December 2008

What messages are we sending?

Get the low-down on lipids

Fitting in fiber: Tips for parents

Getting your groove on: Video game systems that get you up and moving

Healthy Lifestyles Program helps parents get on the path to good health

What messages are we sending?

Brian Fidlin, PsyD, program director, NEW Kids

Do you allow clinic staff to take a smoke break in front of your clinic where patients enter? Of course not. Smoking is not healthy for families and it sends the wrong message to patients and families who may happen to see them. Consider another scenario. How do you feel about candy dishes on desks and staff drinking regular soda and eating doughnuts in the break room?

Parents and children who hear us emphasizing the messages of healthy eating and daily physical activity will quickly ignore those messages if they do not see examples of healthy living.

We need to create an environment that demonstrates that we do what we teach. Here's how you can help create a healthier office environment:

• Start the discussion. At your next staff meeting, bring up the topic of what messages we are sending to families. While most of your staff members are concerned about the obesity epidemic, they may have some strong feelings if this means doughnuts might not be allowed in the staff break room.

• Examine your clinic policies around what items are allowed in patient environments or patient-observable environments. If none exist, consider developing policies around this topic.

• Create a place for staff to integrate physical activity into the day. After sitting in front of a computer screen for a few hours, who couldn't use a stretch break? Encourage staff members to use their lunch breaks to walk around the building, or even around the block. Be creative – you may even consider adding a Nintendo Wii^TM to your staff break room.

• When planning the next office potluck, make sure to include fruits, vegetables and low-fat, low-sugar items.

While these changes may be difficult to make at first, it allows us to send the right messages to the children and families we serve.

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Get the low-down on lipids

Laure DeMattia, DO, Children's Hospital of Wisconsin

The Bogalusa Heart Study and the Pathobiological Determinants of Atherosclerosis in Youth Study have helped us understand that atherosclerosis, or hardening of the arteries, begins in childhood. In addition, pathology studies have shown that an increasing number of risk factors such as elevated LDL, hypertension and obesity are associated with increased risk of fatty streaks and fibrous plaques in the aorta and coronary arteries.

The American Academy of Pediatrics updated its previous recommendations regarding screening and treatment for cardiovascular health. The organization now recommends that:

• All children older than 2 years should be using low-fat dairy products.

• Children between the ages of 12 months and 2 years who are overweight or at higher risk due to family history of obesity should begin using reduced-fat dairy products.

Here is how the American Academy of Pediatrics recommends screening and treating cardiovascular health:

• Children and adolescents at higher risk of cardiovascular disease, who have a family history of premature cardiovascular disease or dyslipidemia, should have a lipid screen starting at age 2 and no later than age 10. If the test is normal, children should be retested in three to five years. If the test is abnormal, implement dietary/physical activity changes. Recheck in three to six to months.

• For overweight and obese children with an elevation of triglyceride and/or low HDL, diet and exercise is the first-line approach to treat these lipid abnormalities.

• If LDL consistently is greater than 190 and the child is 8 or older, consider treatment with a pharmacologic agent.

• If LDL consistently is greater than 160 and there is a family history of early cardiac event or more than two risk factors, consider treatment with a pharmacologic agent.

• If LDL is greater than 130 and diabetes is present, consider treatment with pharmacologic agent.

References:
Daniels, SR, Greer, FR, and the Committee on Nutrition. Lipid Screening and Cardiovascular Health in Childhood. Pediatrics. 2008; 122: 198-208

Newman WP III, Freedman DS, Voors AW, et al. Relation of Serum Lipoprotein Levels and Systolic Blood Pressure to Early Atherosclerosis: The Bogalusa Heart Study. New England Journal of Medicine. 1986; 314(3): 138-144

McGill HC Jr., McMahan CA, Zieske AW, Malcom GT, Tracy RE, Strong JP. Effect of Nonlipid Risk Factors on Atherosclerosis in Youth with Favorable Lipoprotein Profile. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Circulation. 2001; 103(11): 1546-1550

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Fitting in fiber: Tips for parents

Jennifer Allen, RD, CD, Children's Hospital of Wisconsin

The NEW (Nutrition, Exercise and Weight Management) Kids^TM Program often recommends adding fiber to the diet as a weight management tool. This is an important topic to cover with families that have done well with the 3-2-1-0 Blast Off to a Healthier Family! Program and are ready to take the next step in achieving their weight management goals.

Fiber is a nondigestible carbohydrate. It burns calories being broken down but does not ultimately contribute to weight gain. The best sources of fiber in the diet are fruits, vegetables and whole grains. Although the fiber in these foods is not digested, it makes us feel full. When more fruits, vegetables and whole grains are added into the diet, they displace other foods that are more concentrated sources of calories such as refined carbohydrates, meats and dairy. While meat, dairy and other carbohydrates are part of healthy diet, they typically are eaten in excess.

Your patients may ask about fiber pills or fiber-containing powders such as Metamucil^R and Benefiber^R as a way to boost their fiber intakes. These products are great tools for certain patients, but don't lead to the adoption of healthy eating habits that will promote long-term weight loss. Pills and powders also are the most expensive way to add fiber to a diet. Your patients could easily spend $4 a day getting their recommended 25 grams of fiber from supplements.

Download a handout outlining quick shopping tips to help parents provide higher fiber food options for their children. Remind families to gradually increase their fiber from food choices, while drinking enough water throughout the day.

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Getting your groove on: Video game systems that get you up and moving

Healthy lifestyles program helps parents get on the path to good health

Sydney Hofer, YMCA of Metropolitan Milwaukee

The NEW Kids at the Y Program is a great way for families to learn to make healthy choices in their lives. Once the program ends, it sometimes is hard for families to maintain these changes.

Making permanent lifestyle changes to improve health can be challenging. Most people start out strong, then falter somewhere along the way. Whether it is losing weight, exercising, reducing stress or curing an undesirable habit, starting and sticking with a program long enough to affect change is a major challenge.

The YMCA's Healthy Lifestyles Program can help. Healthy Lifestyles is a 10-month program that uses behavior science techniques developed by Stanford University, as well as group dynamics and one-on-one coaching to help adults achieve and maintain personal goals.

Kids look to their parents to be role models in all aspects of life. When parents make good decisions and take steps to improve their health, they set a great example for their kids. Healthy Lifestyles is a great follow-up for parents who have been through the NEW Kids at the Y Program.

Healthy Lifestyles currently is offered at the Downtown, West Suburban, Rite-Hite Family and Southwest YMCAs. Learn more here.

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