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Stop Obesity Early

Parents, we have a problem! Obesity is a serious health concern in America, and it's a problem that can begin in infancy. About 15 percent of American children are overweight—almost four times the rate of 30 years ago. Twenty-five percent of all children who are overweight will grow up to be overweight as adults. The U.S. Centers for Disease Control and Prevention recently issued this dire, but true, warning: Obesity is an epidemic, and if the current trend continues, one-third of children born in 2000 will become diabetic later in life.

In response to the epidemic, I—along with the entire Sears Family Pediatrics practice—have developed an obesity-prevention plan called the Lifestyle, Exercise, Attitude, and Nutrition (LEAN) Program. Our goal is to help children of all ages become lean—which means having just the right amount of body fat for their individual body size and type—rather than skinny. And that begins at babyhood.

The first three years of a child's life is an important time for learning lean ways of eating and living. The health habits you instill in your child in this early, impressionable stage can last a lifetime. Babies are naturally round and plump, of course—an adorably pinchable layer of fat insulates your little one's body from the cold and elements. Fat stored in the early months provides fuel for the toddler years, when children are often too busy exploring their world to stop and eat. In fact, many babies are quite chubby by 4 to 6 months of age, but for most this extra fat will burn off when they start to crawl and walk. Here's what you can do to make sure those cute rolls of baby fat are left behind as your tot becomes a toddler.


Contributing editor William Sears, M.D., is the author of 32 books on childcare, including The Baby Book.

The 'Right' Diet

1. Breastfeed for as long as possible.
Research has shown that babies who are breastfed lean out sooner and are less likely to become obese later in childhood. Furthermore, the longer a baby is breastfed, the less likely she is to become overweight. Why? Babies naturally learn these healthy eating lessons at their mother's breast:

* Self-regulation. Knowing when to stop eating is a very important skill in weight management—and one that breastfeeding encourages. When your baby feels hungry, she fusses a bit or squirms into her favorite breastfeeding position. When she feels full, she stops nursing or slows down just a bit so she doesn't get as much milk. In short, she learns to trust her own hunger signals. Babies who learn to do this aren't as likely to overeat later in childhood.

* Food does not always equal comfort. After your baby is filled up on breast milk, she may let go of the breast, fully satisfied, or she may continue to suck for comfort, but in a slow way that brings her very little milk. As a result, she learns to associate the good feelings that come with sucking with the warm sensations of being held in your arms, not the feeling of having an overfull tummy.

2. Observe your baby's cues when formula-feeding.
If you're formula-feeding, you can still apply the lessons of breastfeeding to help your child develop a healthy relationship with eating.

* Follow his cues, not the clock, and offer feedings when he's hungry. A young baby's tummy is about the same size as one of his fists, which means that he does better with smaller, more frequent feedings.

* Allow him to decide when he's full. Don't urge him to finish the last ounce or half-ounce in the bottle if he's not interested. You don't want him to learn that feeling "stuffed" after a feeding is normal.

* Don't offer a bottle every time he cries. Try to find other ways to comfort him-music, massage, or rocking.

3. Limit the "terrible two."
The "terrible two" are what I call a duo of factory-made food ingredients that provide nothing but empty calories: corn syrup (or high-fructose corn syrup) and hydrogenated or partially hydrogenated oils (a source of unhealthy trans fats). You'll find one or both of these listed among the ingredients of many processed foods, including packaged cookies, crackers, bakery goods and other snacks. Foods that depend on "the terrible two" for flavor and texture teach children to prefer sweeter, fattier foods, putting them on the road to being overweight.

4. Avoid juice abuse.
Fruit juice provides vitamins and energy for children, but too much of it can take the place of more nutritious foods and drinks, such as milk, in a child's diet. Simply follow a few basic guidelines when it comes to giving your sweetie the sweet stuff:

* Limit the juice to no more than 4 ounces a day for infants 6 to 12 months.

* Stick to 6 ounces or less for 1- to 4-year-olds.

* Only buy juice that is labeled "100-percent fruit juice," and avoid juice "drinks," "cocktails," and "punches," which contain relatively little real fruit juice and lots of sugar. Also steer clear of beverages that contain artificial sweeteners, colors, and/or flavors.

* Even 100-percent fruit juice tends to be very sweet, so it's a good idea to cut your child's juice with at least a little bit of water. And when she's thirsty, offer a glass of water instead. If she just wants a sweet treat, substitute whole fruit for juice on occasion.

5. Feed your child a "right-fat" diet.
Fat isn't bad for babies, so there is no need to fear it. In fact, fats are the most nutrient-rich food, packing in the most calories in the smallest volume. Plus, for optimal development of the brain and other vital organs, infants and toddlers need to eat more fat, proportionally, than adults do.

In general, stay away from packaged "low-fat" foods, which are usually high in sugar and other sweeteners, such as corn syrup. Fat boosts the flavor of foods, so when the fat is taken out, manufacturers often add more sugar to make up for the lack of taste. No need to use skim milk either. From ages 1 to 2 (never give cow's to kids under 1), babies need whole milk. Remember it this way: No cow's milk under 1, whole milk until 2, and low-fat after that.

Focus on healthy fats for your baby, like those found in breast milk, infant formula enriched with the omega-3 fats DHA and ARA, salmon (I like to serve it once a week), egg yolk, and avocado. In our family, we call these foods "grow foods" because they promote healthy development of the brain and nervous system and help the heart and immune system grow stronger.

Set a Good Example

6. Focus on healthy carbs.
Kids don't need a low-carb diet, they need a "right-carb" one. Carbohydrates give children energy to play and grow, and the carbs they consume should be packed with fiber and/or protein. The types found in sweetened beverages and many packaged foods are empty; they don't have the protein, fat, or fiber needed to satisfy a child. As a result, children tend to overeat these types of foods, taking in too many calories and not getting enough nutrition.

The carbohydrates found in whole-wheat bread, cereals, and fruits and vegetables, on the other hand, tend to be more filling and less fattening (in the long run), and children have less of a tendency to overeat them. How to tell if it's a "right carb"? Look at the package label. If the food is high in carbs but contains very little fiber, protein, or fat, don't buy it.

7. Fill your toddler up with fiber.
If she's at risk for obesity, is already overweight, or is one of those children who just love to eat (and overeat), give her lots of fiber, which is filling without being fattening. High-fiber foods stay in the stomach longer, where they absorb water and take up a lot of space. As a result, kids (and adults too!) feel fuller and are less likely to overeat. Great sources of fiber for toddlers include high-fiber cereals, prunes, kidney beans, lentils, whole-wheat spaghetti and bread, pears, chickpeas, sweet potatoes and oranges (leave the white membrane on).

8. Less TV for tots.
Besides the worries about what young children may see on television, pediatricians are concerned that too much TV plays a role in childhood obesity. Children (and adults) don't burn many calories sitting in front of a television set. If they're snacking mindlessly on junk food while they watch, they'll take in far more calories than they use up. What's more, even the littlest kids are influenced by what they see on the small screen: Commercials teach them that eating junk food isn't bad for you—it's fun, and it's what the cool kids eat.

If you do let your tot watch TV, watch it with him. Play games and dance along with the characters on the program. Use commercials for junk snacks to educate your child about good food. He will believe you, not the people on TV, when you tell him, "That's yucky and not good for you. It doesn't help you grow."

9. Forget the "clean-plate club."
Don't insist that your little one eat every bit of food on her plate. Your job is to serve good, healthy food, and her job is to eat as much as her body tells her she needs. Remember, tiny children have tiny tummies, so don't expect your toddler to eat three large meals a day with nothing in between. They prefer to eat small amounts, more often. Making a child "clean her plate" lessens her trust in her own hunger cues. You want her to eat when she's hungry and stop when full.

10. Get your baby moving.
Most babies are very active on their own-keeping up with them can be a challenge. But some babies and small children are quieter. They prefer to watch and think rather than dive in and participate. Since they use less energy, they tend to put on weight, and the chubbier they get, the less active they become. If this sounds like your baby, do what you can to encourage him to be more active. The best way to do this is to get down on his level and play. Lie on the floor and let him climb all over you. Play "chase me" games around the house, or go outside to walk and run.

Finally, set a good example. If you're passionate about eating right and keeping fit, your child will pick up your good habits. You have more influence over him in the first three years of his life than at any other time. Take advantage of this, and teach him about healthy living by staying lean yourself.