Ethan Milich will start his senior year at Sweet Home High School next week, nearly 70 pounds lighter than when he started last school year.
Milich, 18, of Amherst, has health challenges that predispose him to obesity – but the steps he’s taken in the Children’s Healthy Weigh of Buffalo program include a roadmap for any family that wants to help its youngest members pursue or maintain a healthy weight.
“The No. 1 thing is, we never call it a diet. It’s a lifestyle change,” said Dr. Indrajit Majumdar, an endocrinologist and medical director of the program, launched at Women & Children’s Hospital in late 2014.
Healthy Weigh helps patients set up and maintain a healthy eating regimen, increase physical activity and get to the root of unhealthy choices.
Otherwise, those who continue to gain weight run the risk of related diseases that include insulin resistance, diabetes, high blood pressure, elevated cholesterol and obstructive sleep apnea – even in childhood. For a small number of teens, it also may point to the need to take medication or undergo a sleeve gastrectomy to reduce the size of the stomach.
Milich underwent such a procedure in July, but beforehand, he lost 20 pounds using the other tenets of Healthy Weigh.
The challenge for overweight and obese children – in Erie County, that’s one in three children overall – is that a growing body of research shows that more than half of weight problems have a genetic cause.
“You have to recognize that it’s not just a bad environment,” Majumdar said, “but the good news is that with the right guidance, it is all modifiable. It is hard work but it is very much doable.”
START WITH EATING
1. Understand your eating triggers “You have to become aware of where the problem comes with eating,” Majumdar said. “You try to find out what the culprit is and take it out.” That can vary from individual to individual, he said, from child to child, and family to family.
Families with concerns are encouraged to talk about them with their child’s pediatrician, who can recommend a nutritionist or the Children’s Hospital program.
Some children eat because of stress, others out of boredom. Some learn to see food as a reward. Healthy Weigh dietitian Kathy Kornacki often hears parents talk of children who don’t eat breakfast or lunch, then gorge themselves late in the day. The stress of a new school year, trying to fit in, trying to squeeze in more activity, can pack on pounds, she said.
Kornacki and two program psychologists ask families to track their eating choices in an effort to explore how many calories are being consumed, and why. “We work on small changes,” she said. “We don’t try to throw everything at them at once. It’s educating. It’s having them become aware of ‘What am I eating?’ ‘How much am I eating?’ ”
2. Balance is key Healthy Weigh is a collaborative team that includes doctors, the dietitian, the psychologists, a physical therapist and an occupational therapist. The makeup of the team shows there are several factors that go to carrying, or reaching, a healthy weight.
“We don’t do a heavy focus on calories because if you’re eating your daily servings of each food group, and staying within portion sizes, you’ll keep within those calories,” Kornacki said. “Kids have enough stresses without counting calories.”
She urged parents to look at the big picture by using choosemyplate.gov, a federal website that recommends balanced servings of whole grains, lean proteins and plenty of fruits and vegetables. The site also includes food choice tips for adults and children.
Dining out is one danger, Kornacki said. “We find kids stopping after school on their way home and being able to buy $5 worth of food. We talk about those foods being very dense. For not much nutrition, you’re getting a lot of calories. We also have some families who come in and they’re eating out every night. We have to be reasonable about it. We set a realistic goal, say cutting that in half. My recommended goal would be once a week.”
3. Avoid sugar Cereals, baked goods, cookies and much more tend to be loaded with sugar, which turns on the pleasure centers in the brain, making us eat more, and contains empty calories, creating a cycle that promotes weight gain. The typical American child consumes more than three times the maximum daily amount recommended by the American Heart Association (see related story, Page 7). A large source of sugar in the U.S. diet includes sodas, flavored milks, fruit juices and sports drinks – beverages available at most homes and in many schools. Stick with water, Majumdar said.
4. Reduce carbs Pasta, potatoes, rice, processed grains and corn are all fat culprits. “Taking these out of your diet is going to make a world of difference,” Majumdar said, adding, “Corn is not a vegetable. It’s a pure starch.” The goal, Kornacki said, is to incorporate complex carbohydrates found in fiber, brown rice, whole grains (including whole wheat pasta), sweet potatoes and many vegetables.
5. Read labels Milich’s mother, Jennifer, had to feed her son pureed foods for a few weeks after his surgery. By that point, the Healthy Weigh program already had showed her and her son how to better read food labels. “I never knew how much sugar was in baby food,” she said. “It’s frightening.” Other foods with high fructose corn syrup – an ingredient that promotes weight gain – include many ketchups, yogurts, salad dressings and nutrition bars. “Organic does not mean better, either,” Jennifer Milich said.
6. Reduce portion sizes A serving size of pasta generally is considered a half cup. Six grain servings a day are recommended, at most. “If you eat a cup of rice, that’s two grains,” Kornacki said. “Some kids are eating three cups of rice at a meal and going back for more, having no concept about how much they’re eating. Having an awareness of this is key.”
One way to get the right portion sizes? “We talk a lot about meal planning,” Majumdar said. Having healthy snacks at the ready, in reasonable portions, also is important, he said. “It’s too easy to open a bag of chips.”
7. Be a role model “Parents are key,” Kornacki said. “They’re involvement is vital. They’re doing the shopping – and in some cases giving kids money to go for fast food. Providing kids with the best options, the healthiest options, is key.”
What parents eat and how they talk about food also is crucial, Majumdar said. “When mom and dad are on board, obviously they will be able to guide their child in the right direction,” he said. “When the whole family comes together, everyone benefits.”
Healthy Weigh staff talks with parents about meals they’re making at home and encourages them to favor baking, broiling or steaming instead of frying, and avoiding the overuse of oils. “Some parents don’t think about meals,” Kornacki said. “They’re on the run, making pasta without having a protein and a vegetable. Incorporating those things makes for a healthier meal overall.”
Healthy Weigh leaders believe families, schools and communities all play a role in assuring that children have the right educational, dietary and physical activity options available to maintain or pursue a healthy weight. Jerry Turcotte isn’t affiliated with the program but agrees.
Turcotte weighed 232 pounds five years ago, not ideal for someone 5-foot-4. Today he weighs about 170 pounds after changing his eating choices, joining a basketball league and starting a fitness program for kids called Exercise Like the Animals. He has gotten a taste of how things go fitness-wise for many Western New York families once the school year hits. Hundreds of young people take his classes at parks across the region during the summer – but he has found less of an appetite for his classes when it comes to bringing them into preschool, after-school and school programs. He is among those disappointed that the Buffalo Public Schools are among those who don’t meet minimum state fitness requirements.
He and Healthy Weigh recommended the following kid fitness strategies for the new school year.
1. Create a fitness plan “Anything that is planned generally turns out to be more successful,” Turcotte said.
Healthy Weigh occupational therapist David Vokes and physical therapist Lauren Dunaway design an exercise plan for every child enrolled in the program. They assess exercise capacity and work to build upon it. After a few weeks of fitness – which includes walking, partial sit-ups, chair squats and wall pushups – those in the program can do more and “their heart rate isn’t jumping as high,” Dunaway said.
“Some of the people we work with didn’t exercise at all,” Vokes said, “so we need to build healthy habits. You brush your teeth every morning, you do these exercises every day.”
2. Walk every day Ethan and Jennifer Milich use his iPhone to keep track of their steps and try to walk at least 8,000 to 9,000 of them every day.
“I wanted to be active,” Ethan said. “I wanted to bike ride. Now I can.”
3. Vary your exercise and make it fun Ethan Milich enrolled in the program about eight months ago, and is exercising on an elliptical machine and using dumbbells. Some patients with joint pain start fitness in the water. “You can improve without going to an expensive gym,” Majumdar said. “As exercise capacity improves, we take them toward high-intensity exercise, which is the best way to get all of your muscles trained.”
Turcotte likes to mix his fitness, which includes hoops, walking his dog and teaching fitness along with his sons, Max, 9, and Simon, 6. “I’m still having fun doing it,” he said.
“As we get to know our patients better,” Dunaway said, “and see how they respond to our exercise program, we try to tailor it more to things they like or are interested in. Some of the girls get more dance or Zumba-style exercise. Guys do more weightlifting. We’re trying to change it up for them all the time so their bodies keep responding.”
Give your kids options when it comes to sports and activities, she advised. Try swim lessons, tennis or basketball. Hit the local playground several days a week. Take up cross-country skiing or ice skating this winter. “If you like what you’re doing,” she said, “you’re going to do it every day.”