Tuesday, November 4, 2014

One Healthy Option Needed for the Children of Central Texas

By Lianne Marks, MD, PhD
Round Rock Internist

I can’t stand idly by anymore. As an internist, many of the chronic medical problems I see my adult patients develop are based on patterns that began in childhood.

Unfortunately, unless something changes, this is likely to worsen in future generations.  As a child, I can’t recall walking into a restaurant and seeing children pacified by ingesting various shades of yellow-brown (fries, chicken nuggets, soda, macaroni and cheese) as appears to be the norm today. As a society, how can we tolerate restaurant menus in their current state? Sure, there are excessive calories and fat on a typical restaurant menu, but the standard patron is a responsible adult, correct? It is all about reasonable choices. Some restaurants have heart healthy choices, so we can choose between the grilled salmon with rice pilaf and the “heart attack” hamburger with French fries. What about our children? Are they any less deserving of reasonable choices? In fact, the opposite appears to be true. In general, “kids’ menus” have a much smaller selection. Usually it consists of some combination of hamburgers, fries, hot dogs, chicken nuggets (what are these really, anyway?), and macaroni and cheese. The fat (particularly saturated fat) and calorie content of these options are appalling, particularly in comparison to their lack of nutrients.

When I started medical school in 1995, I was surprised to learn how the most obese patients tended to have the lowest levels of nutrition, as measured by laboratory markers.  Surely, they would have the highest level of diabetes and other chronic diseases, but how could they possibly be malnourished via a marker of protein-calorie malnutrition such as pre-albumin? Alas, this is the paradox of unhealthy eating: too many calories, and not enough nutrition. Don Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services, has noted, “Every system is perfectly designed to achieve exactly the results it gets.” When children go to a restaurant and see the children’s menu formulated for them by the “responsible adults,” they believe this is what they should be eating. The typical kids’ menu has been integrated into our American culture, particularly in a state like Texas, where one in every three children is either overweight or obese. It is time for physicians and parents to stand up for our children and revolt against the cheap calories void of nutrition that are being provided by restaurateurs. To be fair, the system has been working so far for the restaurants. Restaurants spend less money, kids are happy, and parents seem satisfied as their offspring munch happily away on French fries.  Unfortunately, this encourages momentary complacency and long-term unhappiness.   When and where and how can we stop this and change the culture for the sake of our children? How about now and here in central Texas, one of the bastions of obesity in this most obese of nations.

How we care for our children and how we allow them to be treated is the message society is sending to the future. It is an interesting cultural message considering our society is so cautious about other things that may be hazardous to children. Could you imagine if there was a drink menu for children that contained alcoholic and caffeinated beverages? Oh, that’s right, we do proffer caffeinated sodas; these are allowed and even encouraged in our culture whereas tea and coffee are not. Interestingly, sodas clearly increase the risk of type 2 diabetes in the population, whereas tea and coffee decrease the risk.

Alcohol is culturally banned for children in the United States because people are worried about creating miniature alcoholics. However, in Europe people are generally allowed to have alcohol at a younger age, and many articles have been written about how this helps discourage binge drinking. Do our cultural mores line up with what we want for our children’s future? What about children smoking cigarettes? I think most rational adults would agree this would be an abomination. This would most certainly create future nicotine addicts. That is why we as a society have worked hard to decrease advertising to children and taken other measures in this regard. How, then, is it acceptable to create fat and sugar addicts, and future type 2 diabetics by not providing healthy choices? We are learning not only about how our brain’s design determines the choices we make, but also how the choices we make determine our brain’s design. This is due to “neuroplasticity” and “epigenetics,” the ability of the brain and the expression of our genes to change during our lifetime in response to the environment. This is best understood with substance abuse, such as nicotine and alcohol abuse, but likely also is relevant with regard to substances such as high-fructose corn syrup. Experiments at the University of California showed that when rats drink water with high-fructose corn syrup added, they develop learning and memory problems in six weeks.  We also know that the same risk factors for diabetes contribute to risk for Alzheimer’s disease, a problem that is growing like diabetes and exploding into a national epidemic. This has caused researcher Suzanne de la Monte, MD, MPH, at Brown Medical School to provide another name for Alzheimer’s dementia. She calls it type 3 diabetes.

A report titled “Fast Food Facts 2013,” created by the Yale Rudd Center for Food Policy & Obesity, reveals some astounding facts about the state of nutrition in our nation.   According to the report, even though fast-food chains have been working on improving their “healthy options,” less than 1 percent of all kids’ meal combinations met recommended nutrition standards. Not a big deal, you say — children and parents know better than to eat fast food. However, the data suggest otherwise; 33 percent of children and 41 percent of teenagers eat some form of fast food daily. The children most likely to be eating unhealthy food also tend to be the most disadvantaged in other ways, such as financially and educationally. Several arguments have been given for this including that unhealthy options are cheaper in grocery stores, healthy options are not available in poorer areas, and the most frightening, this represents a “treat” that poorer parents can provide for their children at low cost. How many children spend their daydreaming time wishing for their weekly or daily trip to the fast-food restaurant?  How does that set them up for later life, when they end up as poor adults who are also obese and have type 2 diabetes and potentially other health and cognitive problems?

The problems are clear for those wishing to examine them. Next comes the minor issue of how to institute cultural change. I would answer “slowly, carefully, and driven by parents.” Mandating health is extremely difficult to do at best, and my libertarian father would be very upset at the idea of outlawing French fries and soda. We live in a capitalistic society, so this is the system we need to use to support change; we speak with our dollars and where we decide to spend them. Jamie Oliver has tried to fight the battle in the school lunchroom, another extraordinarily difficult battlefield, where funding from soda and vending machines often is a needed source of revenue for the school and difficult to replace. Instead of banning food, the first emphasis needs to be on providing healthy choices in schools and in restaurants.

Start by asking local restaurants to provide at least one healthy option on their kids’ menu. You can do this in person, by phone, by mail/email, or on their social media website. Go to the Facebook site that will be formed for the purpose of this discussion, onehealthyoption, and weigh in on your concerns. Help bring the consumer weight of parents to bear, by submitting information to www.onehealthyoption.org about restaurants that have agreed to or already list at least one healthy option on their kids’ menu. This website will start with local restaurants, i.e., in Travis and Williamson counties. When a restaurant has at least one healthy option in its children’s menu, it will be listed as green, or onehealthyoption-certified. If it has no healthy options on its children’s menu, it will be listed in red, and if unknown, it will be listed in black.   Feedback to this website from parents will help constitute a grassroots effort that will hopefully feed back to the restaurants and let them know that parents are demanding more for the children of Texas.

As we are heading into the holidays, isn’t this the time to make a change for our children and their future? Adult eating habits are created in childhood and can last a lifetime. We have all met children and adults who refuse to eat vegetables. Culturally this has been acceptable, but can we as a society afford the financial burden this will propagate? Not to mention the burden of pain and suffering to individuals and families due to the health related problems of unhealthy eating. How important is this for our country’s children?   Billions of dollars and hundreds of thousands of lives are lost each year due to poor diet and physical inactivity. You decide …

The onehealthyoption.org site was created by parents, for parents as a grassroots effort to change the options provided to children in central Texas. It will decipher healthy options based on simple criteria that can be applied to all restaurants (as opposed to calorie/fat counts and the like, which can be applied to only nationwide chains or other restaurants that have paid large fees to have each of their entrees nutritionally analyzed). 

Additional Resources
The Williamson County Wellness Alliance has a Healthy Eating Working Group focusing on improving nutrition and increasing community gardens; see more here: www.healthywilliamsoncounty.org/. Part of its efforts include a ¡Por Vida! seal on healthy entrees at four restaurant partners.

There are also programs nationwide sponsored by the restaurant industry, such as www.healthydiningfinder.com/. This site includes a Kids LiveWell program.

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