Good eating habits start younger than you may think

<p>Oliver is only a year old, but his highchair sits at the table next to the grown-ups. While we eat a sumptuous feast, his parents feed him some of the same food served to us -- pureed in a simple hand-crank baby food grinder right there at the table. And when he has had enough, Oliver uses his tiny hand to sign, "Full!"</p><p>His mom watches for that hand-sign and immediately stops offering more food. She then turns to her own plate and enjoys the rest of her meal while Oliver happily plays with his toys on the tray. In this way, Oliver is learning eating habits that will help him avoid obesity throughout his life.</p><p>Childhood obesity is epidemic in the United States. Over the past three decades, obesity rates have almost tripled for children between the ages of 2 and 5, and more than quadrupled for children between the ages of 6 and 11. Obese children are at greater risk for many health problems, and are much more likely to grow up to be overweight adults.</p><p>We screen for obesity by using the Body Mass Index (BMI), a measure of weight in relation to height. In children, the BMI is adjusted according to age and gender, giving a "BMI-for-age" value. This value is placed on a growth chart and the percentile ranking is noted. If 85 percent to 95 percent of children had a lower BMI-for-age than Oliver, he would be considered overweight. If he were above 95 percent, he would be considered obese.</p><p>How can parents protect their children from this epidemic? It is so easy to pacify a child with food he desires, and sometimes difficult to make smart choices. But we know that weight is a balance of energy-in/energy-out. Using Oliver as an example, let's look at the energy-in component as he learns to regulate his own food intake.</p><p>Oliver was breastfed for at least six months, which will help him because we know that the longer a child is exclusively breastfed, the less likely he is to be obese later in childhood. This may be due to physiologic factors in human milk, as well as the feeding and parenting patterns associated with nursing.</p><p>Absence of family meals is associated with lower fruit and vegetable consumption, so Oliver's family makes a point to eat together for at least one meal each day. He has been slowly introduced to the same foods his parents enjoy. They're keeping it simple as he develops his tastes, and they are making sure their nutrition is balanced and healthy. They do not try to "tempt" him with special foods; they consistently offer him choices straight from the family table. This way he has learned to enjoy the same foods as the rest of his family.</p><p>Research has shown that parents' behavior has a significant effect on a child's ability to regulate his own food intake. Young children do not start out with food control issues; if a baby is hungry, just like any healthy mammal, he will eat. Oliver is allowed to refuse food at a meal. He will then be offered a nutritious snack -- like vegetables or fruit, low-fat dairy foods, or a whole grain goodie -- later in the day. Children naturally go through periods of little appetite, and food can become a huge power struggle within the best of families. Verbal prompts to eat at mealtime, overly close parental monitoring and attentiveness to noneating behavior may create problems with a child's ability to make good food choices later.</p><p>Living here in Sonoma County with a cornucopia of healthy food choices makes it pretty easy to offer nutritious choices to your children. Make healthy meals a family affair, and avoid power struggles at the table and in the kitchen. It really is one of the most important responsibilities of parenting: teaching our kids to eat well, and to make choices that will keep them clear of the obesity epidemic.</p><p>(Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before followingany recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.)</p>