My mother use to say, "she's just a little healthy" whenever she was discussing a child who was a bit larger than the norm. Today, more and more littles are just a little extra "healthy" according to her terms. In reality, twenty percent of children are #overweight or #obese and the trend is increasing. The consequences of childhood obesity is significant and the remedy is complex, including interventions in the school, within the community, and at home. A child who is overweight is likely to grow up to be an overweight adult. Identifying littles who are overweight or obese in their youth and creating a wellness plan for them is crucial as it has a direct effect on their lifetime health.
Programs for addressing childhood obesity are primarily aimed at school-aged children, yet eating habits and activity are already well established by this age. Additionally, being overweight as early as five years of age is a predictor of weight in adulthood. Preferences for food is established quite early in life and family habits strongly influence these eating behaviors in children. It has been said that it's easier to change someone's religion than their diet so establishing a clean diet early on is imperative to long term vitality.
Interestingly, a longitudinal study found children from homes without the father present, mothers with depression, or children who are frequently confined to playpens during their infancy later have a great incidence of obesity in early adulthood. Fewer siblings, single parents, increased screen time, and sedentary activities were found as contributors to obesity in a second study. A child's environment greatly influences their risk for childhood obesity, but genetics also play a role. Admittedly, genetics have not evolved as quickly as the childhood obesity rates have climbed over the past few decades so our genetics do not hold the onus of blame.
Mindfulness Regarding Feeding Practices
What we choose to eat and how we eat it and even how often, reflects our religious beliefs, health and illness beliefs, and our available resources. #Breastfeeding decreases obesity later in life, but again, our food practices reflect our culture. Our culture even reflects our individual view on obesity and body image. These practices are like muscle memory; we follow their trends without much conscious awareness. My sister chose not to breastfeed and when I inquired why, she admitted to knowing breastfeeding would be healthier for her and her daughter, "but it just isn't what my friends do." It is hard to wrap your head around practices you haven't seen firsthand.
This is similar to how we feed our toddlers. Many are familiar with purchasing baby foods (full of dyes, sugars, and sodium) which are ultimately force-fed to our littles. Remember them pushing the food back out with their tongues because they weren't quite mature enough to coordinate their tongue, which then meant you had to scrape the excess off their chin and pile it back in their mouth? This is a developmental milestone.
Children typically begin mouthing items and foods far before their gastrointestinal tract is really ready to handle such foods. This initial playing with their food causes many to assume they are hungry, but is the just first step in their developmental journey. When we shovel it in via the baby spoon, scraping it off their face and shoving it back in, we are ignoring their need to move through each of these stages physiologically.
Exposing children to foods before they are developmentally ready increases their incidence of allergies. Rather, offer them foods from your plate that they can safely naw on and probably toss to the floor. Once you notice food starting to actually disappear, their guts have matured and increasingly ready to be introduced to new foods. Avocados are a great start. Vegetables in particular are a great start. You might even give your toddler a large, raw carrot and let them naw on it. Rice cereal is void of any nutritional value except the fortified iron (another intriguing discussion for another time).
Interestingly, as I talk with children about what they eat, their account can differ significantly from that of their parent's. I've also began to realize that what I think is a "good eater" is very different from what parents may feel is a "good eater." This was true too as a maternity provider. It wasn't uncommon in my training within a large, tertiary center to have a gestational diabetic bring in her liter Mountain Dew to her prenatal appointment and have no real awareness this was the foundation of her pregnancy difficulties.
Maybe the greatest hurdle though is the perception that change is necessary. One study that evaluated the parent's perception of their toddler's obesity found that parents are unlikely to identify them as overweight and those same parents are often feeding their children very unhealthy foods. A few years ago myself, I initiated care with a nurse-midwife for my primary care and due to years of abusing my body, I was far from optimal health, certainly surpassing my optimal weight. She shared that she felt we can be "the picture of health" and also be overweight. After all, I had no other health concerns, right? Today however, I suffer from liver disease and pre-diabetes because I allowed myself to endure more than a decade of significant stress causing me to live in a sympathetic dominant state for decades. My reserve is now gone. My provider missed an important opportunity to make a real change in my health and a critical time in my life. As a clinician, this especially true for children. While we want to honor every body, and certainly never shame anyone for their size, we must intervene early if we seek to offer them a path towards optimal health and wellness.
Holding Ourselves Accountable
The Department of Health and Human Services published the 2nd edition of Physical Activity Guidelines for Americans in 2018, providing an excellent resource of evidence-based recommendations for individuals of all ages. These guidelines challenge preschool children, ages three through five years, to remain active for the vast majority of the day. Children who are six-years-old through seventeen-years-old need at least 60 minutes of scheduled physical activity daily.
At every single visit, we will talk about food choices and movement, as well as self-care, relationships, and lifestyle habits, such as sleep, grounding, and getting sun on your face. This is true primary care. However, conversations within a single consult offer only so much education and accountability, which is why Eden clients are not just single visits, but rather members in our wellness program. Here we can continue to engage in discussion about #wellness, strategize how to apply these principles in our lives, and really encourage one another.
The Gut Microbiome
We can't skip out on the gut microbiome and its role in obesity; I am after all, a functional medicine doctor. We know from the livestock industry that antibiotics increase body size and rate of growth. We also know that antibiotics disrupt our gut flora, which leads to dysbiosis, when then leads to inflammation, and ultimately higher incidence of obesity. We also know that those who are obese have fewer bacterial strains of Bacteroidetes and more Firmicutes.
In children we know that those with higher rates of Bifidobacterium in their stool as infants are more likely to be of normal weight at the age of 7 years, and we know that babies who are breastfed are 13 to 22 percent less likely to be obese at the age of 7 years, which likely relates to the gut flora established from their momma's milk. Further, we know that Staph aureus in the stools of children during infancy produces toxins that trigger inflammation, so again, this can ultimately result in obesity. The alteration of gut bacteria precedes obesity.
If you'd like to talk more about your little's ones health, connect. We'd be happy to get you established in our primary care practice.
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