Nutrition Unscrambled

Combating Obesity: Schools Monitoring Physical Activity and More

By Anna Shlachter, MS, RD, LDN
January 17th, 2012

An article from Latino Fox News discusses program that a New York school district (and those in St Louis and South Orange, N.J.) is implementing to combat obesity. They have purchased monitors that track heart rate, activity and even sleep. The students wear these and the information is uploaded for the teachers to use (for long term tracking). Do you think this make kids/parents more aware of the need for activity? Will having a tracking device make a difference in habits? What about eating habits?

Alone, I am not sure this tool will do much except show us that children do not get enough activity or sleep. If used as a teaching tool with math, science or nutrition curriculum, I could see it being beneficial for the students. It could really tie in the calories in/calories out as far as high calorie/low nutrient dense foods in fun way for students.

So thoughts?
Will this improve health of students?
Is it a matter or privacy (some groups feel so)?

Chew on This-Are We Responsible for the Actions of Others in the Obesity Story?

By Anna Shlachter, MS, RD, LDN
December 8th, 2011

Last week I was able to attend a seminar that reviewed part of the 3rd International Forum on Food and Nutrition with the theme “The Importance of a healthy Diet During Childhood” with other health professionals in the Chicago area. We were able to listen to recorded sessions from Aviva Must, Robert Lustig and Marion Nestle. Lisa Sutherland moderated the day and led us to discuss ideas, implications and more.

I’ve summarized some key points from the seminar:

Dr. Aviva Must, Tufts, gave us insight to the stability of fruits and vegetable intake. There was an interesting slide showing with the Double Pyramid “how to feed children, selves and the environment.” Childhood obesity is known to be “tracked” through adulthood and is associated with the consumption of sugar sweetened beverages, reduced fruits/vegetables, increased portion sizes and meals away from home. Another key discussion was how fruit and vegetable intake in childhood correlates to intake as an adult. The evidence in this area remains overall weak regarding stability of fruit and vegetable intake. Fruit and vegetable intake does tend to decline from childhood to adolescents and then increase, but overall absolute fruit and vegetable intake is low.

Dr. Robert Lustig, University of California at San Francisco, gave us startling statistics – 165 million Americans will be obese by 2020 and 100 million Americans will have diabetes by 2050 (CDC Division of Diabetes Translation, 2011). A key point of this discussion was that obesity is not the problem; the problem is actually metabolic syndrome (for people of all sizes).He also mentions chronic fructose exposure promotes metabolic syndrome and hepatic functions were discussed as it related to this issue. It was noted that we ingest much more sugar than necessary and recognized the AHA Scientific Statement to reduce sugar intake from 22 tsp/day to 9 tsp/day (males) and 6 tsp (females). It was tied together by referring to the Maillard reaction- “instead of roasting 1 hour at 375 degrees, we slow cook at 98.6 degrees for 75 years”.

Dr. Marion Nestle, New York University, discussed food system issues and marketing came out loud and clear and the impact it has on choices for children. In addition, she spent some time discussing influential initiatives like Let’s Move and other programs including Jamie Oliver, Sugar-Sweetened Beverage Taxes and yes there was mention of pizza as a vegetable in the school lunch program. There also have been recent movements of Occupy Big Food and Occupy the Food System.

Three speakers with different viewpoints, but it is clear that the main outcome was to not point the finger and one “reason” for obesity and continue to think of it as a comprehensive solution to fight the battle. We did foster some great conversations and ideas from the day. Check out the video archive of the event for more information.

The question of the day was “Are we responsible for the actions of others?” Lisa Sutherland started us with the question and I think it gives us something to “chew on”.

Childhood Obesity Roundtable

By Anna Shlachter, MS, RD, LDN
October 28th, 2011

ENC hosted a roundtable on October 24 and 25th to discuss obesity and nutrition in children. Participants included research and clinical experts from Harvard, University of Illinois and University of Missouri, two Registered Dietitians – a school nutrition director and a private practice practitioner. We had a great discussion about strengths and gaps in current research, nutrition in schools, counseling strategies and overall nutrition issues. It is clear that the school nutrition program is working hard to improve children’s nutrition, but what happens when they go home? We also discussed that more studies have been completed in adults but not children. At best guess we assume that the adult studies can translate to child nutrition.

These conversations are good to have especially with the researchers and practitioners. It really brings perspective to areas that each can contribute a great deal of information. This can lead to future ideas for research and health related materials we can provide our health professionals for their patients. ENC will continue to promote overall health, including fighting the obesity epidemic. We know eggs have a great role in child nutrition, affordable, 70 calories and full of valuable nutrients.

Beyond Restriction: Setting the stage for kids to Self Regulate food intake

By Marcia Greenblum, MS, RD
September 13th, 2011

Hi Readers – today we have a post written by one of our Registered Dietitian Advisors, Mary Donkersloot. Enjoy!


When a child is overweight, truly overweight, what is the remedy? The first reaction is often restriction. A doctor may send the patient to my office with a calorie prescription; “put this kid on a 1200 calorie diet” the note will say. But we dietitians (and Oprah) know that restriction often backfires. Restriction promotes eating in the absence of hunger. When food becomes available, the child (or adult, for that matter) is likely to overeat; such is the body’s primal need for food. Hence, the phrase, diets don’t work.

The trust model
When I was studying nutrition in college, several decades ago, we were taught about the trust model, developed by Ellyn Satter. I still use this model with my patients today. It goes something like this: It is the job of parents or caregivers to provide meal structure, breakfast lunch dinner and snacks. The parent is also the gatekeeper, determining what food is in the house, and what is on the menu for breakfast, lunch and dinner. The child’s job is to decide what and how much they will eat at these meals and snacks. According to this philosophy, children know what their bodies need to grow and feel good. If provided a balance of food, in a structured setting, they will eat an appropriate amount of food. By giving the child autonomy, the child learns to self-regulate their appetite. Sometimes we can correct weight and feeding issues simply by working with the parent to implement this routine.

We proceed based on the assumption that young children will naturally adjust their food intake over a day’s time to result in a consistent number of calories. But researchers are observing that this long relied upon regulatory system is being altered by our changing feeding patterns and the foods we feed our children today. We know the ability to self-regulate decreases with age, year after year, especially with girls.

Susan Johnson directs the Children’s Eating Laboratory at the University of Colorado Health Sciences Center, said that research as evidenced a population-wide shift over time. She told me in the 1980’s children were compensating for about 90% of extra calories they were getting. By the 1990’s they were compensating for about 45% of the excessive calories.

The reward system
In my own practice, I have found that what children eat doesn’t depend solely on the body’s desire to balance its calorie equation. There is something else we must factor in to the trust model. This is known as the reward system. And in many overweight children (not to mention adults) the reward system is winning.

What makes the child want more when we know their calorie needs are met? There are three things the parent needs to factor into the trust model:

1. The lack of structure can predispose the child to what we call chronic over-feeding. The child wants food frequently and may use the food to self-soothe.

2. The super-stimulating effect of the food may cause the child to want more and more. When we eat food that is high in sugar, fat and salt, a cookie for example, we stimulate neurons, the basic cells in our brain. These neurons are part of larger circuits that form a complex communication system, that create a positive feeling when we eat the cookie. This information, the yummy factor, is stored in the brain and helps to control behavior in the future. Studies with rats and sweet foods have shown that the more these neurons fire, the more sugar a rat will consume. In other words, we will work harder to get more of the cookie, steal another when mom isn’t looking. But you may note that not everyone goes after those cookies with the same gusto. Some people are more likely than others to find the food reinforcing. What we know from scientific research is that sugar and fat can condition the behavior of those who are vulnerable.

3. Kids may have become accustomed to large portions. When they are served more, they eat more. We nutritionists call this “portion distortion”. We become accustomed visually to a certain volume of food, and tend to expect a similar portion size it on at subsequent meals. Some kids lack the control only to eat when they are hungry. Those are the kids that are more vulnerable to eating beyond their calorie needs when they are served large portions.

Does my child have a problem?
Ask your pediatrician. First he or she will assess your child’s weight and body mass index (BMI). You might expect them to plot your child’s BMI on a special pediatric growth chart to show you the category of weight your child is in. They can advise you how to proceed. If your child is considered at risk of overweight or overweight, you may be referred to a registered dietitian to help you map out a plan to improve your child’s weight and health through a better diet.

The global obesity pandemic: shaped by global drivers and local environments

By Anna Shlachter, MS, RD, LDN
September 6th, 2011

The Lancet has created a series of articles, intended to state the case for action on obesity.  The first article reviews the aspect of global drivers and local environments. The UN and its agencies will be meeting in September 2011 to discuss non-communicable diseases (NCDs) as it affects population health and development to help solve the obesity challenge.

Below are highlights from the article.  We as health professionals already know many of these. I think the approach of looking at obesity in the large picture rather than pieces is long overdue. There have been many “smaller scale strategies” and some of those have been successful in targeted areas.  I think the approach of looking at obesity in the large picture rather than pieces is long overdue.  What does this really mean though?

We’ve all seen the numbers and generally are aware of the history of obesity.  Obesity began in most high income countries in the 1970-80’s, but now most middle and low income countries also have obesity.  Three years ago, in 2008, it was estimated that 1.46 million adults globally were overweight and 502 million were obese.  Children were estimated at 170 million as overweight or obese.  Other trends within obesity are prevalent as well, but these numbers tell the story.

A Hoad, Somerford and Katzenellenbogen article (Aust NZ J Public Health) drives home that obesity has overtaken tobacco as the largest preventable cause of disease burden in some regions.

What are some key indicators in this report?

  • Economic Effects
    • Sufficient wealth-this has been an enabler for obesity.  This however, is not always indicative as shown in the Pacific Island nations and others. 
    • Some countries are faced with a substantial burden of undernutrition also has an emerging burden of overnurition and related diseases to both forms of malnutrition.
    • Obesity is the result of people responding to the obesogenic environment and the obesogenic environments arise because governments and business are responding the economic and politic environments.
    • Drivers of the obesity epidemic
      • Several studies have shown that technological changes have created cheaper and more available food calories and have driven forces towards overconsumption. 
      • The “built environment” Changes in our overall habits- less physical activity (driving instead of walking) as well as increased of the food supply starting in the 70’s.  Interestingly enough if everyone was following the fruit and vegetable recommendations of the dietary guidelines, there would not be enough fruits and vegetables for everyone.  What does this say about the oversupply of food? 
      • Cultural preferences such as (body size) can have a significant effect in different regions. 
      • Marketing-On the marketing question-Is the market failing children”?  You decide
      • Genetics- an article by Bray GA states genetics loads the guns but the environment pulls the trigger.
      • Approaches and implications to address obesity
        • The figure below shows a framework to categorize determinants and solutions of obesity.
        • Sustainability and affordability remain to challenges for programs.
        • The major strategies available to directly affect behaviors aim to increase motivation to make healthy choices and include social marketing health education and promotion programs.
        • Realistically policy interventions can be directed at the environment (rather than the individual).
        • The article suggests the solution to obesity should be developed on a global level.

Stay tuned for reviews of the next articles in the series.

Program helps obese kids keep weight off long-term

By Mitch Kanter, Ph.D.
February 18th, 2011

Childhood obesity continues to be a major problem that afflicts many children in the US. According to the CDC, over 20% of the kids in America are considered obese, based on BMI. In spite of various high profile weight control programs recently developed to combat the epidemic, the sad fact is that overweight children tend to become overweight adults, and overweight adults are more prone to chronic disease conditions including CHD and Type 2 diabetes.

 A recent study conducted at Yale University (MedlinePlus) offers some hope. In this long term project, overweight children participated in an intensive weight control program that included physical activity and frequent nutrition education. Initially, the children met twice per week to perform physical activity and attend classes on proper eating. After six months, they met twice per month. After two years, long after the activity and nutrition classes were curtailed, many of the kids who participated in the program maintained BMI. Control subjects who did not participate in the program continued to gain weight and increase their BMI. The moral of the story- -educational intervention in young, susceptible children may pay dividends. A cure for the epidemic? Hardly. But a step in the right direction. Certainly.

 The recent Dietary Guidelines stressed nutrient density, among other things, as a way to eat healthier while consuming fewer calories. Relatively simple advise that by no means is a cure for the obesity epidemic. But it is sound advice. The Yale study is a good reminder that looking for foods and snacks that provide good nutrition without a lot of calories is the right thing to do for our kids. As parents, we’d do anything to protect our children’s health. Seeking nutrient dense food options is a form of health protection that is often overlooked.


Nutrition Unscrambled  is written by nutrition experts with the Egg Nutrition Center, which is funded by the American Egg Board. It is monitored and maintained by the public relations agency of record. The mission of the Egg Nutrition Center is to be a credible source of nutrition and health science information and the acknowledged leader in research and education related to eggs. For more information, click here.

About the Bloggers

Mitch Kanter, Ph.D. is the Executive Director of the Egg Nutrition Center. For more information about
Mitch, click here.
Marcia Greenblum, MS, RD is the Senior Director, Nutrition Education at the Egg Nutrition Center. For more information about Marcia, click here.
Anna Shlachter, MS, RD, LDN is the Program Manager, Nutrition Research and Communications at the Egg Nutrition Center. For more information about Anna, click here.

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All information provided within this blog is for informational and educational purposes only and it is not to be construed as medical advice or instruction. Please consult your physician or a qualified health professional on any matters regarding your health or before making changes to your diet or health behaviors.