All the above mentioned results led to the following nutrition guidelines:
• select healthy foods (i.e. foods with high CHO content and low fat and
protein contents as well as foods with low glycemic index), • frequent number of meals a day,
• normal-sized portions and
• flexible control.
These guidelines should replace strictly controlled diets.
The development of a healthy lifestyle has to include changes in both what
is eaten and how it is eaten. In younger children most of the recommendations
will be targeted at parents. As children age, more teamwork is needed between
parents and children. For adolescents, the advice is targeted directly to the
adolescent [45].
Foods Choices
Principles of foods choice [46]:
• plenty of low-energy beverages as well as vegetables,
• moderate animal foods (low-fat variants),
• use high fat and sugary foods (i.e. foods with high glycemic index) sparingly.
Because of the importance of nutrition in the prevention and treatment of
overweight and obesity as well as growth and development, recommendations
for healthy food intake have been set and are outlined in the Food Guide Pyramid
[47]. The pyramid provides recommended intakes for five food groups as shown
in figure 1. These guidelines of food choice apply for normal-weight as well as
overweight children and adolescents. The aim is to achieve energy and nutrient
intakes appropriate for age, height and lifestyle. The goal for obesity treatment
in children should be to established long-term weight control. The achievement
of the median BMI for age and sex is usually an unrealistic goal for treatment.
In contrast to adults, children have the advantage that they are still growing in
height. As a result, maintenance of weight or modest weight loss, while children
continue to grow in height, reduces their degree of overweight [45].
The protein, fat and carbohydrate intake should be 15, 30–35 and 50–55% of
daily energy intake. Only 10% of energy intake should come from biscuits, chocolate
bars, crisps and other energy dense snacks as well as high-energy lemonades.
The recommendations for food groups are made in terms of servings per
day. The objectives for food intake are to increase complex carbohydrate- and
fiber-containing foods in the diets to five or more daily servings for vegetables
(including legumes) and fruits, and six or more daily servings for grain products.
In addition, the content of fat in the diet has to be reduced. Beverages
should be low in energy and glycemic index.
In summary, children and adolescents should emphasize foods from grain,
fruit and vegetable groups, along with moderate amounts of low-fat foods from
the milk and meat group. Choose a variety of grains daily, especially whole grains
and choose a variety of fruits and vegetables daily. Choose foods and beverages
with a low glycemic index.
Mealtime Frequency
The recommendations include frequently intakes of the healthy foods. Three
to five mealtimes a day were recommended, i.e. breakfast, lunch and dinner and
an additional two snack times to avoid hunger only, one in the morning and one
in the afternoon. Frequent snacking between mealtimes should be avoided.
Methods to Realize Guidelines in Daily Practice
A panel of pediatric obesity treatment specialists suggest a number of
components of successful lifestyle changes in eating patterns which may help
realize the guidelines of Foods Pyramid as well fat reduction and in following
energy intake reduction [26, 45, 47–59]:
Environmental factors:
• Plan eating to avoid hunger not as a time-filling event.
• Eat only at mealtimes and recognized snack periods.
Eat, if possible, as a family so there is social intercourse and time is spent
during the meal waiting for others to be served. This may contribute to
satisfaction from a meal and psychological satiety.
• Eat a meal in a normal-sizes portion. It may be helpful for parents and children
to visualize a ‘healthy plate’ of which half is filled with salad and
vegetables, one fourth with starch and one fourth with a protein source
(meat, fish, etc.).
• Discourage eating in front of the television or snacking when playing/
working with the video or computer.
Foods choice:
• Select whole foods or raw unprocessed foods whenever possible and prepare
meals at home.
• Raw ingredients, rather than ready-prepared bought foods, make it easier
to see what is being consumed. Many prepared foods are cheaper than their
raw ingredients due to supplementation of starches and fat.
• It is more time consuming to eat whole foods, for example apples compared
with apple juice. This helps satiety. Wholemeal bread is of similar
energy content to white bread, but may have greater satiety effect.
• Drink water or blend water with juice rather than only fruit juice or carbonated
drinks. Recognize that whole fruit juice contains a lot of energy in
one glass. Drinks with sweeteners even though lower in energy than those
with sugar may encourage a sweet tooth and should be avoided.
• Use semi-skimmed milk and low-fat yoghurts and cheese.
• Use margarines and spreads sparingly.
• Avoid sugared or chocolate-coated cereals.
• Avoid biscuits, chocolate bars, crisps and other energy-dense snacks at
break times. Preferably eat fruits or vegetables as snacks.
Preparation:
• Grill, boil or steam foods rather than fry them.
• Avoid adding butter or other fats and oil to cooking.
• Avoid thickening gravies.
Behavioral factors:
• Understand and practice a flexible control of eating behavior instead of a
high rigid and cognitive control.
• Find strategies to cope with stress and/or with boredom.
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