Getting Fit, Bit by Bit
Small Changes Pay Off Big for Family Health

Don't tell kids they need to exercise. Instead, plan fun family activities like walking, cycling or playing sports together.

By Christina Elston

Something has to change. One-third of American children are obese or at risk of becoming obese, according to federal health officials. These kids are in danger of developing diabetes, heart disease, osteoarthritis, cancer and a host of other health problems. And things will only get worse unless families do something.

But what should we do? The words "diet" and "exercise" sound more like difficult, unpleasant chores than upbeat, healthy changes that kids and adults will enjoy. Just where do we begin, and how do we stick with it?

The answer lies in making small improvements, a little at a time, and in changing the way we look at and respond to our children's lifestyles.

Change Your Focus

Start by viewing diet and exercise in a more serious light.

  • "Nutrition and activity decisions are really health decisions," says Sandra G. Hassink, M.D., editor of the American Academy of Pediatrics' A Parent's Guide to Childhood Obesity. Putting these issues in the "health realm" will give you the proper perspective.
  • Now, stop counting calories and look at the big picture. When feeding your family, focus on healthier food, rather than fewer calories.
  • "Basically, people want to eat until they feel satisfied," says David Katz, M.D., director of the Prevention Research Center at Yale University School of Medicine. "If you improve your food choices, it will take fewer calories to feel satisfied."
  • Offer more fiber, fresh fruit and vegetables; cut back on processed, sugary or fatty food. This way, your meals will be more filling but without the excess calories from sugars and fats.
  • Emphasize healthy activity over burning calories. "Exercise isn't really about burning excess calories," says Robert Lustig, M.D., director of the Weight Assessment for Teen and Child Health (WATCH) program at the University of California - San Francisco. "After all, you have to jog for 20 minutes to burn off two chocolate chip cookies."

  • Instead, use daily physical activity and a healthy diet to keep insulin levels low. Low insulin levels mean that your body has more available calories to burn, and you won't need to eat as much.
  • Target your efforts toward the entire family so no one feels singled out. Everyone will benefit from good nutrition and healthy activity.
  • Work toward small changes that become habits, rather than a dramatic diet-and-exercise makeover. "Small changes done every day really will make an impact," says Hassink. Stop bringing soda into your home; start walking the kids to school every day, etc.
Change Your Motivating Tactics

If you let on that you're overhauling the meals your kids eat and the daily exercise they get, they're likely to dig in their heels. So change the way you approach it.

The case to be made to a kid is not diabetes prevention, Katz says, "it's having more fun later today." Show your children that good food will give them more energy, and that being active can be fun.

Another activity motivator for many children is extra time with Mom or Dad, says Dana Weintraub, M.D., of the Center for Healthy Weight at Lucille Packard Children's Hospital at Stanford University. Entice kids with an after-dinner family walk or a backyard soccer game. Being on a team with other kids is also a big draw. "When we ask the kids what they enjoy about sports, 'new friends' is up there very high," Weintraub says.

Take a democratic approach when it comes to food issues, Katz advises. "You need to engage your kids so that they do not sabotage this effort," he says. This means negotiation, and even taste tests, so that you can all agree on new food choices. Otherwise, your kids might just sneak their junk food in elsewhere.

Change Your Shopping Habits

Shop smart and improve your family's diet one "food category" at a time, says Katz. You can find better breads and cereals, better dairy, and even better snacks than what you may be eating. "In every category," Katz explains, "there's a range of choices in terms of nutritional qualities."

Most of us eat too much fructose (sugar) and too little fiber, says Lustig. He offers two simple rules for healthier shopping:

1. Choose only foods with 3 grams or more of fiber per serving.

2. Buy only beverages with five calories or less per serving, with the exception of skim milk.

Sugary drinks are a major problem for many families, according to Jaimie Davis, R.D., Ph.D., a researcher at the University of Southern California's Keck School of Medicine. Sodas, sports drinks and even fruit juices are stumbling blocks, Davis says. "If kids could learn how to drink more water, it would have a big impact on obesity."

To ease children away from sugary drinks, Davis suggests watering down sports drinks, or mixing whole fruit in the blender with a little water to make high-fiber juice.

High-fiber foods will fill your family up faster, and keep the body's insulin levels lower so that less sugar is stored as fat, says Lustig. To get more fiber into your diet, move away from processed and fast foods. "Fast food is fiber-less food," he says.

Instead, look for "whole-grain" breads, pastas, tortillas and breakfast cereals to gradually substitute into your family's diet. "Don't go from Cocoa Pebbles to Fiber One," says Davis, who suggests mixing a higher-fiber cereal with a cereal your child likes, and gradually increasing the high-fiber portion.

You can also increase your family's intake of fiber-rich fruits and vegetables. Mix veggies into pastas with sauce, or add them to homemade pizza. Add chopped vegetables to salads with your child's favorite dressing. "Even if they're covered in ranch, you're still getting the fiber," Davis says.

As you move away from processed foods with hidden sugar - which prime the palate to prefer sweet tastes - your family will begin to prefer healthier foods, according to Katz. For each single-food substitution (for example, whole-grain bread for white bread) you will likely see a preference change in a week or two.

"If you commit two weeks, you'll be in the clear," Katz says.

Change Your "Screen Time"

Increasing physical activity usually means getting the family off the couch:

  • Cut down on screen time gradually. Aim for a two-hour limit on screen time for TV, video games and computers. "You don't need to take a big leap," Hassink says. "What you need to do is take little steps away from that television set."
  • Get your kids into structured after-school activities - even if they aren't sports related. It will help curb their access to TV and food, Hassink says.
  • Get outside for a while every day. Go out with a purpose: play catch, take a walk, or go for a bike ride around the block. "Kids are going to get bored if they're just sitting around," says Davis.
Since kids tend to be active in short bursts, give them chances to be active throughout the day. "If you look at how kids are active, they're active intermittently," says fitness specialist Stephen Ball, Ph.D., a professor of exercise physiology at the University of Missouri - Columbia. "They might run hard for a few minutes, then they might sit down and rest for a few minutes. That's OK."

Kids need several hours a day of less-intense activity, Ball says. He and colleagues have created MyActivity Pyramid as a guideline of physical activity goals for kids. It's similar to the food pyramid we're all accustomed to for nutritional requirements. The base of the activity pyramid is dedicated to "everyday activities," such as playing with the dog or helping in the yard.

"These are just things that you would normally do, but you're not sedentary," he explains. "These are things that we need to be doing every day."

Next come active aerobic and recreational activities like sports, to be done three to five times weekly; then flexibility and strength activities, such as yoga, to be done two to three times a week. The pyramid is capped with an "inactivity" level, and the accompanying advice to "cut down."

Change Their Minds About Sports

Families also need at least 60 minutes a day of more intense activity, and team sports can be a great way to get it. Unfortunately, lots of kids - especially those who struggle with their weight - have had negative experiences with sports.

"But just because kids say they don't like sports, doesn't mean they aren't going to like them in the future," notes Weintraub. If you can find your kids a positive sports environment, it will often become a positive experience for them.

Check with your child's school, organizations such as the YMCA, or your local parks and recreation department for options in your area. Talk with other parents about activities their children participate in, and the experiences they have had. "Ask whether [the sport organizers] emphasize positive experiences for kids, and equal play time," Weintraub suggests.

Look for a leader who doesn't mind if kids need to ease into drills and full participation. Some kids who have been really inactive might not be physically up to full participation at first, she says.

For kids who prefer individual activities, the options include dancing, biking, jump rope and individual sports such as gymnastics. The key is to let the choice of activity be your child's.

Because children who don't have many chances to be active are often bored, most will appreciate being away from the TV. They'll even notice positive changes after a couple of weeks.

"You relieve the boredom, and they like it," Hassink says. "They report that they feel better. They can do more."

And because they will be healthier, they'll likely have a lot more living to do.

Christina Elston is a senior editor and health writer for Dominion Parenting Media

On the Web Resources:

  • Body Mass Index (BMI)  - This Centers for Disease Control Web site offers an explanation of BMI, BMI calculators for children and adults, and nutrition and weight resources.

  •  - This site of the director of the Prevention Research Center at Yale University School of Medicine has information about his books on nutrition, as well as two school-based programs for kids - "Nutrition Detectives" and "ABC for Fitness."
  • MyActivity Pyramid  - The University of Missouri Extension's visual guide helps kids ages 6 to 11 to learn about increasing activity in their daily lives.
  • Steps to a Healthier You  - The U.S. Department of Agriculture's new food pyramid also includes dietary guidelines and a way to customize a plan to fit your child's nutritional needs.
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