Weight Stigmatization

As parents, we hope our children will never be picked on because of their weight, and we certainly hope our child will never tease their peers about their weight. According to Wikipdeia, the definition of weight stigma refers to "invidiously discriminatory attitudes towards overweight/obese or underweight/thin individuals that influence interpersonal interactions". Weight stigmatization exits -its time to pull your head out of the sand !

This topic is rather distressing but I think its worth posting because as parents, aunts, uncles, caregivers, friends, medical personnel, school counselors and teachers, we need to give it some consideration. I am reading a series of articles dedicated to this topic and some of the points I've taken from it are as follows (and some are my own views).

• Weight stigmatization exists across all ethnic groups - it is a problem for all youth.
• An estimated 26% of adolescent girls and 22% of adolescent boys are teased about their weight (Neumark-Sztainer et al, 2002). This is likely an underestimation of the actual truth.
• In one study, a quarter to one half of adolescents said the teasing bothered them (van den Berg et al. 2008). Again, this is probably an underestimation of the truth.
• One study found that teenagers who were teased about their weight were more likely to use unhealthy behaviors such as restricting carbohydrates, fasting, taking laxatives, and vomiting.
  

Deep breath....it is upsetting, isn't it ?

Research in this field also indicates that teasing children/adolescents about weight is related to the following problems:

• Body dissatisfaction
• Low self esteem
• Anxiety
  
• Increased depression and withdrawal
• Decreased physical activity
• Eating disorders

Family members, in particular siblings, may tease each other about their weight. However, the family home should be a safe "no teasing" place for the child. How a family member (in particular caregivers) view a child's body shape, and how they treat that child, is the foundation on which that child builds their self esteem, and how they view their own body image.

What about parents who internalize the idea of 'being thin' and their 'dieting practices', how does this affect a child ? Your children watch your behavior. As one author wrote "Mothers who are obsessed with their weight and hate their bodies teach their daughters to do and feel the same" (Fontaine, 1991). If you do this, you need to stop.

Some of the most widespread consequences of childhood obesity are psychological. The message we need to work on translating to our children is one of 'overall good health'. Pediatric doctors should ask children and teenagers if they are teased about their weight, who is teasing them and the degree to which it bothers them. We need to praise our children for making healthy choices, encourage lots of physical activity and work towards helping our children achieve healthier weights. How do we do this ? Turn off the TV, shut down the computer, take away the video games, stop buying them soda and junk food, and take a sport up with them.....sounds like a lot of work ? It is.

Calcium needs of children

Calcium is the most abundant mineral in the body. More than 99% of total body calcium is stored in the bones and teeth and the remaining 1% is found throughout the body in blood, muscle, and the fluid between cells.

Calcium has several important functions, for example

• It is vital in the construction, formation and maintenance of bone and teeth.
  
• It is an essential component in the production of enzymes and hormones that regulate digestion, energy, and fat metabolism.
• It maintains all cells and connective tissues in the body.
• It is a vital component in blood clotting systems, helps in wound healing and may prevent gum disease.
• It is involved in blood pressure control, nerve transmission, and release of neurotransmitters.
• It is essential for muscle contraction.

In the US, more than 60% of dietary calcium comes from milk and dairy products. Adequate dietary calcium intake during growing years is critical for the accretion of peak bone mass, which protects against osteoporosis later in life. The U.S. Department of Agriculture's Food Guide Pyramid (http://mypyramid.gov/) recommends that children two years and older eat 2-3 servings of dairy products per day. A serving is equal to:

1 cup (8 fl oz) of milk
8 oz of yogurt
1.5 oz of natural cheese (such as Cheddar)
2.0 oz of processed cheese (such as American)

Dairy products are the most concentrated food sources of calcium (e.g. one cup of milk contains approximately 271 mg of calcium). But what if your child/adolescent doesn't drink milk or is lactose intolerant, how do they meet their calcium needs ? In this case you need to consider other sources of calcium, for instance:

Calcium-fortified orange juice is a very good source of calcium, however because the calcium settles on the bottom of the carton, you need to ensure you shake it before pouring. Since most children require more vitamin D in their diet, choose an orange juice that is fortified with vitamin D as this will help improve calcium absorption. You may be inclined to think that giving your child several servings of juice is the solution to their calcium needs. As parents we need to keep in mind that excess juice intake may provide excess calories in the diet of our children. The American Academy of Pediatrics' recommendation is that children over the age of 7 years limit their juice consumption to 2 servings per day. So while calcium-fortified juice provides a useful alternative to dairy as a calcium source, drinking too much orange juice is not recommended.

Canned fish, such as salmon and sardines, are excellent sources of calcium. A single sardine contains 92 mg calcium, while a 3 ounces can of salmon (with the bones) contains 181 mg calcium. OK, this is great except I can't imagine too many children eat sardines. Perhaps we will have better luck with salmon, hmm.....not so sure they'll eat the bones !

Next idea...

Calcium fortified soy milk, (note, natural soy milk is not a good source of calcium, it needs to be calcium-fortified), is an alternative to dairy milk. Again, sedimentation of the calcium occurs so you need to make sure to shake the carton. One report (1) found that unshaken samples of soy beverages had only 31% of the expected calcium and there is some concern regarding whether the absorption of calcium in these products is the same as that of dairy milk. But it is a good alternative to dairy if your child does not drink milk.

Processed foods such as ready-to-eat breakfast cereals contain calcium. If the food label states the product contains 10% of calcium on the label - this is equivalent to approximately 100 mg of calcium.

Other foods that contain modest amounts of calcium include citrus fruit, dark-green leafy vegetables (chinese cabbage, kale, collard greens and broccoli), nuts/seeds and peanut butter.

If your child doesn't eat dairy products, will they have an adequate intake (AI) for calcium?"

First of all, lets review the AI for calcium:

500 mg for children aged 1 to 3 years
800 mg for children aged 4 to 8 years
1,300 mg for children aged 9 to 18 years.

One study (2) conducted in children aged 9 to 15 years found that an adequate intake (AI) of calcium could not be met if the child was eating a dairy-free diet and so they recommended that calcium-fortified foods should to be included in the diet. Ideally, calcium fortified juice or soy milk should not be a substitute for dairy milk. However, given that only 25% of boys and 10% of girls are getting enough calcium in their diet, its a welcomed solution for parents.

References:
(1) Heaney, R. (2006). Journal of the American Dietetic Association; 106 (11); 1753-1754.
(2) Gao et al. (2006) Journal of the American Dietetic Association; 106 (11); 1759-66.

Out of my comfort zone...

I dislike tabloid papers for obvious reasons but today I really hate them. Lets take this weeks poor victim - Jessica Simpson. On one hand I am outraged to read headlines like "Jessica Simpson and her fat pants" or "weighty issues for Jessica". And on the other hand, I'm concerned for teens reading this trash and believing that JS is fat! What effect does this have on teenage girls who are overweight? Or what about the girls who have distorted body images, how does this effect them? Jessica may have gained weight but she is a healthy weight. Do teenagers get this?

I asked one teenager, what do you drink at school? (back to the beverage issue!). Her response was "Arizona Iced Teas - about 3 a day". I could have told her all the reasons in the world why it would be better to drink water, but the bottom line is she likes these drinks. How do we talk to teens about making healthier choices ? On one blog I was asked about teens drinking coffee drinks and the effect of caffeine on their growth. I need to research this topic a little more, but I'm wondering, if we told our teens "drinking caffeine will stunt your growth" - would they care ?? I don't have answers to these questions.

As adults, we know that if we eat a lot of saturated fat for example, our cholesterol goes up and we may experience a heart attack sooner rather than later. The 'cause' and the 'effect' of eating unhealthy becomes clearer as we age. For most teens its about how they look, so talking to them about how they look, or how they think they look, and how this makes them feel is the important issue. If they are overweight, how do we help them ? As parents we need to take an active role in this step - provide healthy foods, prepare meals and work out with our teens. I am sure this is easier said than done !

I'm definitely out of my comfort zone when it comes to the mind of teenagers. I have no idea what they think about body weight and health issues. Any teenagers reading, or parents of teens, please share your thoughts !