Eczema Blues

This was originally a 3-part post series which had been combined into a single informative post. It was a timely series due to rising childhood obesity as well as studies linking obesity with asthma symptoms and eczema in children.

Childhood Obesity

Marcie Mom: Thank you Rania, I’m so pleased to have you help in this series. I’m passionate about helping eczema families, and for those who have eczema children who are obese, they may have concerns over the type of foods to eat. Let’s tackle obesity, and along the way, offer some alternatives to children with eczema. Let’s get started!

Wait, what’s Obesity? Isn’t a little plump ok?

According to CDC’s data, the number of children from 6 to 11 year old in the US who were obese increased from 7% in 1980 to 18% in 2010. In 2010, more than 30% of children and adolescents were either overweight or obese. Overweight is defined as having excess body weight for the particular height while obese is defined as having excess body fat.

Parents in certain cultures may wrongly think that children ought to be chubby, but data collected showed obesity in children can carry on to adolescence and adulthood.  Children who are obese are also at risk of high cholesterol, high blood pressure, diabetes, heart diseases, bone and skin problems.

CDC’s Children BMI Calculator

MarcieMom: I’m looking at CDC’s page on BMI for children and parents should know that BMI for kids though calculated the same as for adults, don’t have a healthy weight range to follow. Instead the BMI should be compared versus growth chart that takes into account the child’s age and sex.

Rania, can you share with us how you would assess if a child is beyond his/her acceptable weight and for parents who wish to monitor this themselves, should they be looking at local growth chart (vs CDC) or is there a even simpler way for parents to monitor?

Rania: A child’s weight is largely dependent on his age and gender, and even taking into account those factor, it’s still variable. Because the calculation for BMI takes into account height, BMI-for-age percentiles are often regarded as the most precise way to measure obesity in children. Based off of this measurement, children who are below the 5th percentile are classified as underweight; between the 5th and 85th percentile is regarded as a healthy weight; between the 85th and 95th percentile is classified as overweight; and equal to or greater than the 95th percentile is classified as obese.

Contagious Eating Behavior

Rania, you have blogged about the likelihood of someone being obese if there is a friend or family. Do you have any example to share where you’ve helped the whole family (parents and child) to overcome obesity? What is usually the key motivation for these families who have successfully lost weight?

Rania: Yes, eating is a contagious behaviour not only between groups of friends but also within our own families. Clients come in and they see the effect they have on their families. They may be bringing donuts home or they like to snack on the couch. Of course, we like to share but sometimes this is not always caring!  Oftentimes, I will have a client come in who wants to lose weight and sometimes couples decide to get healthy together. They also realize that their diets/lifestyles affects their children’s food choices and preferences (frozen and fast food preferred to fresh/home cooked meals). When working with families it is important to get the children involved. Take them to the grocery store, get them involved in menu planning, and find ways to get them excited about being in the kitchen. You also want to keep in place some of their favorite meals but find a way to make them healthier and fun.

Kids Eating Strategically

For children, including those with eczema, fruits and vegetables, omega 3 and probiotics are beneficial (see Dr Sears series here). In a study of more than 500,000 children over 50 countries, three or more weekly servings of fruit reduced the severity of asthma, hay fever and eczema symptoms in 11 percent among teens and 14 percent among children. Moreover, essential fatty acids in Omega 3 are also good for the heart, brain, hair and skin.

Children’s Calorie Needs

MarcieMom: To maintain a healthy weight, one part of the equation is not to consume more calories than we need or use (for living and exercise). On WebMD’s website, an active child of 2-3 year old can consume 1000 to 1400 calories, while a 4-8 year old girl consumes 1,400 to 1,800 calories (boys 1,600 to 2,000 calories).

Rania, few questions –

1. You are America’s Eating Strategist^TM! Do share with us what eating strategically looks like for a child?

Rania: Eating strategically for a child is actually very similar to eating strategically as an adult. Regardless of a person’s age, he should aim to eat as nutrient-rich a diet as possible; this would include plenty of (and a variety of) fruits and vegetables, lean protein, whole grains, nuts, seeds, and dairy. Certain nutrients are especially important for children, like calcium (which supports bone health and nerve, muscle, and heart function), iron, folate, vitamin A, and vitamin C. While treats are okay in moderation, aim to limit calories from saturated fats, trans fats and added sugars; these foods can often displace healthier nutrient-rich foods.

2. I’m looking at the calories guideline (above) by CDC. Would this differ for a girl in US who is Caucasian versus a girl in Singapore who is Chinese?

Rania: A child’s recommended calorie intake is consistent across all cultures and ethnicity.

3. For a child who is obese and need to cut down on calories, how many calories are safe to be reduced without compromising the health of a growing child?

Rania: The number of calories a child can safely reduce in his diet is dependent on the child’s age, current weight, activity level, and gender, so there’s no specific, all-encompassing number. For younger children, sometimes allowing the child to grow into his weight–as opposed to losing weight–may be preferred. Talk with your child’s health provider to determine a safe weight loss or weight maintenance goal.

Sample Meal Plan

MarcieMom: Rania, for a child who has eczema and obese, what do you think is a sample meal plan to ensure that the calories to be consumed include sufficient fruits and vegetables, fish and other sources of omega 3, and probiotics?

Rania: Breakfast: Steel cut oats with blueberries and almonds; Lunch: Hummus and chicken wrap with vegetables (tomato, lettuce, onion, etc.); Dinner: Salmon, mashed sweet potatoes, and a salad; Snack: Yogurt with probiotics

Vitamin D, Milk Allergy

MarcieMom: I read on your blog the benefits of Vitamin D and calcium. For children who dislike milk or have a milk allergy, what would be your recommended alternatives to ensure they get the protein and calcium?

Rania: Quality sources of protein include lean meat, poultry, fish, eggs, nuts, seeds, legumes, and beans. Different types of dairy, like cottage cheese, kefir, and Greek yogurt, combine both protein and calcium. Besides milk, good sources of calcium include leafy greens like kale and spinach, white beans, cheese, some fish, tofu, and fortified products like cereal.

MarcieMom: The common food allergens for children are egg, cow’s milk, wheat, peanuts and soy. Which of these do you consider important to be in a child’s diet and what are the alternative sources of food to get the same nutrition benefits?

Rania: None of these foods are absolutely essential for a child’s health, but they do contain valuable nutrients.

Eggs and milk are probably the two most important foods in this group, but there are other foods that provide the same nutrients as they do. Eggs are a great source of protein and contain vitamin D and choline. Vitamin D can also be found in certain fish and fortified orange juice, milk, and yogurt. Choline, which maintains proper cell functioning and communication between muscles and nerves, is also found in chicken, turkey, shrimp, grass-fed beef, collard greens, swiss chard, and cauliflower.

Cow’s milk is another good source of protein, and it also contains calcium and vitamin D. Calcium is found in leafy greens like kale and spinach, white beans, cheese, some fish, tofu, and fortified products like cereal.

Anti-Inflammatory Foods

MarcieMom: Obesity is linked to chronic diseases, and chronic inflammation. Which are the anti-inflammatory foods that you would recommend as part of a child’s meal plan?

Rania: An anti-inflammatory diet should include plenty of fruits and vegetables; omega-3 rich foods like salmon, flaxseed, and walnuts; and herbs and spices, especially turmeric and ginger; and whole grains (refined grains exacerbate inflammation); nuts and seeds.

Snacking for Kids

MarcieMom: From what I’ve read in magazines, advice on snacking or no snacking and eating before 7pm or not seem to be changing all the time. 

For children, what do you think is the right snacking approach? Is there a difference if the child is obese?

Rania: The belief about the healthfulness of snacking is constantly changing–studies have found that people lose weight when they snack, and others have found that people gain weight when they snack. It seems as though there’s no hard and fast rule; instead, it’s an individual thing. Some kids may perform and feel better with snacks; others might do better with three square meals. It’s helpful to teach your child about mindful eating and to listen to his body–as opposed to external cues, like the amount his friend’s are eating–to determine when he’s had enough food. If he eats when he is hungry and stops when he’s full, your child should naturally fall into an eating pattern that’s ideal for him.

It’s helpful to teach your child about mindful eating and to listen to his body

Dessert Recommendation

Any dessert recipes would you recommend for eczema kids?

Rania: Because dessert’s main ingredients–sugar, saturated fats, and refined grains–are inflammatory, it’s best to limit desserts. Desserts that include anti-inflammatory foods, like zucchini chip muffins, can help counteract the effects of those ingredients and add valuable nutrients at the same time. Look for desserts that include fruits, vegetables, nuts, seeds, and spices (like cinnamon), which can display less healthy ingredients and add flavor. If desserts with healthier ingredients are unavailable, it’s okay to indulge in less healthy desserts once in a while.

Exercise for Weight Loss

MarcieMom: A last question on the other part of the equation to lose weight – through exercise. What is your recommended type of exercise for children, and number of hours, taking into account that some children with severe eczema may not be able to go swimming or tolerate excessive sweating?

Rania: The CDC recommends that children get 60 or more minutes of aerobic exercise per day. Exercise doesn’t have to be planned; just running around on a playground during recess contributes to a child’s daily 60 minutes. Exercise can exacerbate symptoms of eczema, but even moderate exercise, like brisk walking, is beneficial to a child’s health. Team sports are another good option: in one study, it was found to decrease depression and emotional upset in patients with eczema.