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Wednesday, September 26, 2012

Childhood Nutrition ~ From Preventing Malnutrition to Preventing Obesity

In my opinion, childhood obesity is THE single health issue of our day.  If for no other reason, but because obesity is so darned difficult to reverse.  In Utopia, all children are raised in loving environments, taught the wisdom of the world, and when they reach adulthood have equal footing to make their way in this world.  Now that's Utopia, but I think we can strive for as many children as possible to reach adulthood in a position to put their best individual foot forward.

I'm a child of the 60's.  My parents were born and raised in the Depression and WWII.  I believe this influenced not only how they parented, but how this generation formed policies based on their priorities.  Nutritional guidelines, RDA's and all such related things were born out of efforts to prevent malnutrition and disease.  Diseases of deficiencies were real "in their day" and in the true form of forging a better life for one's children, this was a priority for them.    A lot of research capital was spent to determine the nutritional needs of children, and childhood obesity was quite rare.  This is not to diminish the plight of those rare cases, but public policy always targets the majority potentially impacted.  Also, at that time a fat child was more likely to be considered healthy than a scrawny one.  My how times have changed.

When I was in grade school, our school participated in a voluntary milk program.  For a nickel we got a small container of milk each day -- usually midmorning at least in the younger grades.  We didn't drink milk in our house (Mom did use it in recipes and warm cereals, we just didn't drink it by the glass),  but my parents enrolled us kids, probably more not to make us feel left out.  I also believe one could get this milk for free if one qualified.  In my grade school there was no school lunch program, there probably was not much need as this was before property taxes exploded disproportionately -- so there were few if any living in the community who could not afford the, then, smack dab middle of the middle class homes that made up the vast majority.  School lunch programs developed during my lifetime.  

First there were subsidized lunches and/or lunches provided to the needy.  But those kids who partook were subjected to teasing, stigma, etc.   Apparently, the parents could not be trusted to spend individual aid on lunches for their kids to bring to school so the idea was to bring the nutrition directly to the children.  Noble ... but we can see the slippery slope we've long since slid down to where we are today.  My generation was the pre-self-esteem generation.  Teachers didn't worry over hurting our feelings with too much red ink on a page, though at least in the lower grades we still got gold stars or fun stamps on our exceptional work.    We had advanced and remedial classes.  Kids with speech impediments had therapy, etc.etc.  School was for education, not social engineering.  Parents were responsible for feeding their children, and I'm sure there were cases where the parents struggled where they sought out resources to assist them.  This was, after all, the purpose of food stamps and programs like WIC, etc.

Look, human beings almost never do everything for themselves.  We enter into contracts with one another to divvy up labor and such.  Bartering being rather less efficient, particularly on larger scales, currency allows for easier transactions.   I know this much about things one does not pay for:

  1. You get what you pay for is a sound cliche, and 
  2. You tend to care about and fight for value in goods and services you do pay for because on some level you are assessing that value to you based on what you earn for whatever you do for a living.  
I believe school lunch programs were well intentioned.  But the answer to dealing with stigmatization of those using the programs is to find more discrete ways of delivering the services to those truly in need, while many school systems merely adopted universal school lunches.  

Now my memory is fuzzy, but there was no talk at all about breakfasts when I was a kid.  And I wonder if those studies that came out some time in the 80's or 90's aren't at least partly responsible for this obesity epidemic.  Breakfast was not "the most important meal of the day" when I was a kid.  These studies too, seemed to evolve out of truly malnourished cases.  IOW, there's a big difference between a kid who wakes up late and/or just skips breakfast and a kid who was hungry but sent to school without breakfast because their parents couldn't afford it.  As food was now provided in many cases at lunch, there were probably more than a few households where things were tight where they counted on that lunch to be breakfast and lunch.  And now many schools provide breakfasts as well, and I've seen talk of dinners too.  

In any case, we now have edicts from on high as to what qualifies to be sufficient nutrition, which morphed to required nutrition.  And now we're at a point of limiting nutrition in the schools, because the pendulum has long since swung from the side of a safety net against malnutrition to controlling matters to stem obesity.  And it's a one size fits all approach that comes down from on higher still, and all the more misguided and inefficient.  My brother was not much older than me but ate a ton more than me for as long as I can remember.  The only things we received equal amounts of were treats, although on the occasion we got pizza (a real treat for me!) he got an extra half-to-full slice.  Waaahh, no fair!!  You have ridiculous stories coming out seemingly every day -- lunches brought from home taken away, bans on certain foods that can be brought from home, limiting food available in vending machines, limits on portions.  This is not the schools, but in a city where many are cheering Nanny Bloomberg's soda downsizing, he's also essentially banned "home cooking" in shelters because the nutritional content (especially transfat and salt contents) of foods cooked from scratch cannot be verified.  That is INsane!  

So what prompted me to jump the gun on following up on the School Lunch Survey (come on over and participate!) were a pair of competing takes on the fall-out over the new guidelines, in addition to the Moms' complaints from my prior post.  Let's start with one of those complaints -- one child left behind?  Annie, whose toddlers eat more than 750-850 cals for lunch (after eating at least three eggs routinely for breakfast) tells the tale of an older boy at the school she used to teach at.  This boy slept through most of the school day except for lunch -- from which she and a fellow teacher concluded he likely had a disturbed homelife where he felt too unsafe to sleep, and this was likely his only hot meal of the day.  I would say that if this were the case, NO school lunch program fixes it.   One of the problems with such programs is that one-size-fits-all is what ends up being the best -- though totally inadequate -- approach.  What are the alternatives.  Allow just this boy to get more -- then what of the jocks?  How about if Johnny walks several miles to and from school ... should he get as much as the jocks?  Then you'll have someone arbitrarily deciding that slightly pudgy trombone player Joe should get less than Suzie field hockey.  And what if you do individualize calories -- how to dispense that?  Different vouchers?  What if one kid is not hungry for all of their food one day, while their friend skipped breakfast because they woke up late and will gladly take the second sandwich.  Will there be a food patrol?  I was very active in high school, an all season varsity athlete and then some on the side.  Yet I pudged up a bit when I started eating large lunches of 850 cals at Burger King instead of lunch brought from home.  

Speaking of athletes, FTA Mom Sadie sue, was complaining how her oldest daughter would not be able to make it through 2.5 hours of volleyball practice on that level of lunch calories -- only the lunch she described was hardly anything close, which I'll address in a moment.  But lunch is not necessarily supposed to sustain an athlete.  Bring more food from home -- a banana and nut-butter perhaps?   We ate around noon and practiced often at 3:30.  Frankly I wasn't hungry before and would feel weighed down if I ate a snack.  Where's all this fat burning glory when you need it anyway?!  I don't recall most of my teammates eating anything between lunch and practice either, and often times lunch was more on the order of 400 cals or so.  The coach sometimes provided orange wedges, or we'd bring a snack for (after) away games and the bus ride home. 

Which brings me to Tom Naughton's blog post on some school lunch protests which cites this news piece:
... Protesters in Kansas and elsewhere say 850 calories isn’t enough for some high-schoolers, particularly athletes who can burn calories by the thousands. ...
They made a parody video that:  
... shows students staring woefully at lunch trays, stuffing lockers with junk food, collapsing during volleyball practice and crawling on the ground in exhaustion.  
Here are the lyrics:
Give me some seconds, I,I need to get some food todayMy friends are at the corner storeGetting junk so they don’t waste away
Ummmm ... am I the only one who hears this and doesn't go into a rage against the USDA, Michele Obama and Big Food?  If these teens aren't given their lunch in school, of course they have to get junk so as not to waste away?  This is utter nonsense.  First of all, if you're doing farm work or serious labor at home, your sustenance for that activity should be obtained at home.  Secondly, why is the alternative to school/government provided food necessarily junk to these people?  If they can buy and bring junk, they can buy and bring nutritious food.  Quitchyerbitchin!!  But then the article goes on to describe the lunch: 
... The lunch included one cheese-stuffed bread stick, a small dollop of marinara sauce, three apple slices and some raw spinach. Kirkham [a teacher] supplemented the lunch with items from a salad bar, including cubes of ham, bacon bits and dressing, which were available only to teachers. “I asked why the sauce had no meat and I was informed that due to the breadsticks containing cheese, the meat would put us over the guidelines for protein,” Kirkham wrote.
“Now think of a high school boy who works out at least three hours a day, not including farm work. … I’m furious. The ‘cheese’ inside the breadstick is approximately three bites. This is ridiculous.”
The basic lunch included raw spinach that students couldn't add some stuff too (dressing?!) from the salad bar?  But let's add up the calories for this supposed sample lunch.  A cheese stuffed breadstick with approximately 3 bites of cheese.  Let's give that a generous 2oz serving size = 200 cals, 150 cals for the bread (also likely a generous estimate), and 50 cals for the apple slices and spinach.  We're at 400 calories, likely closer to 300 calories.  Even supplementing, unless Kirkham drowns her salads a la Jimmy Moore, we're likely talking no more than 200 cals likely less, but we're led to believe this isn't available to the students.  That lunch does not match the calorie limits.  So either people are getting whipped into a fury based on false claims (like that never happens, right?), or the calorie limits/suggestions aren't being followed. Sadie sue told us her oldest (11 or 12) was fed a mere two chicken nuggets, small cup of peaches and some mushy green beans her daughter didn't eat.  Yes, that is indeed insufficient, but it's also not consistent with the caloric guidelines -- I can only assume she's encouraging her daughters to avoid any grains that might be part of that lunch.  I'm sympathetic to that ... a topic for another day ... but to use a partial lunch to portray a picture of starvation is not exactly an honest debate.

Look 800 calories is a lot of food.  This is the point made by Yoni Freedhoff when he weighed in on House Republicans seeking to overturn limits.  
If they're in kindergarten through fifth grade they'd be stuck with a paltry 650 calories a meal; sixth through eighth grade - 700 calories; and ninth grade and up 800 calories.

The horror!

But wait, 650 calories is more calories than I have for lunch.
Yoni looks to be a somewhat tall man shown running (read: active) in his profile pic.  Now granted growing children in general, and teenagers in particular, do tend to need/utilize more calories per pound than adults, but their caloric needs seem to be way overestimated to me in general.  Depending on how you source those calories, 500 calories is quite a lot of food!  One can make a substantial turkey, ham or roast beef sandwich with cheese lettuce and tomato for that.  Indeed most of Subway's 6" sandwiches come in under that, most would even make it under the 800 calories for a foot long!

Also, can someone please tell me whether exercise burns a lot of calories or not?  I tend to agree with the side and the science that demonstrates -- not so much.  I didn't count calories as a kid, and I'm quite sure Mom didn't either, but I know what 500 cals looks like and I know I probably ate at most that much most meals at home and I was extremely active.  I was also lean but didn't run around with gnawing hunger either.   I think Reps are responding to the complaints being heralded by Naughton and made by folks like Sadie sue likening 6-800 calories for ONE meal to some sort of starvation.  This is absurd.  It seems this central planning is here to stay ... if I had my druthers it would just be abolished and replaced with a soup, sandwich and salad bar with a fruit basket at the end.  Give the kid a debit card of sorts and subsidize the truly needy.  Done and get over it.   But otherwise, trying to police against overeating is misguided and can legitimately harm those with higher caloric needs.  So as an alternative, provide a basic 500-600 calorie meal of "normal" proportions of 15-20% protein, 40-55% carb, and 30-40% fat to all.  This really should be more than sufficient base and no kid is going hungry on that.  We have other programs to provide food for the household in need, and the role of school lunch programs should not -- because it CANNOT -- be a surrogate for such.  

One meal per day cannot provide 100% of anyone's nutritional needs nor will it dictate anyone's dietary intake.  It goes both ways.   Dietary habits can be influenced by one institutional meal, but they are still more likely to be influenced by the dietary habits and beliefs of the parents.  My own parents would have sent me to school with a lunch every day if I grew up on the 90's.  But is there policing so that I could not have also gotten a lunch to eat the fries or whatever that tripped my fancy for stuff I couldn't get at home?  

I am passionate about preventing childhood obesity because there's nothing more sad to me than to have to deal with this for one's entire life -- to never know what not being obese is like.  Clearly this is influenced by environment in most cases and I'm sorry, but I can't get past my personal experience-based opinion that where children are concerned in this modern world, access is a huge problem.  No, I'm not ignoring the relatively rare genetic/inherent propensity towards obesity.  That is clearly real, and I've known enough kids in my life to see that the types of foods kids are exposed to can have widely varying impacts on weights.   Still, the biggest difference I see nowadays where kids are concerned is greater access to potentially problematic foods and lesser parental involvement in dictating diet.

Let me ask you this.  If school lunches were magically converted tomorrow to exactly what you would want your child to be fed ... do you think this impacts the childhood obesity epidemic?

Read more here:


Hornet0123 said...

The fact that congress is even debating on how many calories a child should be eating makes me very sad!

paleotwopointoh said...

Teenagers aren't adults. Even people discussing this issue have noted that before the 850 cal cap was imposed (and it's a high, schools can provide less calories and apparently are), students took nearly 800 calories under the old rules, on average and schools offered more calories on average when 850 was a minimum rather than a maximum.

Kids hit puberty at different rates and making assumptions about what they need to eat based on adults who are upset about being fat or struggling with weight maintenance is a big part of the problem. Over-restriction of food leads to overconsuming, usually of junk food.

The demographics are very different than when you were a kid. Far fewer two parent families at all.

Evelyn aka CarbSane said...

I agree with pretty much every thing you said. I don't think calorie limits are in any way productive here. However I also don't think school lunches should be designed to feed a teenage football player as if they may not have been fed breakfast or might not get a big enough dinner. Describing not doing this as in any way "starving" the chil'ren just grates.

Yes I realize demos are different, and I don't think this is something that will change back anytime soon, probably never. However if kids have access at home and/or between school and home to different foods, providing only certain so-called healthy foods and/or downright forbidding others will not be effective. A school is not a prison! Such policies may have worked in my day, when we would have eaten what we got and not had access outside of school (for me, school was an opportunity to have forbidden foods, not vice versa).

I'm with Hornet -- it's very sad that congress critters (of all political stripes BTW) are even debating such things.

Dave said...

I remember when I played HS football, I would purchase two lunches every day to get adequate fuel for practice. I was lean with good muscle definition and never had to count calories, and ate quite a few of them. I think the biggest difference between then and now (in my 30s) is food availability. As a kid I had to starve most of the day because food wasn't accessible until lunch, and even then the portions were too small. Then at home I could only eat what was served to me or at least purchased by my parents. I took for granted the good home-cooked meals that turned out to be pretty healthy as we didn't eat as many processed foods as I have been eating in adulthood. So with age I have the same appetite as in HS, but probably am not as obesity-resistant as I was back then, coupled with having higher accessibility to food and being too busy to prepare mainly whole foods, I can see why I have gained some weight since then. The one thing I don't think has changed is my activity levels. If anything I exercise more now, as I took athletics for granted in HS but am more disclipined as an adult.

George Henderson said...

Wow, a carbsane post that didn't push me into rebuttal mode. Much good sense was talked.

My 2 children eat a big dinner, usually includes potatoes and meat, not skimping the fat. They have whole milk cocoa for desert.

The girl, 12, eats a bacon sandwich, or bacon and refryed potatoes, for breakfast and takes no lunch to school by choice. She comes home hungry and always eats a massive dinner. She has no extra weight, she likes candy but probably eats it once a day. Drinks water when thirsty. Likes salt on food.

The boy eats no breakfast, takes to school sandwich (chicken or peanut butter), beerstick, banana and fruit. Doesn't always eat it. Comes home, has sandwich, cheese or banana if hungry, eats dinner (but may or may not eat it all). Sometimes gains a bit (when staying with grandparents or friends) but loses it again. Sometimes eats candy, but not much.

These are two active kids. Basically they get by with one large meal and one smaller one per day, plus milky cocoa for supper.
Food is prepared with dripping, olive oil, or butter, never other oils or spreads. Sugar is available but used very slowly. No cakes or biscuits, desserts are occasional canned berries and cream.
These kids don't feel deprived, enjoy their food. They know they're lucky, because they have vegan friends.

Susanne said...

I read through the comments on the article you linked to that Tom cites. It seems like many of the commenters don't really have any sense of what are normal daily calorie allowances either for kids or adults. The only specific numbers I see are a couple of times when people point out that "Michael Phelps eats 12000 calories a day and looks fine, LOL". Are they under the impression this is what is normal for people? Only a tiny minority of students are hulking high school football players. On the other hand, a significant proportion today are hulking not-participating-in-any-physical-activity-at-all students. Especially since phys ed programs were the first to be cut, decades ago: your kids especially past elementary likely don't have any required phys ed anymore in their school. Because, like, taxes are too high. And seriously even in Kansas how many teenage farmhands are there?

A lot of the anti-guideline commenters also find a way to bring in their complaints about "big government". The school lunch program is one of the ORIGINAL GREAT SOCIETY PROGRAMS YOU LOONS. In its mere existence it is pretty much the classic example of a big government social welfare program. Anyone can read about it here: Hey, you were a participating in a socialist enterprise all along and didn't know it. :)

You can't really logically complain about the way a school lunch program is provided to you and then blame changes on "gummint interference". School lunch programs don't fall out of the sky on the wings of free-market angels. (But then I know more than one Medicare recipient who wants "government out of her Medicare" too.)

Don't like it? Write to your representative, yes. But the government is mandated to care for the "general welfare", not just vegans or paleos, or the "elite". (That's what Paleomom and Mr FreeTheAnimal call themselves BTW.) Or do what school lunch haters have always done and pack your own frigging lunch. If you trace the rumors of fascist lunch-monitors to their source, they almost always turn out to be a misunderstanding of what happened, or a deliberate misrepresentation, from the same sort of people who insist prayer isn't allowed in school. (Anyone is allowed to pray on their own, whenever they want. Really. There are no secret police prayer monitors.) A lot of the food bans, especially of things like peanuts, are actually instigated by parents' complaints, not by draconian school dieticians, which the school probably doesn't have, because they got cut a long time ago too.

I sympathize more with the students who the program was originally created for, who have school lunch or breakfast as their main source of nutrition for the day, not with the special snowflakes whose moms feed them boutique diets. Why are they relying on school lunch anyway? It probably has tons of HIDDEN GLUTEN in it and is, like, totally not organic.

Margaret said...

Another unfortunate case of the government interfering too much. It's been on the local news here in Portland, Oregon, that high school athletes aren't getting enough to eat at school and they are no longer allowed to purchase 2 lunches, which is what they used to do. The calorie restriction should only apply to kids with a weight problem, but then the school would have to profile kids, and that's not PC. Why do some folks think we all have to be the same, no matter what? I read the new guidelines and it's all just way too many rules. How sad for the kids, and the country.

eulerandothers said...

There is a TON of information and research done about nutrition and caloric needs and physical activity, etc. The obesity research is great, but athletes and anyone involved with moving their body competitively want research about the best ways to achieve this with the help of nutrition. They get it. There's a lot going on, and these aren't mysterious murky waters.

When you look at obesity studies, you're shining a light on just one aspect of health. There's lots more going on in research - and as much as aging gets attention, so does growing!

Kids and lunches: I volunteered at my kids' school and saw that 'healthy' meals went into the trash, with pizza and burgers being chosen whenever the option was offered. Schools can only do so much but one thing they can't and won't do is force 'good' food down a kid's throat.

(Exception: I had to eat everything on my plate at Catholic high school or my parents would know why. The nun at the table made sure we all started together and finished together and ate our food - I was thin and stayed thin, by the way - with our plates decided for us, we all ate the same thing with no choice involved.... English boarding school tactic, if you ask me!)

Sanjeev said...

about the spammers click on the user name to go to the user's profile

Once there, on the bottom lower right is "report user"

This brings up a "report abuse" dialog and spam is one choice for the types of abuse

Being able to attach a link or URL to the spam would solidify the case and blogspot doesn't let us do that

but just reporting may be enough.

Evelyn aka CarbSane said...

Just now getting back to comment on this. You had me cracking up with the "special snowflakes" comment there!

I think that regardless of one's position on government programs/involvement, I would hope most of us can agree that this one has just gone woefully awry!

I just watched the video. Kinda pathetic IMO.

Evelyn aka CarbSane said...

I deleted the spam, but I really gotta love how it is usually good comments that get tossed there (and the new interface makes checking even more difficult to remember) while the occasional spam-a-lot makes it right on through. These xenical ones were less obvious than some, but really.

Thanks for the feedback folks!

It seems we're talking buying "a lunch" these days, perhaps a choice of one or two varieties? But "a lunch" including everything and nothing more? This is foreign to me as our cafeteria in jr/sr high had entrees, but also sandwiches, yogurt, desserts, chips, etc. one could buy. Not to mention you could just get sides of whatever came with the entree (usually pretty gnarly) that day.

I'm just not getting kids going hungry on 800 calories for lunch. Even athletes, and especially those volleyball players fainting on the court. I played volleyball and often ate lunch with several of my teammates. On odd days we may have eaten that much, but for most of us that would have been a big lunch day and many of us were already struggling with our weights a bit. Not obesity by any stretch, but some of what I saw in the volleyball players in that video.

bentleyj74 said...

Maybe they should lay off the redbulls and test for QT syndrome.

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