Transcription:
Nutrition and Obesity in Pediatrics

Joey Wahler (Host): There's so much focus on adults trying to eat right or lose weight. But what about children? We're discussing nutrition and obesity in pediatrics. Our guest, Dr. Swati Narain, she's a Pediatrician for Maimonides Medical Center. This is Maimo Med Talk, a podcast from Maimonides Medical Center Center. Thanks for listening. I'm Joey Wahler. Hi, Dr. Narain. Thanks for joining us.

Swati Narain, MD: Hi Joey. Thank you so much for having me.

Host: Great to have you with us. So first, generally speaking from your experience, just how big a problem is lack of proper nutrition or obesity in kids?

Swati Narain, MD: Oh, that's a very, very big problem and it's a problem that's just been growing. So, as of now, if you look at the national data, post pandemic, the estimates are that about 22% of children are obese. And when we say obese, we mean they have gained a lot of weight. There is also another category called overweight. So about 16 to 18% children are overweight.

Host: Wow. So that being said, at what age usually should parents really start to focus in on their child having a proper diet? And what are some keys in those earlier years?

Swati Narain, MD: So you've hit the nail on the head, and nutrition starts from the time the child is born. So it's very important that parents be educated right from the beginning, right from day one, as to what the child should be eating and there's a lot of misconception and a lot of myths in society.

So, you know, they need to speak to the doctor or somebody with a degree in nutrition and learn what are the healthy things. But a few things that I can say at the top of my head are breastfeeding, beginning with the right kind of solid food, and also developing healthy eating habits early on.

Host: So you mentioned misconceptions. What would be one at least, that you can think of right off the bat, that you'd like to clear up for us?

Swati Narain, MD: Sure. The most common one that I deal with, especially with school-aged children, oh, my child is skinny. So I tell them chubby babies are not necessarily healthy babies. They look cute, but they're not necessarily healthy babies and skinny babies are actually healthy. So I mean, parents need to understand what is healthy.

And that's something you learn only when you go to the pediatrician because they measure the height and weight of the child, and then they will tell you based on the height and the weight and the weight for the height as to what is normal for the child.

Host: And you mentioned a moment ago, eating the right solid foods along with breastfeeding or just following breastfeeding in many cases. And obviously your pediatrician is the one who can guide you there, right?

Swati Narain, MD: Yes. There's also a lot of emphasis on eating foods that are prepared commercially. I often joke and I said, that's not pet food that you had to feed your child. So you should be eating your child's food and your child should be eating the food that you eat because food is culture, food is love, food is your family, and you don't need to buy the baby's food from a store to feed the baby.

And oftentimes the early foods that parents start with are very high in carbohydrates. So, like fruit even. Too much of fruit can be bad. In fact, nowadays they recommend a good food to start with could be proteins right away.

Host: Gotcha. So that aside, what are some generally good eating habits or bad ones for that matter, to be mindful of in younger kids?

Swati Narain, MD: So the first and foremost is, letting the child decide. It's called division of responsibility. So it is letting the child decide how much to eat. Parents decide on the quality of the food. So the child cannot decide, I want to have a chocolate, or I want a bag of chips. No, what is put on the child's plate has to be decided by an adult. Hopefully the right kind of food. And then the child decides how much to eat. So that the child learns to follow his or her own satiety clues and like I was mentioning, chubby babies are not necessarily healthy babies. They may look very cute. And then teaching children to have healthy eating habits.

I often draw the comparison between going to school wherein you learn to read, write, draw, and do the numbers work. And for a similar reason, you go to the doctor where you learn to eat healthy. And if you teach them healthy eating habits early on, it's going to stay with them for a lifetime.

Host: And following up on that, as children do get older and become more independent and busy and subject to outside influences, how can parents still have that hand in their kids' eating habits to make sure all is well?

Swati Narain, MD: So that's a very, very important question and a very relevant one. There has been enough research to show that children who learn to start eating healthy early on, like when they're 2, 4, 6 years old, continue to eat healthy when they're older, when they're teenagers because they have, number one, learned what is healthy food.

And secondly, and more importantly, they have learned to make healthy eating choices. So if you learn to eat healthy as a child, where there was vegetables, you know you had food from all the important food categories, in the right proportion, you are likely to continue eating healthy. So if a teenager eats has eaten healthy food as a four year old, he's probably going to continue eating healthy.

Host: Well, that's good to know that at least if you give them the right push at the beginning, they can hopefully carry that on on their own. How about the first signs to look for that your child may in fact be on the verge of being either overweight or obese. When are they in danger of crossing that line? What's the thumbnail there?

Swati Narain, MD: Exactly. And like I was mentioning, it's hard for parents to know and sometimes parents are surprised when we tell them that we are a little concerned about the child's weight because the child to them, looks lovely and healthy. So it's very important to go to your pediatrician regularly for well visits.

And when you go there, you should review the child's height and weight. Because no two children are the same in terms of size. So it's your weight for your height based on your age, and we have graphs and tables that have been developed by CDC and WHO. And the pediatrician can also not just look at the child and say, this child has a weight issue, or somebody doesn't have a weight issue. So we look at the graph to see where the child is based on his height, his weight, and his age. So that can only be told to you by the pediatrician.

Host: Another thing as a pediatrician that you offer, of course, is help in avoiding a poor diet or weight issues or treating those things if necessary. So what are a few of the things that you do most in those areas?

Swati Narain, MD: So, the most important is learning to develop healthy eating habits early on in life. So there should be an emphasis on vegetables as part of every meal. We encourage physical activities, and nowadays screen time is a menace. So we teach parents that you don't need the cell phone to entertain the child. In fact, it's not your job to entertain the child. They have to explore the world and learn to entertain themselves. So those are some of the important things we tell families. And with families who truly have a weight problem, what I encourage them to do is make a single lifestyle change, stick with it for some time, and slowly over time we add new changes because you can't change these things with the flick of a switch. So we have to be patient and work with the family.

Host: Now, a kid's body type of course isn't necessarily going to be the same at adulthood, so if there is a nutritional or weight issue, it can still be addressed long before they're fully grown. Right?

Swati Narain, MD: Right. In fact, it's interesting that a lot of teenagers who have a weight issue or are obese will continue, 60 to 80% of them will continue to be overweight as adults. Whereas children, if they lose their weight by say 10 or 11 years, actually don't have a high risk of gaining weight later. So early on in life, it's actually preventable, but if it continues into adolescence and teenage years, it's not going to go away.

So, here in lies the cure for preventing adult obesity. We still don't have a cure for adult obesity. But if we can raise a population of healthy kids, we are basically preventing problems from developing later on in life.

Host: Nipping it in the bud.

Swati Narain, MD: That's right. You got it.

Host: So a few other things. You mentioned parents trying to pass these proper starts in life onto their kids, but what if the parent has a weight issue or a dietary issue themselves with overeating, et cetera? How much more challenging then is getting your child to eat right and maintain a healthy weight if you're not doing that yourself?

Swati Narain, MD: You're absolutely right because a lot of foundation of childhood obesity is in genetics. It also depends the weight of the parents. So know, something, when you're in the uterus, which is called epigenetics, your genes get altered if the mother is diabetic or has a weight issue, which leads to children gaining excessive weight later.

So when they come to the clinic, we also discuss it with parents that, if you've had diabetes when you were pregnant, then your child may be at more risk for gaining weight later on. And therefore, we need to monitor the diet very closely.

Host: And then finally, in summary here, for those listening, what's your advice to parents that think their kid may be headed down the wrong nutritional or weight road. If you see things started to go the wrong way, what's the first step in kind of getting things back on track?

Swati Narain, MD: Honestly, it's not a very straight answer here, but yes, you should definitely go to your pediatrician and have a detailed conversation because it's again, I wish obesity was simple; eat less and move more. It's not that. There is mental health, involved. Nowadays we are talking of trauma and adverse childhood experiences.

Also, obesity is associated with the lower socioeconomic status. So if you're living in a food desert, it's very hard for some of these families to vegetables. So they default to the bodega down the street, and that's where they get their food from. So you have to look at the whole family holistically and work with the family.

And therefore it's very important to go to your pediatrician where they can look at the bigger picture and see how they can help you. Sometimes the families live in neighborhoods that are not safe. So, how do you tell a child to go to the park when the neighborhood is not safe?

Host: Gotcha. I mean, all great points. And so your answer, there seems to be, Doctor, there is no one answer. There are a lot of balls in the air there, so to speak, and so you really need to seek the advice and the treatment of a professional.

Swati Narain, MD: Right. And the doctor has to meet the family where they are, rather than give them a laundry list of things to do, oh, you need to fix this. Oh, you need to fix this. And in my experience, a lot of families know what's wrong. It's just that they can't get to it. So we have to be patient and kind to the families.

Host: Understood. Well, folks, we trust you are now more familiar with nutrition and obesity in pediatrics. Dr. Swati Narain, thanks so much again.

Swati Narain, MD: Thank you so much for having me. It was a pleasure speaking to you.

Host: Same here. And for more information, please do visit maimo.org. That's M-A-I-M-O.org. Or for an appointment, please call 718-283-1600. Again, 718-283-1600. If you found this podcast helpful, please share it on your social media, and thanks again for listening to Maimo Med Talk, a podcast from Maimonides Medical Center. Hoping your health is good health. I'm Joey Wahler.