Guest: Janet Carter - Registered dietician.
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. Today, I am talking with Janet Carter who is the coordinator of the pediatric Heart Health Program at children’s hospital Medical University of South Carolina. Janet, just what is the Heart Health Program for kids?
Janet Carter: It is a pediatric weight management program and it’s the cardiac preventative program of the MUSC children’s hospital, and we work with overweight kids and their families to help them learn some healthy habits and try to lose weight and be healthy for the rest of their lives.
Dr. Linda Austin: So you are really trying to get kids of to the right start.
Janet Carter: Exactly.
Dr. Linda Austin: Let’s talk about the very difficult issue of how parents can help their children who may have a tendency to eat the wrong food to develop better habits. First that the age of kids who are most frequently brought to you is what?
Janet Carter: I generally see kids from around 6-year-old to 13-year-old, but we can see anywhere from 2 to 20, that’s the reason we are open to see.
Dr. Linda Austin: And what are some of the most common problems that parents describe their kids having with their eating habits?
Janet Carter: A lot of kids that we get are picky eaters, a lot of kids tend to be very focused on eating where it tends to, kind of, takeover their thought patterns and their life basically that is very focused on eating for various reasons and a lot of times we have to have psychological backup also to deal with some of the reasons behind it.
Dr. Linda Austin: Like what sorts of reasons?
Janet Carter: Some of the kids have some backgrounds that may have been abusive situations or different family situations where their parents or their mother or their father may be out of their lives or just different stressful situation where food has become a comfort for them and it is their way to cope with the stress that they are having in their lives.
Dr. Linda Austin: Do these children then also get psychiatric or psychological treatment if it’s more than just simple eating the wrong foods?
Janet Carter: A lot of children that we have, and again this is a fairly small population that has these psychological issues, but most of those kids that we do get that have these issues are also being seen outside of the Heart Health Program from a psychologist or some other program.
Dr. Linda Austin: So may a first question then to ask is, is my child under some kind of stress watching mummy and daddy get divorced, new baby in the household, grandma is ill and has moved in, or grandma has just died that may be triggering that kind of use as food is the comfort behavior.
Janet Carter: Yeah that is definitely something that needs to be addressed, but also I think another big problem is that a lot of the families just don’t know what eating healthy really is and that’s where the education and that where Heart Health really shines is that, you know, we really educate the families what are healthy foods? How do you prepare healthy foods? What are healthy portions? A lot of our families eat out a lot because of time constrains I help them to plan how to be able to eat healthy meals at home or healthy meals out, which is tough to do under very serious time constrains.
Dr. Linda Austin: What are some of most common bad food habits that the children you take care of have?
Janet Carter: From an eating perspective, it’s a lot of junk food, candy, chips, a lot of beverages that are sugary beverages, soda, Kool-Aid, and juice. Unfortunately, lot of people of think that fruit juice, even if it is 100%, is a healthy thing, but it’s really is not healthy. It has lot of calories that these kids don’t need, and so a lot of kids are over doing with juices and drinks, and also I found again the eating out situation is tough for these families and eating out is very difficult to eat healthy, low calorie, low fat, and cheaply. So, a lot of these families go out to eat and a lot of times it is fast food, and even if it’s not a fast food it’s very hard to make healthy choices at restaurants.
Dr. Linda Austin: So share with us some of your favorite strategies and tips that you tell parents.
Janet Carter: Mainly the best thing that parents can do for their kids is to be a good role model and to take on these habits themselves and show the kids that ?I enjoy eating healthy, it’s good for my body? and then the kids would really want to emulate that with their own habits, and especially if there is respect build in the family between the kids and the parents that role modeling will really work very well.
Dr. Linda Austin: I would think especially for younger kids, if you exercise restrain to the grocery store I mean if you are not bringing the junk food in the house, I would think that would help us. Is that too simple minded strategy?
Janet Carter: No, no, that is absolutely true. That is one of biggest suggestions that I make from black and white perspective as far as what you can do when you are trying to grocery shop is just if don’t have the food in the house it’s very unlikely that anyone going to runout and get it. So, cravings tend to not happen as much. Obviously, the eating of the food is not going to happen because it’s not there and it’s just very much easier not to have this stuff in the house; out of sight, out of mind.
Dr. Linda Austin: You mentioned earlier that some of these children just become very preoccupied with eating and probably sneaking and eating to what I would imagine. What are some strategies that you use to help with that?
Janet Carter: A lot times, I will suggest that the parents and their children come up with lists of things that they can do that will keep their bodies active and that will keep their brains active so that they just find interest in something else, some sort of hobby or some sort of playtime or game or something they that can do that where it will divert their attention from constantly thinking about food to doing something that they really enjoy. A lot of my kids love to read, color, draw, paint, and ride their bikes, so I work with that as, you know, do those things. Don’t be so focused on what to eat and stuff, but a lot of the kids are sitting and watching TV and playing on video games and thinks like that, it’s very easy for the thoughts of food to come into their minds.
Dr. Linda Austin: Are there any particular eating habits that tend to trigger cravings of food for example, does eating, let say, carbohydrate snacks at lunch tend to make you want more carbs later on in the day that sort of thing.
Janet Carter: I don’t believe that there is really any scientific data to back that up, and there may be any dodo evidence that people would say that that happens. I know that sometimes when you get into a habit of eating sweets a lot, you tend to want more sweets, but I tend to think that if people just eat a large volume of food that they just get into habit of eating large volume of food and grazing, kind of, where they are eating a lot all day long and not really eating structured snacks or meals, but other than that I am not really sure that there is anything.
Dr. Linda Austin: What do you say to the parents who describe their children as just getting into the refrigerator at all times. I have heard parents talk about buying a week’s groceries and the next day they are all gone that their child is just kind of back hit them down, what kinds of things can a parent do?
Janet Carter: Unfortunately, that goes back to the structure of the family and that might be a little bit deeper issue then we can address in Heart Health. What parents need to do from the beginning is set up the guidelines as far as what the children are allowed to do without asking permission first. The children need to ask permission to eat or to go into the kitchen or go into the refrigerator and get food. That is crucial, a child shouldn’t have free rein over the kitchen, especially a young child, of course once they get to be 12 to 13, of course, then they choose their own things, but these younger children 5, 6, and 7-year-old they should be asking their mom or dad ?can I have this? before they go and get it, that is the division of responsibility in the household that should be set up from get-go.
Dr. Linda Austin: Do you ever find that parents create a backlash in their kids by calling too much attention to diet and food, that instead of a parent as oppose to saying ?don’t eat this, don’t eat that? let’s say instead encourage exercise or distract to other kinds of activities as oppose to turning it into a control battle between parents and children.
Janet Carter: Yeah, I think that’s a very important issue, and often times when doing the Heart Health sessions, I am concerned about the kids even being at Heart Health having that become something that causes them to really over think eating all the time and have it be very overpowering to them. I definitely believe that getting physically active is a huge, huge part of this as well. You can not overlook the importance of that, and a lot of times just getting the kids more physically active can counterbalance some of the poor eating habits where ?yes? they wouldn’t have to focus so much on their eating habits if they were just to get their bodies moving and become more active.
Dr. Linda Austin: As a psychiatrist, sometime I have seen situations that may be very different from what you are saying where a parent, usually a mother or sometime a father, but usually a mother becomes overly preoccupied with her and her parents in dieting and then by extension it’s usually a daughter and in the sense contaminates the daughter’s thinking by becoming overly focused on it, and I have seen it go both ways where some daughters tend to become anorexic or bulimic or some would become obese almost in defiance of that. So, I would think your challenge then would be to stay in the middle zone with parents not becoming either under concerned or over concerned.
Janet Carter: I definitely think that there is risk of that happening with our kids if the parents are not secure with themselves or in a good healthy place with their habits, and we also try to work with the parents along those lines too. Of course, our focus is on the children, but we do have sessions with the parents that we can discuss these issues. You know, I like to talk to them about how they feel about their own weight and what are their hang ups. I think, all of us everyone in the world, I think, has some sort of food issue, not that is necessarily unhealthy but I think everyone has some sort of issue with food. A lot of people are concerned about eating healthy, a lot of people concerned about their weight, a lot of people are concerned about their parents, and so getting to the bottom of what the parents are thinking is really important part of program as well.
Dr. Linda Austin: Janet - thank you so much for talking with us today.
Janet Carter: Thank you.
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