The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Thursday, March 01, 2007

What Happened to Childhood?

It's nothing like I remember. I remember walking to school-- just a few blocks to elementary school and less than 2 kilometres to high school. I remember playing outside all day, making up games with other neighbourhood kids until mom called us in as it got dark. I remember finding pop in the fridge and knowing that meant that mom and dad were having people over.

At the risk of sounding incredibly old, being a kid is entirely different now. Parents drive kids to school even just a few blocks away. Unstructured, unsupervised play time seems to have gone the way of Crystal Pepsi and cassette tapes. It's just... different. And those differences are just the tip of the iceburg.

Child obesity has been in the news a lot lately. Along with the disturbing statistics are the discouraging findings-- dieting and food restriction in childhood and adolescence not only fails to result in weight loss, but actually results in a long term increase in BMI. So what can we do that will make a difference?

There are 5 very specific factors which have been shown to accurately predict a child's risk of obesity. The problem is figuring out how and when to identify these factors. Should we be asking about them at the 18 month well baby visit? Should they be added to our Rourke sheets? If we wait until 3 years, is that still too early? Will it be too late?

Here are the 5 factors:
  • Consumption of more than one 6-8oz sweetened beverage per day (coke, Gatorade, fruit juices... anything sweet)
  • Media time (including TV, computers, video games... even cell phones qualify)
  • Parental presence at dinnertime (one or both parents sitting down with kids to eat)
  • Unscheduled active time (time spent being active that does not include formal team sports)
  • Fast food consumption more than once a week (regardless of type-- Subway sandwiches vs. chicken fingers vs. Big Macs)
Some of these (such as the fast food) are pretty predictable. Others, such as parental presence at the evening meal, are a little surprising. And no doubt just reading these made a lot of parents out there feel pretty darned defensive. But before I get a flurry of comments defending their fast food eating/juice drinking/absence at mealtimes, I need to remind people that these are not rules-- there is no God of obesity looking down on us with a checklist and cursing children who don't follow them with poor health and excess fat. These are guidelines for how to reduce your child's risk, and a place to start examining old habits if your child is starting to fall into the 'overweight' category.

I don't claim to have all the answers. And maybe I'll be more sympathetic when I have my own children to feed. But right now, I cringe whenever I hear a mom complain that her picky toddler won't eat anything but McDonald's french fries. Why does a 2 year old know what McDonald's french fries taste like? I can't help but feel slightly judgmental (and then immediately guilty for feeling judgemental) when parents bring an obviously overweight child into my office. Unless this child is independently wealthy and buying their own food, the responsibility falls squarely in the parents laps. They control what is available to eat in their house. And, for better or for worse, the parents activity level is the biggest predictor of how active their kids will be.

I don't claim to have all the answers. I'm certainly not immune to concerns over body weight-- it's been at the forefront of my mind for as long as I can remember. I remember being 8 or 9 years old and refusing to wear a purple striped top because I believed it made me look fat. I don't want that for my kids, and I wish I knew how I could ensure that weight won't be a problem for them. I know I can't guarantee it, but I'll do the best I can by not having unhealthy foods in the house, being active as a family, limiting computer/TV/video game time and making sure that Mr. Couz or myself is there to sit down to dinner. And when my patients come in asking me to put their chubby kids on a diet, I'll give them the same advice. I just hope that will be enough.


Blogger Indian Medic said...

Reading the post reminded me of the show on Discovery channel, ‘Honey we are killing the kids!’

The five factors about seem to sum it up. Parents don’t realize when their kid’s weight creeps up on them.

When I tried suggesting to my cousin that her 3 year old daughter, dotted upon by the whole family and considered cute, cuddly and ‘healthy’ was on her way to the Obesity, I had to endure the scorn and anger of everyone from the kid’s grandmas and grandpas to uncles and great-aunts.
Luckily enough, the mom took my advice and took the necessary steps to rectify things

2:55 AM

Anonymous Anonymous said...

If the parents are active and eat balanced meals, then so will the children. It is much harder for the children to be obese if they are playing outside with the parents and there is no junk/fast food in the house.

4:25 AM

Blogger phdatc said...

I have enjoyed reading your blog. I am a member of the medical community although from the academic standpoint. I find it astonishing when my friends with young children discuss "Cookie Crisp" ceral as though it had any place in a morning breakfast. And if you suggest that this may not be the best choice, they get defensive. But I truely beleive the defensive response is only guilt in another form.

Keep talking to those parents Dr. Couz.. keep fighting the good fight.

9:59 AM

Anonymous Anonymous said...

I can't help but feel slightly judgmental (and then immediately guilty for feeling judgemental) when parents bring an obviously overweight child into my office.

Do you read the junkfoodscience blog? You should. Please keep in mind that even before recent increases in the prevalance of obesity, at every point in human history, some people were fat. Not because they were eating too much junk food, not because they weren't active enough, but because human weights, like heights, fall on a bell curve. So it's presumptions to assume that every overweight kid presenting in your office is that way because of poor parenting.

10:56 AM

Blogger Couz said...

I don't assume that every child who is obese is that way due to poor parenting. But when the incidence of obesity has risen as much as it has in north america over the past 20 years, calling it 'the end of the bell curve' is denying there's a problem.

And when I see an overweight child whose family eats together, avoids junk food and fast food and is active together on a regular basis, I'll let you know. Hasn't happened yet.

12:16 PM

Anonymous Anonymous said...

And when I see an overweight child whose family eats together, avoids junk food and fast food and is active together on a regular basis, I'll let you know. Hasn't happened yet.

I wonder, how many of the thin children you see do all those things as well?

12:23 PM

Anonymous anon2 said...

Great post.

To respond to the latest comment, I'd personally say that I think a fair number of the thin/non-overweight, non-obese kids probably do have equally poor habits, but some are genetically predisposed to be thinner. They may run into other issues, like dental caries, diabetes or weight issues down the road if their habits are established into adolescence and adulthood.

We all know people who seem to be able to eat anything, be inactive and still maintain a normal BMI, but it's definitely not universal. Also, are they really healthy? Kids especially need good nutrition and activity as they grow, and we know that there are benefits of good nutrition and activity beyond weight alone.

7:32 PM

Anonymous Anonymous said...

Also, are they really healthy? Kids especially need good nutrition and activity as they grow, and we know that there are benefits of good nutrition and activity beyond weight alone.

I agree with you entirely. This is why I cringe when I read posts such as this one about the attitudes towards overweight kids. If we want to help ALL kids, then we should focus on habits rather than weight. We should ask EVERY kid and parent about eating well and keeping active, and not make assumptions based on the size of the kid, becuase all that does is tell thin kids that unhealthy habits don't hurt them because they are thin anyways, and stigmatize fat kids and put them into a position where at a young age they are already stressing out about their weight -- something that isn't likely to help them at all.

7:53 PM

Anonymous Anonymous said...

"Why does a 2 year old know what McDonald's french fries taste like?"

You Go Girl! Tell it! Amen!

(I remember my horror at my usually health conscious mother sneaking my 1 yr. old an oreo...they think it's cute.)

Your sentence at the top should be plastered on billboards.

8:41 AM

Blogger Bohemian Road Nurse... said...

Whenever I am grocery shopping, I see quite a few parents giving their kids cookies and treats in order to help them "behave" while in the store. I think that sets a bad habit. (And when I was a little girl, I was expected to behave without treats...)

4:03 AM

Anonymous jojomd said...

Great post Couz. As you know I don't do a lot primary care but my answer to your question about whether we should be asking about those five factors regularly is: Absolutely.

10:24 AM

Blogger Foxy said...

Very interesting. I am constantly horrified by parents who claim their kids just won't eat anything but [insert junk here]. It's not like the kids can buy it.

11:36 AM

Blogger Liana said...

Anonymous 7:53, I'm pretty sure Couz follows the guidelines and asks all parents about their kids' diet/activities at annual check-ups.

I think you might be the one making assumptions here...

7:42 PM

Blogger mrbunsrocks said...

Couz, I'm with ya. It's heartbreaking to see so many obese kids out there. I've seen way too many kids who only eat chicken fingers, hot dogs and mac&cheese. I just don't plan on feeding those things to my kids on a regular basis - I don't really eat that way, so why should my kids? They'll eat what I eat or they'll be awfully darn hungry. I think that a lot of the times, parents are SUPER busy and just don't have the time (or the energy, once they find the time) to stand up to their kid, whom they probably don't see as much as they would like.

I'm thinking it's probably easier to turn mealtime into less of a battle than it is to make your kid sit in front of a cold plate of whatever for hours on end. I just don't think that the easy way is the route to take on this one.

I like this post - I mean, sure, there are people who are genetically more predisposed to be larger, but not 2/3 of the population......

3:08 PM

Anonymous MLO said...

I wish I could find it, but recently I saw a study that indicated that exposure to certain hormones prenatally predispose some people to be overweight. It was near a study about precocious pubescence as well.

I have to wonder if there isn't something underlying the problem of obesity, oh, like High Fructose Corn Syrup and Corn, Soy, Wheat, and Milk products in EVERYTHING kids and adults eat. I'm always amazed at the amount of stuff people eat over and over again without realizing it.

Now, granted, I'm way more aware of food due to my allergies (the real kind), but it can't be good for any omnivore to eat the same things repeatedly.



3:23 PM

Anonymous Michael McKinnon said...

Hi: I'm a writer with the Medical Post and am interested in speaking with you about your blog. Please email

2:36 PM

Anonymous Anonymous said...

Yes, kids and adults need to eat healthy, nutritious food (and what those foods are, are a topic of another discussion). I would like to suggest that our inability to turn off our TVs and get off our duffs is a big culprit. We got rid of our TV a number of years ago. It's amazing what a change to our life it's had -- in terms of our relationships and our health.

11:23 AM

Blogger medstudentitis said...

To the person who said we should focus on all kids and not just overweight ones (anon 7:53), that's what is recommended, that is the meaning of prevention. If we only took to heart the 5 measures when it comes to overweight kids, we'd never get anywhere but keeping these things in mind for ALL kids will prevent a significant number from becoming unhealthy and obese. An ounce of prevention is worth a pound of cure.

4:32 PM

Blogger Fresh Hell, Texas said...

I'm the mother of a teenager, I've had plenty of time to make mistakes both big and small but I must admit the control issue stil baffles me.

Even at 14 my kid does not get to dictate the menu. Even with picky eaters, when only healthy choices are given, then only healthy choices can be selected.

I recently had a friend ask me how I keep soda out of the house. I told her I don't buy it. End of story.

Same with clothing and so on. I take input from my child but the final word is mine. I take that responsiblity very seriously, even when it makes my child unhappy.

4:55 PM

Anonymous Anonymous said...

I've just gotta say that the flip side of forcing your kid to eat what you eat could be picky adult eaters. I don't have kids and I plan on only letting them eat healthy, but I think I'm going to have to be careful not to close their minds off for good on food options by having them form negative memories about ceratin foods.

My boyfriend is pretty picky now because he remembers being forced to eat multi-grain bread, fish and onion when he was little, and now won't even try these foods. That's not healthy for him in adulthood either.

5:08 PM

Anonymous jen said...

Anon 508: It's all in your bf's attitude now. I was forced to eat multigrain bread (only kind in the house with french bread as a treat for french toast), and whatever was on the menu for everyone else in the house. Now most of that stuff are my favourites. I can't imagine buying white bread (except for French toast, but really how often does that happen!?)

The only exception was prior to turning 12/junior high anything with a really strong/spicy flavour it was okay to only have to try one bite. I;ll tell you sometimes that one bite of curry (or steak & kidney pie or pad thai or whatever) sat on that plate for a loooooong time and was finally eaten with the biggest mouthful of rice imaginable.

The family dinner factor makes so much sense. For me the gradual change over the junior high years was with the implicit message "you're maturing, your tastes will mature too, no more coddling". There were no verbalized rules, but really who wants to be 16 years old saying "I'm 16 so only 16 peas!!!" Everyone is going to have stuff that they find REALLY unpalatable (brussel sprouts is the classic) but multigrain? puhleez. Next time your bf is picky just assure him that he's 32 (or whatever) so he only has to eat 32and3quarters bites!!!

10:28 PM

Blogger SeaSpray said...

When my neighbor worked really long days and had to bring and pick up her kids from daycare as well she said that McDonalds was considered one of the food groups in her house.

12:26 AM

Blogger Couz said...

Anon 5:08, I have to second what Jen said. In fact, it's been shown that much 'picky eating' can actually be traced back to NOT ENOUGH exposure to novel foods in childhood, therefore not giving children the opportunity to expand their palate. Sure, some tastes are acquired (and some aren't-- I still don't eat liver) but others come with repeated exposure.

I know a girl who grew up in a traditional German household where meals always consisted of meat and potatoes-- the only spice she was exposed to was table salt. Now as an adult, she doesn't eat most vegetables, anything spicy, any 'ethnic' food, any fish, any seafood-- exotic food for her was Italian. She blames the fact that she grew up on meat and potatoes. Anecdotal, but interesting none-the-less.

12:59 PM

Anonymous Anonymous said...

Yeah, I see your point. In fact I know someone like that too. I think the key is moderation. Forcing a kid to eat something they really hate (like fish) can create permanent bad attitudes towards it. (Kinda like eating too much shrimp when drunk and know...You're suddenly not able to eat shrimp anymore) And on the other hand, never exposing your children to variety is bad too. I think instead of forcing my bf to eat sushi (really, for a kid??), they could have made him something different but equally healthy.

11:30 PM

Anonymous Anonymous said...

My kids are now middle-aged. When the gang of them were growing up, all very near in age, nutrition, needless to say, was very big for me. I never bought soft drinks, we had juice from juicing fresh fruit a few times a week, otherwise they drank water or milk. Planning balanced meals and introducing different foods and even fancy recipes was important. One of my sons so hated spinach the first time I served it, cooked, that from that moment (as a three-year-old) his favorite cuss word or nasty name to call someone was "Spinach". Well, other foods provide the nutrition of spinach so I never served it again.

We ate McDonald's hamburgers once a month. Once a week, I made a small batch of cookies or candy. Otherwise, treats were fruit, nuts, etc. They loved cut up vegetables and dipped them in their favorite salad dressing.

I was so earnest and I think consciencious. My kids got lots of free play time, and never more than one hour tv a day, if that. All were healthy, none were ever fat. However, as young adults they gorged on fast foods, soft drinks and sweets and most had weight control issues at one time or other.

But you know what? I feel I did my best, and indeed did give them a healthy start. What they did with that was out of my control. So I never got in a tizzy.

I'm just saying that parents should take their responsibilities very seriously. What is provided during those growing years will affect their health for 50 or 60 years of adulthood regardless of how careless they might become later.

7:11 PM

Anonymous Anonymous said...

"I'm thinking it's probably easier to turn mealtime into less of a battle than it is to make your kid sit in front of a cold plate of whatever for hours on end. I just don't think that the easy way is the route to take on this one."

Actually, I don't know of a professional organization in the *world* that recommends this type of behavior. Food should not be a battle. Period. Children should *never* be forced to "sit in front of a cold plate of whatever for hours on end" just to get them to eat the desired food. Research has shown this generally has the effect of making healthy foods even *less* desirable. It's a terrible idea.

Please, don't anyone do this to your children! Start them out with healthy habits, don't introduce junk at a young age and when you get to the point that junk has been introduced, talk regularly about *why* it's not good for your body to eat more than small amounts of it and why it is good for your body to eat healthier foods. We've *never* limited our children's food choices in any way other than not purchasing foods with HFCS or trans-fats and not eating out frequently (even sit down restaurant food is generally pretty unhealthy). Nor have we ever forced them to eat a single thing they don't like, but at 3 and 10, they're very healthy eaters. This comes from witnessing us enjoy healthy foods and from being introduced to healthy foods at a young age, not from being forced to eat things they didn't want to eat.

3:47 PM

Anonymous Anonymous said...

"In fact, it's been shown that much 'picky eating' can actually be traced back to NOT ENOUGH exposure to novel foods in childhood, therefore not giving children the opportunity to expand their palate."

Don't you think there is a difference between making a food available and forcing a child to eat that food? I see a very, very, very clear difference between *offering* my 3-year-old chicken liver pate and telling her she *has* to eat some of it. So what if she refused the first 5 or 6 times? No big deal. She eventually tried it and now she eats it whenever I make it. My son was that way with beets, but now he eats them with gusto. Forcing a child to eat a wide variety of foods isn't the same as offering a wide variety of foods.

3:56 PM

Blogger jokergirl said...

I find that a lot of kids' bad eating habits are because of the habits lived by the parents. If you can't spend the time to cook a good meal, where should the kid learn good eating habits from?
A way to get kids interested in good food is to give them control - let them help in the kitchen and make up food plans together. The same goes for working out - if you're not interested in it, why should the kid be?

At the risk of tooting my own horn, you might enjoy - it's mainly a parenting blog with a food focus that I sometimes write articles for.

7:44 AM


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