Healthy Advice

Dr. David Katz answers questions from NEA Today readers

In conjunction with the March cover story on child obesity, we invited NEA Today readers to submit questions to Dr. David Katz, M.D., director of the Yale Prevention Research Center at the Yale School of Medicine. Here's Dr. Katz's advice on making eating healthier for you, your family and your students.  

Q: I'm a school counselor. Where can I find the latest psycho/nutritional therapy for binge eaters? I have a student who is obese. He eats well in school, has maintained his weight for approximately three weeks, then gained seven lbs. within the next three weeks. I have been working with him since November and feel unsuccessful. I know I need more help. Also, is there any free summer camp or study I can get him involved in?

Dr. Katz: A good source for health information in general is www.healthfinder.gov. This is a search engine that only identifies health-related Web sites reviewed and approved by the U.S. Department of Health and Human Services. For this particular issue, the Web site of the National Institute of Mental Health at the NIH (www.nih.gov) will also be helpful.

Relevant studies, and camps, would be those accessible to you. The NIH Web site will provide information about studies around the country. For information closer to home, I suggest making use of local resources. This is something an area psychiatric social worker can readily find out for you. Contact the psychiatry department of a local hospital or medical center, and ask if there is a social worker you can speak with.

This problem will be challenging no matter what, but there is help out there.

Q: What do you think of the food pyramid, and what should be done to reform it?

Dr. Katz: I think it's more good than bad, and represents a better dietary pattern than the one most people in this country follow! Its limitations, excesses, and deficiencies relate to politics, as described in the book Food Politics, by Professor Marion Nestle of NYU.

People are used to the pyramid, but I think we can do better. People don't eat off of pyramids; they eat off of plates and bowls. I think a plate that actually shows the kinds of foods, and represents relative portion size recommended for a typical day, would work well. But improving the pyramid would also be fine. The 2005 dietary guidelines begin to show the way: provide clear advice about specific foods rather than broad food categories; distinguish "bad" from "good" fat, and carbohydrate sources; and ideally, provide information about foods people should avoid, as well as foods they should choose.

Q: What advice can you give to someone who knows how to eat in a nutritionally sound manner, but succumbs to overeating when food is present and particularly when he is under stress?

Dr. Katz: Two tips. First, find another way to deal with stress so you are not so dependent on food. You can't just take the food away; you need to replace it with something that works as well. Only you can tell what that will be. Perhaps massage, meditation or yoga; maybe a good workout. Maybe music. Maybe even therapy. But address your stress, don't ignore it, or it will continue to get the best of you.

The other issue has to do with skillfulness in dealing with the food that is always available. There are many strategies that pertain, the simplest of which is to fill a snack pack with nutritious items each day, and take it with you everywhere. That way, you are in charge of the food you choose when hungry -- or stressed -– rather than somebody who stocks a vending machine. For more details on how to deal with the food that's "out there" all the time, permit me to recommend as a resource my book, The Way to Eat.

Q: What is your take on low-fat and low-carb diets? Is this a sound way of eating?

Dr. Katz: No, although low-fat diets have much more to support them than low-carb. But rather than give a long and detailed answer, I'll give a short and general one. Eating well -– for lasting health and weight control -- never has been, is not, and never will be about choosing which of only three nutrient categories to abandon.

Rather, eating well in a balanced, pleasurable, and sustainable manner has always been, is, and always will be about choosing wholesome foods within each of those categories. Lentils and lollipops are both carbs; they are not the same. French fries and olives are both high in fat; but they are not the same. The emphasis for healthful eating should be on choosing healthful foods, not tossing out the baby with the bathwater, because they happen to be in the same tub of nutrients.

Q: I have to eat lunch when my students do -- at 10:30 in the morning! By the end of the day, I'm starving and out of steam -- and tempted to reach for chocolate or chips. What can I do to keep my energy up throughout the day?

Dr. Katz: This is easy; use the strategy I use. Fill an insulated snack pack each day with non-fat yogurt, fresh fruit, fresh veggies such as baby carrots, whole-grain cereal in a ziplock bag; whole-grain bread; nuts and seeds; perhaps a hard-boiled egg. Things that are quick to prepare and toss in. Then at any time during the day when you can get a 30-second break, eat something if hungry. This will not only control your hunger, but lower blood insulin levels and facilitate weight control.

Q: Are there any reasons why students should take nutritional supplements? Can they take them at any age? Are there any precautions to know about?

Dr. Katz: I think it's a good idea. There are enough vitamins tailored for children that finding one that's age-matched should not be difficult. I think they are a nice insurance policy to protect against sub-optimal eating. Overdosing is dangerous, however, so avoid high doses of any single nutrient, and stick with a multi suitable for the child's age group; after puberty, adult doses are fine.

The critical issue is this: supplement, not substitute. The benefits of healthful eating simply cannot be put into any pill.

Q: You can put veggies on a school lunch plate, but you can't make kids eat them. How can we as educators and parents counter marketing campaigns that promote sugary cereals, candy bars, sodas, etc. that have become such "staples" of the American diet?

Dr. Katz: First, fight those marketing trends! The Institute of Medicine has a committee examining food marketing to children right now; I was among those who testified before them. If every parent and teacher opposes the aggressive peddling of junk food to our kids, guess what? It will stop!

But you can fight it at home, too. Talk to your kids about the fact that ads are about selling something, not about what's good for them. Tell them you are looking out for them, because you love them. Teach them about food marketing deception. Need help? Go to www.thewaytoeat.net, scroll down to the bottom left, and click on the link for "nutrition detectives." That's a program I developed, along with my wife, to teach kids age 8 and up how to recognize, and resist, food labeling deceptions. I have delivered it in schools and at conferences around the country.

Finally, be a role model; walk the walk. Take your children by the hand, and have them walk it with you!

Q: What role do herbs and spices play in keeping us healthy? For instance, I've heard that chili peppers help clear your arteries and veins.

Dr. Katz: Most herbs and spices are very nutrient-rich, but are eaten in quantities too small to make a major impact on health. Exceptions are salt –- which can damage health in quantities we routinely ingest -- and garlic, which has healthful properties in fairly standard doses. By all means make liberal use of herbs and spices -– but for major effects on your health, it's what you're putting them on that counts!