Strategies to decrease calories (or increase activity level) are used to stabilize a child’s nutritional status (e.g., improved weight to height ratio) and promote improved health status. Calories are avoided by removing calorie rich foods/beverages when menu planning. Another strategy is to decrease the typical volume of intake by the child at meal and snack times.
Background Education for Providers
Children need calories for both metabolic energy expenditure but also for growth and weight gain. When children eat in excess of their needs, they store the extra energy as adipose tissue. Children can also gain excess weight by eating high-calorie, minimal nutritional quality foods. By decreasing the caloric intake, a child presumably will decrease their weight velocity to a point which energy expenditure and growth needs are more closely matched by the dietary intake. One consideration for treatment is the physical activity of the child. Children should have no more than two hours of sedentary activity each day. Common problems include: television viewing; computer use; video games; and time spent using telephone, cell phones, and/or texting. Children should also include one hour of moderate to vigorous activity each day. This exercise period does not need to be continuous but can be distributed across the day. This can be measured by an accelerated heart rate, breathing faster, and sweating. Before beginning any planned increase in exercise frequency or intensity, consultation with a physician is advised.
Lower calorie foods – Avoiding foods that are higher in fat and sugar content will decrease calorie intake by the child. Examples: fried foods, commercially prepared food items, sweetened beverages, junk food, etc.
Reduced calories-Selecting items with reduced fat content and/or low-sugar or sugar free items that the child already accepts will decrease calorie intake. Examples: low-fat or fat free milk, sugar free beverages, lean meats/protein, etc.
Decreased intake-Decreased volume of intake also decreases the total number of calories consumed by the child. Strategies to decrease the volume typically stem from behavioral interventions including goal setting with differential reinforcement applied for reaching volume goals.
What may work best for one child/family combination may not work best for another. The value gained by changing a nutrition behavior is also going to be guided by how much the child was engaging in that behavior prior to treatment. Example: a child who drinks 20 ounces of fruit juice daily is going to see a greater benefit by removing the fruit juice vs. a child who only drinks 8 ounces of fruit juice two times per week. Much of the determination of what nutrition behaviors should be altered will depend on where the family is starting from, and which ones they are willing to change.
There are common areas that you can investigate with the family when working toward better nutritional habits for weight management. Consider the following: meal in-consistency (skipping meals), over consumption of sweetened beverages, high frequency of snacks and/or poor quality snack choices, high frequency of eating meals from restaurants (high calorie, high fat), unbalanced intake of food from each of the food groups.
It is important to remember that the nutritional quality of the foods remains important. The general goal is to maintain a healthy diet while decreasing the calorie intake. Families may inquire about restrictive diet plans, weight-loss meal replacements, or supplements which claim of great weight loss. These products/plans should be avoided as there can be health risks associated with these products and only provide a short-term result (if any) while using the product instead of establishing lifelong healthy behaviors. Instead families should be encouraged to use one of the strategies described above to decrease the intake of calorie-rich foods and replace them with lower calorie nutritious foods.
Instructions for Provider
From the “areas of concern” identified on the Secondary Screener, share results with the family. Briefly explain how each of these behaviors will contribute to potential health complications if not changed. Ask which one(s) they feel would be easiest to address. After the family has identified 1-2 areas to work on, share the corresponding educational handouts and guide the family as to how they can make better “food and beverage choices” to improve their health.
If the family completes the nutritional changes suggested, you can discuss additional changes with the family. Some families will be eager and willing to address changes to improve health. Others may be overly challenged by the changes and need more time before proposing additional changes. If you have been working with a family for some time and you are not seeing a decrease in the rate of weight gain in relationship to height velocity, then you should consider a consultation with the Nutrition Network staff.