News reports about the growing rate of childhood obesity are published almost daily Finger pointing is rampant, with parents, schools, fast food companies, Coke, Pepsi, Madison Avenue, and even video games all being assigned responsibility. Although who’s to blame is debatable, the fact that our children are overweight is undeniable. Registered dietitian, Connie Evers, an author, speaker and consultant, has spent 20 years promoting the nutritional health of children and adolescents. She has graciously agreed to share her thoughts with us on children’s nutrition and the growing concern of childhood obesity.

In addition to writing, consulting and speaking engagements, you run a children’s nutrition web site dedicated to teaching nutrition for kids. Please tell us about it:
Nutritionforkids.com began about 10 years ago as a way to post the “Feeding Kids: News & Views on Child Nutrition” newsletter on the web. Prior to the website, I sent the newsletter out to an email list of about 50. I am (pleasantly!) surprised that the newsletter and the site have seen such tremendous growth over the years, primarily through word-of-mouth. The site features my books, handouts, stickers, and of course, the “Feeding Kids” newsletter, which now has a direct subscription base exceeding 5000 (and a much wider readership than that, since the newsletter is extensively forwarded to other mail lists). The website has far exceeded my expectations; thanks to the site I have a global presence and have met many wonderful professionals via email. The website also has connected me with a wide array of interesting projects over the years.

My latest book, Good for You! (Disney Press, ©2006), will be available later this summer. There will be complete information on my website n August.

What is your opinion on the childhood obesity “epidemic” that’s come to light in recent years?
This “epidemic” has actually been 30 years in the making. Several things have happened in America since the late 1970s which have contributed to this trend. The availability and intake of sweetened beverages has greatly increased among children and teens, kids have more disposable income, there is easy access to large portions of food and beverages , families do not prioritize shared meals, the electronic age has promoted sedentary lifestyles, safety issues pose a barrier for many children as far as playing outdoors, mass media bombards us with the message of over-consumption , and the list goes on.

In a nutshell, kids of the 70s (including me!), played outdoors more, ate more home-cooked family meals, and were restricted in terms of sweetened beverages and other “treat” foods.

I talk a lot about nutrition culture in my book and other writings. The opening quote of How to Teach Nutrition to Kids (24 Carrot Press, ©2006) summarizes my thoughts:

“As parents and educators, it is our job to create a new culture for health, one where we model good eating and fitness habits, provide healthful shared meals and set limits on foods with little nutritional value.”

What health problems are emerging in children as a result of this childhood obesity problem?
Sadly, we are seeing more adult diseases in children, including type 2 diabetes, joint problems, and risk factors for coronary heart disease such as high blood pressure and elevated cholesterol and triglyceride levels. If the obesity trend continues, some experts predict that the current generation of children may have a lowered life expectancy than their parents.

There is a ton of controversy about the role food and beverage companies play in marketing their products to children. What are your thoughts on the “marketing to children” issue?
Marketing low-nutrition foods to children is not a positive practice and it should be sharply curtailed. I believe it is one factor that has contributed to poor nutrition practices among youth. Studies clearly show that children respond to the marketing and advertising practices of the food industry. Of course, the vast majority of the money spent is to promote low-nutrition foods such as sweetened cereals and beverages, candy, fried snacks, and fast food.

Another societal change involves the control that children have over the family budget. Today’s kids definitely influence the food that is purchased at the store as well as the choices families make when dining out. Marketers understand this trend and are thus devoting more attention and dollars to sell children on “brands” at increasingly young ages.

What are your thoughts on junk food and fast food? Are there any that are acceptable?
I’m a big believer in moderation. I think “treat” foods have a place in the diet and restriction often leads to disordered practices such as secretive eating, hiding food and binging. Children who are forbidden to ever eat treats often learn how to obtain them other places. I always tell families that they should have mostly healthful foods available but compromise on treats and sweets sometimes. A child who eats well can easily have 1-2 servings of extra foods each day. The big challenge here is to teach children what exactly a “serving” is, since so many packages and beverages contain three or more actual servings.

As far as fast food goes, I recommend that families restrict fast food dining to no more than once weekly. Even though fast food restaurants tout their salads and more healthful offerings, most children will end up ordering a typical high-fat fast food meal with a soft drink.

Exercise and inactivity are often cited as cause for children being overweight. Is it that children aren’t exercising and playing like they once did, or are they overeating and/or eating the wrong foods?
Both factors – overeating and inactivity – are at play. But I think the biggest challenge is to get kids to move more. It’s important to find the right activity for each individual child. While youth sports have increased in this country, they have also become increasingly competitive. So, the child who is not gifted athletically often doesn’t have the choice to play on an organized team. We need to promote lifetime fitness for all children, which includes activities such as swimming, bicycling, running, hiking, rock climbing, dancing, etc., which can be enjoyed well into adulthood.

Which foods are children getting too much of? Conversely, which foods are they not getting enough of?
Too much: Soft drinks, sports drinks, sweetened teas and fruit drinks, French fries, fried chips and other high-fat snacks, fast food, candy, and pastries.

Not enough: One percent or skim milk, low-fat yogurt, fruits and vegetables (other than French fries and fruit juice), whole grains, beans, fish, and water.

There seems to be increasing debate about the benefits of milk. Is it good for children or not? If it is good, how much should a child have?
Milk is a highly nutritious food and is the primary source of calcium and vitamin D in a child’s diet. It is also a great source of protein, B vitamins, and potassium. I recommend that children over the age of two drink 1% or non-fat milk. I always tell my teenage (athlete) sons that milk is the best post-workout beverage in terms of replacing carbohydrates, protein, and electrolytes!

For children who are lactose intolerant, there are lactose-free dairy products available. In addition, yogurt is usually well tolerated by most lactose-intolerant individuals.

A small percentage of children have a milk allergy or are vegan, which makes it necessary to use a milk substitute such as soy or rice milk. It is important that these beverages are fortified with calcium and vitamin D.

How can schools better influence children’s nutrition?
I work with schools frequently and my main message to them is that school nutrition programs should also have an educational mission. Their job is not to simply feed children, but instead to educate them about healthful food choices and to provide a cafeteria environment with mostly healthful choices, enough time to eat, and a positive relaxed environment. One key factor to success is to involve students in the school nutrition program. When students feel ownership, they are much more likely to promote it to their peers and communicate that school food is “cool,” not gross.

Competitive foods (such as the junk food sold in vending machines and student stores) really has no place in schools, especially during the school day. It undermines the positive efforts of the school nutrition program.

What is the single worst food you see children consuming in the modern diet?
I would have to say sweetened beverages, because they dump a lot of calories and sugar into a child’s diet without ever really satisfying thirst or hunger.

An activity I do with children is to bring in a large sized soft drink, show them the actual amount of sugar in the drink, and calculate the calories. I then bring in real food and have them create a meal for the same amount of calories. They are very surprised to find they can have a sandwich, fruit, string cheese and whole grain crackers or baked chips for the same amount of calories. We then talk about which one is more satisfying and sticks with the body longer.

There is a surge in cases of childhood diabetes. How do you suggest that we as a nation curb this trend?
The type of diabetes that is on the rise in children is type 2, which is directly related to rising obesity rates.

Which foods, if any, do you simply refuse to eat due to their negative health impact?
Hmm... I try not to think about foods in this way. I think most foods (even the most decadent) can be enjoyed in moderation. I eat (and enjoy) small amounts of dark chocolate several times each week. But I honestly cannot remember the last time I drank a regular soft drink. And I rarely drink diet soft drinks.

What are the best/worst trends you currently see in the average child’s diet?

• Best: Bottled water is now trendy, kids are starting to “get it” about nutrition and fitness and I have learned that they love to cook. Cooking with kids is a great way to introduce them to new, healthful foods that they will definitely try!

• Worst: Too few servings of fruits, vegetables, whole grains, beans, nuts and low-fat dairy products.

You get to be queen for a day and as part of being queen you get to mandate three changes to the American diet, what would they be?

1. A return to healthful, shared family meals.
2. More emphasis on fresh, locally grown (when possible) plant-based foods such as fruits, vegetables, nuts, beans, and whole grains.
3. Better beverage control: 2-3 cups of 1% or non-fat milk, one serving 100% fruit juice, and as much water as needed to quench thirst.
4. (I’m the queen so I get to add this one): Americans of all ages would discover how much better they feel when they move, play and exercise on a regular basis.

How prevalent are eating disorders among young girls?
Estimates vary, but it is believed that approximately five percent of women will experience some type of eating disorder in her lifetime.

What can parents and educators do to reduce cases of eating disorders?
We should focus on eating well and enjoying food. Parents (particularly mothers) are powerful role models and should not obsess over food, nutrition or body image. Our focus really needs to be on normalizing eating, which addresses both obesity and eating disorders.

Are their significant differences in the nutritional needs of girls versus boys?
As children approach puberty, there are significant changes in growth and development. I always like to point out to parents that growth patterns are different between the sexes. In girls, it is normal to add a few extra pounds prior to a spurt in height. In boys, the timing seems to be more synchronized (height and weight increases occur at the same time).

This is a big topic, which I don’t think I can completely address here.

Regarding infant nutrition, what are we doing right and what are we doing wrong?

• Right: Breastfeeding is on the rise. We need to continue to encourage woman to breastfeed but make sure we are not judgmental or preachy about it. Any breastfeeding is good and if a woman can breastfeed for the entire first year, that is spectacular.

• Wrong: This is anecdotal, not scientific: I have observed babies with soft drinks, fruit punch and other sweetened beverages in their baby bottles. Not only are they missing out on the nutrients they need, they are at high risk for tooth decay and are forming very bad habits.

Let’s play a little word association. I’ll give you a word and you tell us what you think about it in relation to children’s nutrition.

• Soda: One of the worst culprits in the decline in children’s nutrition habits.
• McDonald’s: Their goal is to sell their brand to children practically from birth. Very slick marketers!
• Video games: Not only sedentary, but psychologically addictive. Without parental controls, kids will literally sit at the computer for hours!
• Sweetened cereal: “Sugar with vitamins added.” HINT: Kids will eat the non-sweetened varieties if that is what the parents purchase. (As a mother of three, I know this from experience!)

The best way to teach nutrition to kids…
Is for adults to model positive health habits. This message is often difficult for parents, caregivers, and educators to hear because it often requires them to make significant personal changes. Whether we like it or not, children learn more by watching our behaviors and less by listening to what we say.