Issues with Feeding Twins

The following is a cross-post from LittleStomaks.com.  Click here to see the original. 

Question: How can I get my twins to eat well and develop healthy habits?

Answer:

You would think that a dietitian would have an easy time when it comes to feeding their own children right? After all, we do consider ourselves the nutrition experts.  I find it is quite the contrary.  Knowledge does not always equal 100% success when it comes to feeding your kids.  Along with being a dietitian, I am also the proud father of not-quite 3-year-old twins, Reuben and Shira.  Being a father of twins and a registered dietitian, I think I’ve gained some unique perspective on feeding children.

Before being father, I remember sitting in school earning my bachelor’s degree, and learning about Ellyn Satter.  I found out she was a dietitian who had very interesting insights into feeding children.  I knew she wrote many books on the subject I never was motivated to read them until I found out my wife was pregnant.  Until you have children of your own, you never really know what kind of parent you will be or how you will handle any given situation.  You think you will handle it one way but until that actual moment is there, you never really know. Feeding my children was a perfect example of this.
What I loved about Satter’s theory is that focuses on responsibilities.  She believes that a parent’s job is to provide healthy, balanced meals to their children.  Then it is the child’s responsibility to eat the meal.  A parent is not a short order cook and should not run to the kitchen to make a whole new meal just because he/she doesn’t like what is being served.  Sounds simple?  In theory it is but until you experience the five-minute tantrum that your son is having because he doesn’t want pasta with vegetables, you don’t know how hard that is.

Having twins adds another complexity to all of this.  Some think that twins (no matter if they are identical or fraternal) should be similar since they have the same birthday, are raised together and share most of their experiences.  Wrong!  Twins are really just siblings who share a birthday and can be as different as night and day, especially when it comes to food.  My kids eat the same meals as each other but how they react during a meal is totally different.  One is more likely to get upset and the other is more likely to lose attention quickly and eat only one or two bites of food before asking to leave the table.  We learned that there were differences very early on.  Our daughter was colicky for the first four months of her life.  We tried everything to relieve the symptoms.  There was one point when she had different bottles, nipples and formula than our son.  It was our first lesson that what applied to one would not necessarily apply to the other.

If you want some insight into chaos theory, come over for dinner one night.  It is a bit of a circus but despite all of this, my wife and I have two kids that are actually very good eaters.
So how did we do it? They key is that with most things behavioral, there is no quick fix.  It takes time and consistency but pays off in the end.  Here’s what’s worked for us and maybe it can work for you too.

1. Everyone sits down at the dining room table with the TV off for dinner. (Unless there is a big football game on!)  This gives us structure at night and allows us to connect with each other
2. Have regular snack times.  If one child doesn’t eat at dinner for any reason (mood or not hungry) my wife and I know that they won’t starve.  They will have a balanced and nutritious snack in a couple hours that will satisfy them
3. As your children get older, involve them in the meals.  I made falafels at home for the first time last month and the kids helped by adding the ingredients in the food processor.  Since they were apart of the process they were more interested in trying this new food.
4. Grow some vegetables with your kids.  They will love watching the plants grow and be excited to see how a cucumber started from a seed to the long green vegetable that is now on their plate.
5. As they get older, give them a choice between two things for dinner.  Every night I ask, “Ok, do you want this or that for dinner tonight,” and that’s it.  I don’t give them more choices and I try not to get into a negotiation.

Thintervention: Definetely Not BVM

Photo courtesy of Bravo TV

I will admit it, I watch and enjoy reality TV.  Since some of my favorite shows (Top Chef and West Wing reruns) are on Bravo TV, I see a lot of their ads for new shows.  Maybe just because I'm a dietitian I was naturally drawn to one of this season's new shows, Thintervention with Jackie Warner.

If you are familiar with Bravo, you might recognize Ms. Warner from her previous series Workout which highlighted the personal and professional drama that comes from a Beverly Hills health club.  Her new show, Thintervention is a less personal drama but more like the Biggest Loser.  It tracks a small group of people who are working with Ms. Warner to lose weight.  Her expertise is as a personal trainer and according to this site holds certifications from the International Sports Science Association (I.S.S.A.), and National Endurance and Strength Association (N.E.S.T.A.) but no nutrition degree or certification of any other kind.  The greatest thing she has to offer is the best six-pack abs on TV.  But abs of steel in no way qualifies her to give sound nutrition advice or help people find a successful weight loss plan.

I watched just enough of Episode 1 to see Ms. Warner literally punish her client for eating 150 calories of cookies. Her basic nutrition advice was to eliminate all sugar from her clients' diet.  When she found that her client did not follow this "order", she made him walk up and down the stairs in his house until he burned the 150 calories from the cookies he ate.   My thought when I saw this was a little shocked.  Working with obese individuals, I never try to demonize a specific food or punish someone for not making a healthy choice.  What message does that send to the client and how does that promote long-term healthy eating?  It doesn't but it does get ratings.  Since I couldn't watch the whole first episode I thought I should give Ms. Warner a chance and try to catch a full episode.

Last night, after putting the kids to bed I figured I would watch Episode 2.  I still have a bad taste in my mouth.  Thankfully, there wasn't much in the way of flawed nutrition information from Ms. Warner during the episode.  Her only really great kernel of "nutritional wisdom" was to talk about her pre-workout shake.  See the recipe here but to summarize, it's protein powder, glutamine powder, branched chain amino acid (BCAA) powder, L-carnatine, flax oil, spinach and fruit.  I'm not an expert in sports nutrition but it seems like a lot of supplementats to me.  Wouldn't teaching her clients how to find some of those ingredients in whole foods that they can find in any market be more useful? 

The most disturbing thing about the episode though was the end.  All but one of the clients lost weight.  Most averaged a few pounds but no, "huge numbers." Jackie's reaction to the weight loss was simple: disappointment.  Not reassurance, not a congratulatory hug.  No, disappointment.  There was no discussion about how the body fights weight loss and that it might not be realistic to lose 5+ pounds every week.  No, there was disappointment.  How does that motivate someone to stay with a program?  Now I know that this is TV and that we are only watching the show for the drama that ensues but with something as personal weight loss, drama is not the name of the game.  Losing two pounds in a week is a big accomplishment for anyone and should be congratulated. 

I'm sure that Ms. Warner's clients get results.  I'm sure that they lose weight while following her exercise and diet plan, but is it sustainable? Is she helping her clients make life-style changes to make the weight loss permanent/ Is she teaching them to change how they think about food?  Is she giving them the tools to have a healthy relationship with food?  From what I've seen so far, the answer is no.  I wish her clients success and good health.  Maybe after they are done filming they can go to the ADA website, find a Registered Dietitian and  see how the nutrition experts do it. 

Relationships and Food

I apologize ahead of time but this is going to be a more personal post than others, but I have been thinking about some things and I wanted to share some thoughts with you all. 

This month I am celebrating my 7 year wedding anniversary with my wife.  I am by no means a marriage or relationship authority but coming up on this milestone has forced me to reflect on my relationship, love and of course how that relates to food.  My wife and I have both, at different times in our lives, struggled with weight and we each have our own issues with food.  I gained weight during and after college by eating too much and not exercising.  As I look back on it now, I was a very unhappy person and food was my best friend.  I didn't like work, I didn't like being single and the only constant was food.  Food was there for me no matter what and it would comfort me late at night when there was no one else around.  I changed my habits before I met my wife.  I quite literally woke up one morning and decided to eat better.  I lost over 100 lbs by being a different person, I ate better, I exercised, but more importantly, as I lost weight I felt better.  After losing the weight I met my wife.  I told her about my relationship with food and she had similar experiences and that helped bring us together. 

So where does this whole story lead me to?  As a dietitian helping individuals lose weight I often hear something like, "When I get skinny, I'll be happier."  I wish it was that simple but it never is.  Weight loss is not a quick fix to happiness.  The problems you had when you were heavy are going to be there when you are thin.   I think it goes back to the old saying, "You have to love yourself before you can love someone else."

One of my fears as my wife and I started dating and as we settled into our lives together as a couple was would we both gain weight.  I'm sure that we all have stories from friends who talk about how they got comfortable with their partner, stopped exercising, ate differently and started to gain weight.  Well interestingly enough, there's some research on the topic and according to this article from the Mayo Clinic:

Co-habitating increased the odds of becoming obese for women by 63 percent, compared with only 30 percent for men. Marriage doubled the risk of obesity for both men and women — 107 percent for men and 127 percent for women.

The study's findings are echoed in this person's personal story posted on Discovery Health.  She talks about how her weight changed once she moved in with her boyfriend.  It's gives you a glimpse into one person's struggle with weight while also enjoying a new relationship.

Being a dietitian didn't prevent me and my wife from having a similar experience after we got married.  We each "relaxed" just a little and we began to notice some increase in our weights.  But I have I learned after 7 years of marriage.  Just like good eating, love requires some balance, variety and moderation.  We have learned to live together and build a life together and now I couldn't imagine life without her, but building that life took time and patience.  Here's what we do to enjoy each other and stay healthy at the same time:

1. We try to cook at home as much as possible.  The one place we don't get along is in the kitchen so we don't cook together but we have roles in the kitchen.  We plan a week's worth of meals at a time and we make a point to eat together as a family without the TV on.  Since we had kids, we also make sure to have a family Shabbat meal together.
2. We try to find activities that we can do together that keep us active.  Recently we started hiking together and it gives us a great break from our lives to enjoy each others' company while also getting our heart rates pumping
3. We talk about our feelings together instead of using food to soothe us. 

My New Love: A CSA

I have to admit that I have a little bit of a love affair going on right now and I can't hold it in anymore: I love my CSA.  No, I don't have some strange infatuation with a new governmental agency.  CSA stands for Community Supported Agriculture.  If you have never heard of a CSA let me explain the basics.  Simply put, a CSA allows you to purchase a set amount of local produce on a weekly or monthly basis.  When you join a CSA, you agree to pay a subscription fee for fresh, local produce that you can either have delivered to your door or pick up from a designated location.  The fee you pay goes directly to support the farm(s) you buy from, so essentially you are investing in your own food.

Because I get to work with other dietitians, I learned about CSAs from them.  Since I don't live in the same area as my co-workers, I couldn't subscribe to their CSA so they pointed me to Local Harvest.  They have a simple search tool to find a CSA that was convenient for me and I found Abundant Harvest Organics.  I signed up and for the past few months I have been picking up my box every Saturday morning.  I pay for a small box of locally grown, organic vegetables and fruits and it is enough to last my family of four a whole week. You can see one of my most recent box contents on the right.  The great thing about Abundant Harvest is that they also have a ton of add-ons.  Which means I can pay a little extra but along with my regular box I can also buy grass-fed beef, pasture raised chickens, organic nuts and even coffee just to name a few of the products. 

Here's the beauty of a CSA:

• I know that I am supporting a group of small, local farmers who are committed to providing fresh, organic foods. 
• I take my 2 1/2 year old twins with me every Saturday morning while my wife stays at home to relax.  We get to spend some quality time together and they love opening up the box and saying, "Surprise!" and they try little bites of all the produce we get.
• We cook more at home and include more vegetables in everything we make.

CSAs are gaining popularity.  It seems everyone I tell about my CSA says they have heard of other friends getting one.  Someone recently pointed me to Farm Fresh to You.  They are a CSA that delivers your box directly to your house.  Pretty convenient eh?  I also read this week about CSAs being delivered via food trucks to areas that would not normally have access to fresh fruits and vegetables.  Get the whole story here.

There are also some CSAs that provide their members with other benefits aside from fresh produce.  Hazon is a Jewish CSA whose goal is to promote sustainable living and agriculture to the American Jewish community. 

Joining a CSA has been a great experience.  I feel better about where my food comes from and my family has enjoyed trying new recipes to make use of each week's bounty.  My wife and kids will always be my main loves but my CSA has helped develop my love for fresh, locally grown, organic foods.

So Long to Salt

I wrote about the 2010 Dietary Guidelines last month and I thought it would be a good idea to dive a little deeper into one new guideline: "the goal [for sodium] should be 1,500 mg per day."  Sounds like a simple goal but given that our country loves salt, this is a very difficult thing to accomplish.

Salt is 40% sodium and 60% chloride.  The most concerning element is the sodium.  We need sodium in our diet but the problem is we get way too much.   Diets high in sodium are associated with increased risks for high blood pressure which then lead to chronic kidney disease, stroke, heart disease and congestive heart failure.  The Mayo Clinic has a great article for more background. 

Almost all of the sodium we eat comes from processed foods.  There are some foods that naturally contain sodium, but for the most part, anytime we shop for food in the market or go out to eat we are eating sodium.  In an article from the Center for Science in the Public Interest (CSPI) about how to reduce sodium, the physician they interviewed said, 

"...75 to 80 percent of the sodium we consume is added to food before we open a package or walk into a restaurant. So unless you make everything—including breads, crackers, cereals, soup, pizza, spaghetti sauce, salad dressing—from scratch, you can’t easily avoid the salt."

The reality is that we are hardly cooking anything from scratch.  What most people do at home is not generally cooking, we're heating.  We need to learn to cook again.  I wrote about cooking at home earlier but another great resource is from this blog Inspired RD.  She has great recipes that will truly inspire you.

Until we learn to cook we need to do two things:

1. We need to read the food labels when we shop.  When you pick up a food label, start by looking at the serving size of a product.  Next move down to see how many milligrams (mg) of sodium a product has.  Try to find foods that have 300 mg of sodium or less per serving.  
2. We need the government's help to pressure the food industry to use less salt.  Marion Nestle wrote a great piece on this very topic you should read.  In addition to this, read the Institute of Medicine's report on Strategies to Reduce Sodium Intake in the United States. One of the key recommendations is to have the FDA change and regulate how much sodium can be safely added to foods.

By choosing lower sodium foods and food companies reducing the amount of salt in processed foods, we can start to make a difference.  To quote the movie Food Inc. "You vote with your fork three times a day."  Make each vote count and you'll be surprised about how well you can do if you just make a little effort.

Updates to Recent Posts

CLEANSE UPDATE:

Last week I wrote a post about cleanses.  Just days later First Lady Michelle Obama (who I praised here) was interviewed by Ladies' Home Journal.  In the interview she admits that occasionally she  does her own "cleanse" every now and then.  In the article she says,

The cleanses are good for a short period of time. I can't live my life on a cleanse. But they help me clean out my palate. Because when you start adding things like sugars into your diet, you start craving them. And the more you eat, the more you crave. . . . So maybe I'll do a cleanse for two days. It isn't a way of life, because I like food too much. But it is good to break your mind-set.

I was a little shocked by the First Lady's comments about her cleanse mostly because she's been doing such a great job of promoting healthy eating habits.  I recently found a great blog that recapped some opinions about Mrs. Obama's comments.  You can read the whole post here but to summarize I think the article  does a great job of presenting arguments from Marion Nestle and Jeff Stier, associate director for the American Council on Science and Health discussing the First Lady's cleanse as well as her press release for clarification.

While I agree with eating less sugar, a better way to break that cycle is not by going on a cleanse.  Cleanses are temporary solutions to a long-term problem.  If you continually eat a lot of high sugar foods what is more important is helping change the behavior that is driving you to choose these foods. 

At least the First Lady is not doing a cleanse to lose weight.  With all the talk of cleanses, I was so pleased to read this story about John Goodman.  He's lost 100 lbs. by doing something amazing: eating right and exercising!  Bravo, Mr. Goodman.


EXTREME EATING UPDATE:

I've written about extreme eating already here and here.  Well there's a new extreme food to talk about.  Denny's jumped into the fray with their Fried Cheese Melt.  It's a grilled cheese filled with fried mozzarella sticks.  A lovely mix of appetizer and and entree to clog your arteries and expand your waist.  The estimated nutrition information from this CBS article: 845 calories and 34 grams of fat. Oy vey!

Another Celebrity Cleanse

Detox and cleanses are all the rage these days.  In our constant craving for the quick fix, many turn to a cleanse or detox for that instant gratification to shed some quick pounds or remove those "harmful toxins" from our body.  I was not surprised to hear that yet another celebrity was promoting their latest detox/cleanse plan.  This time it was Demi Moore via The Huffington Post who was defending her new regime The Clean Program.  I guess her and her husband were on the Master Cleanse for some time but then switched to the Clean Program.  Naturally this article caught my attention and I felt it needed further explanation.

So what's the theory behind cleanses?  Basically they are selling you the idea that our bodies build up toxins from an unhealthy lifestyle.  You start a cleanse by fasting and/or taking a laxative to help you "eliminate" waste.  Depending on the program, you slowly add some food back but continue to restrict most foods while on the program.  The theory is by taking a 21 or 14 day cleanse, we are helping clean out our systems and promoting better health.   This article and this blog post will offer you some good background on detox/cleanses as well as highlight some of the potential dangers.

So after reading the article previously mentioned, I headed over to The Clean Program to see what it this detox/cleanse was all about.  According to the site:

The Clean Program is a 21 day detox program that is specifically designed for the person on the move. Unlike traditional cleanses, you need not stay at home while you detox on the Clean Program. This cleanse is designed for those who want to live their life and still get Clean

The program (which costs $350!) consists of two detox shakes and supplements taken twice a day plus one regular meal (they suggest lunch)  from their "elimination" diet plus more supplements.  I was pleased that they provided some scientific research to support their program.  When I read their articles though I was not surprised they they were simply analysis of other research and not randomized, double-blind placebo controlled studies.  Neither article really showed their program as effective but instead were general articles about the role of detoxes related to chronic diseases.  The Clean Program is just another in a series of very slick marketed products to try to help you be healthy.  That $350 could probably be better spent on a couple months worth of fresh fruits and vegetables.

So what is the bottom line?  A cleanse is a short-term solution to a long-term problem.  You might lose weight from a detox but that will likely be water weight and possibly a loss of muscle mass and more importantly as soon as you are off your detox/cleanse you'll probably just gain all that weight back.  Want to hear the easiest way to keep your system clean?  A diet rich in fiber.  How about eating plenty of fresh fruits and vegetables, less meat, exercise and drink plenty of water?  But what of these pesky toxins in our body?  Well we have organs (the liver and kidneys) in our bodies whose function is to remove toxins from our body. 

With all due respect to Ms. Moore and all future celebrities and sales people trying to promote a detox,  don't believe the hype.  There is no quick fix to good health.  Focus on a healthy lifestyle and live a life of balance, variety and moderation.