Guiding Your Kids to Healthy Eating
Childhood sets a lot of things for kids on their journey to adulthood. Dreams for the future are being decided, strengths and skills are manifested, and most importantly, a lot of habits are formed. The habit of eating is one of the most important factors that need to be set early on.
An unhealthy child is a mother’s nightmare – obesity and undernourishment are two of the biggest problems that plagues the US and even the world.
Existing studies show that half of obese teenage girls become really obese by their early 30s. Childhood obesity has gone more than tripled in the past 30 years. The percentage of children aged 6–11 years in the United States alone who were obese increased from 7% in 1980 to almost 20% in 2008. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.
So, how do we get past this problem of malnutrition of our kids?
Education – the best way is to educate them in the habit of healthy eating. Here are some tips on how to guide your child into eating healthy:
- Home is where health starts
The first place that should promote healthy eating is at home. Always keep healthy food on hand. Meals should have a fun variety of food to choose from. Eat with them on the dining table. This will expand your scope of influencing them to eat healthily.
- Step Up Your Treats
Some might say that most treats promote unhealthy eating habits and may contribute to the overall nutrition of your child, but the truth is, there are many healthy alternatives for treats. Instead of giving them ice cream and sprinkles, offer them frozen yogurt and dark chocolate instead. These are equally nutritious alternatives for your child.
- Adjust that Attitude
Children learn well in a friendly environment, which calls for a lot of patience. Often, our kids don’t make healthy choices and would lead us to nag them into eating healthy. A “never give up, never surrender” attitude is needed in helping your child make healthy eating options.
- Promote that Fruit
Kids love fun tasting foods, which is why they are more prone to liking junk foods or sweets. That is why fruit itself gives a better and healthier alternative. Turn that apple into a sugar-free smoothie or delectable fruit juice. A mango shake will surely be a fun, healthy and yummy treat for your kids!
- Too much of everything is too much
Sometimes, nourishment depends on the quantity of the food. Teach your kids to stop when they have had enough. The discipline of eating relies on how much food is going in whether healthy or not.
- The Calendar is Your Friend
Make a weekly (if possible) schedule of your meals. This helps you be on track and plan nutritious meals for your kids and family, allowing for any improvements on your daily menu.
Going healthy doesn’t have to be expensive, but it requires a lot of commitment and guidance. Just follow the guide mentioned above and you’ll surely achieve your goal in no time!
It’s so hard to remember to take your medicine, let alone take it correctly (with food, on an empty stomach, not at the same time as other things you’re taking, at night, without grapefruit juice… the list seems endless). There are so many barriers and distractions that can get in the way. Many people aren’t thrilled about having to take medications because they worry about side effects, or they’re having side effects, or they just don’t like the idea of needing to take medicine. If it’s for prevention, like aspirin to prevent strokes, or to treat an “invisible” condition like high blood pressure, they may not think they need it at all.
Even when a person is highly motivated, there are still missed doses. Even when that person is a doctor! I had strep throat last year, and for the life of me I couldn’t consistently remember to take my amoxicillin three times a day. (Which is probably why I got strep again.)
As a primary care doctor, I try to prescribe only the drugs needed, be mindful of side effects, and find the simplest regimen possible. But many people require a lot of medications, and their regimens may be necessarily complex.
The cost of not taking medicine correctly
Doctors, pharmacies, and insurance companies are all acutely aware of the poor outcomes and massive costs incurred by “medication noncompliance.”* Research articles on medication noncompliance show that when people don’t take their medication, they are likely to get sicker (even die) and incur higher healthcare costs. This is especially true for people with chronic illnesses like diabetes, high blood pressure, high cholesterol, and heart disease.
So let’s instead talk about medication adherence. Medication adherence sounds so much better. Because it is. Almost all research examining medication adherence demonstrates a link between improved medication adherence and better health outcomes, longer life, and lower health care costs.
*Medication noncompliance. I hate this term, because it sounds like patients are being willfully disobedient. Hey, when I missed all those amoxicillin doses, it was because I frequently work through lunch or am out and about in the mid-afternoon. Either the pills were not on me, or fluids were not on me, or I simply didn’t have the opportunity to take them. I wasn’t noncompliant, buster!
What helps people take medicines correctly? Here’s what the research says
A recent study tested three really inexpensive gadgets designed to improve medication adherence. These included: a pill bottle strip with toggles with day numbers that could be slid closed; a digital timer cap that recorded the time and date of the last time the cap was opened; and a standard pillbox like the one my grandmother uses. Adherence was measured using pharmacy claims data.
Would you believe there was no difference between any of the gadget groups? In fact, the only group who had improved adherence was the control group, who had received absolutely no help in remembering to take their medicine. Researchers did note that previous studies have shown adherence changes according to what’s going on in a person’s life, which makes sense.
A recent analysis of over 700 studies on this topic looked at a broad range of strategies including special packaging, individualized instructions, consequences/rewards systems, and reminder devices. The only somewhat consistently effective approach was habit analysis, and linking medication adherence with existing habits. What does that mean? It means that if I’m prescribing a pill that’s to be taken twice a day, I ask the patient, “Can you think of anything that you always do twice a day?” and if the patient says “Yeah, I brush my teeth,” then I say, “Okay, then take this pill every time you brush your teeth. Put the bottle with the toothpaste.”
Obviously, this simple approach isn’t going to work for everyone. Will anything really help people take their medications? A recent analysis of 65 studies of medication adherence in the elderly provides a clue. Researchers identified eighty obstacles to adherence, including impaired memory or cognition, poor dexterity, depression, anxiety, or other mental health issues, language barriers, alcohol or drug use, low education level, sleep problems, cost and insurance issues, resistance to care or skepticism about treatment, inadequate medication labeling, vision problems, pills needing to be cut, dissatisfaction with the physician… on and on.
How best to help people take their medications? As those conducting this analysis concluded: it’s complicated.
Though it seems Americans don’t agree on much, screening for cancer is an exception. Who wouldn’t support preventing or identifying cancer at an early, more treatable stage, when the alternative is pain, toxic therapies, and a shortened life? That may be why people get confused when news headlines don’t reinforce a “just do it” message. A recent example of the disconnect between public perception and medical evidence is screening for prostate cancer using the prostate-specific antigen (PSA) test. The United States Preventive Services Task Force (USPSTF), a non-governmental expert panel that produces guidelines for primary care providers, proposed new recommendations saying doctors should only order the PSA test for older men after discussing its pros and cons and eliciting preferences for screening.
Screening for prostate cancer with the PSA test: The backstory
To understand the new draft recommendation requires a brief history of this test. Introduced in the 1980s as a way to follow patients already diagnosed with prostate cancer, it began to be used to screen for new cancers. Given that the PSA is an easy blood test to perform, it was quickly adopted — without waiting for evidence that it actually worked. For many years, the USPSTF said there wasn’t enough information to recommend for or against the PSA test.
That changed in 2012 when the USPSTF released a controversial recommendation against screening. It was based in part on a large US study showing no decrease in prostate cancer deaths among men screened using the PSA test. The recommendation also reflected concern about the test causing a surge in prostate cancer diagnoses, many of which were small, low-risk cancers being treated with surgery or radiation — treatments with common side effects.
I was uncomfortable with this “don’t screen” recommendation and am happy about the proposed change. Here’s why: while the US screening trial was negative, another large study in European men showed a small decrease in prostate cancer deaths after more than 10 years of follow-up. Moreover, specialists had devised new strategies to avoid overtreating low-risk cancers.
Having a conversation about screening with the PSA test
I discuss the pros and cons of the PSA test with my patients and ask about their personal preferences for screening. I tell them that while screening can reduce death due to prostate cancer by 20%, the “bang for the buck” is small. It takes screening of over 1,000 men to prevent one death. I also highlight that the benefit of screening is years off, but the risks of treatment — impotence, incontinence, and bowel problems — occur right away.
I also emphasize the PSA test isn’t very accurate. There can be anxiety due to false positive results, meaning further testing shows no cancer. I mention the potential for diagnosing a low-risk cancer where the treatment may be worse than the disease, and that following them closely without treatment may be preferable. How much a man wants to know something like this can differ — some view it as useful information, others see it as an endless source of worry.
Finally, I share my own perspective. As a medical student in the late 1980s learning about the PSA test, my grandfather was dying from prostate cancer. He was an otherwise healthy man who had many good years left, and I wondered if the PSA test could have helped him. Because of this family history, I have decided to have the PSA test. But I’m also unsure what I would do if I didn’t have that history. The small potential for benefit must be weighed versus the risk of false positives or of finding a low-risk tumor that may never cause harm. I can see how two men without risk factors for prostate cancer could make different decisions.
So, I think the USPSTF got it right. This is a decision best made by a well-informed patient in collaboration with his doctor. The challenge in implementing this is practical: the short time I have with each patient. I could save time by simply ordering the test without a discussion. But in my role as health advisor, I need to be able to not only say when I think we should or should not do something, but also when there is a choice. And when there isn’t one right decision for everyone, my patient is the best person to make the choice that’s right for him. I can state my personal preference, but need to highlight why that may not be the right answer for him.
Have you heard of the blood type diet? I thought it had been debunked long ago but patients keep asking about it, so I figured I should learn more.
What’s the Blood Type Diet?
In 1996 Peter D’Adamo, a naturopathic physician, published a book in which he described how people could be healthier, live longer, and achieve their ideal weight by eating according to their blood type. One’s choice of condiments, spices, and even exercise should depend on one’s blood type. Soon, the book was a best seller and people everywhere were finding out their blood type, revising their grocery lists, and changing how they ate, exercised, and thought about their health.
Here are some of the recommendations according to the “Eat Right for Your Type” diet:
- Those with type O blood should choose high-protein foods and eat lots of meat, vegetables, fish, and fruit but limit grains, beans, and legumes. To lose weight, seafood, kelp, red meat, broccoli, spinach, and olive oil are best; wheat, corn, and dairy are to be avoided.
- Those with type A blood should choose fruit, vegetables, tofu, seafood, turkey, and whole grains but avoid meat. For weight loss, seafood, vegetables, pineapple, olive oil, and soy are best; dairy, wheat, corn, and kidney beans should be avoided.
- Those with type B blood should pick a diverse diet including meat, fruit, dairy, seafood, and grains. To lose weight, type B individuals should choose green vegetables, eggs, liver, and licorice tea but avoid chicken, corn, peanuts, and wheat.
- Those with type AB blood should eat dairy, tofu, lamb, fish, grains, fruit, and vegetables. For weight loss, tofu, seafood, green vegetables, and kelp are best but chicken, corn, buckwheat, and kidney beans should be avoided.
As mentioned, the recommendations for the blood type diets extend well beyond food choices. For example, people with type O blood are advised to choose high-intensity aerobic exercise and take supplements for their sensitive stomachs, while those with type A blood should choose low-intensity activities and include meditation as part of their routine.
But does it work?
High-quality studies about the blood type diet had not been published in peer-reviewed medical literature. Even now, a search in the medical literature for the author’s name reveals no research pertaining to this diet. Studies published in 2013 and 2014 about the blood type diets are worth noting. The 2013 study analyzed the world’s medical literature and found no studies demonstrating benefit from a blood type diet. The 2014 study found that while people following any of the blood type diets had some improvement in certain cardiometabolic risk factors (such as cholesterol or blood pressure), those improvements were unrelated to blood type.
Does it make any sense?
The theory behind this diet is that blood type is closely tied to our ability to digest certain types of foods, so that the proper diet will improve digestion, help maintain ideal body weight, increase energy levels, and prevent disease, including cancer and cardiovascular disease.
Type O was said to be the original “ancestral” blood type of the earliest humans who were hunter-gatherers, with diets that were high in animal protein. Group A was said to evolve when humans began to farm and had more vegetarian diets. Group B blood types were said to arise among nomadic tribes who consumed a lot of dairy products. And since Group AB blood was supposed to have evolved from the intermingling of people with types A and B blood, type AB recommendations were intermediate between those for people with types A and B blood.
Each of these theories has been challenged. For example, there is evidence that type A was actually the first blood group to evolve in humans, not type O. In addition, there is no proven connection between blood type and digestion. So, in addition to a lack of evidence that the diet works, serious questions remain about why it should work in the first place.
So, what’s the downside?
It’s a fair question, especially since some improvements were seen in people who adopted certain blood type diets (see link above). Eating based on your blood type requires you to know your blood type and then follow a restrictive diet. Personal preferences might be a problem: a vegetarian with type O blood may struggle to stay on the assigned diet, and people who love red meat may be disappointed to learn they have type A blood. Recommended supplements are not cheap; neither are the recommended organic foods. And if you have certain health conditions, such as high cholesterol or diabetes, a nutritionist can make better evidence-based recommendations for you than those determined by your blood type.
Advocates of blood type diets may say that while the ideal study has not yet been performed, the absence of evidence doesn’t prove they’re ineffective. And there’s also no proof that these diets are harmful. So, my guess is that interest in the blood type diets will not disappear any time soon. But there’s a reason that bookstores have rows and rows of books on diet, each claiming to be highly effective if not the best. We simply don’t know which diet is best for each individual person. And even if we did, sticking to any single diet is often challenging.
Stand by — it’s likely you’ll soon be hearing about yet another best diet. And my guess is that it won’t have anything to do with your blood type.
Headaches are common in childhood. Most of the time, they are nothing to worry about and are caused by common minor illnesses, a mild bump to the head, lack of sleep, not getting enough food or drink, or stress. Migraines can also be seen in childhood, but with awareness and avoidance of triggers, they don’t usually cause problems.
Sometimes, though, headaches are a problem — and something to worry about. Here is when you should worry:
1. When a headache is accompanied by a fever and a stiff neck. Your child should be able to look up at the ceiling, touch his chin to his chest and shake his head back and forth. If he can’t, you should bring him to an emergency room to be sure he doesn’t have meningitis.
2. When the pain is severe and unrelenting despite acetaminophen or ibuprofen. Any bad pain anywhere deserves medical attention.
3. When a headache is accompanied by frequent or persistent vomiting, especially in the absence of other signs of illness like fever or diarrhea. It may just be a virus, and children may have vomiting after a head bump, but it’s worth a call to the doctor, as vomiting can be a sign of pressure on the brain.
4. When along with a headache, your child is unusually sleepy or has trouble walking, talking, or doing other normal activities. Again, it could just be a virus — but you should check in with your doctor.
5. When a headache wakes your child from sleep. Sometimes children wake up for other reasons and realize they have a headache; that doesn’t count. But if the pain itself is waking the child from sleep, that’s not the average headache and you should call your doctor.
6. When a headache is worse lying down. The way you most commonly notice this is that the headache is at its worst first thing in the morning and gets better as the day goes on. This is the opposite from the way most headaches happen, and can be a sign of increased pressure on the brain. If you notice that this is the pattern, call your doctor.
7. When the headaches are frequent — or are interfering with daily life. If your child has headaches two or more times a week, or they are making it hard for your child to do homework, play, or otherwise live a normal life, give your doctor a call. It doesn’t necessarily mean that something serious is going on, but it’s worth a visit to be sure — and to find ways to manage and hopefully prevent the headaches. This is particularly true if you find yourself giving your child medication frequently; it turns out that giving medication frequently can cause headaches to be more frequent.
8. Whenever there is something about a headache that worries you, even if it isn’t on this list. I always respect a parent’s instincts — and always want to allay a parent’s anxiety. So if something doesn’t seem right to you, or if you have a question, call your doctor. That’s what we are here for.
We have all done it. We are prescribed a medication to help us, but we don’t take it as directed, or at all. Sometimes we don’t even fill the prescription.
Why? Things get in the way of getting to the pharmacy. One last phone call at work or one more math problem with your child. Or we begin to feel better and stop taking the medicine. Or we don’t understand the instructions. Or we are not convinced the medication will work. Or there are side effects we do not like. Or the medication is too expensive.
Or any of a hundred other reasons.
Adherence is how well we follow the recommendations from our health provider. Medication adherence ranges, but the track record isn’t good, with the average rate about 50%.
What are the consequences of non-adherence? Disease progresses. Medications are wasted and become less effective in the long term. Hospitalization risk increases. As a society, the potential financial cost of non-adherence is $100 billion per year. As the late former Surgeon General C. Everett Koop said, “Drugs don’t work in patients who don’t take them.”
Partner with your provider to maximize motivation
While there are many factors that influence adherence, motivation plays an important role. Increasing motivation to stick with a medication regimen requires work by both the patient and the provider.
Think about your current and future life goals and how this medication can help you reach these goals. Clearly communicate these goals to your provider and encourage your provider to help connect taking your medication correctly to your life goals and values. Explain your schedule and activities, and ask him or her to help find a medication regimen that fits your lifestyle as closely as possible, to make adherence as easy as possible.
Ask direct questions about the medication, including how often to take it (fewer doses are better!), potential side effects, and cost. Repeat the answers back to ensure you’re clear on the instructions. At your next visit, talk about how you are doing with taking your medications. Don’t be afraid to bring up any barriers that prevent you from taking them regularly and correctly, including cost.
Other tips for sticking with your medications
There are several ways to increase motivation to take medication as prescribed.
Think about why you are taking the medication in the first place. Will it help reduce pain so you can return to work? Prolong your life so you can spend time with your grandchildren? Find ways to remind yourself of why it is important and visualize the results of success! Put a picture of your family next to your medicine.
Track progress in a journal. Use a sticker chart and reward yourself (a movie, a special purchase) regularly and often.
Take your medication at a similar time each day. Perhaps you can combine taking the medication with other regular, daily activities that are already part of your routine (for example, brushing your teeth), so taking the medication becomes “automatic.”
Use a medication planner/pill box. Send yourself email and text reminders.
Enlist family and friends to help with these strategies.
So, develop a plan to increase your motivation to take your medications as prescribed, and find strategies to be successful. Your life goals will thank you!