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Medical Nutrition Therapy
Setting goals
The family should be informed that the weight is just a symptom of more important underlying damage caused by fructose, poor nutrition and lack of exercise. Goals should emphasize attaining a healthy lifestyle and eating healthy foods for life, in order to maintain a healthy body, irregardless of the current or future weight or BMI measure. Overweight is merely a symptom of a more serious problem: metabolic dysregulation, which can result in deadly diseases, such as diabetes, high lipids, high blood pressure, liver disease, mental depression, heart attack and stroke.
Screen for obesity-associated diseases, including depression
Basic labs should include blood pressure, liver panel, lipid profile, thyroid function, insulin level, hemoglobin A1C, and sed rate. Screen for depression using a questionnaire tool.
Motivation, motivational interviewing
It's hard for any patient to adhere to a treatment without being motivated to do so. The treatment for metabolic dysregulation requires large changes in the lifestyle habits of the entire family. Getting everyone on board takes either very good motivational skills or a major miracle. The experience with tobacco cessation was similar, but did not involve the whole family (as much). Tobacco cessation became more popular as the public gained a better understanding of the damage caused by tobacco use. The same "awareness factor" may be helpful with fructose damage and lifestyle habits that affect metabolic dysregulation.
Some practitioners are adept at a new technique called motivational interviewing. This technique allows the patients to identify personal goals and make their own suggestions as to how to achieve them, gently guided by the knowledge base of the practitioner to assure success.
Find out exactly what the child and family members are eating
Start with a "drinking history" to determine exactly what beverages are being consumed in the home (by everyone!). Having sugar and high fructose drinks in the home for some family members will undermine the health goals of everyone in the family. Emphasize the importance of drinking mainly water and skim milk. There should be no sugar or high fructose drinks kept in the home. You will need to spell out exactly what this means, since many high fructose drinks are commonly thought to be healthy, such as fruit juice and "sports drinks". At this point, we are still allowing non-caloric sweeteners in beverages, since there is no know harm to the teeth or to the metabolic system.
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Set a standard of healthy food for the whole family (not just the affected child) |
Make a game out of discovering the sugar content in foods. When we see sugar caked on top of a donut or other food, we can be sure that the sugar content is huge. But most foods have the sugar hidden, and it is up to us to read labels to find out the sugar content. Over 10 grams of sugar in a serving is concerning. For example, Cheerios has 1 gm of sugar, as opposed to raisin bran with 12 gm of sugar!
Self monitoring (diet and activity log)
Keeping a log of all foods and beverages consumed can be a strong motivator to choose healthy foods. It can also be used as a tool for teaching which food choices were appropriate. An activity log is also a good idea, both as a motivator and a more accurate measure of activity to report back to the physician.
Walking works
The Kentucky Pediatric Society has developed a program to encourage more walking, coordinated through the YMCA and other local fitness venues. A grant from Blue Cross Blue Shield provides free odometers to measure progress in walking for fitness. After school sports can be another source of activity, but be selective. Many football programs encourage the linebackers to gain weight through excess caloric intake. Many sports venues have snack bars where high sugar foods and beverages are sold. Some teams even provide high fructose sports drinks to the players rather than water during games and practice sessions.
