute (2002). Celebrate healthy eating: family nutrition news and tips [on-line]. Available: http://celebratehealthyeating.org/che_edu_brk_fam_tips_.cfm.
• Duyff, RL. The American Dietetic Association's Complete Food and Nutrition Guide, Chronimed Publishing, 1998, p. 10.
• Filipic, M. (2003). Chowline: children's portions aren't always smaller [on-line]. Available: http://ohioline.osu.edu/news/.
• Food and Health Communications (2004). Healthy shopping check list [on-line]. Available: http://www.foodandhealth.com/shoplist.php.
• Food Standards Agency (2003a). Can I get all my daily fruit and veg portions from juice? [on-line]. Available: http://www.foodstandards.gov.uk/healthiereating/asktheexpert/fruitandveg/fruitjuice.
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• Schuster, E. (1997). Making sense of portion sizes. Oregon State University Extension Service.
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• United States Department of Agriculture (2002). How much are you eating? [on-line]. Available: http://www.usda.gov/cnpp/Pubs/Brochures/.
• United States Department of Agriculture (2003b). Nibbles for health: does my child have a weight problem? [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (2003c). Nibbles for health: family food shopping -- spend less, get more [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (2003d). Nibbles for health: family meals -- fast, healthful! [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (2003e). Nibbles for health: Pyramid servings -- how much, how many? [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (2003f). Nibbles for health: why breakfast? [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (2003g). Nibbles for health: why snacks? [on-line]. Available: http://www.fns.usda.gov/tn/Resources/nibbles.html.
• United States Department of Agriculture (1999a). Q&A: why did USDA develop a Pyramid for young children? [on-line]. Available: http://www.usda.gov/cnpp/KidsPyra/Q&A.html.
• United States Department of Agriculture (1999b). Tips for using the Food Guide Pyramid for young children 2 to 6 years old [on-line]. Available: http://www.usda.gov/cnpp/KidsPyra/.
• United States Department of Agriculture (1999c). Visual aids make 'portion sense' [on-line]. Available: http://www.kidsnutrition.org/consumer/archives/portioncues.htm.
• United States Department of Agriculture (2003h). Where do your favorite foods fit? [on-line]. Available: http://www.usda.gov/cnpp/Pubs/Brochures/.
• United States Department of Agriculture & United States Department of Health and Human Services (1999c). Food Guide Pyramid [on-line]. Available: http://www.cnpp.usda.gov/pyramid.html.

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Download PDF version of this newsletter:

• Download Newsletter only: Childhood Overweight: Favorable Food Practices (268K)
• Download Individual Handouts:
  • (Handout 1) Family Food Serving
  • (Handout 2) Food Guide Pyramid for Children Ages 2-6
  • (Handout 3) Food Guide Pyramid for Children Ages 7-12
  • (Handout 4) Food Guide Pyramid
  • (Handout 5) Recipe Cards
  • (Handout 6) Healthy Shopping Checklist
  • (Handout 7) Fun Snack Ideas
  • (Handout 8) Visual Cues for Recommended Serving Sizes
• Download this Newsletter and 8 Handouts in one PDF file (762K)

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Special Series on Childhood Overweight

• Childhood Overweight: An Epidemic on the Rise, Part 1: Physical Activity for Families
• Childhood Overweight: Favorable Food Practices, Part 2: Following the Food Guide Pyramid
• Childhood Overweight: Fostering Healthful Behaviors, Part 3: Engaging Children in the Process
• Childhood Overweight: Community Mobilization, Part 4: Coming Together to Improve Health

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Last updated: February 8, 2005

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