Connecting Kids with Food, #77

Dr. Michael Dedekian:

The epidemic of obesity that we see in children and adults has no single trigger. It's a multifactorial issue. I think there is a popular misconception that obesity is a personal choice, and it is not a personal choice. I think if you ask anyone who's overweight if they have chosen to be overweight, they would not say that they have chosen to do that. Certainly any child who is overweight has not chosen that for themselves. But but there are many other factors like genetics and family history and environment that are not under our control and we need to think very broadly about this issue.

Dr. Kevin Strong:

Educating kids that junk food is bad for you and companies are deceiving you and having kids decide I don't want to eat junk food. No one of any age likes to be told what to do, so the idea is to have kids vote with their own decision.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 77, connecting kids with Food, airing for the first time on March 3, 2013. This week's guests include pediatric endocrinologist Dr. Michael Dedekian of the let's Go program and Dr. Kevin Strong of Dunk. The junk food it fuels our bodies, but does it nourish our souls? As with many adults, children have become increasingly disconnected from the food they eat. Much of it is highly processed and looks nothing like the plant or animal from which it originated. It is also perhaps too readily available. Based on the obesity epidemic in this country, its convenience has led us to consume food on the fly instead of eating mindfully and with gratitude. We need to reconnect with food and help our kids to do so as well. Does anyone really know what is inside a cheese doodle? Most of us harbor no illusions about obvious junk food, though. If you remain unconvinced, read the February 20, 2013 New York Times article, the Extraordinary Science of Addictive Junk food. It takes many different chemicals, including preservatives, colors and flavor enhancers, to keep our favorite snacks sitting fresh and pretty on our supermarket shelf. Our children may not realize this, however, it's our job to educate them about the food they eat and to steer them toward less processed alternatives. One way of doing this is to think local. Local foods tend to be fresher, which usually means they're more nutritious and taste better. Buying local foods benefits the local economy, that is your neighbors, and decreases the distance a food item must go before reaching your plate. This cuts down on pollution caused by the vehicles that transport the food. As you buy and eat local products, discuss what this means with your children. Better yet, show them. Help them put a face on their food. Visit a local farm together or perhaps even have a CSA or Community Supported Agriculture Farm Share. For a reasonable fee, you can get a weekly allotment of fresh organic produce from multiple area farms. For more information, check out csacenter.org another idea which is going to be increasingly possible as the months get warmer is grow your own food. Don't be intimidated by this thought. Kids love to grow things and they really don't expect much. The best way to teach a child about the origins of her food is to walk her through the process. Start with a few windowsill herbs in the winter, adding a small garden plot in the summer. Choose foods that your child will like, but be creative. Try a few unknowns. Your child will be more likely to eat that funky looking squash if she cared for it with her own hands. Once you have that funky looking squash in hand, help your child make the most of it. Get out your favorite kid's cookbook like Molly Katzen's Pretend Soup for Preschoolers and select a recipe together. An older child can help with planning, shopping and even most of the food preparation. Younger children are capable of skills such as pouring with help and mixing exercise common sense. Of course, don't ask a child to do things beyond her ability level and provide adequate supervision. Make one night a week kids night and let them take over. Work with them to plan and create the family meal and then break bread together. It's time to bring back the family dinner. Try to eat together at least once a week. Children love rituals, so make the family dinner special. Get out the cloth napkins and fancy china and let the kids set the table. Light a candle and turn on some classical music. Begin the meal with a show of gratitude. Thank those who help bring the food to your table. From tilling the soil to toasting the bread from planting a squash to planning a meal, there are many opportunities for connecting our kids with food. This connection adds value to the food that we need for fueling our bodies. More importantly, it provides nourishment for the soul. We hope you enjoy today's conversations with endocrinologist Dr. Michael Dedekian of the let's Go program and Dr. Kevin Strong of Dunk the Junk. And let us know if you have suggestions for connecting our kids with food. Are you a mindful eater? Do you really spend time savoring the food that you put in your mouth and chewing it and digesting it? Do you enjoy what you eat or is it a constant battle? Is it a struggle? Are you always feeling guilty about the calories and the fat content? It's time that we got more mindful about the food that we eat and whatever it is we put in our mouths, enjoying it to its fullest. This is the type of thing that I discuss with my patients at the Body Architect in my medical practice there. We need to get beyond dieting in our conversations about food and nutrition, not only with our children, but with ourselves. This is the only way that we're going to enjoy fully the lives that we have only one of. For more information on mindful eating or to set up a time for a conversation with me at the body architect, call 207-774-2196. I look forward to helping you connect back with your own food in your own life. Anybody who's been paying attention to the news knows that this national epidemic of obesity and being overweight is something that we've been concerned about for quite a while. And we're especially concerned because we're heading down into the younger years. An individual here in Maine who spends a lot of time thinking about what this means, obesity, and being overweight in children is Dr. Michael Dedekian, who is a pediatric endocrinologist right here in our lovely city of Portland. Thanks for coming in.

Dr. Michael Dedekian:

Thanks for having me.

Dr. Lisa Belisle:

Dr. Mike, first tell us, what's a pediatric endocrinologist?

Dr. Michael Dedekian:

Great question. A pediatric endocrinologist is someone who helps children with growth and any other hormone problems they might have. That includes diabetes and a full spectrum of other diseases like thyroid problems and problems with puberty. Those kinds of issues.

Dr. Lisa Belisle:

It's pretty specialized. Why did you become interested in this?

Dr. Michael Dedekian:

So that's a great question, too. I became interested in endocrinology because I think it's a terrific blend of science and being able to help care for patients. So I have a basic science background from research laboratory, laboratory experience, and the kind of science that we use in endocrinology directly takes what we have learned at the benchtop to the bedside, where we can help children be well and grow.

Dr. Lisa Belisle:

Having spent time working with children and parents through my own medical practice, I know that it takes a certain special ability to communicate that you develop. I think, through pediatric training, this is what you found to be.

Dr. Michael Dedekian:

So that's true. I think no matter what kind of doctor you are, communication is an essential feature. There's no doubt about it. Sometimes things in endocrinology can be complicated, so we do our best to boil things down to their essential elements. But one of the things that inspires me about the field is that endocrinology is very observational, meaning that we have learned from science what the body does naturally and are trying to restore that balance to our patients. And that's usually a pretty easy concept to understand.

Dr. Lisa Belisle:

It is an imbalance that we're talking about now when it comes to children being overweight and obese. What has happened that's caused this imbalance to occur in such a widespread manner?

Dr. Michael Dedekian:

Well, that's the essential question. I think you've really hit it on the head there, and we don't know all the answers to that question. Some people argue that our genetics have not changed that much in the past few hundred years. So therefore, it must be mostly environmental influences that are the root of this problem. It's probably a little more complicated than that, because as our understanding of genes and genetics has changed over the years, we're learning that genes are malleable, that their expression is dependent on certain things in the environment. And even though the DNA code may not have changed, how our genes are being expressed and used in the body may be something that's changing over time. And that's a complex constellation of environmental influences, societal influences, and many other different issues. So I always like to say in the beginning that the epidemic of obesity that we see in children and adults has no single trigger. It's a multifactorial issue, and I gave a couple examples already. Food supply would be another one. The way our food supply has changed, the way portion size has changed, the way our behaviors have changed, the way parenting has changed. All of these things play a role. Socioeconomics is another huge factor as well, and that has changed. So there's no one single issue. I think there's a popular misconception that obesity is a personal choice, and it is not a personal choice. I think if you ask anyone who's overweight if they have chosen to be overweight, they would not say that they have chosen to do that. Certainly any child who is overweight has not chosen that for themselves. So it is not a personal choice. It's not something completely under our control. And I don't mean to absolve us of personal responsibility because that's obviously very important. And what we put into our bodies and how much we move our bodies is important. But there are many other factors like genetics and family history and environment that are not under our control. And we need to think very broadly about this issue.

Dr. Lisa Belisle:

What about the possibility of endocrine disruptors that has been brought up in the last, say, 20, 30 years?

Dr. Michael Dedekian:

That's another great issue and an important one, and one that we're really in the very early phases of understanding. So the field of endocrine disruptors has not been around for very long. The term was not coined that long ago. But we work with some leaders in the field and if anyone is interested, they can look up on the Colby College website a lecture that I gave as part of a day long symposium with Dr. Bruce Bloomberg, who's from California, who has done some really pioneering work in this field and shown that, yes, the chemicals in our environment are concerning and we need to take them seriously. I think we're still waiting for more science and more evidence to point us in the right direction in terms of what should we be telling our patients? What kinds of chemicals and toxins in the environment should we prioritize as ones to avoid? We're still learning, but it's clear that these chemicals absolutely can push us down a path of altered metabolism, and for children, altered growth, altered puberty. We're not sure exactly how it all works yet, but there's enough scientific evidence to show that it is concerning. So I think of endocrine disrupting chemicals as an important piece of the puzzle. It's not the only thing, but an important piece to keep an eye on as we move ahead.

Dr. Lisa Belisle:

I like the idea that you put right out there at the very beginning that this is not a choice. Children are not choosing to be obese and even really adults are not choosing to be obese. Because for me, it comes back to the time I've spent with patients in my own practice and the compassion that's really required to deal with people who are in this really difficult situation that's, that's hard to make changes in. I find that challenging. How have you dealt with that?

Dr. Michael Dedekian:

Well, it is very challenging and it's because there are usually many issues to tackle. For some families, it may be a knowledge gap. And I think that we all have some knowledge gap when it comes to understanding nutrition because it's so confusing. I mean, I learned something about nutrition from my dietitian. Every day I'm in clinic. Sometimes it's a problem of socioeconomics, as I mentioned, and that may mean the family needs more social support. And that's why we work with a social worker in our clinic who's a really essential element. Sometimes there may be mental health issues, sometimes there may be issues within the family that need to be addressed as well. So it is very complicated and we have to deal with it. I feel like in a very multidisciplinary kind of way. And I should say too that a physician working on this in a clinic, seeing one patient after another is nice for individual families, but it's not going to be the solution. The solution has to be much broader and has to involve cultural forces. It's going to take a little bit of courage on behalf of governments and administrations to deal with this issue. But any meaningful long term change has to come from a societal level in some way.

Dr. Lisa Belisle:

We've seen examples of the society starting to wake up and take notice and make changes. What are some of your favorite things that Maine has engaged in to try to decrease the problems with obesity?

Dr. Michael Dedekian:

So that's another great question. And that leads us right into talking a little bit about let's Go. And what's great about Maine is that we really lead the way in many areas and are a model for many other centers and communities throughout the country. So, as you know, I'm involved with and part of my time is supported by the let's Go program, which was started by Dr. Tory Rogers here in Portland. And Let's Go is a multidisciplinary effort that crosses many different sectors of the community and society to prevent obesity. And when it is put in action for kids and families, it's not advertised as obesity prevention. It's advertised and promoted as healthy living, which I think is the right way to go. We don't want kids to be overly focused on a number of their weight. We want them to be thinking with their families about healthy habits. So the mantra of let's Go, the essential message of let's go is 5,000, 210, which hopefully many of your listeners have heard of. And it helps remind us about how to be healthy. It's a healthy living prescription for five fruits and vegetables a day, two hours or less of recreational screen time, one hour of physical activity every day and really putting a limit on sugary beverages and juice. That's the 00 sugary drinks and juice. So it's a healthy living prescription. And kids in Maine and other states in New England and really around the country, there are places far away as Hawaii that are doing let's Go in their communities. Kids in these communities see let's Go messaging all over the place. So they may see it at school, they may see it at their church, they may see it at a Boys and Girls club or ymca. They may have parents who are encountering it at their place of work and then at their physician's office as well. They'll be seeing it. These messaging, this kind of messaging that helps promote healthy living.

Dr. Lisa Belisle:

How has lets go been able to work with the physician offices to put these messages into place?

Dr. Michael Dedekian:

So Dr. Rogers has a well oiled machine and a small army of people who help physicians in their offices achieve this goal. It involves some simple steps, but important steps including making a connection to the community which we help offices do, including using a healthy habit survey with families at well child checks which we also help with and make it easy for physician offices to achieve, and prioritizing proper weighing and measuring of children so that BMI can be calculated. And we this might be a good time to talk about body mass index a little bit. So if your listeners don't know that is a measure of weight for height, you use weight and height to make that calculation. It is not a perfect measure of how obese you are, but it is a measure that we find useful on the medical side to predict risk. In other words, if a child's body mass index is far, far above the normal range for age, we know that over time that child is going to continue to struggle and it may help the pediatrician or family medicine doctor prioritize certain interventions for that family. I often encourage my patients, as I alluded to earlier, not to focus on that bmi. I don't think it's right, for example, for schools to be calculating BMI and then sending that information home with the child unless it's in the right context. So we use that measure. That's an important measure in the let's Go program for healthcare professionals. But I think as our awareness of this, not only here in Maine at Let's Go, but as a nation evolves and how this issue should be best communicated to families in the most healthy way, we're starting to rethink how to communicate these numbers to families.

Dr. Lisa Belisle:

What is the scope of the obesity and overweight problem in children in Maine, is it different from the nation?

Dr. Michael Dedekian:

It largely follows national Trends. So between 30 and 40% of all kids in Maine and around the country have a weight that is outside the normal range for age.

Dr. Lisa Belisle:

And how does this impact children's health? We know that long term there's an impact on adult health and longevity and ability to live a healthy life. How does it impact the life of a child?

Dr. Michael Dedekian:

So it can impact the life of a child in many ways. I think I should say first that most children are healthy no matter what their weight is. So adult type diseases are still relatively uncommon in childhood. However, we're starting to see an increase in these diseases in a way that is far beyond what we would have predicted even a few ago years years ago. I always tell people that I got into pediatrics because children usually have one or two medical issues that need to be worked on, and usually they're fixable and solvable. You can fix a broken leg or an infection and send kids on their way and they'll be healthy for 90 more years. What we're starting to see, especially in my clinic, where I see kids who are struggling the most, so it's a skewed population, but what I see is a list of what we call comorbid conditions or medical issues stemming from weight that really look like a adult type medical problem list. So things like pre diabetes and outright type 2 diabetes. Hyperlipidemia, meaning high cholesterol, children who need medical therapy for elevated cholesterol levels, young women and young teenagers who are having problems going through puberty and having irregular menstrual cycles is an issue. Obstructive sleep apnea, something we usually only think of as in an adult population, is much more common in the children that I see. And then the social comorbidities I think are important to mention as well. Not every kid who has a weight issue struggles socially, but many do. And quality of life by various psychosocial measures is often lower in children who are really struggling with their weight. And that's a major issue as well, and something that we really emphasize and focus on also. So the medical issues really run the full gamut. Anything that an adult can have because of a weight issue, a child can have too. Usually it's in the early phases. So we love to get involved early. The earlier the better, and often we can prevent those issues from really becoming a problem.

Dr. Lisa Belisle:

How do you usually begin working with a family on this issue? Because it does go beyond the child. And in fact, sometimes just focusing on the child can be very stigmatizing. So what's the approach?

Dr. Michael Dedekian:

Well, the approach we use in our clinic is first to say some of the things that I said earlier in this interview, which is to take away blame and to point out that there are many issues that can cause a weight problem. We emphasize that we want kids to feel comfortable in their own bodies, no matter what those bodies look like. So we start from there and I feel that that really helps. We also emphasize that we don't have a particular weight goal in mind or a particular number in mind, and many families are relieved to hear that. So once we break down some of those barriers, we can then open up the discussion a bit more and we really try to let families lead the way. So we look like to find out what families see as the greatest barriers to better health in their family and work on those issues first. And we'll help guide them and give suggestions, of course. But we really try to let families be in the driver's seat. We have several themes that we emphasize in the clinic. One of them is that families need to work together. That rules within the family around food should be the same for everyone. You shouldn't have a different grocery list for different members of the family. So if something is expected of the child, we expect it of the whole family as well. That's something that's very important. So we see where families are. We have themes in mind to work with them on, but we really let them lead the way.

Dr. Lisa Belisle:

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Dr. Kevin Strong:

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Dr. Michael Dedekian:

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Dr. Kevin Strong:

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Dr. Michael Dedekian:

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Dr. Kevin Strong:

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Dr. Lisa Belisle:

How has all of this impacted the way that you've parented your own children? You have a one year old and a four year old and I can't imagine that there's. That you can separate that easily.

Dr. Michael Dedekian:

Well, that's a great question. I think there's no doubt that I'm healthier personally because of the work that I do. And that's probably just the nature of medicine and being around a great team, including a great dietitian and social worker and other physicians who are always teaching me something new about this. So it's helped me, it's helped me parent for sure. I think it's given me a little bit of courage too to take certain things out of the house. So for example, I always tell my patients that if something is there there, it's much easier to eat and if it's not there, then you won't eat it. I always sort of poke fun at my staff in the hospital if they bring me donuts or if they bring donuts to share with everyone, guess what? I eat them. You know, I don't let them go to waste. And I think that's true of anyone. But if those donuts or that ice cream isn't there in your home, then it's not going to be there as a barrier to better health. And I usually tell families, go out once a week and have ice cream instead. You know, give yourself a special treat once a week, but don't have it in the house that way. It's a measured portion, you've had a good week, you're giving yourself a little bit of reward for it. And that way kids don't feel like they're completely deprived of things, which we want to avoid also. So I definitely practice what I preach. I like to be able to tell my parents that in a very honest way. And I think we do a good job. And I think my kids are growing up in a very positive environment. I don't think they're hyper aware of food or have some anxiety about food. I think it's very healthy. The other thing I've been able to witness is in my daughter's day school, they were not doing the let's Go program when we first started there a few years ago. This is the Trinity Day School in Portland. And they did a wonderful job bringing the let's Go program to the day school. And I saw how they cleaned up snacks. They now offer a healthy fruit and vegetable to all the children at snack time, even if they don't have it in their own lunch that they bring. There's no juice anymore in the whole daycare, which was a little bit of a shock to the system to some parents, but the kids adjusted and are totally fine now with it. They have healthy celebrations, meaning that for birthday parties and holidays, there are healthy snacks and treats offered instead of cookies and cupcakes, which really has cut down dramatically. Right. I mean, if you think about it, in a class of 40 kids, you know, there's a birthday every week, so there's some sugary something every week. So when we rolled out this idea of healthy celebrations, it was a real relief to the childcare staff and also to the parents that the kids were going to be having healthy foods instead of sugary things all the time. So I've seen how it works on a parent level. I like the kinds of things that it does in my own family, and we're educating our family and grandparents are keeping an eye on what's going on, too. That's always a tricky one, and I think we're doing well.

Dr. Lisa Belisle:

Are you originally from Maine?

Dr. Michael Dedekian:

I spent a lot of time growing up in Maine, so it feels very much like home. And was very thankful that my parents decided to retire here and we came along for the ride.

Dr. Lisa Belisle:

So is there something about Maine and the ability to go into the outdoors and be active and have an active lifestyle that drew you here?

Dr. Michael Dedekian:

Yes, absolutely. I mean, Maine, I think, has one of the greatest quality of life kind of existences you can live. I mean, it's just the right kind of place for me. We do love to be outside. We love nature in all its seasons. And I always tell kids in my clinic who say there's nothing to do or there's nowhere to go outside to play. You know, there may be some kids who live in neighborhoods that are a little tougher than others, but Maine has a lot of space. There's plenty of snow to shovel. There are plenty of leaves to rake and places outside to go. So I'm always trying to encourage my families to take advantages of the great resources that we have here in Maine. It is such a wonderful place to be and a great place to raise a family. Family and tremendous opportunity to be healthy if you know what to do and where to go.

Dr. Lisa Belisle:

Your kids are 1 and 4. So I don't know that you've experienced this personally, but do you have any thoughts on the way that we've kind of developed this kids sports institutional, I don't know, megalith that's now out there in society. That's where we push kids early to do sports, which helps them to be active. But then that necessarily sort of shucks off kids at an early age if they're not. If they don't have the right skills. And then it causes a lot of parents to kind of sit around and watch their kids rather than being active themselves.

Dr. Michael Dedekian:

Right? Yep, that is true. I think that many times when we talk to families about being active and exercise, they think of organized sports as the only option. So we are always trying to counsel our families that exercise doesn't mean you have to go and run a marathon or join a sports team. It can be helping with yard work. It can be taking the dog for a walk. It can be trying to walk to school when you can. It can be trying to walk more during your day, taking stairs instead of elevators, simple things like that. So I do think that our culture does get us caught up in organized sports. And, you know, kids are competing at such an intense level level now, they're almost being trained like Olympic athletes in some circles. And I think that does stigmatize exercise and activity a little bit and make it seem unreachable for those kids who are not naturally very athletic or might not be as interested in sports. So I do think it's important that we have a broad view of activity. We try to call it activity. Instead of exercise, I just say move or play. I mean, for kids of a certain age, it's just playing. That's all they need to do. So you're right. We do need to be careful about what we call exercise and activity. If there are kids interested in sports, that's great, they should go for it. But there's a lot of other ways to get there too.

Dr. Lisa Belisle:

Are there any interesting things coming up in the science of pediatric endocrinology? Obesity, being overweight?

Dr. Michael Dedekian:

So there definitely are some important advances coming our way. I think the biggest question that is still being studied is how does extra weight at a young age affect health in the future? I think we all take it as obvious that too much extra weight in an early age is going to adversely affect health in adulthood, and that seems to largely be true. But exactly how that happens and what kinds of risks are most important to prioritize, that's something that's still being studied. So one example would be type 2 diabetes. There is no formal definition of pre diabetes in children and teenagers. So that's something actively being studied and being looked at. We use a definition from adults that probably works, but children have a special situation with their biology and their growth and puberty puts them in a little bit of a different category that we need to look at carefully. So I'm always careful when making that diagnosis of prediabetes. There was just a huge study that came out, part of the Today study, recently published in the New England Journal of Medicine, looking at the Progression of type 2 diabetes in young people. There were some discouraging results showing that young children and teenagers with diabetes tend to have a more severe form of type 2 diabetes than in adulthood. And the medicines used in adults with relatively good effect aren't quite as effective or long lasting in younger children. So these kinds of issues are ones we'll continue to keep watching as we move forward.

Dr. Lisa Belisle:

Has it made any difference at all that we've taken sugary drink, sugary snacks out of many of the schools and the vending machines and the hot lunches? Has there been any impact on a child's ability to study and focus?

Dr. Michael Dedekian:

I think that school is a tremendously important part of this puzzle. It's a major emphasis of our program at let's Go. And yes, I think that not only are you removing calories from children's education environments, extra calories that are usually not necessary, but there probably is a beneficial effect on helping kids focus as well. We work with some physicians in the community who work with children who have adhd. Some of these children definitely need medicine, others may not. And some practitioners are using a more nutritionally based approach to ADHD and having some good results with that.

Dr. Lisa Belisle:

How can our listeners find out more about the let's Go program so they

Dr. Michael Dedekian:

can visit our website and I would encourage them to do so. It's letsgo.org no apostrophe and they'll see information there. On the 5210 program, there are very handy and user friendly handouts and recipes books for families interested in getting new ideas about healthy snacks and healthy living. So that's a great place to get started and we would love for people to visit our website and we're very reachable if you need to reach me or Dr. Rogers. Our contact information is on the website and we're happy to take a call from anyone who's interested in learning more.

Dr. Lisa Belisle:

We've been speaking with Dr. Michael Dedekian about childhood obesity and some of the issues surrounding it. We've been really privileged to spend this time with you and thank you for coming in and working on this important topic.

Dr. Michael Dedekian:

Thanks for having me. It was a pleasure to be here.

Dr. Lisa Belisle:

Anyone who has kids knows that it can be quite a challenge to try to step outside of the mainstream messaging that takes place and try to encourage them to eat healthy foods and not necessarily in eat the types of things that they're seeing the pop stars eating on television. Kevin Strong Dr. Kevin Strong especially knows this. He is the CEO and co founder of Dunk the Junk and a pediatrician who has practiced formerly in the Mid coast region and now in Lewiston. We're really happy to have you in to talk about your pet project, Dr. Strong.

Dr. Kevin Strong:

Well, thanks for having me. That was a nice intro.

Dr. Lisa Belisle:

Well, it's impressive the work that you've done. I'm looking at right now a poster that is just very graphically interesting in a way that I don't see often in public health. It's the top 10 foods to dunk and it's the art really grabs one's attention. Especially if I was a child looking at this poster, it would really grab my attention. I think that that's been the preface. It's been the premise of what you're trying to do is communicate with kids in a way that they understand.

Dr. Kevin Strong:

Yeah. And I think your intro also kind of touched on this. I mean I think it's really challenging for parents these days to steer their children towards healthy eating. I mean, there's so much advertising pumped at them, encouraging them to eat junk food and junk food's cool. And then parents have to, of course, try and battle that, which is. It's difficult when the access isn't even great. So the idea with the project really, I mean, at the heart of it is to brand healthy eating. Make it cool to not eat junk food, make it cool to eat healthy food. And that's really what that effort is.

Dr. Lisa Belisle:

Well, tell me about these top 10 foods. What are they and why did you choose them? You don't have to go through them all in order if you haven't memorized them. But why this top one is especially interesting to me.

Dr. Kevin Strong:

Yeah, I mean, I think the mission statement really for our project is to dismantle the junk food epidemic. And really what that means is to reverse the childhood obesity epidemic. Because obesity is caused by sugar, excessive sugar consumption, mainly in sugar sweetened drinks. We know that there's tons of articles that confirm that. So the idea with the top 10 foods is to really take that science and make it executable with a cool program. So those are, they're basically all sugar based. There's a number of them that are drinks because again, you get, you get the most impact by taking the sugary drinks out and then you dunk it and it becomes the alternative unprocessed form. So the most sort of easy one to translate would be a fruit roll up becomes a piece of fruit, or a veggie puff becomes a vegetable. And that's we preach is eat from the earth. Eat food in its original form. That's basically how those came about.

Dr. Lisa Belisle:

And this top one is soda. So you're dunking it, like literally dunking it through a basketball hoop, which is something that kids understand. And I know that you've gone out and you've done some work in the community and you've had basketball players come in and do some dunking. And so it's this very strong visual. You dunk it through the hoop and it becomes water or milk. Because one 12 ounce soda has 10 teaspoons of added sugar. That's pretty significant.

Dr. Kevin Strong:

Yeah. And that's the 12 ounce. So you know that's the smallest.

Dr. Lisa Belisle:

That's not the 711 Big Gulp.

Dr. Kevin Strong:

No, no. So you could just do the math. The original big gulp was 44 ounces. So you know, approximately four times the 12 ouncer. So you're looking at 40 teaspoons.

Dr. Lisa Belisle:

And we know that the. And you even have this on your poster. The American Heart association recommends that adult, adult women consume 6, 6 teaspoon of added sugar or less per day. Adult man consume 9 teaspoons of added sugar or less per day. So that's an adult. And if you drink one soda, then you've already surpassed that by quite a lot as a child, right?

Dr. Kevin Strong:

Yep. And you know, a lot of people are drinking a lot more soda than that. There's also a lot of sugar, a lot of sugar served at the school lunches and breakfasts. I mean, if you tally the I did in a school district in Maine, that will remain nameless because it's pretty consistent around the districts. It's not meant to single anyone out. And around the country, if you have breakfast and lunch at school, which a lot of the underserved kids or kids, families who are struggling to get by, they're. A lot of them are eating there. They get 31 teaspoons of sugar by eating breakfast and lunch at school, which is five times what the American Heart association recommends right at school. And then if you went home and had a little bit of soda, some juices or whatever, you can see where you get into these really, really high and toxic levels of sugar consumption. And that's what the science tells us.

Dr. Lisa Belisle:

Well, what does sugar do? And people who are listening probably have some sense, but review that for us because it's significant.

Dr. Kevin Strong:

Yeah, I mean, this is my easiest question to answer because it really gets to the science and the research. I mean, it's pretty scary where the science is starting to point us on what sugar has really been doing. And it's important to stress that we're talking about sugar in insane levels. You know, I'm not saying sugar is in normal consumption amounts back thousand years ago was toxic, but the sugar at the levels we're consuming is toxic. So obviously everybody knows that it increases your risk of obesity. And then you can extrapolate the morbidities from obesity. Obesity increases your risks of various types of cancers. So if sugar consumption makes you obese and obesity increases your risks of an number of cancers by the transitive property, you can associate those. A lot of the top researchers right now in cancer research are working on insulin like growth factors. Insulin is an anabolic or pro growth hormone. So if you have highest levels of sugar all the time, your insulin is always up. So you have an anabolic hormone coursing through your body. That's not good. It's pro growth, it's oncogenic. Many people think it could create a Cancer growth environment. And if anyone wants to read more about that, there's an article in the New York Times Magazine, April 2011, written by Gary Tabes. I don't know if I'm pronouncing it right. T A, U, B, E, S. And it's called is Sugar Toxic? And it's a great review of this and it'll bring you the links where you can read more about it. Otherwise I'll consume the whole interview.

Dr. Lisa Belisle:

Well, it is interesting too because sugar appears in things that you wouldn't necessarily think are unhealthy and things that we've encouraged people to eat. Granola bars. A granola bar can have four teaspoons of added sugar and fruit or vanilla yogurt. A six ounce fruit or a vanilla yogurt has three and a half teaspoons of added sugar. Peanut butter can have one teaspoon of added sugar per serving. And also hydrogenated vegetable oil instead of peanut oil if you're having a cheap substitute. So there's things that we give to our children routinely that we think are good for them, but something. There's a disconnect there. One of the articles on your website, I believe it was Mother Jones.

Dr. Kevin Strong:

Yeah.

Dr. Lisa Belisle:

And it talked about the sugar industry. And I think it was 1976 that our sugar consumption was down. We weren't as obese, people weren't spending as much to eat sweet foods. And the sugar industry said, well, this doesn't really work for us. We need to put some money into telling people how healthy it is. And they even promoted sugar as something that's good for being on a diet, ironically.

Dr. Kevin Strong:

Yeah, yeah, yeah. That article does a real good job, I think, outlining sort of the propaganda that's gone on over the years, similar to other industries where science was starting to show us things weren't good for us and big money was involved. So people came out with their own campaigns to keep sales up. So that that article really details that chronology really well and it lets you know that this has been going on a long time and now we're seeing the effects of not acting earlier.

Dr. Lisa Belisle:

Well, it's also interesting for me because as I'm reading it, I'm starting to feel, and I don't have a problem with marketing per se, but I start to feel a little bit deceived because it's not just that I'm eating sugar because I crave it myself as, you know, as an individual. I want something a little sweet. I'm eating sugar because these messages are so constant and they're so pervasive, and they're out there and being aimed at our children. And you have small children, so how does that make you feel as a father and a doctor, that this is such an ongoing and difficult thing to combat?

Dr. Kevin Strong:

Yeah, I mean, that's another amazing question that could have a really long answer, you know, weaving in child psychology. But I would say for my own children, we don't have a TV in our home. And it wasn't originally because I didn't want to expose them to advertising per se. I just didn't want that to distract our ability to communicate as a family. But now when they catch TV when we're out, they see an ad and they're like, I want that. I want that. I want that. As soon as they see an ad for whatever it could be for upholstery repair stuff, my daughter will be like, I want that. Let's get that. They say it's the best because they haven't seen these. They haven't been inundated with them. So it really has shown me the power of those marketers and those ads.

Dr. Lisa Belisle:

You were an outpatient community pediatrician, and now you're an inpatient pediatrician. Are you still seeing the effects of sugar consumption and obesity on the health of the children that you deal with in the hospital?

Dr. Kevin Strong:

Yeah, yeah. Yes, totally. And it's different. It's difficult because, you know, in the inpatient setting, you're dealing often with acute problem that's come up. But you see, you always try and see the patient as a whole, so you can see some more sort of chronic issues that the patient may have. Fortunately, at Central Maine Medical center, where I work, they've done a really good job of supporting us. And I often feel that I have time in the rooms to do things I couldn't even have done as an outpatient doctor, education things. And they're open to that. And I think that's, you know, like, that's good medicine. You know, if you have a patient interaction, why just, you know, treat the acute problem? Why not, you know, give a little preventive counseling and stuff? So.

Dr. Lisa Belisle:

And how do families respond when you do some of the preventive counseling in the inpatient setting?

Dr. Kevin Strong:

Yeah, I always wait until I have a relationship with the patient, at least the second day of the hospitalization. So. Because I think you obviously, it's a difficult potential discussion. You have to sort of have a relationship, I think, with a patient. I mean, it at least increases your chances of things really going in the right direction and really motivating the family. I wanted to go back to that last question, really also, though, because talking about kids and motivating kids and the kids like it, I forgot to say that that's also really what this is about. It's about kids educating kids, that junk food is bad for you and companies are deceiving you and having kids decide. Young children, teens decide. I don't want to eat junk food. Because we all know any parent knows you tell your child not to do something. You know, no one of any age likes to be told what to do. So the idea is to have kids vote with their own decision, so there's not that parental conflict and stuff.

Dr. Lisa Belisle:

Anyway, I understand that you're in the process of opening up a clinic that's going to deal with healthy eating and kids who need some help with healthy eating issues. Is that going to incorporate motivating the children themselves to make changes in their diet?

Dr. Kevin Strong:

Yeah, we're at Central Maine Medical Center. I'm working with the outpatient doctors there, Central Maine Pediatrics, to set up like two days a month or something initially where kids can come for nutrition counseling. And it really is going to be a pure implementation of Dunk the Junk. I mean, there's educational pieces that we have, the infant children's book and the poster Top 10 Foods to Dunk. And it's set up to be tracked and studied and followed up. And so that's the idea. We can have patients come in. If they want to be involved in the study, great. If not, they just get to come and learn about nutrition. They get a poster, they get the stickers. We go through the video. So it'll be good for me to be actually doing it so I can see how it's flowing. And then when people give me feedback, we can make adjustments to make it even more satisfying for doctors offices or school nurses at home.

Dr. Lisa Belisle:

We've talked about the poster and the work that you've done in schools with having people come in and actually dunking things and actual basketball hoops. But you are interested in starting this very early on. You have a book called Eating the Alphabet, and you were Talking to me recently about the fact that even starting kids with the right finger foods can make a difference. Some of the things that we've thought are good finger foods for a really long time actually already have added sugar. So we're sort of starting the kids off training their mouths and their palates with sugar.

Dr. Kevin Strong:

I mean, the book, it's Animals Ate the Alphabet and it's got some poetry, some alliteration. It promotes literacy, and it's meant to excite toddlers about trying new foods. Or an animal trying a tiger having tabouli or a polar bear pouncing on papaya, stuff like that. But in the back is an appendix on solid food introductions in an unprocessed fashion for infants. You know, at four to six months at the doctor's office, you get a little talk about how to introduce solids. And I'm tired of Cheerios being the number one finger food. Why is General Mills get the. Get the pole position? So that's what this is. It's a rewrite. And I'm just going to read you this. This is called the Doctor's Note. Lead in. Have you ever tried an apple after eating a fruit roll up? Have you ever tried a carrot after eating a veggie puff? Whole oatmeal after a bowl of Cheerios? The brain's ability to sense natural taste pleasures is desensitized by the inundation of the supernatural flavor intensities created in big food labs. I often hear frustrated parents say, but my child will only eat box cereals and chicken nuggets. Yet infants around the world whose diets are not primarily processed foods do not manifest these troublesome taste preferences. You can change these eating patterns in your household, and as more parents like you join in, we can make a difference across the country. This book is here to help you choose healthy foods that your child will ask for again and again. Almost done. If processed food with added sugars or added salts aren't overwhelming an infant's palate, the brain will sense and enjoy natural food in all its subtle sweetness and saltiness. Give your infant's brain and palate the opportunity to experience the natural flavor intensities of real food. So that I think that's sort of the answer to the why is if you keep it out, you're not going to have problems. And I could have never done it as well as that's written.

Dr. Lisa Belisle:

So instead of Cheerios, what do you recommend?

Dr. Kevin Strong:

Well, we like things in the original state as close to the original state as possible. So you would talk about, like, Barley with the husk on, you know, that or the oatmeal, that's steel cut. It's sort of kernelly and crunchy still. If you have that fibrous core still on, as close to the original form as possible. It takes longer to degrade in your stomach, so the release of sugar into the body is slower, which is really what we're looking for.

Dr. Lisa Belisle:

Most doctors don't go the path you're going down. So how'd you get here?

Dr. Kevin Strong:

I mean, I think the real answer, it's more just about like I wanted to find a way to connect with kids. And these are things, these ideas are things kids would love and enjoy their exciting things. Art, sport, that kind of thing.

Dr. Lisa Belisle:

And is it because you knew that this is the type of thing that you connected with when you were a kid?

Dr. Kevin Strong:

I think there's a little bit of that sort of paying attention to both what I like still and what kids coming into my practices were talking about. You know, I did some informal polling the years leading up to starting this. We asked kids, you know, what are your interests? What are your activities when they come in for physicals? It's on a general checklist. So you have a pretty good sense of your population. And a big piece of that, obviously is our social media and our web presence and our use of video. That's probably our strongest piece is our edited sound, edited videos.

Dr. Lisa Belisle:

So where can people watch the videos, find out more about Dunk the junk where Order the Animals Ate, the Alphabet book or all the various projects that you're involved in?

Dr. Kevin Strong:

Yeah, I mean, we have. This is our website. It's the easiest. You can get to everything through it. There's tabs at the top shop or calendar, stuff like that. It's www.dunkthejunk-u n k t h e j u n k dot o r g. And then there's an F and a T on that page. It'll take you to the Facebook or Twitter and I encourage people to check those out. We try and be funny and we post a lot of art.

Dr. Lisa Belisle:

Doctor Kevin Strong, it's been a pleasure to spend time with you. You're clearly very passionate about what you do and you're very creative in the way that you're approaching kids nutrition. And I think it's so important, given what we know about sort of the state of kids health right now in our community. So. So thank you for spending time with me and talking with me more about this important project.

Dr. Kevin Strong:

And I'll write back at you. I mean, thanks for doing what you do. I mean, it's important, so important to get the educational message out and this is the kind of outlet that can do it. So thank you.

Dr. Lisa Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 77, Connecting Kids with Food. Our guests have included included Dr. Michael Dedekian and Dr. Kevin Strong. For more information on these guests, visit drlisabelisle.com the Dr. Lisa Radio Hour and Podcast is downloadable for free on itunes. For a preview of each week's shows, sign up for our E newsletter and like our Dr. Lisa Facebook page. You can also follow me on Twitter and Pinterest Dr. Lisa and read my take on health on The Bountiful Blog bountifulpath.com We love to hear from you, so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also, please let our sponsors know that you have heard about them here. The individuals who make this show possible are each personal friends of mine. I'm privileged that they enable me to bring the Dr. Lisa Radio Hour to you each week, so tell them that you appreciate their caring. This is Dr. Lisa Belisle hoping that you have enjoyed our Connecting Kids with Food show. Thank you for allowing me to be a part of your day. May you have a bountiful life.