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Feeding Lessons

By Susan Okie
Special to The Washington Post
Tuesday, March 22, 2005; Page F01

Eleven-year-old Adam Barnett has learned a new way to eat. For breakfast on a recent morning, he had a bowl of high-fiber cereal with milk and mixed fruit. The lunch he carries to school typically includes a peanut butter sandwich, fruit, yogurt and skim milk. He often snacks on high-fiber, low-fat health bars or cucumber pickles -- and he drinks plenty of water. Fried potato chips and French fries have been banished from his home in Newton, Mass. Pizza, when it's served, is often homemade on small loaves of whole wheat pita bread.

Adam does not consider his new pattern of food choices a "diet." He calls it an eating plan, or a healthier way to eat, and he's been following it for almost three years. "I've been doing really well on it, and I'm going to keep it up," he said.

Making meals a family affair as often as possible is a strategy that nutrition experts endorse to help kids develop healthy eating habits. (Photodisc)

_____Live Discussion_____
Youth and Obesity: Susan Okie, special to The Washington Post, will be at 2 p.m. to discuss how parents can arm their children against obesity.
_____Related Articles_____
Covert Operations: A Few Parental Food Tricks (The Washington Post, Mar 22, 2005)

Adam learned about the eating plan at Optimum Weight for Life (OWL), a research and treatment program for overweight children directed by David Ludwig, a Harvard pediatrician and obesity researcher at Boston's Children's Hospital. OWL is based on a growing body of research suggesting that a diet rich in fruits and vegetables but low in refined starches and sugars, and which also contains protein, unprocessed whole grains, some dairy products and a moderate amount of fat, may be healthy for the heart and least conducive to weight gain and diabetes. In the medical literature, such an eating plan is called a low-glycemic-index diet.

Adam's mother, Laura, knew by the time her son was 8 that he would need to learn to manage his weight. As adults, she and Adam's father had struggled intermittently with their own weight problems. At 8, Adam weighed enough to qualify as obese, and he seemed to be hungry all the time. The family's pediatrician, concerned that the boy was unhealthily heavy, referred Adam to OWL, which treats overweight kids 4 and older. After Adam underwent an initial medical evaluation, he and his parents attended group sessions to learn about the new eating plan.

Adam watched a slide show to get the basics of the plan, while his parents learned how it is thought to work. Starchy foods like potatoes or bread made from white flour are rapidly broken down to sugar by the body, tending to raise blood sugar levels rapidly and trigger a corresponding surge in insulin. A few fruits -- bananas and watermelon, for instance -- also cause a quick surge in blood sugar (glucose).

Such foods are said to have a high glycemic index. ("Glycemic" is a medical term that means "putting sugar into the blood.") On the other hand, protein and fat, as well as most fruits and vegetables, which are high in fiber, take longer to digest, so they raise blood sugar more gradually and do not provoke such a large or sudden insulin surge. Hence, they have a low glycemic index.

Whole grains that have not undergone much grinding or processing are also digested slowly. In addition, including some fat as part of a meal slows the emptying of the stomach, so that nutrients are not delivered too rapidly to the intestines, where digestion and absorption into the bloodstream take place. Studies by Ludwig and his research team have found that children who were given a breakfast containing foods with a low glycemic index were less hungry during the day and consumed fewer calories than those who ate a breakfast containing an equal number of calories but composed of high-glycemic-index foods.

To Adam's mom, part of the appeal of the OWL program was that Adam would be less eager for snacks between meals -- although healthy snacks are permitted in moderation. Laura also liked the plan's flexibility. "What I think works about it is, it doesn't say 'You can't have' and 'You can have,' " she observes. "It tries to say 'More of this, less of that.' You keep foods in proportion."

Following the plan required big changes in Adam's eating habits.

"At the start, it was just so hard for me," Adam recalls. At one point "I said, 'I can't do this,' and I almost stopped. But my mom and dad encouraged me to go back [to the plan] again."

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