Tuesday, 29 November 2011

Gentle Weight Management for Children

I’ve received a couple of calls recently either from parents worried about their children’s weight or by parents worried about their children being worried about their weight.  

Weight is a sensitive issue for most people and it is just as sensitive an issue for children which is why I am sometimes amazed by the harshness of the comments made directly to the child as well as dismayed by the situations I’ve heard about where a child is given a ‘telling off’ or ‘warning’ by their medical doctor or paediatrician.

It is so incredibly important that every child knows they are loved by their parents for who they are.  Forgot the after school activities and the expensive presents, the best gift you can give to your child is to let them know that you love them exactly the way they are.  Yes, we may not like the way they behave sometimes, but in terms of their appearance, they need to know that they are (in our eyes) completely and utterly perfect!  I do worry that constant criticism of a child’s weight destroys their confidence as well as increasing the risk of the child having disordered eating patterns later on.  As parents we should be as ferocious as Rottweiler’s in defending our children against any unkind or thoughtless comments as well as taking care not to make insensitive comments ourselves.

So, what can you do if you feel that your child might be putting on a little bit too much weight?
  • Check their growth curves
Most children tend to roughly follow the weight and height curves of their birth and after their first year there is a steady growth rate just up to the puberty spurt (9-14 for girls) and (10-17 for boys). Note that BMI is measured in a different way for children as it takes into account their age and gender and uses percentiles to assess it relative to other children of the same age and sex. If your child is rocketing upwards in terms of their weight, you could discuss your concern with your family doctor but I would not do this in front of the child, it is better to have this discussion alone. 
  • Do not put them on a diet and don’t start to talk constantly about weights and diets. Focus instead on healthy eating, having more energy for sport etc
Most children do not need to be put on a diet and certainly should not be ‘losing’ weight. They are still growing and developing so it is incredibly important they receive the nutrients they need.  If a child is overweight, the aim is simply to slow down the rate at which the child is gaining weight.
  •  Review the family diet
Take a long and honest look at the family diet and make subtle healthy changes for the whole family.  Do not single the child out!  The usual culprits are sugars (cakes, biscuits, sweets but also hidden sugars - sweetened yoghurts, white bread, crisps and breakfast cereals), too many snacks and large portion sizes.  I often find that many children ask for food simply because they are bored - a child does not really need to eat again within a couple of hours of having a meal.  Offer fresh fruit, plain biscuits or unsweetened yoghurts between meals if your child really is hungry (and often when they are offered this type of selection they magically decide that they are not hungry!) and never offer food as a ‘reward’ or to ‘comfort’.  Limit unhealthy foods, but do not ban them completely.   Remember that our roles as parents is to teach our children to moderate their food intake on their own and refusing to let them eat certain foods does not help them do this.  
  • Check their levels of physical activity 
Ideally our children should be moving around at a moderate level for at least 60 minutes a day.  Tempting as it is to let them sit in front of the Wii or their DSs, do try to include sport and games in their daily routine.  I’d also add here that we should not force our children to do sports, particularly if they dislike team sports.  Try to find activities they enjoy and that you can share with them, such as walking, cycling and dancing.  Plan family activities at the weekend to include a long walk, swimming or bike ride and make sure your children see you moving around too!
  • Give them compliments
Boost your child’s confidence, particularly if they are might be feeling self conscious and worried about their weight.  Let them know how incredibly amazing you think they are, compliment them as much as possible and plan enjoyable activities you can do with them.  

And finally, if anyone ever gives you or your child a hard time about their weight, then please send them to see me and I will sort them out!

As always a recipe.  This time a winner of a cookie recipe, perfect after a long Sunday family walk with hot chocolate for the children and tea for the adults.  It is high in fat and sugar and yes, I could play around with it to make it healthier, but in the spirit of this blog post I won’t.  This recipe is perfect exactly as it is!

Charlotte’s cookies

Makes 10-12

Heat oven to 200 degrees.
Blend 125g butter and 100g of castor sugar in a food processor until creamy.  Add 1 large egg yolk and a couple of drops of vanilla extract, and whizz again before before adding 125g plain flour and 100g chocolate chunks.  Use floured hands as dough will be very soft and shape into ‘flattened golf balls’.  Place on baking tray covered with grease proof non stick paper and bake for 10-15 minutes.

Resist eating straight away and drag the family out for a long walk before coming back to demolish them!

Sunday, 6 November 2011

Is BMI the best indicator of health?

I’m doing some research for a weight management programme today and have been busy looking at the ins and outs of the Body Mass Index (BMI) which is one of the most common methods used to assess weight in relation to height.  The BMI calculation involves dividing the weight in kilograms, by the square of the height in metres.

For example, weight 80kg, height 1.85m, then the BMI is 80/(1.85 x 1.85)  = 23.37

(Note that BMI applies to adults between the ages of 18 and 65 years of age, and should not be used by pregnant or nursing mothers and might not apply to serious athletes which higher muscle masses).

BMI classifications were decided by The World Health organisation in 1995 who originally recommended three cut off points, 25, 30 and 40, based on anthropometric international data examining populations, weight and disease risk.  These classifications have now been refined and are as follows:

18.5 or less  Underweight
18.5 to 24.99  Normal Weight
25 to 29.99   Overweight
30 to 34.99  Obesity (Class 1)
35 to 39.99  Obesity (Class 2)
40 or greater  Morbid Obesity

These ranges apply to both men and women, and are meant to take into account build and muscle mass.

The health issues associated with having a BMI in the higher ranges include cardiovascular disease, diabetes, joint issues and a possible higher risk of cancer.  However BMI may not necessarily give us the best picture of our health for the following reasons:
  • It is possible to be fit, well muscled and well built (yup - those ‘heavy bones’ we inherited!) and have a BMI of overweight, despite having a low level of body fat.  In contrast a skinny, low muscled, unfit individual might have a normal BMI.  
  • There are some studies which actually show no greater risk of overall mortality for individuals who sit in the overweight category (BMI of 25-29.9) while being underweight is linked with being more dangerous for our health.  This could possibly be for the reason above, while the underweight category will include people with underlying disease processes - such as heart disease, lung disease, cancer or infection, which can cause weight loss.  Some researchers have highlighted that despite the conflicting evidence being overweight is still a risk to health because excess weight tends to progress and can also be hard to lose. Many overweight people can go on  to become obese which is linked with definite health risks.  
[(Lewis et al (2009) Mortality, Health Outcomes, and Body Mass Index in the Overweight Range American Heart Association 119: 3263-327]
  • One of the most important points to make about BMI is it that does not take into account fat composition and where fat is deposited in our bodies. Lean muscle weighs more than fat!  Research shows that it is far more dangerous to store the fat around the middle, where it is known as ‘visceral fat‘ which is strongly linked with cardiovascular disease and type 2 diabetes.  Visceral fat is not more dangerous because it sits closer to our hearts (as many people seem to think!), but because abdominal fat is ‘metabolically active'.  It  produces chemical substances which trigger inflammatory processes, and these processes then damage our blood vessels and interfere with blood sugar regulation. Better measures to assess fat composition are hip to waist measurements and skin-folds tests.  Ideally the waist circumference should not be more than 80cm for women and 94cm for men.  The waist hip ratio is calculated by dividing your waist measurement by your hip measurement and should not be more than 1.0 for men and 0.8 for women. 
It is interesting that fat stored on the thighs and bottoms seems to play a protective role, so all your lovely Rubenesque pear shapes should celebrate!  Research now links fat on the lower part of the body (known as gluteofemoral body fat) to playing a protective role in managing long term fat storage (it ‘traps’ excess fats and prevents them floating around your body causing mayhem!) and reducing inflammation.

[Manolopoulos et al (2010) Gluteofemoral body fat as a determinant of metabolic healthInternational Journal of Obesity 34, 949-959]

So, while BMI is probably ok as a health indicator for those at the upper and lower ends, it is less clear cut for those individuals in the overweight range.  In this case, waist circumference and other measurements to assess fat composition will give a more accurate picture of health.  

As always, a recipe.  Adapted from 101 cookbooks (http://www.101cookbooks.com/ ) a fantastic blog and given to me by my friend Janelle who runs ‘Big Apple Yoga’ at Villennes http://www.bigappleyogafrance.blogspot.com/

Chinese cabbage salad

The dressing is incredible and can be used pretty much with any salad.  I like to use red cabbage rather than the white cabbage the original recipe suggests.  I love the colour which to me screams of autumn (a bit like red wine!).  It is a great source of Vitamins A and C, and like all the cruciferous family a source of substances called ‘indoles’, compounds linked to a reduction in cancer risk.

Lovely served as a side dish with cold roasted meat.  I ate it last night with salmon brochettes - salmon strips marinated in teriyaki sauce.  

3 large shallots, skinned and thinly sliced
splash of extra-virgin olive oil
pinch of salt
1 tablespoons miso
1/2 teaspoon powdered mustard (or a bit of whatever mustard you have around)
2 tablespoons brown sugar (or honey or agave)
50ml (brown) rice vinegar
70ml cup mild flavored extra-virgin olive oil
1 teaspoon pure toasted sesame oil (optional)
1/2 of a medium-large red cabbage
75g slivered almonds, toasted
2 large grated carrots
large chunk of grated radish (radis noir)

Stir together the shallots, splash of olive oil and big pinch of salt In a large frying pan over medium heat. Stir every few minutes, you want the shallots to slowly brown over about 15 minutes. Let them get dark, dark brown (but not burn). if needed turn down the heat. Remove them from the skillet and onto a paper towel to cool in a single layer. they should crisp up a bit.

Make the dressing by whisking the miso, mustard, and brown sugar together. Now whisk in the rice vinegar and keep whisking until it's smooth. Gradually whisk in the olive oil, and then the sesame oil. Two pinches of fine grain salt. Taste and make any adjustments if needed.

Cut the cabbage into two quarters and cut out the core. Using a knife shred each quarter into whisper thin slices. The key here is bite-sized and thin. If any pieces look like they might be awkwardly long, cut those in half.

Gently toss the cabbage, carrots, shallots, almonds and radish in a large mixing/salad bowl. Add a generous drizzle of the miso dressing and toss again - until the dressing is evenly distributed. Add more a bit at a time if needed, until the salad is dressed to your liking.


Tuesday, 1 November 2011

Supermarket shopping - rules which can be broken......!!

I made the stupid mistake of doing my weekly food shop with my children last week which must have added at least 20% to to the cost of my trolley.  Even though I like to think of myself as a ‘health supremo’, I let my three little cherubs add sweets, flavoured yoghurts and a large jar of nutella  to my shopping as I was feeling just too worn out to protest.  

The golden rules for shopping healthily are generally to shop as your ‘grandmother’ would have shopped which means:
  • Avoiding processed, refined and ready prepared foods
  • Avoiding buying any item which your ‘grandmother’ would not recognise as food
  • Avoiding buying any item which has more than 5 ingredients
This usually means sticking to the outside aisles of the supermarket (fruit and veg, meat and fish etc) rather venturing into the middle.  Depending on your supermarket, the alcohol aisle may or may not be on the outer aisles......!

As always, rules are made to be broken.  ‘Grandmother’ possibly did not mind not having a life and spending the whole day shopping and cooking!  Maybe she had a husband who worked 9-5pm and was around to help in the evenings rather than husbands who travel away all week (though there is a possible question mark around whether most men of that generation did help with children!).  She might have had a family circle nearby to help her, rather than living far away from any family and having to take her children shopping when she and they are cranky, hungry and tired.......

So, with all this in mind, I think we are doing well if we can follow these rules roughly 70% of the time, and that rather than mentally beating ourselves up about the sweets and biscuits we do give our children we should also give ourselves a big pat on the back for the number of times we get it right!

I’m just looking at the ingredients list of the Nestle Smarties yoghurt that my children 'forced' me to buy and wondering just when nutritional labelling is going to get clearer.  To be fair, while it does indicate that there is 24.5g of sugar per 120g pot (20.4%), it is hard to work this out from the list of ingredients.  My ‘grandmother’ certainly would not have recognised this as a yoghurt and it contains 24 ingredients.....

The contents of the yoghurt part alone looks like this, with my comments in brackets:

Sweetened strawberry yoghurt  83.3%:
  • 85% partially skimmed milk yoghurt
  • 7.2% sugar (at initial glance - under 10% so ok-ish)
  • 5.5% strawberries (don’t even think about counting this as a 1 a day portion, which is a 80g serving!)
  • fructose (er - that’s sugar too - how much?)
  • rice starch [amidon de riz] (white processed starch which helps stabilise the yoghurt)
  • milk concentrate
  • flavour (which one?)
  • Colouring E162 (natural red food colour derived from beetroots)
  • E296 (malic acid, used to balance acidity.  No side effects noted from use as an additive)
  • Vitamin D
The smarties element has 14 ingredients and no info on the sugar percentages.....!

Leaving you as always with a recipe:   Ricotta, spinach and pesto lasagne, which is perfect for a chilly autumnal evening.  Serve with a large salad and you’ve got your 5 a day

Tomato sauce:  Fry 1 large finely chopped onion with 75g chopped bacon (add a glug of olive oil if bacon is lean) for 5 minutes or until onion is softened. Add 2 chopped sticks of celery, fry for a further 5 minutes then add a 2 tins of tomatoes, 2 bay leaves, 2 crushed cloves of garlic, 2 tbs tomato puree and 2 tsp of mixed dried herbs.  Add 300 mls of water and simmer gently for 20 mins before adding a good slug of red wine and seasoning.   Blend the sauce slightly if you have fussy 'pick out the vegetables from the sauce' children!

Ricotta filling:  Mix 500g ricotta with 200g chopped mozzarella and 100g grated parmesan.  Add in 100g fresh pesto sauce, a handful of pine nuts and 300g of cooked chopped spinach (fresh or frozen).    Tear in some fresh basil if you have some and season generously.

Make up the lasagne:  Put a shallow layer of tomato sauce in a baking dish.  cover with lasagne sheets (use the dried no need to pre cook variety).  Then add layer of cheese mixture.  Repeat the layers a second time and you’ll end up with the ricotta layer on top.  Do a final layer of lasagne, cover with the tomato sauce and sprinkle with fresh parmesan.  

Leave the lasagne to ‘rest for a couple of hours at least if possible, so the sauces have time to soak through into the lasagne sheets, then bake at 180 degree for 30-45 minutes.  

You may have some tomato sauce left in which case you can freeze it or serve it with wholemeal pasta spirals if you have any members of your family who flatly refuse to eat spinach*sigh*!