Paging Dr La Puma

Feb15

How To Recognize If Your Child Is Obese: Results from a Pediatrician’s Office

Posted in: Child Obesity, High Cholesterol, Obesity and Weight Loss

Many studies now show parents underestimate their overweight kids’ weight.

A New York pediatrician’s office shows that barely 10% of parents of overweight kids actually thought their kid was overweight.

In contrast, fully 60% of parents of normal-weight kids knew that their kid’s weight was normal. Parents of overweight kids were off by an average of 45%tile.

Parents of normal-weight kids who underestimated are more likely to be concerned about their child’s weight than parents who get it right.

Parents most likely to make changes are those who knew that they themselves were overweight, had overweight kids over 8 years old, and those who thought their kid had a health problem.

Obese children have a high risk of diabetes, high cholesterol and metabolic syndrome. These are all disorders thought only to occur in adults–like my patients–until several years ago.

Bottom line: parents have a hard time discerning when their child is overweight, and it is different for adults than for kids. For kids, use the BlubberBusters BMI for kids calculator: good, clear explanations and info.

Leave a Comment
Feb8

Your Weight, and “The Burger and Fries Recovery”

Posted in: Aging and Costs of Aging, Child Obesity, Obesity and Weight Loss, Wellness and Health

If it were true that “Americans are still better off spending an extra hour at work and letting someone else do the cooking,” then America’s obesity rate would be going down. But it’s not.

Home cooking is one of the few natural defenses Americans have against obesity.

The usual complaints, including those in the Zagats’ “The Burger and Fries Recovery” (WSJ, 1. 24.11), are that it’s too expensive and takes too long. But it’s not and it doesn’t.

An average fast food meal has about 1000 calories, and according to a Tufts 2010 study, the menu underestimates those calories by 18%.

Most take-out and quick restaurant meals are highly processed. Many contain starches and chemicals you’d never add at home, including “natural flavors”. Calories are hidden.

Home cooked meals, on the other hand, have fewer calories. They also pack the quality of life and kitchen-table wisdom that take-out and bargain restaurants just can’t match.

From the University of Minnesota: five home cooked meals weekly cut the risk for anorexic and bulimic behaviors in teen girls by 75%.
From the USDA: 35% of Americans who are not overweight or obese spend an average of just 6.8 minutes more shopping and cooking than the overweight and obese.

It’s true that an average home cooked meal isn’t cheaper per calorie than a typical restaurant meal.

But cheaper per calorie is not the proper standard. If it were, a 99-cent 2 liter soda (at over 800 calories) might be the standard bearer.

Home-cooked meals are first in a series of small steps in the right weight loss direction: away from highly processed, fattening food, and towards healthier and better-tasting home-cooked food.

What if restaurants were rated for a separate Zagat category? H, for Health. Your Health.

1 Comment
Jan27

What Doctors Should Say to Patients Who Want to Lose Weight

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

I was interviewed recently by the American College of Physicians about best practices for physicians who find it uncomfortable to speak with their patients who want to lose weight.

The resulting article focused on “motivational interviewing”: I just think about it as how to speak with patients.

Here is a video on motivational interviewing about weight loss. The actors are clumsy and the advice is imperfect (artificial sweeteners are not the solution, there is no motivation elicited, the patient probably feels deprived, and the doctor is still directing instead of listening well). But this type of conversation is a first step.

The real problem is that people don’t know how to do what physicians (may) tell them to do.

The lack of training for physicians about what to say and how to say it doesn’t help. I got 4 hours of nutrition in medical school, and 2 hours in cooking school. None were about obesity.

Finally, most physicians aren’t paid to have these conversations. They need to code a visit about weight management as something else, so they can be paid. I hope this changes with health reform. And it may.

Motivational interviewing is a good tool–with enough time, compensation, evidence-based content and practice it will help. We can do it: POLST has done it for care near the end of life. Obesity could actually be easier.

Leave a Comment
Jan20

Is Walmart Better-For-You? Yes, Nutritionally.

Posted in: Aging and Costs of Aging, Child Obesity, High Cholesterol, Obesity and Weight Loss, Uncategorized, Wellness and Health

As Marion Nestle points out on NPR’s piece on Walmart’s nutrition initiative, farm subsidies are what drives the availability of processed foods over whole, fresh foods. We often don’t eat and cook healthy because it’s cheaper not to. And kids too often suffer.

But what she missed is the difference between philosophy and practice. Whether better-for-you processed foods are good is not just a philosophical question. It’s a practical one. The answer is “Yes,” though the processed products are not ideal. At least for my patients with hypertension, heart disease and high cholesterol.

Walmart’s economies of scale will drive down whole veggie prices to consumers, and that’s more important than the salt and sugar subtractions on processed foods.

Broccoli may be presented not wilted in a package or dessicated in a boxed dinner, but as a head. And with cheaper, whole vegetables should come cooking lessons, kitchen innovations, cutlery, spice mixes and ways to put veggies on the plate, quickly.

Because time is the most precious commodity. When you’re working 3 jobs and taking 4 buses in a day, it’s hard to find time to cook. But Walmart can help solve that problem for many of its customers too.

Only 26 percent of the nation’s adults eat vegetables three or more times a day, including lettuce on a burger. Walmart (and soon to follow Walgreen’s, Kraft, Target, and more) can and will help.

2 Comments
Dec21

Treating Overweight Kids…With What?

Posted in: Child Obesity, High Cholesterol, Obesity and Weight Loss

Dr Molly Ferguson is a naturopath in Michigan who is courageous enough to discuss treating childhood obesity.
Video: Treating Childhood Obesity

Putting kids on a diet has long been terrifying to physicians because we are frightened about creating eating disorders (the other way!)

But there is good data to show that the suggestions she makes: “eating the rainbow”, “eating fewer processed foods”, and “avoiding chemical additives” can have beneficial effects on kids’ health: improving immunity, increasing energy level at school, reducing hyperactivity symptoms.

Is there a good diet for overweight kids? If there were just one, all kids would be on it.

Childhood obesity has leveled off in kids ages 2-5, because Moms are super concerned, and have more control over what there is to eat. The next frontier: kids ages 6-11 or 12.

I think teaching kids about food and the basics of how to cook would transform family lives: treat Mom’s diabetes, and Dad’s cholesterol and heart disease, and Sis’ asthma.

Eating and cooking healthfully to lose weight has worked for adults enrolled in Chef Clinic, and in adults who make big lifestyle changes.

Should overweight kids be on a diet? And if so, what would one look like?

Leave a Comment