Dr. Keith Ayoob, EdD, RD, FADA

Pediatric Nutritionist

Rose F. Kennedy Children's Center

Fitness Food Fun Feelings

Q:  My son is 11 and looks to be a little overweight. He eats a balanced diet, but very large portions. When I try to serve him less, he protests. How can I get him to cut back without making him feel bad about his weight?

Q:  My kids refuse to eat almost all fruits and vegetables. What can I do?

Q:  How much fiber do kids need?

Q:  My 12-year-old daughter just announced that she's a vegetarian. Is this safe?

Q:  Are diet soft drinks OK for kids?

Q:  Can soft drinks be part of a healthy diet?

Q:  Will soft drinks and fruit drinks make my kid fat?

Q:  Are there any health risks for overweight children?

Q:  How do I know if my child is overweight?

Q:  My child is overweight. Should I put him on a diet?

Q:  My daughter won't drink milk. Will this have negative consequences for her future? What can I do?

Q:  What's the proper amount of calories per day for my 11-year-old son?

Q:  My 12-year-old is a bit chubby, but her siblings are thin. How can I keep snacks such as cookies and candy around for my thin kids but discourage my daughter from eating these foods?

Q: My son is 11 and looks to be a little overweight. He eats a balanced diet, but very large portions. When I try to serve him less, he protests. How can I get him to cut back without making him feel bad about his weight?

A:  

Congratulations on having a child who has a healthy appetite and eats a balanced diet–you're the envy of many parents with children who are picky eaters!

Keep in mind that your son is approaching puberty, a time when it's natural for kids to gain body fat in preparation for that famous adolescent growth spurt. Your instincts are correct that it's not good to pressure him about his weight. Otherwise, you risk triggering more serious issues surrounding his weight and eating habits.

Continue to offer him a wide variety of foods and trust him to choose portion sizes that feel right to him. At the same time, get the whole family involved in fun and healthy physical activities, such as walking and biking together. If your son likes to play a particular sport, provide lots of positive feedback for his efforts. Soon it's likely you'll have a more streamlined adolescent with terrific eating and exercise habits.

More information:
Make Fitness a Family Affair
Portion Distortion–It's How Much You Eat that Counts

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Q: My kids refuse to eat almost all fruits and vegetables. What can I do?

A:  

You're not alone in this particular challenge. Many kids turn up their noses at fruits and vegetables; yet the vitamins, minerals and fiber in these foods make them an essential part of every eating plan. As one example, MyPyramid recommends that kids eat 2 ½ cups of vegetables and 1 ½ cups of fruit daily, based on an 1,800-calorie diet (go to www.mypyramid.gov to get specifics for your child).

The good news is you can get kids to eat–and actually enjoy–fruits and veggies. Here are some ideas that I've seen work over and over again:

First, be a role model. Kids learn what they see, so make sure your kids see you relishing fruits and veggies, too.

Don't force the issue or kids are likely to resist even more. Keep a relaxed attitude and a ready supply of the fruits and vegetables they do like to eat.

Get kids involved in simple cooking tasks, such as breaking apart green beans or broccoli florets or peeling tangerines. Kids are much more likely to eat the foods they're involved in choosing and preparing.

Go extra heavy on fruits and vegetables as ingredients when you prepare meals and snacks. For example, add extra chopped vegetables to family favorites such as soups, stews and spaghetti sauces. Serve angel food cake for dessert topped with sliced strawberries. Also, fruit is OK as a dessert all by itself sometimes–offer a wide variety to your kids and let them choose the ones they like.

For after-school snacks, set out an array of baby carrots, red pepper strips and cucumber slices for dipping. Tuck small packs of raisins in their lunches or backpacks.

More information:
How To Pack Grade-A Lunches That Kids Will Like

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Q: How much fiber do kids need?

A:  Like adults, kids need fiber to promote healthy digestion and to reduce risk for heart disease and some cancers later in life. Fiber is found in foods such as whole wheat bread, raisin bran, oatmeal, dry beans, fruits and vegetables.

There's a simple formula to give you a ballpark figure regarding how much fiber kids ages 3-18 need: Just add 5 to their age to determine how many grams of fiber they need each day. For example, an 11-year-old child needs 16 grams of fiber per day (11 + 5). One way to learn how much fiber foods contain is to check the Nutrition Facts label on packaged foods. It tells you the number of grams of fiber in one serving of the product and the size of a serving.


More information:
Figuring Out Food Labels
Give Your Child a High Five for Fiber

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Q: My 12-year-old daughter just announced that she's a vegetarian. Is this safe?

A:  

With proper planning, your daughter can thrive on a vegetarian diet. However, a healthy vegetarian diet involves a lot more than skipping meat, poultry and fish. A steady menu of pizza, chips, ice cream and soft drinks–but devoid of whole grains, fruits and vegetables–is vegetarian, but clearly not nutritious. The challenge is even greater if your daughter also gives up products such as milk, yogurt, cheese and eggs, which are rich in nutrients such as protein, calcium, vitamin D and vitamin B12.

One way to follow a balanced vegetarian diet is to eat the recommended servings from all five MyPyramid for Kids food groups, while choosing meatless options such as eggs, dry beans, nuts, nut butters, peas and soy products (tofu, tempeh, veggie burgers) from the Meat & Beans Group. To make sure your daughter's vegetarian eating plan is safe and meets her nutrient needs, I recommend that you ask her family physician or pediatrician for a referral to a registered dietitian (RD).

Locate a registered dietitian (RD) in your area by going to Kidnetic.com partner, the American Dietetic Association.


More information:
Conquering MyPyramid for Kids!
Going Veg

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Q: Are diet soft drinks OK for kids?

A:  

Let's look at your question in terms of both safety and good nutrition.

First, it's safe for older kids who eat a well-balanced diet to have a soft drink that's sweetened with a sugar substitute.

Regarding good nutrition, a diet soft drink is again OK and can help kids meet their daily fluid needs. However, many kids don't get enough calcium, so make sure they get at least three cups of foods and drinks from the MyPyramid Milk Group daily (for kids aged 2 to 8, it's 2 cups daily). One cup equals one cup of milk or yogurt, 1-1/2 ounces of natural cheese or 2 ounces of processed cheese.

Search the site of Kidnetic.com partner, the American Dietetic Association.

More information:
Conquering MyPyramid for Kids!


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Q: Can soft drinks be part of a healthy diet?

A:  

Parents often wonder if soft drinks can fit into a well-balanced diet. A typical concern is that some kids might miss out on important vitamins and minerals when they drink soft drinks instead of nutrient-rich drinks like milk or 100% fruit juice. It's important that soft drinks don't replace foods and drinks that are rich in calcium and vitamin D, which are important for optimal bone growth and bone health, especially in the pre-teen years.

To help your kids get the nutrients they need, make sure they get at least three cups of foods and drinks from the MyPyramid Milk Group daily (for kids aged 2 to 8, it's 2 cups daily). One cup equals one cup of milk or yogurt, 1-1/2 ounces of natural cheese or 2 ounces of processed cheese. When kids eat a healthy, well-balanced diet and are physically active, enjoying an occasional soft drink is fine.

More information:
Conquering MyPyramid for Kids

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Q: Will soft drinks and fruit drinks make my kid fat?

A:  

Being overweight is caused by taking in more calories than are burned off. Sweetened soft drinks and fruit drinks–like all beverages that have calories–can contribute to an intake of excess calories.

Kids should get the important nutrients they need by eating (and drinking!) a wide variety of foods from MyPyramid. And kids should always balance what they eat with plenty of good old-fashioned physical activity. If they eat well and are active, enjoying an occasional soft drink or fruit drink is fine. I advise parents to tell their kids: Eat right. Play hard. Repeat.

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Q: Are there any health risks for overweight children?

A:  Unfortunately, yes. Overweight children are at greater risk for cardiovascular diseases, diabetes and other serious health problems. For instance, six out of 10 overweight children and teens have at least one risk factor for cardiovascular disease, such as high cholesterol, high blood pressure or high triglycerides. Twenty percent of overweight children have two or more risk factors. As the number of overweight children has increased in the past several years, so has the incidence of type 2 diabetes among kids. In addition, overweight children are more likely to become overweight adults.

The best way to help an overweight child is to establish healthy eating and physical activity habits for the whole family. For more information, check out the links below.



Four Steps for Helping an Overweight Child
Make Fitness a Family Affair

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Q: How do I know if my child is overweight?

A:  

That's a good question, because you can't always tell just by looking. Kids come in all shapes and sizes and it's natural for their body fat level to change as they grow. For instance, it's not uncommon for children to develop extra body fat around their middles right before the famed adolescent growth spurt.

To help determine whether a child (or adult) is carrying an unhealthy amount of body fat, health professionals often use a measurement called the Body Mass Index (BMI). If you suspect that your child is overweight, ask his or her doctor to make an assessment using your child's BMI. Before you go, read up on the BMI at the link below.

Assessing Your Child's Weight with the Body Mass Index (BMI)

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Q: My child is overweight. Should I put him on a diet?

A:  Generally, unless a child is seriously overweight, the best strategy is not a weight-loss diet, but slowing the rate of weight gain so the child can "grow into" his or her weight. That's accomplished by establishing healthy eating habits and a physically active lifestyle.

Weight loss usually is not recommended for kids because they need enough calories and other nutrients for healthy growth and development. In addition, restricting food can cause children to lose touch with their natural abilities to gauge hunger and fullness, or, in extreme cases, can trigger an eating disorder.
In situations where a weight loss plan is necessary, it should always be under the guidance of a doctor and registered dietitian (RD). As a first step, I recommend that you ask your child's doctor to assess his weight and recommend what steps are best.



Four Steps for Helping an Overweight Child

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Q: My daughter won't drink milk. Will this have negative consequences for her future? What can I do?

A:  Frequently, kids refuse to consume some food or beverage that we parents know is important for good health. Instead of forcing your daughter to consume something she doesn't like—milk, in this case—encourage her to consume other foods that contain the same nutrients. With milk, the two most important nutrients are calcium and vitamin D, which help to build strong bones.

Encourage your daughter to consume other calcium-rich foods she likes, such as cheese, yogurt or calcium-fortified cereals and orange juice. Even foods such as beans, almonds, oranges and broccoli contain calcium. Keep in mind that you can also slip milk into recipes such as smoothies or substitute milk for water in oatmeal and tomato soup.

You can find vitamin D in foods like egg yolks, fortified cereals and fish like salmon or sardines.

One often-overlooked source of both calcium and vitamin D is milk powder. Use it to sneak milk's nutrition into pancake batter, smoothies, soups and even muffin recipes. That way your daughter will get the nutritional benefits of milk without even knowing it!

In addition to these eating tips, encourage your daughter to regularly participate in weight-bearing activities such as running, jumping rope or push-ups. These activities also help build strong bones.


More information:Them Bones

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Q: What's the proper amount of calories per day for my 11-year-old son?

A:  

MyPyramid for Kids provides an estimate of daily calorie needs based on age, gender and physical activity level.

A report by the Institute of Medicine states that active 9 – 13-year-old boys need just under 2,300 calories per day. Keep in mind, however, that this is a general recommendation. Your son may need more or fewer calories than this.

In addition to his age, height and weight, your son's calorie needs depend on factors such as how physically active he is, his stage of growth and development and how speedy his metabolism is. It's a good idea to talk to your son's doctor for a specific assessment of his calorie needs. Keep in mind that any recommended number of calories will be an estimate at the start and may need some fine-tuning based on the above influencing factors.



More information: 
Conquering MyPyramid for Kids!

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Q: My 12-year-old is a bit chubby, but her siblings are thin. How can I keep snacks such as cookies and candy around for my thin kids but discourage my daughter from eating these foods?

A:  Make healthy eating habits a family affair–everyone can benefit from following a healthy diet. This way, you'll take the focus off your daughter's weight and the notion that she shouldn't eat certain foods. Otherwise, she might feel self conscious and set apart from the rest of the family. For instance, gradually stock up on many different types of nutritious snacks the whole family will like. Some ideas are fresh and dried fruit, cherry tomatoes, baby carrots, yogurt, cheese sticks, pretzels, baked tortilla chips, pita bread, hummus, salsa, bean dip–and, occasionally, some favorite cookies and candy, too. All your kids will learn to like a wide variety of foods, and treats such as cookies and candy won't take on a "forbidden" appeal to your daughter.

More information:
Four Steps for Helping an Overweight Child
Make Fitness a Family Affair

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