The BMI (Body Mass Index) is a tool for understanding obesity and its use in children is growing. Your pediatrician has probably used it at your child’s annual check-up and you may have seen it used in the school setting soon.

But what is it exactly?

The BMI is an assessment tool that looks at the relationship of weight and height, determining the status of a person’s body weight for their current height.  The BMI calculation will classify an individual as underweight, healthy weight, overweight, or obese.

The BMI is a screening tool that was developed for populations to determine public health risk for chronic diseases such as heart disease and diabetes. Its use in children over the age of two has increased over the years due to the rising incidence of childhood obesity. Most pediatricians are routinely assessing the BMI at your child’s annual check-up.

The best thing about the BMI measurement is it can help you see trends in your child’s growth and allow early intervention if needed. Normally, children grow along a self-established channel and curve. If there is a sudden jump up on the BMI growth curve, this may indicate your child is picking up extra weight. If there is a drop on the curve, weight loss may be a concern.

The BMI measurement has its limitations. For example, the BMI provides a total body index and does not differentiate body frame size and muscle mass from fat stores.  In other words, you may have a large-framed child that is muscular who may be classified as overweight or obese.  Looking at children as individuals including what they eat, how they eat, how physically active they are, and the parents’ frame size can help keep the right perspective when it comes to your child’s weight and interpreting his BMI result.

If you are told your child’s BMI is too high, consult with your pediatrician, registered dietitian, or other health care provider to gather information and education that is tailored to your child, family, and lifestyle.  An elevated BMI and the associated risks for chronic disease can be normalized and/or reversed with healthy eating, physical activity, and lifestyle changes.  For a BMI calculator tool, go to http://apps.nccd.cdc.gov/dnpabmi/.

In a culture plagued with weight problems and thin idealism, it’s no wonder kids are asking their parents, “Do you think I’m fat?” According to a 2008 Canadian survey, 37% of ninth grade girls and 40% of tenth grade girls believed they were, in fact, too fat.

Many parents are blind-sided by this question and are stumped into silence or heading to Google, the doctor, or a friend for advice. According to Laura Lewis, a psychotherapist and eating disorder specialist in Nashville, TN, the timing of this question is an important factor in deciding how to respond. “If this is the first time this question has come up, tell them they look fantastic, and make sure to stay away from using words like ‘big’ or ‘small’, ‘thin’ or ‘heavy’,” states Lewis. If this is not the first time the question has been asked, then this is a real concern that needs your time and attention. “Sit down with your child and have a conversation, beginning with, “you have asked me this question a couple of times—what’s this about?” she advises.

Lewis states that kids get these questions from a variety of influences, including their own parents, peers, and the media. Coming up with a thoughtful and meaningful response depends upon the influence your child is concerned about.

The Parent: Without even knowing it, parents pass on their own body image and weight concerns to their children. “If you find yourself asking, “Do I look good?” or “Do I look fat in these jeans?” to your hubby or other family members, you may want to temper those questions in front of the kids,” says Lewis.

The Peers: Children surround themselves with their friends and find themselves in situations where body comparisons come naturally, such as the gym and the locker room. Particularly during pre-adolescence, the child has a developmental urge to find out if they are normal. “Answering the question, “Am I normal?” is developmentally on target and relies, in part, on looking at others and comparing oneself with others,” states Lewis.

The Media: The ‘thin is in’ ideal makes its mark on children, too. And when you combine media power with a general desire to fit in, it’s easy to see how questions about self-worth and inadequacy can surface.

So what can parents do?

Most importantly, your child needs to hear you accept and love them regardless of what they look like. Period.

Here are some other things Lewis encourages parents to keep in mind:

Respect and Honor your own body. No matter what the size or shape it is—it is your body after all–and the body that produced your child, and takes you where you want to go.

Tolerate normal child growth.  Pre-pubescent girls and boys gain weight in preparation for the rapid growth of the teen years and this is a normal process.

Focus on your child’s inner qualities. Begin pointing out inner qualities as early as possible to help build self-esteem and worthiness.

Limit media influences. Think twice about buying that fashion magazine for your 11 year old and be sure to scrutinize the TV shows your child is watching.

Attitude is everything! Everybody has value, no matter what it looks like.

When your child asks, “Do you think I’m fat?” she is asking you to discuss your values and ideals about body weight, shape and size. He is also giving you the option to debunk media messages, thin idealism, show your acceptance and assure love. Seems like a golden opportunity to me.

Granola bars sound healthy, right? They are certainly a convenient, on the go snack, but there are a few sneaky facts you need to know before choosing the right one for your family.  Some granola bars are great options, while others pay homage to the candy bar, packing a hefty dose of sugar and fat. Don’t be fooled by the “health halo,” including words like healthy, natural, fiber, low fat, or organic. These claims lure me to the box too…for a closer look.

How is a parent supposed to know which granola bar to choose? The Nutrition Facts Label and the ingredient list on each package can help guide your choices.  First, scour the nutrition facts label to check for sugar, fat, sodium, and fiber; then turn over the package and look at the sources of these nutrients on the ingredient list.

We’ve done some of the work for you.  Check out these randomly selected, kid-oriented options:

*Nutrition information obtained from www.calorieking.com.

Healthiest: We looked at overall qualities, but you may be focused on a single nutrient such as sugar or fiber. In that case, it’s easy to see how each granola bar fares in nutrient categories compared to its competitor.  Kashi TLC Chewy Trail Mix seems to be the overall best choice with low saturated fat, the least sugar, and a good amount of fiber.  Although its calorie content is on the higher side in comparison to the chart as a whole, it is still a reasonable amount for a snack. Pairing this granola bar with a 1/2 cup of milk would add protein and calcium to make it more nutritious, satisfying and filling.

If you want lower sugar content, aim for less than 9 grams of sugar per serving (a donut has 12 grams!).  For fiber, go for more than 2 grams per serving (5 grams per serving is considered a high fiber item). Is sodium a worry?  Shoot for fewer than 200 mg per serving.

Unhealthiest: Hershey’s Reece’s Sweet & Salty with Peanuts seems to be the least healthy with the highest calorie, fat, and saturated fat content, along with moderate to high levels of sugar–but I bet it tastes good.

What are your criteria for choosing granola bars for your child?

Disclaimer: This is just a small representation of a single flavor from each of many popular brands on the market, not of all bars available.  Nutrient content may change with different flavor options within each brand.  The purpose of this chart is Nutrition Facts label education, and not specific brand recommendations.

Forget the old adage less is more.  When it comes to fruits and vegetables more is less.  Eating more fruits and vegetables means more nutrients and fiber and less calories and excess weight gain.  It also means numerous health benefits, particularly related to long-term disease.

Getting the recommended servings of fruits and veggies can be a challenge though, especially with picky eaters. The good news is there are a lot of quick and easy ways to turn your kids into lean, mean, fruit and veggie-eating machines!   

Use common sense: When it comes to food choices, fruits and vegetables are a no-brainer.  They are nutrient-dense, not calorie-dense, which allows you to eat more than almost any other food. Plus, you get the added benefit of fiber, a nutrient that promotes fullness and satisfaction after a meal, not to mention keeps you in the bathroom on a regular basis. One cup of fruits or two cups of veggies contain a similar amount of calories as a 100-calorie snack pack, minus the added fat and sugar!

Look at the “whole” picture:  Experts recommend that children get at least five servings of fruits and vegetables each day. This can be accomplished by adding a serving of fruit to every meal, and a vegetable to at least two meals or snacks. Talk about convenience! Fruits and veggies are the original convenience foods: pre-packaged, pre-portioned, and portable. Check out the many forms of produce available in supermarkets today and remember, in season produce is the cheapest. Although you’ll get more fiber from whole produce, frozen, canned in natural juices, juiced, dried, and even freeze-dried fruits and vegetables are great options, too.

Taste the rainbow: Choosing a wide variety of color for your child’s diet is the best way to ensure that they get a wide variety of key nutrients. The key word is natural colors, not artificial dyes and food colorings. Fruits and vegetables are the ultimate and natural way to add color. Vary your colors each day and within each meal and see how many you can incorporate in your family’s diet.

Check Your Bad Attitude at the Door: Have a positive attitude about eating vegetables! Food should provide pleasure, not pain and eating should be enjoyable, not drudgery.  If you approach eating fruits and vegetables with a positive attitude, your kids will follow suit. Focus on what you get to eat instead of what you think you can’t eat or are missing. A healthy outlook and attitude are just as important as healthy eating behaviors. Studies have shown that focusing on increasing fruits and vegetables is drastically more effective than focusing on eating foods with lower fat and sugar.

Focus on Patience: The name of the game is exposure when it comes to vegetables and fruit (and new foods, for that matter).  It may take as many as 10-20 exposures to a new food before your child will find it acceptable.  So if you are trying a new veggie, don’t despair.  Ask them to try a bite, but don’t force them to eat it if they don’t want to.  Just try again another day, or with another food.

Double Duty: Leading by example, or role modeling, is the most effective way to change your child’s behavior.  If you want your child to eat more fruits and vegetables, then you need to eat them too.  Likewise, you are the decision-maker when it comes to purchasing food, or what I like to call the gatekeeper. If you want your child to eat more fruits and veggies, then make sure you have ample choices on hand.

The plan will fail if you fail to plan. I bet you have heard this phrase before. If you are like many parents, you are busy with children, their activities, and homework. Perhaps you work, or maybe you are busy with housework and volunteer activities. Regardless, time given to others is time taken away from planning and preparing meals for a family.

We all know that good nutrition is the cornerstone of healthy, growing kids. So, how can we be efficient with meals and consider nutrition too? Here are some simple suggestions for planning your family meals:

1. Select a day for menu planning, grocery list making, and shopping.

2. Plan a complete dinner meal for each night of the week (and don’t forget to include the dining out nights on your list–it always feels nice to see that you have a night off from cooking!). Remember to include the healthy, balanced components of a good meal: protein source, dairy, vegetable, fruit, and whole grains.

3. Divide your week into theme nights–Crockpot night (I use this theme for my busiest night of the week); Vegetarian night, Fish night, Potato Bar night, Soup and Sandwich night, Kid’s Choice night, etc.

4. Plan your lunches, breakfast items, and snacks for the week. Don’t forget to account for these–planning will help bring variety to these meals and avoid the boring “bowl of cereal” and “same old sandwich” every day.

5. Write down your grocery list from the daily meals and snacks you have listed. Remember, the great thing about having a list is that you can recycle it! Save your menus and grocery lists and rotate them on a cycle.

6. Think about your budget. If you use coupons or store specials, take these into consideration when planning your weekly menu and grocery list.

7. Not sure what to make? Check out our recipes and videos on Kate’s Kitchen with Kids and Kate’s Kitchen with Teens!

Keep that menu list handy and refer to it throughout the week. Having a game plan and the needed items in the kitchen can calm the stress that goes along with pulling a meal together at the end of a busy day, help you feed your family healthier meals and snacks, and help you feel more successful as a parent!

In a world where much attention is given to prevention and treatment of childhood obesity, the thin child lurks in the corner, causing his parent to sprout grey hairs and plead for her to eat.  From toddlers to teens, the thin child who appears to barely eat, or eek out the average growth every year, is just as much a concern to a parent as the child who overeats.

If your child is thin and you are worried about whether she is getting enough nutrition, here are some guidelines to help calm your fears and feed your child:

Check the growth chart:  Children show us that they are thriving through normal growth and development and this is demonstrated on the Center for Disease Control growth charts.  Your pediatrician graphs your child’s weight and length/height routinely at well visits.  Children who are growing normally will grow predictably on their personal channel of growth. Children who are not gaining weight appropriately may demonstrate a flattening of their growth curve or show a decrease from their usual growth channel percentile.  The growth chart is a good indicator of your child’s overall nutritional status.  If your child appears to be maintaining his usual, predictable pattern on the curve, you can rest assured that your child is getting adequate calories for normal growth.

Consider an age-appropriate multivitamin:  Children who are thin may be selective or fussy eaters and may not be getting adequate amounts of needed vitamins and minerals.  If your child eliminates a major food group (dairy, fruit, vegetable, grains, proteins), consumes more processed foods than whole, natural foods, or is having difficulty gaining weight, a multivitamin may be a prudent addition to her daily diet.

Make every bite count:  Be sure to add fat, such as butter and/or oils, to vegetables. Adding sauces such as cheese or hollandaise, and topping with sour cream or shredded cheese can help boost calories as well. Dip fresh fruit into yogurt, fruit dips, or peanut butter. Dress your pasta: rinse and toss with olive oil, then add butter, cheese or sauce. Choose 2% or whole milk instead of skim or 1% low fat milk. Reconstitute soups and prepare oatmeal with milk instead of water. Boost baked goods such as muffins, cookies, or pancakes with an extra egg or dry milk powder. Every bite of food and every gulp of liquid can make a contribution to your child’s ability to gain weight and grow.

Incorporate a pre-bedtime snack:  Smoothies, milkshakes, instant breakfast drinks or peanut butter toast are good snacks that pack extra protein and calories before sleeping.

Stick to a schedule:  Eating meals and snacks on a consistent basis can help drive the cycle of hunger and promote adequate nutrient intake. Aim to offer meals and snacks every 3-4 hours.

Stay active:  While it may seem that physical activity would promote weight loss, it actually helps children (and adults) to build and sustain the hunger cycle.

Don’t plead, beg, or threaten your child to eat:  These actions set up a negative dynamic around food and eating for you and your child. These are controlling behaviors and may backfire in the long run, as research points out that pleading and disciplining a child to eat may lead to being pickier. Provide ample opportunity and nutritious, acceptable foods on a regular schedule and allow your child to control whether and how much she will eat.

Some children are naturally thin and some are thin due to suboptimal or inadequate nutrition.  Always seek further assistance from a Registered Dietitian or your pediatrician if you are concerned about your child’s weight.

Dining out as part of a healthy lifestyle is often difficult for most people.  But, it doesn’t have to be impossible.  Try some of the tactics below the next time you are at a restaurant.  Your body, and your taste buds, will thank you!

Cancel Your Membership to the Clean Plate Club. Most restaurants, with very few exceptions, serve at least double or triple the recommended portions for every food item.  Divide your plate in half before eating, and take the rest home for a second meal.

The Lighter Side of Lunch Portions. Many restaurants offer smaller lunch-sized portions or “small plates” in addition to the full-sized meals.  But, they may not offer this up as an option unless you request it.  Be sure to ask if a smaller portion is available.  Just keep in mind that it still may be more food than recommended for one meal.

Modify Your Meals. Invisible fats, such as butter and oil, are often added to dishes without the diner even knowing it.  Even vegetables are not immune.  Don’t be afraid to be a little picky when it comes to how your food is prepared.  Butter and oil can be left off of vegetables and meats without sacrificing flavor.

8 HEALTHY HABITS OF FAMILIES WHO DINE OUT

Don’t Fall Into the Salad Trap. This menu item can be somewhat of a wolf in sheep’s clothing. Salads are often among the most fat-laden items on most restaurant menus. You can’t make a meal healthy simply by putting lettuce under it. The toppings make all the difference. And they can add up quickly, especially if creamy or other high fat dressings are used. At the very least, dressing should be served on the side and toppings chosen in moderation.

Don’t Blow it with Beverages. It is all too easy to double the calories in a meal by drinking soda instead of water, especially with unlimited refills. Keep in mind that water is a beverage, and soda is a treat that you drink.

Avoid the Appetizers (or eat your own). Free baskets of food aren’t free of calories. Pass on high fat items, or enjoy a little if you like. Having a small snack of fruit or nuts before leaving home is also a great way to control poor choices caused by hunger.

Be Careful with Condiments. These “little” additions can pack a big punch. If used inappropriately, they have the ability to turn a healthy meal into an unhealthy one. But, chosen wisely and used sparingly, they can be wonderful flavor enhancers. Try low-fat options, like mustard or salsa.

Healthy eating in any situation is simpler with the right tools. Knowing what to do and how to do it is important, but actually doing it is the key. Even small changes can add up over time, so take action now.

Our body shape and size is predominantly determined by genetics. Look at mom, dad, grandma, grandpa, great-grandma and great grandpa, and you will get an idea of what you are going to look like, in part. Your body frame, the way you carry your weight, be it in the hips, thighs, or the tummy, and your predisposition to illness, like cardiac disease, high blood pressure, or cancer, largely come from your genes.

Outside of genetics, our environment plays an impressive role in our body shape and size. Our environment includes the food we eat, how we eat, when and how much we move our bodies, our behaviors around food and eating, and our priorities and methods of taking care of ourselves.

Many people want to change the way they look, especially teenagers. Research indicates that by age 13, about 85% of girls have attempted dieting. The age of dieting onset is getting younger, with 15% of girls trying a diet by age eleven. Even five and six year olds are aware of dieting.

Additionally, research indicates that dieting among teens of all weights (underweight, normal weight, and overweight) corresponds with unhealthy behaviors around food and may be associated with a depressed mood. Furthermore, the risk for eating disorders and weight gain is higher when dieting is involved.

What can we do? We need to help our teens re-align their beliefs and attitudes about their bodies. As parents, we need to play up the positive, including health, physical activity, natural beauty, intelligence, and individuality. We need to filter out the negative messages and the unrealistic images.

How much power do we have to change our body? Sure, we can build muscle and reduce fat stores with exercise and what we choose to eat. But, can we really change our genetic shape and size? Can we really change our fat storage tendencies? Muscle-building capacity? Yes, to the extent our genetic make-up will allow.

So, when your son starts on a rampage to alter his diet or exercise more because they don’t like their body shape or body size, remind them of their genes. Remind them that genes are predetermined and “set in stone.” Remind them that they will be tall, or short, or stocky, or slim, or narrow-hipped or blessed with “birthing hips,” because they come from your family and that’s how your family looks.

Empower your child to make the most of their genetic potential. We all have the genetic potential and the power to be healthy– that comes from eating well and being active. Getting comfortable with your genes is about accepting your body for its natural shape and size, optimizing your genetic health potential through active living and healthy eating.

Did you know the average family eats out 5 times per week? That’s a lot of eating out! In order to eat out and maintain a healthy diet, the right frame of mind is important to have.  Teach your kids the healthy habits and perspective below to help them develop good eating habits that will last a lifetime.

Know the Food Groups.  Learning the foods that your children should be eating each day along with their appropriate portion sizes and balance will help you teach them to make healthier choices at any meal, anywhere, anytime.

Moderation is the Key.  It is okay for kids to have their favorite tasty treats every now and then.  Order small portions of the most indulgent foods and larger portions of healthier ones to provide balance to their meals.  Shoot for mostly healthy foods and 1-2 treats per day on average.

Break Bad Habits.  Ask your children if they are really hungry for their usual after-dinner chocolate or mid-afternoon soda, or if they’re just used to having those foods at that time every day.  If not, then encourage them to pass on the treat, or suggest replacing it with healthier fare.

Plan Ahead.  Many restaurants have menus available on-line, often with nutrition information.  Identify the better options at your favorite restaurants so that your children will have some flexibility and healthy limits.

Cue into Appetite.  Help your children start listening to their hunger and fullness cues and identify them as the signal to start or stop eating. This intuitive eating approach can help everyone avoid overeating and can also move your child toward self-regulated eating.

Use Positive Thinking.  Focusing on the healthy foods that your family enjoys is much more productive than dwelling on the ones that you think you can’t have.  A “glass half full” mentality will make a healthy lifestyle easier to maintain long-term.  Also try to avoid labeling foods as “good” or “bad,” as this can distort your child’s view of them.

Share.  Treats, such as decadent desserts, can be shared with the whole table or with another individual so that everyone can indulge without overindulging. Large entrees can be split between two children or one child and an adult.

Keep a Diary.  Food journaling is a great way to put your child’s eating habits into perspective, for you and them.  It can also offer some accountability.  Write down their food intake, physical activity, and thoughts and moods throughout the day for insight into the impact eating has on wellbeing.

Enjoying food in a healthy way is all about finding a balance that works for your family. While ‘balance’ may sound mundane or boring, it is the secret to success. It involves balancing immediate pleasure with long-term health. Balancing healthy foods with the occasional treat. Balancing calories eaten with calories burned. Balancing food groups at each meal. Balancing restaurant dining with home cooking. How do you strike the healthy balance when eating out with your family?