March 2009

Debunking weight loss claims

Exercising with asthma

Packing goodness into lunch

Educating families about the body's response to physical activity

Engaging activities keep NEW Kids at the Y families motivated

Debunking weight loss claims

Brian Fidlin, PsyD, director, NEW Kids Program

It is frightening how many people think this statement is possible. Our clinical staff members have seen countless families who have fallen prey to the weight loss scams. Who wouldn't love to see results while putting in little to no effort?

The reality is losing weight is difficult. Keeping the weight off is even more difficult.

Upon arriving at the NEW (Nutrition, Exercise and Weight Management) Kids^TM program, many patients expect to see significant weight loss (50 pounds or more) in a very short period of time. Some families are shocked to learn that weight loss takes so much time. Yes, I know that people on the Biggest Loser show have lost 10 pounds or more in a week – but that is reality TV, not reality.

NEW Kids has helped many individuals achieve significant weight loss through hard work over time. But, as the saying goes, "You can lead a horse to water, but you can't make it drink."

When considering a referral to the NEW Kids program, we ask that you consider:

• The child's level of motivation.

• The caregiver's level of motivation.

• The family's ability to make and maintain changes.

This is not meant to discourage you from referring an individual to the NEW Kids program but to remind you that we too, need to have realistic expectations.

Exercising with asthma

Michele Polfuss, APNP, Children's Hospital of Wisconsin

Without a doubt, asthma is one of the most common ailments impacting our pediatric population today. In fact, asthma accounts for a loss of 10 million school days and costs caretakers $726.1 million due to work absences each year (Sharma and Gupta, 2009).

A qualitative study that examined urban children with asthma concluded that many parents worried about their children taking part in physical exercise. As a result, these parents would restrict their children's physical activity. This was thought to be due to lack of knowledge or misunderstanding of medical instructions (Glazebrook, et al 2006).

It is easy to see how misunderstandings surrounding asthma could inhibit weight loss in a child. As medical providers, we need to take time with our asthma patients to educate them on the need for physical activity. We also need to make sure our patients understand that asthma should not prevent them from participating in physical activity.

As with all individuals, if a child doesn't like a particular physical activity, he or she will try to avoid it. Proper medication using the stepwise approach for managing asthma, environmental control, management of comorbidities, anticipatory guidance/education and encouragement to adhere to asthma regimen is imperative to help promote active lifestyles.

Additional resources:
A resource for children about asthma and physical activity from the Centers for Disease Control: http://www.bam.gov/sub_physicalactivity/physicalactivity_meetchallenge_1.html

Resource for health professionals from the National Heart Lung and Blood Institute with information to share with schools, asthma management, action plans and more that includes free handouts and education materials: http://www.nhlbi.nih.gov/health/prof/lung/index.htm#asthma

References:

Glazebrook, C, McPherson, AC, Macdonald, IA, Swift, JA, Ramsay, C, Newbould, R. Smyth, A. (2006). Asthma as a Barrier to Children's Physical Activity: Implications for Body Mass Index and Mental Health. Pediatrics, 118(6), 2443-2449.

Sharma, GD and Gupta, P (2009). Asthma. Retrieved from: http://emedicine.medscape.com/article/1000997-overview on 2/12/09

Packing goodness into lunch

Michelle Smith-Beckley, RD, CD, Children's Hospital of Wisconsin

Many schools are taking steps to improve the quality of student lunches. Many schools are limiting fats and sugars, including fruits and vegetables and avoiding highly processed foods whenever possible. However, some students avoid the school lunch because of a wide variety of descriptive adjectives that tend to be less than positive.

If a child prefers to take a packed lunch to school, check with the family that they are following these guidelines:

1. Always include a serving of fruit. Ideas include any fresh fruit, canned fruit packed in its own juice or dried fruit.

2. Always include at least one vegetable serving. Fresh vegetables cut into fun shapes makes them more appealing. Include a small container of ranch dressing or salsa for dipping.

3. Include a source of calcium. The best and easiest option is to have the child purchase white milk at school. This will include calcium and vitamin D, avoid the added sugar of flavored milks, and the school will keep it cold. If the child will not drink white milk, suggest low-fat yogurt or string cheese.

4. Variety in the entree, please! The entree is what kids will complain about being bored with. Get creative with the sandwich: Cut it into different shapes. Use different breads such as tortilla wraps, pita bread, English muffins or mini-bagels. Parents also can substitute a salad topped with cooked chicken, tuna or a hard-boiled egg for the traditional sandwich.

5. Lunch does NOT need dessert or chips! Remind parents they do not need to include a sweet treat or chips with lunch. Kids occasionally may enjoy those items but should not come to expect them every day. Parents should ask, "Is the food I am placing in my child's lunch going to help their health or make them happy?" To help brighten a child's day, parents may include a personal note, favorite sticker or pencil instead.

Keeping these five basic rules in mind will help keep brown-bagged lunches healthy and fun to eat.

Educating families about the body's response to physical activity

Stacy Stolzman, MPT, Children's Hospital of Wisconsin, and Colleen Dolan, Exercise Science Senior Intern, Marquette University

Physical activity can improve body composition, or the ratio of fat mass to muscle or lean mass, by decreasing body fat and increasing muscle mass. Muscle requires more energy to sustain itself than fatty tissue. As a result, more energy will be burned at rest. Bones also increase in strength and become stronger to allow for greater levels of exercise.

Teach your patient families that the internal benefits of physical activity include a decrease in:

• The resting heart rate. Decreasing the resting heart rate reduces the heart's workload. It has to beat fewer times to do the same amount of work.

• Effort needed for activity. A lower heart rate means that the amount of effort needed for an activity is decreased.

• Work capacity. By reducing the effort needed to do an activity, a child's capacity for activity increases. Now, a child can climb up five flights of stairs using the same effort that it once took him or her to climb up one flight of stairs.

An exercise program is only half of the equation. A proper, healthy diet and lifestyle must accompany physical activity to see positive results. Above all, patience and diligence are key to integrating physical activity into a daily routine.

Engaging activities keep NEW Kids at the Y families motivated

Erin Ruenger, YMCA of Metropolitan Milwaukee

NEW Kids a the Y is a 12-week program that focuses on eating habits, physical activity and techniques designed to help families develop healthier habits. The key for many families who participate in the program is to find ways to keep them engaged after the program ends.

Interactive demonstrations allow the families to learn more about their goals. One family brought in cereal bowls from home to see how much they typically eat. This was not only an eye opening experience but resonated beyond how much they ate for breakfast. They learned the importance of portion control and applied it to their daily lives. The family also began to read labels on food packaging and monitored what they ate when going out to eat. Instead of finishing an oversized meal, they remembered what they learned and boxed up a portion of their meals to save for later.

The NEW Kids at the Y program supports families and works to integrate their behavioral changes with practices at home. When the program includes engaging activities, a motivated family and supportive staff, families continue their lifestyle changes beyond the time the program ends.