Transcription of Connecting Kids with Food, #77
Speaker 1: You’re listening to the Dr. Lisa Radio Hour and Podcast. Recorded at the studios of Maine Magazine in Portland, Maine. Summaries of all our past shows can be found at doctorlisa.org. Become a subscriber of Dr. Lisa Belisle on iTunes. See the Dr. Lisa website or Facebook page for details.
Speaker 1: The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors: Maine Magazine, Mike LePage and Beth Franklin of Re/Max Heritage, Dr. John Herzog of Orthopedics Specialists, Booth Maine, Tom Shepard of Shepard Financial, Apothecary by Design and The Body Architect.
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast show number 77, Connecting Kids with Food. Airing for the first time on March 3rd 2013. This week’s guests conclude pediatric endocrinologist, Dr. Michael Dedekian of the Let’s Go! Program and Dr. Kevin Strong of Dunk the Junk.
Food: it fuels our bodies, but does it nourish our souls? As with many adults, children have become increasingly disconnected from the food they eat. Much of it is highly processed, and looks nothing like the plant or animal from which it originated. It is also perhaps too readily available, based on the obesity epidemic in this country. Its convenience has led us to consume food on the fly, instead of eating mindfully and with gratitude. We need to reconnect with food and help our kids to do so as well.
Does anyone really know what is inside a cheese doodle? Most of us harbor no illusions about obvious junk food. Though if you remain unconvinced, read the February 20th 2013 New York Times article, The Extraordinary Science of Addictive Junk Food. It takes many different chemicals, including preservatives, colors and flavor enhancers, to keep our favorite snacks sitting fresh and pretty on our supermarket shelf. Our children may not realize this, however. It’s our job to educate them about the food they eat, and to steer them toward less processed alternatives.
One way of doing this is to think local. Local foods tend to be fresher, which usually means they are more nutritious and taste better. Buying local foods benefits the local economy, i.e. your neighbors, and decreases the distance a food item must go before reaching your plate. This cuts down on pollution caused by the vehicles that transport the food. As you buy and eat local products, discuss what this means with your children.
Better yet, show them. Help them put a face on their food. Visit a local farm together or perhaps even have a CSA or Community Supportive Agriculture Farm Share. For a reasonable fee you can get a weekly allotment of fresh organic produce from multiple area farms. For more information, check out csacenter.org.
Another idea, which is going to be increasingly possible as the months get warmer, is growing your own food. Don’t be intimidated by this thought. Kids love to grow things, and they really don’t expect much. The best way to teach a child about the origins of her food is to walk her through the process.
Start with a few windowsill herbs in the winter, adding a small outside garden plot in the summer. Choose foods that your child will like, but be creative. Try a few unknowns. Your child would be more likely to eat that funky-looking squash if she cared for it with her own hands.
Once you have that funky-looking squash in hand, help your child make the most of it. Get out your favorite kids’ cookbook like Mollie Katzen’s Pretend Soup for preschoolers and select a recipe together. An older child can help with planning, shopping, and even most of the food preparation. Younger children are capable of skills such as pouring with help and mixing. Exercise common sense, of course. Don’t ask a child to do things beyond her ability level, and provide adequate supervision. Make one night a week kids’ night, and let them take over. Work with them to plan and create the family meal. Then break bread together.
It’s time to bring back the family dinner. Try to eat together at least once a week. Children love rituals, so make the family dinner special. Get out the cloth napkins and fancy china, and let the kids set the table. Light a candle and turn on some classical music. Begin the meal with a show of gratitude. Thank those who helped bring the food to your table—from tilling the soil to toasting the bread.
From planting a squash to planning a meal, there are many opportunities for connecting kids with food. This connection adds value to the food that we need for fueling our bodies. More importantly, it provides nourishment for the soul.
We hope you enjoy today’s conversations with endocrinologist, Dr. Michael Dedekian of the Let’s Go! Program and Dr. Kevin Strong of Dunk the Junk. Let us know if you have suggestions for connecting our kids with food.
Are you a mindful eater? Do you really spend time savoring the food that you put in your mouth and chewing it and then digesting it? Do you enjoy what you eat or is it a constant battle? Is it struggle? Are you always feeling guilty about the calories and the fat content? It’s time that we got more mindful about the food that we eat. Whatever it is we put in our mouths, enjoying it to its fullest.
This is the type of thing that I discuss with my patients at The Body Architect in my medical practice there. We need to get beyond dieting in our conversations about food and nutrition, not only with our children but with ourselves. This the only way that we’re going to enjoy fully the lives that we have only one of. For more information on mindful eating or do set up the time for conversation with me at The Body Architect. Call 207-774-2196. I look forward to helping you connect back with your own food and your own life.
Anybody who’s been paying attention to the news knows that this national epidemic of obesity and being overweight is something that we’ve been concerned about for quite a while. We’re especially concerned because we’re heading down into the younger years. An individual here in Maine, who spends a lot of time thinking about what this means, obesity and being overweight in children is Dr. Michael Dedekian, who is a pediatric endocrinologist right here in our lovely city of Portland. Thanks for coming in.
Dr. Mike: Thanks for having me.
Dr. Lisa: Dr. Mike, first tell us, what’s a pediatric endocrinologist?
Dr. Mike: Great question. A pediatric endocrinologist is someone who helps children with growth and any other hormone problems they might have that includes diabetes and a full spectrum of other diseases like thyroid problems and problems with puberty, those kinds of issues.
Dr. Lisa: It’s pretty specialized. Why did you become interested in this?
Dr. Mike: That’s a great question too. I became interested in endocrinology because I think it’s a terrific blend of science and being able to help care for patients. I have a basic science background from research laboratory experience. The kind of science that we use in endocrinology directly takes what we have learned at the bench top to bedside where we can help children be well and grow.
Dr. Lisa: Having spent time working with children and parents through my own medical practice, I know that it takes us certain special ability to communicate that we develop I think through pediatric training. Is this what you found to be so?
Dr. Mike: That’s true. I think no matter what kind of doctor you are, communication is the essential feature. There’s no doubt about it. Sometimes things in endocrinology can be complicated. We do our best to boil things down to their essential elements. One of the things that inspires me about the field is that endocrinology is very observational, meaning that we have learned from science what the body does naturally and are trying to restore that balance to our patients. That usually a pretty easy concept to understand.
Dr. Lisa: It is an imbalance that we’re talking about now when it comes to children being overweight and obese. What has happened that causes the imbalance to occur in such a widespread manner?
Dr. Mike: That’s the essential question. I think you really hit it on the head there. We don’t know of the answers to that question. Some people argue that our genetics have not changed that much in the past few hundred years. Therefore, it must be mostly environmental influences that are the root of this problem. It’s probably a little more complicated than that because as our understanding of genes and genetics has changed over the years, we’re learning that genes are malleable, that their expression is dependent on certain things in the environment.
Even though the DNA code may not have changes how our genes are being expressed and used in the body may be something that’s changing over time. That’s a complex constellation of environmental influences, societal influences and many other different issues. I always like to say in the beginning that the epidemic of obesity that we see in children and adults has no single trigger. It’s a multifactorial issue.
I gave a couple examples already. Food supply would be another one. The way our food supply has changed, the way portion size has changed, the way our behaviors have changed, the way parenting has changed, all these things play a role. Socioeconomic is another huge factor as well and that has changed. There’s no one single issue. I think there is a popular misconception that obesity is a personal choice and it is not a personal choice.
I think if you ask anyone who’s overweight, if they have chosen to be overweight, they would not say that they have chosen to do that. Certainly any child who is overweight has not chosen that for themselves. It is not a personal choice. It’s not something completely under our control. I don’t mean to absolve us of personal responsibility because that’s obviously very important. What we put into our bodies and how much we move our bodies is important. There are many other factors like genetics and family history and environment that are not under our control and we need to think very broadly about this issue.
Dr. Lisa: What about the possibility of endocrine disruptors that has been brought up in the last say 20, 30 years?
Dr. Mike: That’s another great issue and an important one and one that we’re really in the very early phases of understanding. The field of endocrine disruptors has not been around for very long. The term was not coined out long ago. We work with some leaders in the field. If anyone is interested, they can look up on the Colby College website lecture that I gave as part of the day-long symposium with Dr. Bruce Bloomberg who’s from California, who has spent some really pioneering work in this field and shown that yes, the chemicals in our environment are concerning. We need to take them seriously.
I think we’re still waiting for more science and more evidence to point us in the right direction in terms of what should we be telling our patients, what kinds of chemicals and toxins in the environment should we prioritize as ones to avoid. We’re still learning but it’s clear that these chemicals absolutely can push us down a path of altered metabolism and for children, altered growth, altered puberty.
We’re not sure exactly how it all works yet but there’s enough scientific evidence to show that it is concerning. I think of endocrine-disrupting chemicals as an important piece of the puzzle to not the only thing but an important piece to keep an eye as we move ahead.
Dr. Lisa: I like the idea that you put right out there at the very beginning that this is not a choice. That the children are not choosing to be obese and even really adults are not choosing to be obese. For me, it comes back to the time I’ve spent with patients in my own practice and the compassion that’s really required to deal with people who are in this difficult situation that’s hard to make challenge changes in. I find that challenging. How have you dealt with that?
Dr. Mike: It is very challenging and it’s because there are usually many issues to tackle for something that is maybe a knowledge gap. I think that we all have some knowledge gap when it comes to understanding nutrition because it’s so confusing. I learned something about nutrition from my dietician every day I’m in clinic. Sometimes it’s a problem with socioeconomics as I mentioned. That maybe the family needs more social support. That’s why we work with a social worker in our clinic who’s a really essential element.
Sometimes there may be mental health issues. Sometimes there may be issues within the family that need to be addressed as well. It is very complicated and we have to deal with it I feel like in a very multidisciplinary kind of way. I should say too that a physician working on this in a clinic seeing one patient after another is nice for individual families but it’s not going to be the solution.
The solution has to be much broader and has to involve cultural forces. It’s going to take a little bit of courage on behalf of governments and administrations to deal with this issue. Any meaningful long-term change has to come from a societal level in some way.
Dr. Lisa: We’ve seen examples of the society starting to wake up and take notice and make changes. What are some of your favorite things that Maine has engaged in to try to decrease the problems of obesity?
Dr. Mike: That’s another great question and it leads us right into talking a little bit about Let’s Go! What’s great about Maine is that we really lead the way in many areas and our model for many other centers and communities throughout the country. As you know, I’m involved with and part of my time is supported by the Let’s Go! Program which was started by Dr. Tory Rogers here in Portland. Let’s Go! is a multidisciplinary effort that crosses many different sectors of the community and society to prevent obesity.
When it is put in action for kids and families, it’s not advertised as obesity prevention. It’s advertised and promoted as healthy living, which I think is the right way to go. We don’t want kids to be overly focused on a number of their weight. We want them to be thinking with their families about healthy habits. The mantra of Let’s Go!, the essential message of Let’s Go! is 5210 which hopefully many of your listeners have heard of.
It helps remind us about how to be healthy. It’s a healthy living prescription for five fruits and vegetables a day, two hours or less of recreational screen time, one hour of physical activity everyday and really putting a limit on sugary beverages and juice. That’s the zero, zero sugary drinks and juice. It’s a healthy living prescription. Kids in Maine and other states in New England and really around the country, there are places far away as Hawaii that are doing Let’s Go! in their communities.
Kids in these communities see Let’s Go! messaging all over the place. They may see it at school. They may see it at their church. They may see it a Boys and Girls club or YMCA. They may have parents who are encountering it at their place of work and then at their physician’s office as well, they’ll be seeing this messaging, this kind of messaging that helps promote healthy living.
Dr. Lisa: How has Let’s Go! been able to work with the physician offices to put these messages into place?
Dr. Mike: Dr. Rogers has a well-oiled machine and a small army of people who help physicians in their office achieve this goal. It involves some simple steps but important steps including making a connection to the community which we help offices do, including using a health habit survey with families at well-child checks which we also help with and make it easy for physician offices to achieve and prioritizing proper weighing and measuring of children so that BMI can be calculated.
This might be a good time to talk about Body Mass Index a little bit. If your listeners don’t know, that is a measure of weight for height. You use weight and height to make that calculation. It is not a perfect measure of how obese you are. It is a measure that we find useful on the medical side to predict risk. In other words, if a child’s body mass index is far, far above the normal range for age, we know that over time that child is going to continue to struggle. It may help the pediatrician or family medicine doctor prioritize certain interventions for that family.
I often encourage my patients as I eluded to earlier not focus on that BMI. I don’t think it’s right for example for schools to be calculating BMI and then sending that information home with the child unless it’s in the right context. We use that measure that’s an important measure in the Let’s Go! Program for healthcare professionals. I think as our awareness of this, not only here in Maine at Let’s Go! but as a nation involves and how this issue should be best communicated to families in the most healthy way. We’re starting to rethink how to communicate these numbers to families.
Dr. Lisa: What is the scope of the obesity and overweight problem in children in Maine? Is it different from the nation?
Dr. Mike: It largely follows national trends so between 30 and 40% of all kids in Maine and around the country have a weight that is outside the normal range for age.
Dr. Lisa: How does this impact children’s health? We know that long-term there’s an impact on adult health and longevity and ability to live a healthy life. How does impact the life of a child?
Dr. Mike: It can impact the life of a child in many ways. I think I should say first that most children are healthy no matter what their weight is. Adult-type diseases are still relatively uncommon in childhood. However, we’re starting to see an increase in these diseases in a way that is far beyond what we would have predicted even a few years ago. I always tell people that I got into pediatrics because children usually have one or two medical issues that need to be worked on and usually they’re fixable and solvable. You can fix a broken leg or an infection and send kids on their way and they’ll be healthy for 90 more years.
What we’re starting to see especially in my clinic where I see kids who are struggling the most towards this few population. What I see is a list of what we call comorbid conditions or medical issues stemming from weight that really look like an adult-type medical problem list. Things like pre-diabetes and outright type two diabetes, hyperlipidemia, meaning high cholesterol; children who need medical therapy for elevated cholesterol levels.
Young women and young teenagers who are having problems going through puberty and having irregular menstrual cycle is an issue. Obstructive sleep apnea, something you may usually only think of as in adult population is much more common in the children that I see. Then the social comorbidities I think are important to mention as well. Not every kid who has a weight issue struggle socially but many do.
Quality of life by various psychosocial measures is often lower in children who are really struggling with their weight. That’s a major issue as well and something that we really emphasize and focus on also. The medical issues really run the full gamete. Anything that an adult can have because of a weight issue, a child can have too. Usually it’s in the early phases but we love to get involved early; the earlier the better. Often we can prevent those issues from really becoming a problem.
Dr. Lisa: How do you usually begin working with a family on this issue? It does go beyond the child. In fact sometimes just focusing on the child can be very stigmatizing. What’s the approach?
Dr. Mike: The approach we use in our clinic is first to say some of the things that I said earlier in this interview which is to take away blame and to point out that there are many issues that can cause weight problem. We emphasize that we want kids to feel comfortable in their own bodies no matter what those bodies look like. We start from there and I feel that that really helps.
We also emphasize that we don’t have a particular weight goal in mind or a particular number in mind. Many families are relieved to hear that. Once we break down some of those barriers, we can then open up the discussion a bit more. We really try to let families lead the way. We like to find out what families see as the greatest barriers to better health in their family and work on those issues first. We’ll help guide them and give suggestions of course but we really try to let families be in the driver seat.
We have several themes that we emphasize in the clinic. One of them is that families need to work together that rule within the family around food should be the same for everyone. You shouldn’t have a different list for different members of the family. If something is expected of the child, we expect it at the whole family as well. That’s something that’s very important. We see where families are. We have themes in mind to work with them on but we really let them lead the way.
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Dr. Lisa: How has all of this impacted the way that you’ve parented your own children? You have a one-year-old and a four-year-old and I can’t imagine that you can separate that easily.
Dr. Mike: That’s a great question. I think there’s no doubt that I’m healthier personally because of the work that I do. That’s probably just the nature of medicine and being around a great team including a great dietician and social worker and other physicians who are always teaching me something new about this. It’s helped me. It’s helped parent for sure. I think it’s given me a little bit of courage too to take certain things out of the house.
For example, I always tell my patients that if something is there, it’s much easier to eat. If it’s not there, then you won’t eat it. I always sort of poke fun at my staff in the hospital. If they bring me donuts or if they bring donuts to share with everyone, guess what? I eat them. I don’t let them go to waste. I think that’s true of anyone. If those donuts or that ice cream isn’t there in your home, then it’s not going to be as a barrier to better health.
I usually tell families, “Go out once a week and have ice cream instead. Give yourself a special treat once a week but don’t have it in the house. That way, it’s a measured portion. You’ve had a good week. You’re giving yourself a little bit of reward for it. That way, kids don’t feel they’re completely deprived of things which we want to avoid also.
I definitely practice what I preach. I like to be able to tell my parents that in a very honest way. I think we do a good job. I think my kids are growing up in a very positive environment. I don’t think they’re hyperaware of food or have some anxiety about food. I think it’s a very healthy.
The other thing I’ve been able to witness is in my daughter’s day school, they were not doing the Let’s Go! program when we first started there a few years ago. This is the Trinity Day School in Portland. They did a wonderful job bringing the Let’s Go! program to the day school. I saw how they cleaned up snacks. They now offer healthy food and vegetable to all the children at snack time even if they don’t have it in their own lunch that they bring.
There’s no juice anymore in the whole daycare which was a little bit of a shock to the system, to some parents but the kids adjusted and are totally fine now with it. They have healthy celebrations meaning that for birthday parties and holidays. There are healthy snacks and treats offered instead of cookies and cupcakes which really has cut down dramatically, right?
If you think about it in a class with 40 kids, there’s a birthday every week. There’s some sugary something every week. When we rolled out this idea of healthy celebrations, it was a real relief to the childcare staff and also to the parents that the kids were going to be having healthy foods instead of sugary things all the time.
I’ve seen how it works on a parent level. I like the kinds of things that it does with my own family. We’re educating our family and grandparents are keeping an eye on what’s going on too. That’s always a tricky one. I think we’re doing well.
Dr. Lisa: Are you originally from Maine?
Dr. Mike: Spent a lot of time growing up in Maine so it feels very much like home and was very thankful that my parents decided to retire here and we came along for the ride.
Dr. Lisa: Is there something about Maine and the ability to go into the outdoors and be active and have an active lifestyle that drew you here?
Dr. Mike: Yes, absolutely. I mean, Maine I think has one of the greatest quality of life existences you can live. It’s just the right kind of place for me. We do love to be outside. We love nature and all its seasons. I always tell kids in my clinic who say there’s nothing to do or there’s nowhere to go outside to play. There may be some kids who live in neighborhoods that are a little tougher than others. Maine has a lot of space. There’s plenty of snow to shovel. There are plenty of leaves to rake and places outside to go.
I’m always trying to encourage my families to take advantage of the great resources that we have here in Maine. It is such a wonderful place to be and a great place to raise a family and tremendous opportunity to be healthy if you know what to do and where to go.
Dr. Lisa: Your kids are one and four so I don’t know that you’ve experienced this personally but do you have any thoughts on the way that we’ve developed this kids sports institutional … I don’t know, megolith of it now out there in society? That’s where we push kids early to do sports that helps them to be active. Then not necessarily shocks off kids at an early age if they don’t have the right skills. Then it causes a lot of parents to sit around and watch their kids rather than being active themselves.
Dr. Mike: Right. Yup, that is true. I think that many times when we talk to families about being active and exercise, they think of organized sports as the only option. We are always trying to counsel our families that exercise doesn’t mean you have to go and run a marathon or join a sports team. It can be helping with yard work. It can be taking the dog for a walk. It can be trying to walk to school when you can. It can be trying to walk more during your day, taking stairs instead of elevators, simple things like that.
I do think that our culture does get us caught up in organized sports. Kids are competing at such an intense level now. They’re almost being trained like Olympic athletes in some circles. I think that does stigmatize exercise and activity a little bit and make it seem unreachable for those kids who are not naturally very athletic or might not be as interested in sports.
I do think it’s important that we have a broad view of activity. We try to call it activity instead of exercise. I just say move or play. For kids of a certain age, it’s just playing. That’s all they need to do. You’re right. We do need to be careful about what we exercise and activity. If there are kids interested in sports, that’s great. They should go for it but there’s a lot of other ways to get there too.
Dr. Lisa: Are there any interesting things coming up in the science of pediatric endocrinology obesity, being overweight?
Dr. Mike: There are definitely are some important advances coming our way. I think the biggest question that is still being studies is how does extra weight at a young age affect health in the future? I think we all take it as obvious that too much extra weight in an early age is going to adversely affect health in adulthood. That seems to largely be true. Exactly how that happens and what kinds of risks are most important to prioritize, that’s something that’s still being studied.
One example would be type two diabetes. There is no formal definition of pre-diabetes in children and teenagers. That’s something actively being studied and being looked at. We use a definition from adults that probably works but children have a special situation with their biology and their growth and puberty puts them in a little bit of a different category that we need to look at careful.
I’m always careful when making that diagnosis of pre-diabetes. There was just a huge study that came out part of the today’s study recently published in the New England Journal of Medicine looking at the progression of type two diabetes in young people. There were some discouraging results showing that young children and teenagers with diabetes tend to have a more severe form of type two diabetes than in adulthood.
The medicines used in adults with a relatively good effect aren’t quite as effective or long-lasting in younger children. These kinds of issues are ones we’ll continue to keep watching as we move forward.
Dr. Lisa: Has it made any difference at all that we’ve taken sugary drinks, sugary snacks out of many of the schools and the vending machines and the hot lunches? Has there been any impact on the child’s ability to study and focus?
Dr. Mike: I think that school is a tremendously important part of this puzzle. It’s a major emphasis of our program at Let’s Go! Yes, I think that not only are you removing calories from children’s environments, extra calories that are usually not necessary but there probably is a beneficial effect on helping kids focus as well. We work with some physicians in the community who work with children who have ADHD. Some of these children definitely need medicine; others may not. Some practitioners are using a more nutritionally based approach to ADHD and having some good results with that.
Dr. Lisa: How can our listeners find out more about the Let’s Go! program?
Dr. Mike: They can visit our website and I would encourage them to do so. It’s letsgo.org. They’ll see information there on the 5210 Program. There are very hand and user-friendly handouts and recipe books for families interested in getting new ideas about healthy snacks and healthy living. That’s a great place to get started. We would love for people to visit our website. We’re very reachable if you need to reach me or Dr. Rogers. Our contact information is on the website. We’re happy to take a call from anyone who’s interested in learning more.
Dr. Lisa: We’ve been speaking with Dr. Michael Dedekian about childhood obesity and some of the issues surrounding it. We’ve been really privileged to spend this time with you. Thank you for coming in and working on this important topic.
Dr. Mike: Thanks for having me. It was a pleasure to be here.
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Dr. Lisa: Anyone who has kids knows that it can be quite a challenge to try to step outside of the mainstream messaging that takes place and try to encourage them to eat healthy foods and not necessarily eat the types of things that they’re seeing the pop stars’ eating on television. Dr. Kevin Strong especially knows this. He is the CEO and co-founder of Dunk the Junk and a pediatrician who has practiced formerly in the Mid-Coast Region and now in Lewiston. We’re really happy to have you in to talk about your PEP project, Dr. Strong.
Dr. Kevin: Thanks for having me. That was a nice intro.
Dr. Lisa: It’s impressive the work that you’ve done. I’m looking at right now a poster that is just very graphically interesting in a way that I don’t see often in public health, the top 10 foods to dunk. The art really grabs one’s attention especially if I was a child looking at this poster. It would really grab my attention. I think that’s been the preface, it’s been the premise of what you’re trying to do is communicate with kids in a way that they understand.
Dr. Kevin: I think your intro also kind of touched on this. I think it’s really challenging for parents these days to steer their children towards healthy eating. There’s so much advertising pumped at them encouraging them to eat junk food and junk food’s cool. Parents have to of course tried and battled that which is it’s difficult when the access isn’t even great.
The idea with the project really at the heart of it is to brand healthy eating, make it cool to not eat junk food and make it cool to eat healthy food and that’s what that effort is.
Dr. Lisa: Tell me about these top 10 foods. What are they and why did you choose them? You don’t have to go through them all in order if you haven’t memorized them but why this top one is especially interesting to me.
Dr. Kevin: I think the mission statement really for our project is to dismantle the junk food epidemic and really what that means is to reverse the childhood of this big epidemic. Obesity is caused by excessive sugar consumption mainly in sugar sweetened drinks. We know that. There are tons of articles that confirmed that. The idea with the top 10 foods is to really take that science and make it executable in a cool program.
They’re basically all sugar-based. There are a number of them that are drinks because again you get the most impact by taking the sugary drinks out. Then you dunk it and it becomes the alternative on process forms. The most easy one to translate would be a fruit roll-up becomes a piece of fruit or a veggie pops becomes a vegetable. We preach to just eat from the earth. Eat food in its original form. That’s basically how those came about.
Dr. Lisa: This top one is soda. You’re dunking out, like literally dunking it through a basketball hoop which is something that kids understand. I know that you’ve gone out and you’ve done some work in the community and you’ve had basketball players come in and do some dunking. It’s a very strong visual. You dunk it through hoop and it becomes water or milk. One 12-ounce soda has 10 teaspoons of added sugar. That’s pretty significant.
Dr. Kevin: That’s the 12-ounce. That’s the smallest form.
Dr. Lisa: That’s the 7-11 big Gulp.
Dr. Kevin: No. You could just do the math. The original big Gulp is 44 ounces. Approximately four times the 12-ounce so you’re looking at 40 teaspoons.
Dr. Lisa: You even have this on your poster. The American Heart Association recommends that adult women consume six teaspoon of added sugar or less per day. Adult men consume nine teaspoons of added sugar or less per day. That’s an adult. If you drink one soda then you’ve already surpassed that by quite a lot as a child.
Dr. Kevin: Yup. A lot of people are drinking a lot more soda than that. There’s also a lot of sugar, a lot of sugar served at the school lunches and breakfasts. I did in a school district in Maine or may mean less because it’s pretty consistent around the district. It’s not meant to single anyone out and around the country. If you have breakfast and lunch at school which a lot of the underserved kids or kids’ families who are struggling to get by. A lot of them are eating there. They get 31 teaspoons of sugar by eating breakfast and lunch at school which is five times what the American Heart Association recommends right at school.
Then if you went home and had a little bit of soda, some juices or whatever, you can see where you’re getting to these really, really high and toxic levels of sugar consumption. That’s what the science tells us.
Dr. Lisa: What does sugar do? People are listening probably has some sense but review that for us because it’s significant.
Dr. Kevin: This is my easiest question to answer because the girly gets to the science and the research. It’s pretty scary where the science is starting to point us on what sugar has really been doing. It’s important to stress that we’re talking about sugar in insane levels. I’m not saying sugar is in normal consumption amounts back thousand years ago it was toxic.
The sugar at the levels we’re consuming is toxic. Obviously, everybody knows that it increases your risk of obesity. Then you can extrapolate the morbidities from obesity. Obesity increases your risk of various types of cancers. Sugar consumption makes you obese and obesity increases your risk of a number of cancers by the transit of property you can associate those.
A lot of the top researchers right now in cancer research are working on insulin-like growth factors. Insulin is an anabolic or pro-growth hormone. If you have highest levels of sugar all the time, your insulin is always up. You have an anabolic hormone coursing through your body. That’s not good. It’s pro-growth. It’s oncogenic. Many people think it could create cancer growth environments.
If anyone wants to read more about that, there’s an article in New York Times Magazine April 2011 written by Gary Taubes. I don’t know if I’m pronouncing it right, Taubes. It’s called Is Sugar Toxic? It’s a great review of this. It will bring you the links where you can read more about it. Otherwise, I’ll consume the whole interview right into that.
Dr. Lisa: It is interesting too because it appears in things that you wouldn’t necessarily think are unhealthy and things that we’ve encouraged people to eat, granola bars. A granola bar can have four teaspoons of added sugar and fruit or vanilla yogurt. A six-ounce fruit or a vanilla yogurt has three and a half teaspoons of added sugar. Peanut butter can have one teaspoon of added sugar per serving and also hydrogenated vegetable oil instead of peanut oil if you’re having a cheap substitute.
There are things that we give to our children routinely that we think are good for them but something there’s a disconnect there. One of the articles on your website, I believe it is Mother Jones.
Dr. Kevin: Yeah.
Dr. Lisa: It talked about the sugar industry. I think it was 1976 that our sugar consumption was down. We weren’t as obese. People aren’t spending as much to eat sweet food. The sugar industry said. “Well, this doesn’t really work for us. We need to put some money into telling people how healthy it is.” They even promoted sugar as something that’s good for being on a diet ironically.
Dr. Kevin: Yeah. That article does a real good job outlining as far as the propaganda that’s going on over the years. Similar to other industries where science was starting to show us things weren’t good for us and big money was involved. People came out with their own campaigns to keep sales up. That article really details that chronology really well. It lets you know that this has been going on a long time. Now we’re seeing the impacts of not acting earlier.
Dr. Lisa: It’s also interesting for me because as I’m reading it, I’m starting to feel … and I don’t have a problem with marketing per se. I start to feel a little bit deceived because it’s not just that I’m eating sugar because I crave it myself as an individual when I want something a little sweet. I’m eating sugar because these messages are so constant and they’re so pervasive. They’re out there and being aimed at our children.
Dr. Kevin: Yeah.
Dr. Lisa: You have small children so how does that make you feel as a father and a doctor that this is such an ongoing and difficult thing to combat?
Dr. Kevin: That’s another amazing question that could have a really long answer weaving in child’s psychology. I would say for my own children, we don’t have a TV in our home. It wasn’t originally because I didn’t want to expose them to advertising per se. I just didn’t want that to distract our ability to communicate as a family.
Now when they catch TV when we’re out, they see an ad and they’re like, “I want that. I want that. I want that.” It’s true that they see an ad for whatever. It could be of upholstery repair stuff. My daughter will be like, “I want that. Let’s get that.” They say it’s the best because they haven’t seen this. They haven’t been invaded with them too. It really has shown me the power of those marketers and those ads.
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Dr. Lisa: You were an outpatient community pediatrician. Now you’re an inpatient pediatrician. Are you still seeing the effects of sugar consumption and obesity on the health of the children that you deal with in the hospital?
Dr. Kevin: Yeah, totally. It’s different. It’s difficult because in the inpatient setting, you’re dealing often with acute problem that’s come up. You always try and see the patient as a whole so you can see some more chronic issues that the patient may have. Fortunately, at Central Maine Medical Center where I work, they’ve done a really good job of supporting us. I often feel that I have time in the rooms to do things I couldn’t even have done as an outpatient doctor, occupation things and they’re open to that.
I think that’s good medicine. If you have patient interaction, why just treat the acute problem? Why not give a little preventive counseling and stuff?
Dr. Lisa: How do families respond when you do some other preventive counseling in the inpatient setting?
Dr. Kevin: I always wait until I have a relationship with the patient at least the second day of the hospitalization. I think the difficult potential discussion, you have to have relationship with the patient. At least it increases your chances of things really going in the right direction and really motivating. I wanted to go back to that last question really also though because talking about kids and motivating kids and the kids like it. I forgot to say that that’s also really what this is about. It’s about kids, educating kids that junk food is bad for you and companies are just using you. Having kids decide, young children, teens decide, “I don’t want to eat junk food.”
We all know any parent know you tell your child not to do something, no one of any age likes to be told what to do. The idea is to have kids vote with their own decision. It’s not that parental conflict and stuff.
Dr. Lisa: I understand that you’re in the process of opening up a clinic that’s going to deal with healthy eating and kids who needs some help with healthy eating issues. Is that going to incorporate motivating the children themselves to make changes in their diet?
Dr. Kevin: Yeah. At Central Maine Medical Center, I’m working with the outpatient doctors there, Central Maine Pediatrics to set up two days a month or something initially where kids can come for a nutrition counseling. It really is going to be a pure implementation of Dunk the Junk. There are educational pieces that we have, the infinite children’s book and the poster, top 10 foods to dunk. It’s set up to be tracks and studied and followed up.
That’s the idea. We can have patients come in. If they want to be involved in the study, great; if not, they just get to come and learn about nutrition. They get a poster. They get the stickers. We go through the video. It will be good for me to be actually doing it so I can see how it’s flowing and then when people give me feedback, we can make adjustments to make it even more satisfying for doctors’ offices or school nurses or everyone.
Dr. Lisa: We’ve talked about the poster and the work that you’ve done in schools with having people come in and actually dunking the things on actual basketball hoops. You are interested in starting this very early on you have a book called Eating the Alphabet. You were talking to me recently about the fact that even starting kids with the right finger foods can make a difference. Some of the things that we’ve thought are good finger foods for a really long time actually already have added sugar. We’re starting the kids off turning them out on their palettes with sugar.
Dr. Kevin: The book it’s the animals ate the alphabet and it got some poetries, some literation. It promotes literacy. It’s meant to excite toddlers about trying new foods or an animal trying … tiger having to bully or a polar bear passing on papaya, stuff like that. In the back, is an appendix on solid food introduction in the on-process fashion for infants. At four to six months at the doctor’s office, you get to talk about how to introduce solids and I’m tired of cheerios being the number one finger food. Why does General Mills get the pole position?
That’s what this is. It’s a rewrite. I’m just going to read you this. This is called the doctor’s note leading. Have you ever tried an apple after eating a fruit roll-up? Have you ever tried a carrot after eating a veggie pops? Whole oatmeal after a bowl of cheerios? The brains ability to sense natural taste pleasures is desensitized by the invasion of the supernatural flavor intensities created in big food labs.
I often hear frustrated parents say, “But my child will only eat box of cereals and chicken nuggets.” Yet infants around the world whose diets are not primarily processed foods do not manifest these troublesome tastes preferences. You can change these eating patterns in your household. As more parents like you join in, we can make a difference across the country. This book is here to help you choose healthy foods that your child will ask for again and again.
Almost done. If processed food with added sugars or added salts aren’t overwhelming an infant’s palette, the brain will sense and enjoy natural food in all its subtle sweetness and saltiness. Give your infant’s brain and palette the opportunity to experience the natural flavor intensities of real food. That I think that’s the answer to the why if you keep it out, you’re not going to have problems. I could have never done it as well because that’s pretty tough.
Dr. Lisa: Instead of cheerios, what do you recommend?
Dr. Kevin: We like things in the original state, as close to the original state as possible. You will talk about like barley with the husk on or the oatmeal that is still kernelly and crunchy still. If you have that fibrous course still on as close to the original form as possible, it takes longer to degrade in your stomach. The release of sugar into the body is slower which is really what we’re looking for.
Dr. Lisa: Most doctors don’t go the path you’re going down. How did you get here?
Dr. Kevin: I think the real answer, it’s more just about I wanted to find a way to connect with kids and these ideas are things kids would love and enjoy their exciting things, arts or that kind of thing.
Dr. Lisa: Then because you knew that this is the type of thing that you connected with when you were a kid?
Dr. Kevin: I think there’s a little bit of that sort of paying attention to both what I like still and what kids coming into my practice as we’re talking about. I did some informal poling the year is leading up to starting this. We asked kids, “What are your interests? What are your activities?” when they come in for physical. It’s on a general checklist. You have a pretty good sense of your population.
The big piece of that obviously is our social media and our web presence and our use of video. That’s probably our strongest piece is our edited, sound edited videos.
Dr. Lisa: Where can people watch the videos, find out more about Dunk the Junk, order the Animals Eat the Alphabet book or all the various projects that you’re involved in?
Dr. Kevin: We have this website, it’s the easiest you can get to everything through it. There are tabs at the top, shop or calendar, stuff like that. It’s www.dunkthejunk.org. Then there’s an F and a T on that page. It will take you to the Facebook or Twitter. I encourage people to check those out. We try and be funny. We post a lot of art.
Dr. Lisa: Dr. Kevin Strong, it’s been a pleasure to spend time with you. You’re clearly very passionate about what you do and you’re very creative within the way that you’re approaching kids’ nutrition. I think it’s so important given what we know about the state of kids’ health right now in our community. Thank you for spending time with me and talking with me more about this important project.
Dr. Kevin: Write back at you. Thanks for doing what you do. It’s so important to get the educational message out. This is a kind of outlet that can do it. Thank you.
Dr. Lisa: You have been listening to the Dr. Lisa Radio Hour and Podcast show number 77, Connecting Kids with Food. Our guests have included Dr. Michael Dedekian and Dr. Kevin Strong. For more information on these guests, visit doctorlisa.org.
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