The Downfall of a The Downfall of a Girl’s DietGirl’s Diet

Dr Bob Murray

Nationwide Children’s Hospital

Childhood Obesity Now

Children are Overweight and Undernourished

0

20

40

60

80

100

120

6-11 Mo. 1 Yr. 1-4 Yrs. 5-8 Yrs. 9-14 Yrs. 15-19 Yrs.

CalciumFolate

% Children Consuming

Daily Recommende

d Intake

Magnesium

Vitamin A

Vitamin C

Zinc

Iron

Phosphorus

Critical Age

Data compiled by Dr. John Lasekan, Ross Labsfrom NHANES 1999-2000 and the Continuing Food Survey 1994-96, 1998

Missing NutrientsMissing Nutrients High School Students

Males• Vit A, Vit C, Vit E• Magnesium, potassium• Fiber• Calcium

Females• Vit A, Vit C, Vit E• Magnesium, potassium• Vit B-6• Folate• Thiamin• Iron• Phosphorous• Zinc• Fiber• Calcium

Clark, Fox, JADA 2009; s44

The U.S. Dietary Guidelines

• Food intake is based on daily activity

• Meals and snacks – Vegetables– Fruits– whole grains – Low-fat milk and dairy– Quality proteins

• To make every calorie count, choose nutrient rich foods

Activity Level

FemalesAge (years)

Sedentary Pretty Active Very Active

Calories Calories Calories

4-89-13

14-1819-3031-50

1,2001,6001,8002,0001,800

1,400-1,6001,600-2,000

2,0002,000-2,200

2,000

1,400-1,8001,800-2200

2,4002,4002,200

Activity = CaloriesActivity = Calories

What are the Right Amounts?

• 9 year old with moderate activity• 1400 - 1600 calories

– Breakfast 400 calories– Lunch 400 calories– Dinner 500 calories– Snack 200 calories

1500 calories

Naturally Nutrient Naturally Nutrient RichRich

the basics of nutritionthe basics of nutrition

Focus on fruits.Focus on fruits.

Vary your veggies.Vary your veggies.

Get calcium-rich foods.Get calcium-rich foods.

Make half your grains whole.Make half your grains whole.

Go lean with protein.Go lean with protein.

Know the limits on fats, Know the limits on fats, salt, and sugars.salt, and sugars.

Naturally Nutrient Rich

US Dietary Guidelines

CurrentChildren’s

Diet

Kids & Snack Foods

Snack foods and drinks = 1/3 of daily calories

2/3 of this comes from added sugar

½ of the sugar comes from

sweet drinks

Which account for 10% of daily calories

NHANES III, Kant Arch Ped Adol Med 2003; 157:789

Beverage Ounces CaloriesWater, diet cola 20 0

Milk, fat free 8 80

Orange juice 8 110

Gatorade 20 130

Grape juice 8 150

Snapple 16 220

Coke, 7-up 20 250

Biggie Coke 32 310

TCBY fruit smoothie 20 410

7-11 Big Gulp 44 410

McD’s Vanilla shake 16 580

Nutr Action Letter, June 2006

15

25

35

45

55Milk Soft drinks

BEVERAGE CONSUMPTION per person

Source: USDA, NMPF

gallons

Milk’s Nutrients

• Calcium (30% DV*)• Potassium (11% DV)• Phosphorus (20% DV)• Protein (16% DV)• Vitamin A (10% DV)• Vitamin D (25% DV)• Vitamin B12 (13% DV)• Riboflavin (24% DV)• Niacin (10% DV)

Calcium and Bone

MyPyramid: Dairy products

• 3-a-Day = cups of fat-free or low-fat milk or dairy

– 2 to 8 years old 2 cups per day

– 9 to 18 years old 3 cups per day • 8 oz. milk• 1 cup yogurt

• 1½ oz. natural cheese• 2 oz. processed cheese

Bone Grows Most in Teens

2 6 10 20 years

Bone Thickness

1 m 2 y 18 y

Kids Don’t Get EnoughCalcium

Age Male Female

6-11 y 44% 58%

12-19 y 64% 87%

>20 y 55% 78%

BUBUTT

Too Many Children Avoid Dairy

• Low daily calcium– Take in only 400 mg – Need 1300 mg

• Reasons given– Feel bad taste lifestyle

• More broken bones

Black et al, Am J Clin Nutr 2002; 76:675

More Snacks, More Calories

Total MALES FEMALES

0 Snacks 11% 2156 kcal 1501 kcal

1 Snack 25% 2391 kcal 1812 kcal

2 Snacks 26% 2505 kcal 1944 kcal

3 Snacks 19% 2916 kcal 2136 kcal

4 Snacks 18% 3249 kcal 2437 kcal

Sebastian, J Adol Health 2008; 42:503

“GRAZING is the new norm”

Snacks are Low Quality Food

FOOD GROUPS SNACKS

Grains chips, puffs, breads, cookiesVegetables potato chips, pizza, french friesFruits OJ, apples, non-citrus juicesMilk white, flavored, frozen dairyMeat/beans hot dogs, lunch meats

Oils corn chips, puffs, potato chips Solid fats frozen dairy, cookies, milkAdded sugars soft drinks, fruit drinks, candies

Sebastian, J Adol Health 2008; 42:503

“Avoidance” is Not Enough

Has created a wrong idea:

Few “bad” nutrients =a good food

                                                                                                                            

                 

                                                                                                   

                                                                                                                                         

                                                                                                                            

                 

                                                                                                   

                                                                                                                                  

Less fat, fewer calories, but NOT more nutrientsLess fat, fewer calories, but NOT more nutrients

Does it deserve this?

Read the Whole Label

The Baby with the Bathwater?

Simple – Fun -- FREE

Go to www.snackwise.org

For Smarter Snacking

NOT DIETSNOT DIETS

The Most Important Things

• Limit sweetened beverages

• Eat 5 servings per day of fruits & vegetables

• Eat a nutritious breakfast every day

• Limit portion sizes• Have regular family

meals

• Limit screens to a maximum of 2hrs

• No television in the bedroom

• Moderate to vigorous physical activity for 60 mins/ day