Friday, April 30, 2010

an article about weight that does not induce panic?

"Researchers and doctors are starting to understand that eating healthy foods and getting exercise can matter more than the number that appears when you step on the scale."

"A little physical activity" twice a week was enough to ameliorate some of the harmful effects of a sedentary lifestyle."

"An Australian study found that people in their 70's who were overweight were less likely to die in a ten-year time span."

These are a few quotes that are refreshingly different from the general hysteria about weight from a recent Post article. A few months ago the Post exhorted women to partake in 60 minutes of vigorous physical activity a day if they wanted to stave off weight gain associated with aging. (The natural and as these studies suggest-protective weight gain associated with aging...) Every time you turn around you read about the perils of being "overweight" or "obese," how your pudgy child will die an early death of diabetes and misery.

There is a whole body of research out there that questions some of our most basic assumptions about weight and health, and the fact that even some of them are getting press is exciting.

I think it's a nice start. (Though the article fails in it's discussion about "obesity" in that most studies do not separate once folks get above a BMI of 30. Much of the risk associated with "obesity" does not appear statistically significant until the BMI is over 35 or 40... Just a note on how the statistics can be manipulated or not fully disclosed or understood.)

Thoughts? Did you see this or other "whistles in the hurricane" of health hysteria?

Thursday, April 29, 2010

worldwide readers-what was for breakfast today?

I finally figured out how to install Google Analytics and LOVE that I have readers from 27 countries! I get a little thrill from seeing the map in various shades of green, and I started to wonder. What did you all have for breakfast this morning?

I had a hankering for salt so I made fried eggs, hash browns, whole wheat toast, sliced canteloupe and veggie sausage for the family on my new griddle pictured here with another breakfast. :)

If you feel comfortable, tell me where you are from and what you ate!

Wednesday, April 28, 2010

knives and kids

It's easy to want to protect our kids, or over-protect them. (I would know, my kid is the only one wearing a helmet on her scooter on the block...)
Sometimes that urge to protect can hinder their development. I've seen 3 and 4 year olds using forks with rounded ends meant for much younger children, which can be really frustrating for them.

As Maria Montessori says kids come from, "Help me do it myself."

Here are a few knives we have found most helpful and notes about using knives with kids.

1) always supervise a child with a knife
2) eat family meals together so they can watch you use a knife and learn from you
3) make the task appropriate. Your 3 year old can't cut steak, but she can cut bananas.
4) watch that the child can master a skill before moving on.
5) consider kids' cooking classes. We attended a fun one on knife skills when M was just 4. She learned about curling her fingers under like a "bear claw." When I help her cut, all I do now is say, "Bear claws!" and she tucks her fingers under.
6) have the right tool for the right job (see below)
7) be sure the child is stable-standing or seated
8) be sure the cutting area is stable, use a just-dampened paper towel under a cutting board so it won't slip...

Remember, each child is different in their interests and skills. One child may be more adept at using the knife than another. Watch your child and see if any of the options below might work..

Lettuce knife. Great for kids helping with meal prep. Here is M at 4 cutting green beans. A mom at school told us about this knife. Her son has been chopping veggies since he was three. (He is way better than M at this...)

Ikea knife, nice handle, great starter knife. There is some serration, so be sure to monitor use. Good for cutting bananas, soft fruit...

Fancy kids'-set knife. Right size, good to have with meals. Not too risky.

spreader used for... spreading. Cream cheese, nut-butters, hummus... (On sale at Target after Holidays, mine was 4 for $1...)

What are your tricks with knives, or tools for the kitchen with kids?

Monday, April 26, 2010

"watch your size" or "accept your body" are not the only options

"How can you simultaneously encourage your daughter to watch her size and accept her body?"- Asks a recent article in the NYT.

Already annoyed by the title. It implies that your daughter isn't capable of accepting her size and accepting her body simultaneously. It implies that she can only accept her body if society deems it "acceptable."

Accept her body, or "watch her size" which means consciously trying to maintain or change her size. One large Minnesota study found that teenage girls who practice "healthy" dieting or weight management measures like "watch what they eat," "watch portion sizes" and "try to eat more fruits and vegetables," are heavier than their peers who have never dieted.

Aside from the title, the article also implies that making "small changes" will result in big weight loss. Small changes might make someone healthier or feel better, but likely won't make them lose weight. I wish the article had been a bit more rigorous, less lazy in it's acceptance of many assumptions about weight and more.

I remember a mom of a healthy nine-month-old girl in one of my first talks crying, "Every time I feed my daughter I feel like I'm on a knife-edge between anorexia and obesity." She was one of the reasons why I started Family Feeding Dynamics. I hear similar questions, though less extreme (or honest?) particularly from parents of tween girls. Fear and anxiety are pervasive in some mothers (and fathers) and is effecting the way they feed their children.

What is largely missing in the discourse of obesity vs "healthy" or eating "right" is the model of normal or wellness. (Setting aside for a moment the weightist assertion that you can't be "obese" and be healthy, or that you couldn't be eating well if you are "overweight," or the assumption that low body esteem causes eating disorders...)

Parents, you don't have to live on that knife-edge. Your only options are not obesity or anorexia. It's not just- "let your kid eat whatever they want and not give them a complex, or crack down on portions and forbidden foods and risk a child with low self-esteem and an eating disorder."

There is an alternative. There is normal eating, there is eating competence, feeding well. You can lead by example, feed with love and structure, provide a variety of tasty foods at a pleasant table and not make a big deal about it. Lecturing about eating to prevent disease and illness, feeding from fear and control doesn't help children do best with eating or feel best about themselves. (Two awesome resources are Child of Mine:Feeding with Love and Good Sense, and Your Child's Weight: Helping Without Harming, both by-you guessed it, Ellyn Satter.)

What do you think?

Thursday, April 22, 2010

why don't health care professionals know about non-diet, HAES or feeding dynamics?

Had a great time talking to the LPNs at their annual conference in Alexandria this week. Great questions from these dedicated health care professionals. I got to introduce some important topics like Division of Responsibility in Feeding, Health at Every Size, being careful about growth charts and labeling patients...

One woman astutely asked, "Is this in the curriculum in medical school? Patients are going to trust their doctors on this."

Alas, the answer largely is "no," health care providers aren't getting the whole picture. There were huge chunks of data and information I was never exposed to in my training. Part of my mission is to spread the word to health care providers- at least expose them to another side of this complex story.

Here's what one internist said after she heard me at a conference last year. "Hearing Katja's presentation was really eye-opening. In some ways, I didn't know what I didn't know. The ideas and evidence she presented are revolutionary and it is unfortunate that it is not taught in our medical training. I am working on incorporating some of these ideas into practice and doing my own study of the research. I feel it is helping my relationships with patients be more positive and encouraging and I feel I am better able to help them." (Melissa, MD)

Then another nurse asked, "Why aren't we learning this stuff?"
Still trying to answer that one...

What do you think? Why aren't health professionals (I know a nutrition/public health grad student who has never heard of HAES or Satter's work...) hearing about this stuff? Are you in health care? Were you exposed to these ideas?

Wednesday, April 21, 2010

picky kids and temperament

This is a great quote from Dawn Friedman at This Woman's Work who talks about the very different temperaments of her two children and how it effects how she home-schools. "The surest way to ruin anything for him was to try to lead him — he is a kid who wants to find his own way and will let us know if he needs our help. Even casually offering help might be enough to make him shut down. "
While she is talking about learning styles, she may as well have been talking about learning to like new foods, or how picky a child is. I wonder if this trait translates into eating as well...

You see, some children are VERY sensitive to any pressure to try or like new foods.
What doesn't work:

1) "No thank you," or "one bight rule."
2) rationalizing, or explaining, "You liked this last time, I know you'll like it. You like broccoli, this tastes just like that!"
3) Over-selling something, "This is SOOO good, don't you think so Dad? This is the BEST casserole I've ever made, look at the delicious peppers, they're your favorite color!" Yum!
4) praising or rewarding for trying new foods

The initiative needs to come from the child. Put the food on the table, you enjoy it, have a pleasant time, talk about anything but the food and let the child come to the food on his or her own terms. (This can take time depending on the child's temperament, how much they were pressured and for how long...)

How does your child's temperament play into your feeding and eating challenges?

Monday, April 19, 2010

school lunch in Paris, school lunch in Minnesota

This delightful cultural bit came into my hands recently about school lunches in Paris.
Basically it explains that in France, the children are given from-scratch, challenging and varied meals in the public schools. No frozen foods, no menu repeated in a 32 day cycle. I have family living in France, and this is indeed their experience. Kids sit for up to an hour, have multi-course meals or go home for lunch. The daycare co-op served lamb and ratatouille, not mac n cheese. There is nothing wrong inherently with mac n cheese, but these kids live in a culture that values food, values the experience of eating and honors the children with spending the time and effort to cook and plan a variety of good tasting foods-and the children eat it. (Mostly)
Primary French - French family eating breakfast
Contrast that with the experiences of many children in Minnesota and America. Lunch shifts might start at 10:30. One parent described a scene where the children are all dressed in their snow-suits, ready for their 15 minute recess but swing by the cafeteria for lunch first. By the time the kids get their meals, they may only have 5 or 10 minutes to eat (not to mention how hot they must be all bundled up!)

Regardless of what is being served, does this scenario allow children to have a calm and pleasant meal? (The how of feeding.) Does it allow them time to check in with their bodies to see if they are hungry or full? Do they learn to gobble the food quickly, and as much as possible because they won't eat again until school is done, maybe 5 or more hours later? Or are they so distracted that they might eat very little.

There is a lot of attention now (which is good) about improving the quality and variety of school lunches, but think also about the environment, the setting, what we are teaching children about food and whether we are supporting them in the best way as they form their relationships with food and eating.

M currently is in a Montessori program where the children sit at tables (they have set) with real plates, silverware, cups and napkins. They get about thirty minutes for meals which parents pack. I have to say I like this set-up, and wonder how this will change as her schools change...
What have your school meal experiences been? Could you eat in a snowsuit?

Friday, April 16, 2010

things that make me feel like a...

Here's some fluff for the weekend

Things that make me feel like a

  • pouring EVOO into a pan
  • sprinkling a pinch of sea salt onto something from a little bowl
  • using a rasp (?) for garlic straight into the pan
  • cooking anything with shallots instead of onions
  • capers
  • pulling roasted red peppers out of a jar
  • bay leaves
..."MOM"See full size image

  • saying, "Young lady!"
  • saying, "Give me strength" (maybe the list should be things that make me feel like my mom)
  • setting the table for dinner
  • picking up clothes off the floor
  • wiping butts
  • sticky hugs and kisses
  • getting drawings and presents like bouquets of dandelions
  • waiting with other parents to pick up my kid
  • guilt, oh, and fear (is that fever leukemia???)
(FYI, the things that made me feel like a "doctor" in the early days? Parking in the "physician parking lot," wearing a beeper and flicking a syringe in the air until a tiny bit squirted out!)

What little things mean a lot to you? What stereotypical things make you feel like a Dad, a Mom, a teacher, a lawyer, a chef, a sister...

Thursday, April 15, 2010

when you didn't grow up with family meals

I recently talked with nutritionist, mom and blogger Maryann Jacobsen from raise healthy eaters blog.

I'm impressed with her menu plans, and her thorough posts with practical advice on-raising healthy eaters. Many of my clients were not raised with family meals and feel overwhelmed and intimidated by planning meals and structure. (I was raised with family meals and still often feel intimidated with planning and cooking sometimes.) Maryann did not grow up eating family meals. I asked her a few questions.

What is most challenging about family meals?
I think it's the lack of confidence. For people like me who never learned how to cook, making meals for a family can be very intimidating. When new meals are complete failures it's tempting to throw in the towel and admit I'm just not good at this. But I know it takes time and failures are part of that process. I think the slow cooker is key for any new cook. Not only are the meals easy to prepare buy they usually end up tasting pretty good. It's a great place to start.

What is most fun/surprising about family meals?
How much fun I have with my kids at mealtimes. I complained a lot when my daughter started on finger foods and felt like I was spending my whole day feeding her. But then I realized that this is where we have the most fun. Now that I have two kids the kitchen table is definitely where we laugh and connect the most. It's such a great way to bring the family together. I realize now it's not about making perfect meals, it's about the connection. And since my kids are young (11months and 3 years) I plan to get really good at it by the time they are older and eating more.
I'm also surprised how much easier it gets with time. As I collect recipes that work for our family the whole process runs smoother.

Thanks Maryann! I was thinking about this on the way home with my bone-in pork chops the other day. I finally have it down, but I have overcooked, burned, under-cooked and had to reheat-even microwave food while we were waiting with full plates! Learning to cook is a process, and mistakes are inevitable. Enjoy the process, celebrate and repeat success, start slowly!

Start with what you are eating now. Get the structure down, the fun part of connecting with your family, then branch out and add more when you feel ready!

Monday, April 12, 2010

artichokes have hearts, but aren't animals: learning where meat comes from...

I've heard from three or four moms who are struggling with telling their kids about meat. One has a five year old who is now refusing to eat any meat. We recently navigated this at home, so here are some thoughts. (This is not research based at all, purely opinion...)
M likes meat (this was not always the case, as she was almost 3 before she really started eating the dinner type meats.) Several months ago she asked, "Mom? Where does chicken come from?" (This happened to be expensive free-range chicken, so I could answer with: "This is chicken that lived on a farm and now we are lucky to enjoy it for dinner. Isn't it yummy?" (I said this in a pleasant, non-apologetic way, very matter of fact and changed the subject while enjoying the delicious dinner.) M seemed to accept this, asked a few questions about the chicken dying (it was quick and the chicken didn't feel anything.) "Is that blood?" ("Yes it is. Some people like to eat that part." We were eating a roasted chicken with a red spot near the bone...)

We revisit the topic occasionally to establish that pork was pigs (we are thankful to the pork) that there are no eyes in your chicken or on the shrimp because most people don't eat that part...

By the way, we just had artichokes (twice in one week, she didn't eat any the first time, but did the second) and asked, "Are artichokes real?" Upon further questioning she said, "Well, they have hearts, are they alive like animals?" We chuckled and now call them "artichoke centers..."

The "what's this what I'm eating" talk went smoothly for us. Some things that I think helped...
  • we watch lots of nature TV (LIFE series, Walking With Dinosaurs) that shows the cruelty of nature sometimes. After a few tears shed over the baby Diplodocus getting eaten, we talk about nature, and how that's why the mommy lays so many extra eggs and how some animals get eaten by other animals.
  • we have long visited farms and orchards where there are turkeys running around (yes, that's what we eat at Thanksgiving...) This talk has been going on before she made the connection herself. Again, always in a brief, non-emotional, matter of fact statement.
  • On my part, there was no fretting, no apologizing, no explanations about how sad it is.
  • If I had to, I would kill a chicken to eat. We like eating meat as a family. I have made peace with it myself. I try to buy free-range products when possible and budget allows.
  • Friends tell me their older kids love to watch Bizarre Foods with local chef Andrew Zimmern. He is always so respectful of other cultures and their culinary traditions, and the kids get a kick out of the "yuck factor" of eating bugs. Might help?
A note:
Animal products like meat and eggs have things in them that are not in plant matter. You can do fine eating a vegetarian diet, but it is hard work to get all the nutrients growing kids need. I purposefully am not taking the time here to debate the merits of a vegetarian diet.

What have your experiences been on this issue? What specific phrases helped or harmed? Do you think being prepared in advance would have helped while you "ummed and ahhed" and stammered as you little Angel stared at you with quivering lips and tears in his eyes?

Thursday, April 8, 2010

pan pork chops and convenience foods

These are soooo good and pretty easy. I buy about 1 inch thick, bone-in pork chops.

Easy Peasy Pan Pork Chops: total time 20 minutes

pork chops-1 inch thick
garlic paste
olive oil
salt and pepper
chicken broth

Heat the pan with about 2 Tbspns olive oil to medium/high. Add chops. They should sizzle, but not pop and sputter or smoke. Might need to turn the heat down if it starts to smoke or burn. Cook about 6-8 minutes. put small amount of garlic paste on each chop (1/4 tspn) and smear it on with a butter knife. Flip, sear about 2 minutes. Watch that it doesn't burn. Add about 1/4 cup chicken broth. Cover and cook about 5 minutes. Can take off top to evaporate some of the broth. Remove chops onto plate and cover with foil. Scrape any brown bits off with a wooden spatula, add more broth if you want. Can add any juices from the pork back into the pan.Usually this is the right amount of time to cook the pork. A tiny bit pinkish is OK. If you're new to cooking, you might consider buying an instant read meat thermometer. It can take out the guess-work. Or, you can just cut one open and see if it's done- old school!

Also, use a non-stick pan, and tongs with silicone so they don't scratch the pan.

Yummy with veggie, mashed potatoes. (squash, green beans,brocolli) you can make plain sides and make a little extra sauce if you want!

We had them with Alexia frozen crinkle cut fries, sugar snap peas and salad last night. We were out late playing at the park and I needed to get dinner on the table. It's nice to have a quick protein like this pork dish and have one side in the oven while you put together a salad. I also just served cold, fresh sugar snap peas that we ate plain. It was liberating not to feel like I had to cook a veggie every night (like I had growing up.)

How do you do things differently than you had growing up? Are you simplifying or doing more?

Tuesday, April 6, 2010

what does the "dynamic" mean in Family Feeding Dynamics?

I don't know if this is cool with the blogging world rules, but I am excerpting my own quotes from an interview that's up right now at an awesome blog I love by Dawn Friedman called This Woman's Work. Check it out! She's the first person to ask me what Family Feeding Dynamics means...

"...The word "dynamic" also recognizes that feeding our families is a dynamic process, meaning it is flexible and changes with your family. For example, I had a hard time cooking the kinds of meals I thought I “should” during stressful times, whether we were moving, health reasons, or just being overwhelmed with the needs of an active infant and an over-worked partner. I relied more on take-out or pre-prepped meals at the time, but I “forgave” myself, meaning I let go of the guilt. I think that positive attitude helped me get back to feeling good about cooking more regularly again. So much changes with kids – their tastes, different feeding challenges depending in your child’s temperament and developmental stage, or your home situation with jobs, schedules etc. So you might eat dinner at 5:30 when your child is younger, but change to a seven p.m. dinner when your child starts after-school activities. It’s about being flexible, forgiving, fluid, and dynamic with your approach to doing your job with feeding."

Thanks for helping spread the word Dawn!

Sunday, April 4, 2010

don't let your child's doctor label your child "obese"

Recently I talked to a pediatrician who shared that any child with a BMI over 85% ("overweight cut-off") whether there is a health concern or not will get an official "diagnosis"code of overweight or obese. This means it will become part of the child's medical record list of diagnoses.

Once this BMI > 85% is recorded, that family gets a handout on how to do things better (that handout means the doctor can then bill for services on obesity counseling.) It has advice like: no more than 2 hours of TV a day, no more than 4 ounces of juice, and my favorite- one hour minimum of uninterrupted aerobic activity outside of school (how likely is that for most kids every day.) Strap a pedometer on your kid for 10,000 steps a day! That's like, 4 miles plus. Or, don't let your child be sedentary for more than 30 minutes at a time. So do you have a stopwatch while Timmy is doing homework and have him run laps in the basement?

I digress...

Why does it matter if your doctor "diagnoses" and codes/labels your child as "overweight" or "obese?"

1) your child is open to possible discrimination in terms of future employment, health insurance etc (not sure I believe totally that the health insurance reform will deal with the "pre-existing conditions.") There have been cases where children have been denied insurance because they were "overweight," and also "underweight."
2) labels and shame are not good motivation for positive change. (Are you listening Jamie Oliver?) In fact a child labeled as overweight or obese, regardless of BMI is more likely to feel flawed in every way, more likely to diet, practice disordered eating and gain weight. They are also less likely to participate in physical activity. Words matter.
3) once something is in the chart, it is hard to get out. Think about this. Before any physician, lab tech or nurse meets your child she will see that label on the list of diagnoses. It is well known that medical providers have a bias against "overweight and obese" patients.
  • CDC: "BMI is used as a screening tool to identify possible weight problems for children." and "BMI is not a diagnostic tool. For example, a child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings." I doubt that the diagnosis of obesity put into the chart is based on anything other than BMI which often mislabels the individual...
  • "BMI is not a reliable predictor of health": American Heart Association
  • Child BMI not reliably predictive of adult BMI: United States Preventive Services Task Force: "a substantial proportion of children under 12 or 13 even with BMIs > 95% will not develop adult obesity." (note, there is increasing predictability as BMI increases and the older the child is)
  • a child growing consistently, even at a high percentile is (by definition of the bell curve) larger than the majority of her peers, but to label her as "over" weight when it is likely a perfectly healthy weight for that child is wrong and implies a health risk that is likely unfounded.

At your next pediatric visit, if your child's doctor discusses your child's weight consider this:

1) ask that she do so without your child present
2) ask that the physician not code for or put the diagnosis of obesity in the chart unless there are further diagnostic tests (take in the above quotes.) Point out that BMI is a screen, not a diagnostic test.
3) ask to see the growth chart. If your child is large, but the growth is stable, there is likely not a problem. Ask your doctor to look at the rate of growth. They may not understand or accept this.
4) it is reasonable to look further if there is acceleration of weight gain, or your child is increasing in percentiles. There could be a medical problem, or getting help with feeding might help. (Read Your Child's Weight: Helping Without Harming, Ellyn Satter.) It could also be a pre-pubertal weight gain or otherwise normal pattern, but acceleration or deceleration on the growth chart warrants further eval.

if you get handed one of those handouts consider this

1) ask the physician if their children do one hour of uninterrupted daily exercise outside of school or wear a pedometer.
2) mention that if it's such useful advice, every child should benefit from it
3) point out that there is at best conflicting evidence about the efficacy of any of the interventions mentioned. Don't get me wrong, watching 8 hours of TV a day is not ideal for any child, but no studies have shown that recommending limiting screen time in the primary care clinic setting lowers BMI
4) if you are already doing the behaviors on the list, let them know

Just a couple of thoughts. What do you think? What have your experiences been with your children and getting labeled by the doctor?

Friday, April 2, 2010

New to spices and cooking? Neat new product can help.

I thought this was pretty clever. For $1.99 in the spice aisle you can pick up these McCormick Recipe Inspirations. The recipe comes with. If you've never tried a new spice or are new to cooking, this is a neat way to try new spices without spending a ton of money.

If you have kids, put each spice in a little bowl or pile on a paper towel and have the kids smell each one.

This card is for pasta primavera. Shrimp dishes and more. Experiment, have some fun! Maybe have your child or your picky partner chose one that sounds good.

Good luck!