LUNCHES

grapes

School has started again and I was reminded of my sense of inadequacy over lunch food when my brother in law was complaining about his daughter not eating her lunch.  It reminded me of when I had the same complaint.  But my complaint included a rant about the contents of my daughter's lunch.
You see, I hate to pack school lunch.  This dislike goes back to when I was a child.  I never wanted to do it the night before, and everyone knows you can only do a good job in the morning if you get up early.  So I always foist  the job on anyone I can get to do it.
When my daughter was little, I had the babysitter make her lunch.  I would explain, in excruciating detail, what should be included in a nutritious lunch.  And each evening I would empty her lunch box with a complete untouched lunch.  This lunch would always contain food that did not meet my standards.  After listening to me complain about this for weeks, my husband, instead of telling me to make the lunch myself (a very good call on his part, I might add) stated "what does it matter if she doesn't eat a non-nutritious lunch, or she doesn't eat a nutritious lunch?  She doesn't eat it!"
This got me to thinking about what and how much a lunch should contain.  Obviously, the caloric intake varies depending on the age of the child, and whether or not you are packing mid-morning and after school snacks also, as so many parents do.  I think the best way to think about it is how many calories does your child need in 24 hours, and how many of those will he eat away from home.
A child should always start their morning with breakfast.  In general, they should have some protein and complex carbohydrates.  I'm a big fan of oatmeal, but my daughter isn't.  It doesn't have to be typical breakfast fare, either.  A big favorite in my family is cold pizza.  That meets my requirements and can be eaten on the run.
But this is really about lunches.  I've always thought that lunches should have a variety of things because you never know what you are going to feel like eating.  If you are planning lunch with snacks, that allows you to increase the choices and calories for your child.  Plan on giving them half their daily calories.  Include a fruit, a vegetable, carbohydrate and protein.  Include your child in menu planning.  Not necessarily on a daily basis, but in grocery-shopping.  If they have more say in what goes in their lunch, they are more likely to eat it.
Do you need to include a "treat"?  And if so, what kind?  Some people think of treats as dessert and sweet, others think of treats as salty and savory.  I think of treats as junk food and should not be a daily part of eating.  So my answer is treats are not a daily part of lunch.  Even if they are not eaten!  Because what we are trying to teach with what we send to school for lunch is what is good food.
Next blog will have ideas for the lunch itself!

AS USUAL, THE KIDS PREFER MOM'S!



Fitz, the "fruit guy"



Not only did Ashna try out the food, but one of her friends participated.  I'm always one to encourage kids to to put their "two cents" in, so even though it is summer, I asked Sydney to give her opinion by writing an essay.  Here  is what she had to say.   

                                                                                      

Easy Fruity Recipes

With the new summer heat, refreshing fruit is beginning to make its way to the top of our snacking list. Since sweet, fresh fruit is now in season, making summer specialties like fruit salad, frulatti, and banana frappes are easy-to-make summer treats. I had a chance to critique different versions of each of these recipes.



"B"                     "A"



First I tried two different bowls of fruit salad and was told to evaluate all aspects of both. I tried “Bowl A” first. Even before scooping up a generous serving, I noticed that the fruit was bright, and seems artfully cut and arranged. However, upon eating the fruit, I found that it was slightly mushy and not as brightly flavored as the colors made it seem. When I tried the “Bowl B”, I was instantly gratified with a fresh, sweet burst of flavor from firmer, juicier fruit than found in the “Bowl A”. However, the fruit of the “Bowl B” was less carefully presented than its counterpart; it seemed to be thrown in haphazardly, and the fruit was cut into uneven chunks. Upon careful examination of the pros and cons of each fruit salad, I found that I liked the “Bowl B” better. Although presentation is important for any dish, flavor is the critical tipping point for any taste testing. Before going into this tasting, I didn’t think that the two fruit salads would be any different; after all, it was the same fruit for both! But I surprised myself by noticing distinct differences between the two.

Now, everybody has had fruit salad before, but have you ever heard of a frulatto? No? Well, neither had I, before this. But I was glad that I got to try it. I tried various frulatti with different types of dairy product. We started out with two frulatti made with milk—one with nonfat and one with whole. Both frulatti made with milk had a slightly gritty texture from the ice and the fruit. The frulatto with skim milk was more watery and not very rich, while the one with whole milk was more full-bodied, but still not creamy and smooth. I then tried frulatti made with yogurt. All of these frulatti were smooth and thicker than the ones made with milk. I first tried one made with a plain, slightly sour yogurt, which was much creamier and smooth than the ones made with milk, but the tang of the yogurt did not go well with the sweetness of the fruit. Next, I tried one made with vanilla yogurt. This one was my favorite frulatto at this point in the tasting. It was rich creamy and smooth, and was sweeter than the one made with plain yogurt. Because I complained about the tanginess of the plain yogurt and praised the sweetness of the vanilla yogurt, I then tried one more; the final frulatto we tried had plain yogurt, and extra sugar added in. This was my favorite of all of the frulatti: it didn’t have the vanilla flavor to distract from the flavor of the fruit; it was rich, smooth, and creamy; and the intense flavor of the fruit was enhanced by the creamy sweetness of the yogurt.

Finally I got to try the banana frappes. My reviews of the different versions were very similar to the ones of the frulatti. The frappes made with milk were thinner and less full bodied than the ones made with yogurt. They were not as smooth, especially the one made with nonfat milk, which seemed slightly chunky and not well-incorporated. The sourness of the plain yogurt did not go well with the banana, much like the frulatti. However, the vanilla flavor of the vanilla yogurt complimented the banana rather than detract from it. It was sweet, creamy, and smooth, with lots of fruit flavor. My favorite frappe was the one made with vanilla yogurt.

Dr. Vicki Again. 

So there you have it.  For you parents out there who are letting fast food joints and restaurants intimidate you from cooking for your kids, GET BACK IN THE KITCHEN!!  You don't have to spend a lot of time or money.  The more time I spend with Carla and her family, the less time I'M going to spend in the kitchen.  (Except when my daughter comes home.  I know she prefers my fancy cooking, because her Mom Knows Best!)

PS  A special thanks to Ashna and Sydney for taking the time to eat and then write up their incredible (with no editing by me) reviews.  And a thanks to Marlborough School.  This is where these girls will be entering 10th grade in the fall and learned to write so beautifully and where my daughter graduated from a few years ago and also got a wonderful education.



FUN, DELICIOUS PRE AND PROBIOTIC FOOD!

Much to my dismay, Carla has not made a single quiche since the one we made together.  So I decided to try something different.  With summer approaching and knowing her younger daughter, Ashna, would be out of school, I decided to teach Carla a number of yummy,  easy healthy snacks that she could do with little effort.  I figured I would do this with her kid around so there would be more pressure for her to "whip" these up in the future.  So here are the recipes, with Ashna's reviews to follow.

FRUIT SALAD
Fruit salad is easy to make but it can be time consuming.  It is, however, used for the next recipe, so from a time point of view, it counts for more than one meal.
Anyone can make a fruit salad.  BUT, there are a few techniques that can make your fruit salad stand out next to your neighbors.  Although not necessary, having good tools does make it easier.

  Here are the tricks:
1.  I tend to only make it in the summer.  I think summer fruits elevate a fruit salad from nothing special to an incredible treat.
2.  Vary tastes, colors,  fruits and textures
3.  As as general rule, cut the fruit to follow how it looks like in nature; don't chop it up into little squares or pieces.  You want to be able to recognize the fruit.
4.  Put the fruit that is going to brown on the bottom.  That means bananas, peaches, nectarines, plums, apricots and pitted cherries go on the bottom.
5.  Use only ripe fruit in season locally.
6.  Always cut an orange and squeeze the juice over the top of the finished salad.  It minimizes browning and gives it a nice flavor.
7.  Make an artistic decoration on top.  Presentation is important.


My fruit salads always have the following put in in the order listed:
Banana at the bottom
Peach or nectarine cut in slices
Apricots or plums (or if you can get them, pluots or apriums) cut in slices
A variety of melons (whatever is available) that is sweet and ripe.  I like to get at least 2 that are different colors, but usually I will get 3.  You can cut these in square pieces but I like to use melon ballers and make them in 3 different sizes based on the size of the melon.
Mango and/or Hawaiian papaya (I live in California so these are almost always available)
A variety of berries
Kiwi
Oranges


FRULATTI
The first time I remember having a frulatto was when I was in Italy as a teenager.  I fell in love with them.  Although Americans know them as smoothies, for some reason, I think that the ones that I have had in Italy seem so much better.  As you can tell from the fruit salads I make, I usually have some leftover.  That enables me to make my beloved frulatti.  They are very easy.


Take equal amounts of fruit, ice and dairy.  Blend.  You can add sugar.  (1 1/2 tsp)
See Ashna's review to figure out which kind of dairy you think you might like.


BANANA FRAPPE
The original recipe is from my college roommate, Katherine Dorfman.  It's a great way to use up those really ripe bananas that you imagine that you are going to use to make banana bread, but never do.  (I've made banana bread once in my life.  I prefer to do this.)

Cut up 2 large bananas and freeze them
Blend frozen bananas with
1/2 c nonfat milk
1 t vanilla
1/8 t nutmeg
Optional:  stir in chopped walnuts after bananas are pureed.

Serve immediately.

The problem with making it with nonfat milk is that it melts really fast.  So I decided to tweak it a little to see what I could get Carla to make that would appeal to kids as a healthy alternative to ice cream.  Here are the different recipes, with Ashna's reviews to follow:

2 cut up large frozen banana pieces

1/2 cup whole milk
OR 1/2 cup whole milk with  1 tsp added sugar
OR 1/2 cup nonfat yogurt
OR 1/2 cup nonfat yogurt with 1-2 tsp added sugar
OR 1/2 cup low fat vanilla yogurt

And for those of you who have little ones, you can see the blog I wrote for EcoMom that uses baby food:  Babies and Toddler Recipes.

"B"                  "A"

                       

Fruity Summer Treats (Ashna's Review)

            Now that summer is approaching, fruity treats are becoming more desirable. I was given an interesting opportunity to evaluate different versions of multiple summer treats, including fruit salad, frulatti, and banana frappes.

            First, I was told to try two different bowls of fruit salad and give my opinion on which I liked better. Fruit Salad “A” tasted like it consisted of many fresh fruits. The fruit was firm, juicy, and sweet. Fruit Salad “B” was also quite delicious. However, it tasted a bit “mushier” than Fruit Salad A. I was later told that Fruit Salad A was just chopped up and Fruit Salad B used various fruit slicing devices, for example the melon baller. Fruit Salad B looked much more appealing, however, I liked Fruit Salad A better. I was surprised that I enjoyed Fruit Salad A more, since the same fruit was used.

            Next, I tried different recipes of a berry frulatto. (NB - Actually, I just took the fruit salad - it took on the color of berries because the purple is so overwhelming!   Dr. Vicki)  The first ones were made with nonfat milk and whole milk. I enjoyed the frulatto made with whole milk more so than the nonfat milk. The one made with nonfat milk seemed a bit more diluted than the one made with whole milk. Then, the milk was replaced by yogurt. I first tried the one with nonfat yogurt and I enjoyed it a bit more than the ones made with milk. It had a thicker consistency, however, the frulatti made with milk tasted a little sweeter. Next, I tried the frulatto with vanilla yogurt. Personally, I liked this version the best so far because it was thick, creamy, and sweet at the same time. After this one, I was given a frulatto made with nonfat yogurt and sugar. I enjoyed this frulatto the most because it was similar to the one made with vanilla yogurt but the sugar brought out the fruity flavors more so than the vanilla, which is what a frulatto is all about. This frulatto was the happy medium between the original frulatto made with milk and a berry smoothie.

            Now it was time to taste the banana frappe. The first ones, like the frulatti, were made with nonfat and whole milk. The nonfat frappe tasted a bit too thin and runny. However, the whole milk frappe tasted frothy and sweet and I noticed the flavor of the banana more so than in the nonfat frappe. Next, we tried the frappes with nonfat yogurt, then vanilla yogurt. The frappe made with nonfat yogurt lost the sweetness and had more of a tart flavor. It was also much thicker than the ones made with milk. The one made with vanilla yogurt, however, was thick and sweet, and the banana flavor came through. It tasted kind of like melted frozen yogurt.  Now I was torn between the whole milk banana frappe and the vanilla yogurt banana frappe. I eventually decided on the one made with whole milk because the consistency came across as that of a frappe more so than the one with vanilla yogurt. They were both strong contenders, but eventually my taste buds chose the whole milk banana frappe.

            Later, I was told that all three of these recipes were easy to make. I love knowing that I can just whip up a delicious frulatto every now and then without doing too much work.



Dr.  Vicki again!  So here you have it.  Even if Carla never makes these again, I know that Ashna will.  So I've converted one person into spending some time in the kitchen.  How about you?

PROBIOTICS - do they make the GRADE?

There are books on this topic.  I am going to just give you an overview
1.  Making the Grade
2.  The probiotic microorganisms
3.  Important health effects of probiotics
4.  Safety of probiotics
5.  Types of foods with probiotics

MAKING THE GRADE
For an organism to be considered a probiotic (and by extension, a probiotic food), it needs to have a positive effective on health in humans (not just rats!).  In addition, it should be safe and nontoxic.  The studies done have to be on the specific organism, not on a related species, because close "relatives" do not always have the same physiologic effect in humans.  Other values that have to be taken into consideration include the number of viable organisms ingested to have the health effects and are they still effective at the end of the expiration date.  And don't forget the age, health, gender and race of the person taking the probiotic can affect whether or not something works.

PROBIOTIC MICROORGANISMS

These organisms meet the following criteria:  they are are not toxic or pathogenic, are originally from the guts of healthy people, and can pass through the stomach without losing their effectiveness before they get to the intestines.

Lactobacilli -bacteria found in abundance in the gut of humans
Bifidobacteria - another group of bacteria found in abundance in the normal human gut.

Other probiotic organisms that are found in normal humans but in smaller amounts include some forms of enterococci, streptococci, lactococci,  and some yeast.

HEALTH EFFECTS
The intestine is extremely involved in the immune system both through how it breaks down the foreign bodies that enter into it (food included) as well as its extensive lymphoid system.  The balance of the different organisms in the intestine will change the pH, the production of substances that kill or allow the growth of different types of bacteria and weaken or strengthen the barrier of the intestinal mucosa.  This is where the probiotics are able to enhance health.
There are many scientific studies that try to measure the health benefits.  Some are done well, some are poorly done, some are difficult to do, and some are waiting to be done.  As it now stands, based on the good studies, the scientific community generally accepts that probiotics do the following:
1.  Decrease the symptoms of lactose intolerance
2.  Prevent or reduce both rota virus and antibiotic-caused diarrhea.
3.  Increase remission periods in people with inflammatory bowel disease

There are some studies that show conflicting reports, and the effects are only in certain groups:
1.  Some regulation in gut motility (improvement in some groups with irritable bowel syndrome)
2.  Improvement or resolution of allergies and atopy in infants, but not older patients

And then in some studies things work in the lab, but so far not in people
1.  Cancer prevention
2.  Decrease cholesterol and protection for heart disease

SAFETY
Probably the best way to think about this is that lactic acid bacteria and bifidobacteria have been used for millenia and have been safe.  Also, when they have actually been looked at, there is no evidence that probiotic products are riskier than are similar products that do not have probiotics added to them.  Also, studies done on patients with leukemia and HIV who were taking probiotics did not have increase infections with lactobacilli.

TYPES OF FOODS
Probiotic foods are different from probiotics in that that have to continue to maintain their efficacy throughout production and shelf life.  They also have to be something that you want to buy which means that they look and taste good for most people.

Fermented Milk Products
Yogurt is the most popular type of probiotic food.  Many yogurts on the market actually do not fit the criteria of being a probiotic.  They do not have live cultures, or do not have the organisms that qualify as probiotics.
Hard cheese is difficult to produce as a probiotic, although fresh cheese is easier.  Unfortunately, the manufacturing process of any cheese tends to kill off the bacteria.  To date all the studies testing the effects of the cheese were done in animals and there are no  marketable cheeses so far.

Other potential foods include ice cream and other sweets, but that kind of defeats the purpose in my mind.  Vegetables have not been tested.  There is some talk about spraying probiotics on salami, but no testing so far.  There have been some studies of probiotic milk powder, but no information on its stability and efficacy.  It could be used in powdered milk, formula etc. if it is successful.


BOTTOM LINE ON PROBIOTICS
Probiotics have scientifically been shown to be safe and have a positive health effect, but not as extensively as what has been claimed in the lay press.  At this point, the only way to get it in food is through yogurt.

On to PREBIOTICS in the next blog.

CHOCOLATE!

-

When we were growing up in the 50's and 60's we were taught there were four food groups.  My husband maintains to this day that all the experts were wrong and that there are actually 5 food groups -  dairy, grains, fruits and veggies, proteins and CHOCOLATE!  Some recent studies are backing him up.

As a pediatrician I routinely advise others on how to feed their children.  I also know that my advice is just that:  advice.  Some of it is followed, and some of it is not.  When it comes to raising my own child, however, I feel strongly that my opinion should not be dismissed out of hand and there needs to be some discussion if my food "rules" are not going to be followed.

For many years, the pediatric party line was not to give a baby foods that were likely to cause allergies until after their first birthday; and more recently if you had a highly allergic child you should avoid the most allergic ones until the age of two.  Chocolate was one of those foods to avoid only until one year of age.  Allergies are rampant on both sides of the family.  Because of this, I did not want chocolate given to my daughter before the age of 1.  I do not think of it as a necessary food group.  At my daughter's first birthday I found out that she had been eating chocolate since 6 months of age.  My husband thought that chocolate chips made a "perfect" finger food.  I was not happy.

 In Dec, 2010, the recommendations about allergy foods changed.  Chocolate, as well as all fruits and vegetables, are no longer listed as allergy foods  to avoid.  And there seems to be no benefit to avoiding any allergy foods past 6 months of age.  One of my basic food beliefs has been challenged.  But I've looked at the studies, and they are good.  I am used to reading the literature and learning new things but rarely do I have to change my whole way of looking at a subject.  That is what has happened with my advice on allergy foods.  It is always difficult to change what one has done for years and recommend something different.   Yet, I always try to put it in perspective by thinking about leeches and how doctors of yesteryear would be amazed if they so how I practiced medicine.  So I now have to eat crow and state that there was no harm done that my daughter got chocolate from an early age.  I still, however, do not believe that chocolate is a basic food group and that babies should use it as a finger food!

There are some interesting studies about chocolate as a health food.  First thing to remember is that chocolate is made from the seeds of the fruit of the cacao tree.  Gram for gram, the antioxidant content of cacao bean powder is higher than acai, blueberry or cranberry powder.  Thus, it can be classified as a "super fruit".  It looks like a daily consumption of a small amount (1 oz) of dark chocolate decreases the risk of inflammation which is associated with many diseases, including heart disease.  It also decreases high blood pressure as well as helps insulin resistance in pre-diabetics.   It improves mood (no great surprise there), but also helps mental processing during sustained intellectual effort.  I particularly like that last finding.  To make standardized testing something that my daughter would look forward to (!), we would always give her dark (her preference) chocolate bars to have during the breaks between tests.  We felt that they gave her a "boost" of energy and helped her concentrate.  I loved finding a study that supported our unscientific beliefs.

There can be too much of a good thing.  And this can happen with chocolate.  As Easter approaches, a holiday that places an undue commercial emphasis on chocolate, it is everything else that is added to the dark chocolate that takes away its label as a health food and gets it into the unhealthy column.  There are many things that you can do with chocolate to keep it in the good column.  Eat small amounts.  Make sure it is dark.  Drink it as cocoa without the excess sugar.  And here is a recipe:

                                CHOCOLATE-COVERED
                                     STRAWBERRIES

Ingredients:  strawberries, molding chocolate.
Melt chocolate over double boiler.  Dip strawberries.  Let dry on parchment paper (or waxed paper).  Eat.

One of the most elegant and easy desserts to make.  I use 70% dark chocolate.   If you are going to any functions you can bring these and actually feel virtuous!

Experimental Eating

As I started to become more serious about cooking, I wondered why humans tried some of the ingredients that they did.  Was it hunger?  Was it fortuitous?  I mean really, who in their right mind would follow a pig who is grubbing through the dirt for truffles and take something that smells that musky and pungent from that pig and put it in his mouth?  Well, now that I have been both a pediatrician and a mother I no longer wonder - we eat what we do because of toddlers.
What got me thinking about this, again, is the recent posting of a friend of mine on Facebook.  His child decided to eat not one, but SIX laxative strips.
Over the years, I'm not sure if I have had more phone calls from parents because their children have eaten something inappropriate or because they refuse to eat at all.  I have never been able to figure out why this is so. But I know that in the picture above the last thing thing most toddlers would eat is the broccoli.  (I think the first thing would be a toss-up between the pills and the rocks in the dirt, but that is not an experiment I will try.)
Can parents take advantage of their children's natural curiosity to put odd things in their mouths to get them to try different foods?  I'm not sure.  I have noticed that they do tend to try things that are bland,  like dirt and paper, and usually spit out "spicy" leaves that they find in the garden.  For some reason they prefer their non-food items to be muted in color.  (I base these observations on the calls I get from parents about what their children have eaten.)
One of the things I used to do with my daughter and her friend Mollie is to let them experiment in the kitchen, with close supervision.  They would invent their own concoctions of edible items taken from all drawers and shelves.  Of course, because my daughter was raised with the  understanding that she always had to take "one bite", she insisted that I try everything she made: "Just take one bite, Mama!" she ordered.  Lucky for all of us, this is before the two of them could write, so none of their recipes were kept for posterity.  (I will say her cooking skills today are great and Mollie is no slouch in the kitchen either.)
Can you take advantage of children's love of non-food products?  Again, I'm not sure.  But I do know that I am not a believer in the recent fad of "hiding" foods found in a number of cookbooks on how to get kids to eat.  My reasoning is:  1)  I don't have time to cook a separate dish for each family member  2)  It is important to learn about different tastes and textures  3)  Most importantly, my job as a parent is to teach my child how to eat properly and hiding food is a cop-out.
Which is not to say that I do not take into consideration different likes and palates.  My daughter hates asparagus.  I love them. I did make my daughter take "one bite" multiple times when she was young because I cook them frequently.  But I was finally convinced that she really does not like them and because she eats so many other vegetables when I make them for me I am willing to make something else for her.  And then we are both happy.

Here is a recipe that I've found that most ages, including toddlers eat.  It is easy to make.  It is not spicy, not identifiable as a specific food to a toddler and is versatile.  You can eat it hot or cold.  You can send it in a lunch.  You can bring it to a potluck.  And you can change some of the herbs depending on your family's preference.  Your toddler may even choose it over rocks and other non-foods!.

ZUCCHINI PIE

Ingredients
4 c. grated zucchini
4 large eggs, slightly beaten (or 7 egg whites or 5 oz of egg whites)
1 c. Bisquick
1/2 c. grated parmesan cheese
1 small onion chopped
1/2 c. oil (preferably olive)
1/4 cup fresh herbs (parsley or cilantro) or 2 tbsp fresh basil or rosemary (stronger flavors)

Mix together in a bowl.
Grease a 9x9 inch pan.  Put in pan.  Cook in 375 degree oven until brown (about 50 min.)

Serve hot, warm, cool or the next day!  I hope you try it and your family and friends enjoy it as much as the many people I've given this to, both already made, and as a recipe.

Should Mothers Be Blamed for Everything?

The latest news is working mothers make their children fat (have increased BMI's). When I heard that I immediately felt guilty even though my daughter is grown and has a normal BMI, but I am a (working) mother and prone to feeling guilty whether it's warranted or not.We parents need to stop feeling guilty and look at facts of studies. If you are not a mother, you shouldn't feel guilty. If you are a mother and your children are not overweight, you shouldn't feel guilty. If you are a mother and do not have paid employment (anyone who thinks being a parent is not working is nuts), you do not have to feel guilty. And if you are a working mother whose children's BMI is too much, you also do not have to feel guilty. Because that study did not prove what many reports say. If you want "just the facts, ma'am" and are not into nitty-gritty, just skip to the end and read my conclusions. But I would suggest that you don't do that. Because that is what many people did with the study and accepted the author's conclusion that working mothers cause their kids' obesity. You can instead follow my reasoning and then make up your own mind (or you can also read the study.)
I teach first year medical students. And one of the things that we spend time on is how to analyze studies and whether or not the conclusions drawn are supported from the study. Which means the "devil is in the details". If you investigate the reports about this study, or listen to the interviews of the author, or the "experts" reporting on this study, the details that I am about to reveal have not been discussed. (At least I couldn't find them; I must admit I did not do an exhaustive literature search of other people's opinions.) And this is the meat of the matter.

This paper accepts the conclusions of existing research that shows associations of maternal employment with increases in children's BMI. Next, the authors look at data that was gathered for other reasons to support their hypothesis. But buried in their paper they state that children whose mothers changed their working conditions and schedules had higher BMIs than mothers who worked the entire time. They also found that if they looked at individual children they found these children had increased BMI, but not if they looked at groups of children of working women. The last important point is that they noticed the largest increased BMI if the mother started working when the child was in 6^th grade. (They looked at the Home environment in 3^rd and 5^th grade, but not in 6^th.)

Here are the problems that I find with this research:

1. This was a retrospective study. (They formed a hypothesis and found data that supported what they thought .)

2. Associations are not proofs. (There could be other things going on that caused the increase BMI that were the real etiologies.)

3. There were a lot of suggestions of why children of working mothers had higher BMIs, and many theories given; but no proofs.

4. They stated that studies "have linked maternal employment to children's weight, but the mechanisms that may mediate these associations remain largely unknown." (pg 69).

5. "(A)mong sixth graders, a mother's entry into employment was associated with an increase in BMI …and those children were about 6 times more likely to be overweight" and yet they did not have available a HOME score done in 6^th grade (which measured the Home environment which assessed the "quality and quantity of support and stimulation provided to the child In his or her home environment". )

6. They did not record the children's Tanner Stage, which is a measure of a child's stage of going through puberty. (Pediatricians know that prior to a growth spurt children put on an extra layer of fat which temporarily increases the BMI. This is what you would expect around 6^th grade. Girls go through puberty earlier before boys, and there are racial differences, so that could explain what is happening in sixth grade as the groups were not controlled.)

7. The people doing the study are not pediatricians. Although they all have PhDs, they are researchers and you get a different perspective when you are a clinician.

They did conclude 2 specific things:

1. It appears that the significant factor of BMI is the change in the maternal status of employment for the individual child and not whether or not the mother is employed. 2. A mother's entry into the work force at 6^th grade seems to be most significant.
Here is what I take away from the study. There is definitely SOMETHING going on. I have always said that children are windows on a family. And another way to think about this study is that there is change going on in these individual families. When a parent changes her/his role in the family, it always effects the whole family (think about all the unemployment today and I wonder what a study that looked at the BMI of the children in these families would show us?)
And I think one of the most telling facts about the study is the large effect on the child if the mother enters the workforce in 6^th grade. There is so much missing information from this study that I would assign this paper to my students to discuss what this paper does not tell us and have them discuss why they cannot draw the conclusions that they did.

What I can tell you from a pediatrician's perspective is 6^th grade is an extremely stressful time for all children. They have major physical and hormonal changes, and if you add family changes to their social changes, I am not surprised to see that the biggest BMI change is at this time. My theory (which I think has as much validity as theirs, but is still a theory) is perhaps the mechanism is one of stress eating. Many of us do it. So instead of all of us feeling guilty and start our own stress eating, I would make some recommendations for stress reductions:
1. Do something fun with your child that is physical. (That will be the subject of some columns to come.)

2. . If you are going to stress eating, make sure it is the kind that will not add to your BMI.

So here are some suggestions in the food snacking area:

1. Air-popped popcorn (if you need to put something on it you can get butter-flavored salt or honey mustard powder shake)

2. Sugary cereals. When I was a kid we were not allowed to eat this for breakfast, but for a treat my mother would make a tin-foil cup and fill it with a breakfast cereal (On average, I cup of this stuff has less than 1 tsp of sugar in it!)

3. Baby carrots

4. Berries