Dr. Lichtmann: Building habits early on is huge. It’s not just for their nutrition at a young age, it’s also to build the right habits for when they’re a teenager and adult and they have to deal with diet a little bit more.
(According to the CDC, empty calories from added sugars and solid fats contribute up to 40% of daily calories for kids ages two to 18.)
Dr. Coffin: Even things like chocolate milk, people think it’s good because it’s milk and my kid likes chocolate milk, and I can get him to drink milk if we put chocolate in it. But if you look at the sugar content, it’s actually quite high.
Dr. Lichtmann: Building the right habits makes it so that you’re able to do the right thing when you’re in a position where it’s really going to affect your health that much more. When you’re an adult, if you are overweight or obese, you’re at much higher risk for high blood pressure, high cholesterol, diabetes, early heart disease, all those sorts of things.
Dr. Coffin: We know that the habits that you get set from the time you’re a child really do follow you through your whole life. If you get used to eating when you’re watching TV, that becomes a comforting activity for you and then you do that your whole life. Trying to get kids into mindful eating so that they’re not setting up these habits - oh, I eat when I’m bored, or I eat when I’m stressed or when I’m sad - but using food for healthy nutrition to nourish your body. Teaching kids what the point and purpose of food is, that is very helpful.
Dr. Lichtmann: Have the right snacks available at home. Foods that need to be refrigerated are often more healthy. They’re perishable. They’re less processed.
Dr. Coffin: I always tell people, when you’re hungry is not the time to have to prepare your food because you’re hungry. You just want food. So you’re going to go wherever it’s easy, which is the pantry for many of us. But hopefully, we can turn that into the refrigerator.
Cutting up fruits and vegetables ahead of time, or if you’re like me, you don’t want to take the time to cut up fruits and vegetables, so you just buy the ones that are pre-cut for you. They’re great. You can just grab those. You can munch on celery. You can munch on carrots, put some hummus on it, make it more flavorful.
Dr. Lichtmann: Yogurt with a little bit of granola in it, fresh fruits, avocado on the side of whole grain toast and a hard-boiled egg. Those are really good breakfast sources.
Dr. Coffin: I think we don’t pack certain things because we don’t have an ice pack and we can’t keep it cold during the day. But if you send your kid with an old fashioned lunch box that’s got an ice pack in it, you can do yogurt. You can do hard boiled egg. You can do healthy sources of meat.
Dr. Lichtmann: A lot of the deli meats you buy at the stores are processed. You can go to the counter at your local grocery store and you can get freshly sliced turkey breast, or freshly sliced roast beef. Those would be good on a whole grain sandwich, maybe just use one slice of bread for the meat so you’re not getting too many carbs.
Dr. Lichtmann: Anything you guys are eating, as long as it’s healthy, go for it. Chicken breast with a little bit of pasta or rice works. Make sure that the rest of the plate is filled with fruits or veggies.
You’re allowed to have certain foods that may have a stigma of being unhealthy. You can have those, but it’s all in moderation, including desserts.
Dr. Coffin: You don’t need to have dessert every meal. But some things we have in our head - dessert has to be cake, or pie, or cookies - but it can be anything that’s delicious. You can do fruit with a little bit of whipped cream on it you know. That’s a lower calorie option.
Dr. Lichtmann: It doesn’t have to be something sweet. You go to some other countries and they may have a plate of cheese and fruits and that’s a dessert. That’s an after meal type of a snack.
I remember when I first started paying attention to serving sizes, and I was relatively sad for a few days. But then your stomach and your mind get used it, and you become full off of less. And it actually is more satisfying because you’re not over inundating your taste buds with the same taste over and over again. You just have that right now and feel full and satisfied after that.
Dr. Lichtmann: When it comes to cookies, are you having one cookie or are you having three cookies? Granola bars can be equally as delicious to a kid as a cookie. And it’s just got a little bit more fiber in it, a little bit more nutrition than the flour from the cookie.
Dr. Coffin: There's other bread people make. Banana bread. Zucchini bread is another. You can make breads that have veggies or fruits in them that increase the nutrients.
Dr. Lichtmann: There are still basically five major food groups: dairy, fruits, veggies, grains and proteins. Throughout the day you should get a variety of those things. You can follow USDA's ChooseMyPlate.gov. They’ve moved a little bit away from the food pyramid from many years ago. ChooseMyPlate helps guide you a little bit. There is a little bit more wiggle room than just here you have to get this many servings of this, this many servings of that.
Dr. Coffin: In general we know that it’s hard to get your kid to eat exactly the right number of things. There are vitamins out there that can kind of help supplement. But the body uses nutrients the best when it gets it in the form of food. Food is always better than the vitamins. I usually tell patients, try to have a fruit or a vegetable about four or fives times a day, spread throughout the day. Have three to four servings of something with calcium in it, whether it’s cheese stick, almond milk, whatever it is that you’re using, ice cream sometimes. And then meat, you should be having something with protein and iron. And if you’re not doing that, if you’re a vegetarian or vegan, get advice from a nutritionist, especially a pediatric nutritionist, to make sure that there are no holes in the diet there.
Dr. Lichtmann: I don’t usually recommend vitamins for the majority of my patients. We absorb nutrients better with our diet. I also feel that you don’t want to use the vitamins as a crutch. I don’t have to push the fruits and the veggies or whatever because my child is getting a vitamin. Now there are definitely times when you use the vitamin to transition until you can start getting some of those foods into the diet.
Dr. Coffin: Just encouraging kids over time to get a well-rounded diet is the best way to go.
Some patients have milk allergies or can’t have a lot of dairy. In that instance there’s a very clear hole for calcium in the diet. But for the most part, once you’re over a year old, you no longer need that vitamin D supplement every day that we recommend for babies.
Dr. Lichtmann: There are options at every restaurant that you go for fast food. There are definitely ways to make it healthier. Most restaurant salads have veggies and fruits.
Dr. Coffin: Whenever I go, I always want fries. I can’t go and not get fries. If I go with a group not everyone has to get the combo meal. You can do one fry order, or depending on how many people are in your group, and each person gets a handful of fries. You don’t need to biggie size. No one really needs to biggie size.
Dr. Lichtmann: Fast food does not need to come with a soda or fruit juice. A lot of these restaurants do a good job of having alternates. I don’t necessarily want you to go for the 100 percent fruit juice that sounds more healthy, but still has a lot of sugars. The average kid in America nowadays gets about 30 gallons a year of sugary beverages. It’s an astounding number and it’s way too much. Water or milk with your meals is really what I go for.
Dr. Coffin: High cholesterol, joint disease, chronic back pain, early heart disease, diabetes.
Dr. Lichtmann: Diabetes is going to affect all your body. It’s going to affect your heart. It’s going to affect your kidneys. It’s going to affect your blood flow to your toes and to your hands. It’s going to affect your vision.
Dr. Coffin: This happens especially in kids who drink too much milk. It can inhibit iron absorption and make you too full so that you don’t eat iron-containing foods because you’re just full off of milk.
Dr. Lichtmann: Anything that causes chronic inflammation in your body can set you up for different types of cancer.
Dr. Coffin: Obesity in general is just an inflammatory condition. We know that it does inflame the body and some of it is probably just physical trauma, or the the amount of pressure that’s put on the joints.
Dr.Lichtmann: One of the main organs that’s affected with increased fat in the diet or obesity is the liver. We know there’s an inflammatory cascade that starts off with your liver causing liver damage. People who are obese and overweight, those conditions just can lead to more systemic illnesses.
Dr. Coffin: That’s where I like to give the example of the pantry versus the fridge. If it’s kept in the pantry, the chances of it being one of your should go-to foods is lower. That includes anything that’s a processed carb, anything that really doesn’t need a refrigerator to keep it well past like two days, such as cookies, crackers, chips,pretzels, sugary drinks.
Some people think that "oh well, trail mix is healthy." It can be, but when you look at the serving size of nuts, it’s like a quarter of a cup. It’s a very small amount. When you think about how you eat trail mix out of a bag, that’s probably about six or seven servings.
Go-to foods include fruits and veggies that you’ve already cut up and don’t have to think about it. They’re already there, healthy dairy like low-fat cheese stick, Greek yogurt, whole grains, hard-boiled egg and handful of nuts.
Anything that’s got saturated fats, all of those kinds of things you just kind of want to avoid, such as fried things and processed stuff.
Cookies, crackers, chips, pretzels and sugary drinks are kind of like a dentist’s worst nightmare.
Dr. Lichtmann: I personally am a believer in rather than just substitute what you’re having in your diet to really follow the policy of moderation. I actually am okay with a little bit of butter on bread. But you’re not smearing a whole bunch. You’re doing a little smear to get a little bit more flavor if you need it for your bread. I wouldn’t necessarily substitute it with something else, but you can substitute it if you wanted to with avocado or a nut butter. It adds a little bit more nutrients than straight butter.
Dr. Lichtmann: I would just give a big plug for building habits and know that the changes that you make with your kid’s diet really should be a family thing. If four out of five people in the family are eating a different way than one person, it’s not going to hold. It’s about making a good culture for the family in terms of how you eat. And that’s going to serve well throughout your child’s life.
Dr. Coffin: Don’t be discouraged. Any change that we’re trying to make as adults as kids, it takes time. So the more time you spend on task, the more times you try. We know it can take a kids up to 10 times or maybe even more of trying a food before they actually think they like it.
Dr. Lichtmann: I always like to tell my patients, the rule is you have to try it. If your mom or dad says, let’s try this tonight, you have to try it. If your mom is okay with it, your dad is okay with it, you can politely spit it back out and throw it in the trash can if you don’t like it.
And keep eating together as a family. That’s what I always say. Eat as a family and then you’re less likely to have as much junk.
Watch the San Diego Health video on teaching kids to eat healthy for life.