Does stopping by a fast food restaurant a few times a week with your kids really make a difference in their health? A major long-term study has found a strong association between eating fast food more than twice a week and the development of obesity and type 2 diabetes in teens and young adults.

CARDIA (The Coronary Artery Risk Development in Young Adults study) followed more than 3000 youth in Birmingham, Chicago, Minneapolis, and Oakland for 15 years. An analysis of their fast food intake was published in the January 1, 2005 Lancet.

Even after adjusting for other lifestyle factors such as physical activity and television viewing, the more often people ate fast food, the more their weight crept up over the years and the worse their body’s ability to respond to insulin.

All other things being equal, those who ate fast food more than twice a week gained an extra 10 pounds and had a two-fold increase in insulin resistance compared to their peers.

Meals together at home are great for families for many reasons. When eating out is in cards, be on the lookout for delicious, healthy options. Substituting fruit for French fries, low fat milk for sugary soda are little steps that can add up in a big way over time.

Dr. Greene’s Answer:

The last statistic that you gave is the most telling. Where a child is charted on the BMI growth curve predicts whether there will be an obesity problem later in life much more accurately than where she is on the weight growth curve. Your daughter’s ranking in the 95th percentile suggests that this could be a problem for her, and her family historymakes obesity even more likely.

For most kids, the best approach to eating is not to restrict how much they eat, but to keep the foods as healthy as possible. Snack on fruit and vegetables rather than on chips or sweets. Turning the television off as much as possible to keep kids active can make a big difference.

Some children have a problem with the appetite center of the brain and do need their total amount of food to be restricted. This is not very common, but a child who is still very hungry five minutes after a meal should be checked by a doctor for this type of problem.

It could very well be boredom at age 3. Getting outside to play can make a big difference. Three-year-olds can be endlessly curious. Toy pianos or musical instruments are a big hit at that age and active, pretend play can be very fun.

Dr. Greene’s Answer:

In small amounts, neither diet or regular soda is very harmful. But of course, neither has great benefits.

I have no problems with sugar when it comes naturally with fiber such as with fresh fruits. When it comes to soda, you may not want your child to develop a taste for sugary sodas because the amount he consumes may not stay small. Sugar is loaded with calories and it puts stress on the body’s mechanisms for regulating energy levels.

As for artificial sweeteners, the best research on NutraSweet (aspartame) has not shown any conclusive problems. In the body, it breaks down into two amino acids that are naturally a part of the diet. However, the long term effects of drinking diet soda has yet to be determined. Interestingly, a recent study showed an association between diet soda consumption and an increased risk for heart disease and diabetes (Circulation Feb 12, 2008). Although this finding needs to be confirmed by more research, it’s something to think about.

Personally, I prefer water, milk, and flavored waters (i.e. water with pieces of fruit, vegetables or herbs for flavor).

Dr. Greene’s Answer:

Children do not need to eat large amounts of sugar. In the 1800s, the average American consumed 12 pounds of sugar per year. By 1975, however, after the overwhelming success of the refined-food industry, the 12 pounds had jumped to a world-leading 118 pounds per year, and jumped again to 137.5 pounds per capita (for every man, woman, and child) by 1990. (Food Consumption, Prices and Expenditures, United States Department of Agriculture, 1991).

The effect of sugar intake on children’s behavior is a hotly debated topic in pediatrics. Parents and educators often contend that sugar and other carbohydrate ingestion can dramatically impact children’s behavior, particularly their activity levels. Physicians, on the other hand, have looked at controlled studies of sugar intake and have not found hypoglycemia or other blood sugar abnormalities in children who are consuming large amounts of sugar.

An interesting article appears in the February 1996 edition of the Journal of Pediatrics. In contrast with other research teams, William Tamborlane, MD, et al of Yale University, leaders in child nutrition, reported a more pronounced response to a glucose load in children than in adults.

It is commonly acknowledged that as blood glucose levels fall, a compensatory release of adrenaline occurs. When the blood glucose level falls below normal, the resulting situation is called hypoglycemia. Signs and symptoms that accompany this include shakiness, sweating, and altered thinking and behavior.

Tamborlane and his colleagues demonstrated that this adrenaline release occurs at higher glucose levels in children than it does in adults. In children, it occurs at a blood sugar level that would not be considered hypoglycemic. The peak of this adrenaline surge comes about 4 hours after eating. The authors reason that the problem is not sugar, per se, but highly refined sugars and carbohydrates, which enter the bloodstream quickly and produce more rapid fluctuations in blood glucose levels.

Giving your child a breakfast that contains fiber (such as oatmeal, shredded wheat, berries, bananas, or whole-grain pancakes) should keep adrenaline levels more constant and make the school day a more wondrous experience. Packing her or his lunch box with delicious, fiber-containing treats (such as whole-grain breads, peaches, grapes, or a myriad of other fresh fruits) may turn afternoons at home into a delight.

Refined sugars also affect insulin control, which decides how much fat they will store for the rest of their lives. As a child, I had HoHos, Twinkies, and Ding Dongs as regular parts of my meals because my mother, like so many of that era, wanted to give her children a nice treat. We both shudder now to think of it.

Sugar is not just found in sweets or junk cereal. It’s in almost everything. When you look at labels, you find sugar, sucrose, glucose, dextrose, sorbitol, or corn syrup on almost every label. The more simple meals from whole foods contain much less sugar.

Fruit juices contain lots of simple sugar without much fiber. Many people think of juices as health foods. This simply isn’t true. In small quantities they are fine, but they are mainly a way to get many of the calories and some of the nutrients from a substance, without getting as full and without getting the needed fiber. And children who drink more than 12 ounces of fruit juice per day are, on average, shorter and fatter than those who don’t.

Dr. Greene’s Answer:

Obesity, or over-nutrition, is the generalized accumulation of fat both beneath the skin and throughout the body. Some children are big, or stocky, because they have large skeletal frames. They are not obese. There are general guidelines for appropriate weight for a given height, but these are only general guidelines.

For a girl who is 1.09 meters tall (43 inches), the average weight is 18kg (40lbs). Anywhere between 15-22kg (33-46lbs) would be considered healthy. Your daughter’s 33kg (72lbs.) are significantly outside this range.

Obesity is usually caused by an individual’s eating more food than is necessary for him or her. Less activity than the individual needs can also cause obesity, but this is less common in children. Whatever the cause, certain children inherit a genetic predisposition to obesity. They may eat the same diets as thinner children, but store more of the calories as fat.

The body stores new fat either by increasing the number of fat cells or by increasing the size of existing cells. It is particularly important to control childhood obesity since new fat cells are primarily formed during childhood. Each year of adding these extra fat cells makes adult obesity more difficult to fight.

Overweight children are not gluttonous or lazy. In fact, many studies have shown that obese children do not eat more calories than their peers. And by actually measuring caloric expenditure using the double-labeled water method, investigators have shown that obese children actually expend more energy than their non-obese counterparts. Obese children need less food and more activity than their peers.

A variety of hormonal disorders, including problems with insulin, hypothalamic hormones, and pituitary hormones, can cause severe obesity. There are also a number of rare inherited syndromes (such as Laurence-Moon-Biedl, Prader-Willi, and Cushing) that produce obesity. If a child’s height is appropriate or advanced for her age (like your daughter’s), and if a child has a strong family history of obsesity, one of these underlying medical conditions is extremely unlikely. On the other hand, an obese child with slow height growth should certainly be evaluated.

As childhood obesity has become more common, we are seeing more and more children with hypertension (high blood pressure) and with insulin-resistant diabetes mellitus. For decades, we have seen that these diseases cause serious chronic medical problems as adults – we are now seeing these chronic problems in children as well! While there is still some controversy surrounding when to screen and treat children for high blood pressure and high cholesterol, I would suggest that all parents of overweight children discuss this issue with their pediatrician.

Obesity is very difficult to treat, since it involves permanently changing basic eating and exercise habits. Successes almost always involve changing the whole family’s habits to ones appropriate for the obese child. As we all know, healthy eating and exercise habits are good for us all! Cutting excess intake is best achieved by first keeping a careful record of food consumed, to identify particularly high fat or high calorie problem areas in the diet. The entire family must learn what fat is and what foods are high in fat (such as cheese, butter, margarine, nuts and nut-butters, oil, red meat, fried foods, most processed fast foods or snack foods, etc., etc.). Instead, whole fruit, whole vegetables, and whole grains should make up the bulk of the diet. Whatever the daily activity level of the family, it should be modestly increased.

Most families are not able to make these lasting changes on their own, and will benefit from meeting with an independent party at least once a week for 12 weeks. Ideally this outside individual would be a nutritionist or an expert in weight management, but even a committed friend would do. In many cities pediatric weight management programs such as Shapedown are available, and are very effective. Whatever the source, monitoring should continue at least monthly for the remainder of the first year, and then every 3 to 4 months until the new habits have become very deeply ingrained.

Note: Shapedown is a program that was started at the University of California at San Francisco. You can obtain information about that program or similar programs in other areas by calling (415) 453-8886 or by visiting www.shapedown.com.

Stanford University Hospital also has a program called the Packard Pediatric Weight Control Program. They can be reached at (650) 725-4424 or by visiting: www.lpch.org/.