Tag: guest contributor

Throwback Tuesday: Raising a Child to Love Their Body

Posted on May 17, 2016May 17, 2016 by Laura Cipullo

Throwback Tuesday: Raising a Child to Love Their Body

Image via Rafal Klermacz/Flickr

by Laura Cipullo, RD, CDE, CEDRD and Laura Cipullo Whole Nutrition Services Team

Our feelings about our body may be formed at an early age, and sometimes quite negatively. The National Eating Disorders Association found that 40 to 60 percent of kids 6 through 12 are already worried about how much they weigh, and 70 percent would like to weigh less. Attitudes that kids have at a young age can stay with them through the teen years and into adulthood, potentially setting them up for poor body image and perhaps even contributing to eating disorders.

What can moms do? My Healthy Habits book addresses this with a section on what to say and what not to say to encourage healthy body attitudes, but I also wanted to highlight a Mom Dishes it Out post written by Jennifer McGurk, RDN, CDN, CDE, CEDRD. She offers 9 tips to getting your child to appreciate her body. Check out the post here or below.

Raising a Child to Love Their Body

By Jennifer McGurk, RDN, CDN, CDE, CEDRD

I was recently out with a group of “mom friends,” having one of those conversations talking about anything and everything related to our kids, all under 1 year old. Our conversation turned into an honest discussion about raising our children to be anti-dieting, body image-loving, positive self-esteemed individuals. My friends were worried about being a good example to their daughters, teaching self-esteem, and hoping that their girls will learn to love their bodies. These moms were especially worried about raising girls, but this is a topic for every mom- mothers of sons included! I claim to be an expert in this area, but it’s honestly something I’m concerned about too. I had just talked about losing the last few pounds of my post-pregnancy weight 10 minutes before this part of the conversation came up. My point is that my advice for moms and dads is something I am going to be working on as well. I think moms can all learn from one another and support each other to raise confident children.

Here are my favorite tips:

Eliminate fat talk: Take a good look at yourself and your environment. Do you criticize yourself in the mirror? Do you complain about being “fat”? Your kids will learn from you. Eliminate this kind of dialogue in your life to other people and especially to yourself.
Feel good about your body: Replace the fat talk with positive talk. Do something each day to make you feel good about your body. One of my favorite tricks is something I heard from a therapist: Take a tube of red lipstick and write on your mirror “I am beautiful because…” and everytime you look in your mirror, you have to answer the question.
Model healthy behaviors with food: Show your child a healthy relationship with food by eating balanced meals and snacks. Don’t restrict and binge. Have a wide variety of food in your diet, including food from all food groups, including nutritious and less nutritious foods. Have desserts and fruits and vegetables in your life, and teach your child how to enjoy these foods in a healthy way.
Make time to move with your family: Exercise as a way to feel good, not just burn calories. Pick an activity you love and make time for it. Treat this as part of your self-care routine.
Introduce the concepts of “hungry” and “full” as early as possible: Children are born with the skill to stop eating when they are full but gradually lose this with environmental influence. In order to prevent the dieting “restriction” mindset, it’s important to teach children it’s natural to eat when they are hungry. Therefore, it will be natural to stop eating when full and satisfied.
Do not label food (or yourself) as “good” and “bad”: Every food is included in a healthy lifestyle, no matter what. Restriction of “bad foods” can lead to bingeing. Don’t say “oh I had a good/bad day” because nutrition is not all-or-nothing!
Never force your child to clean his/her plate: This will alter kid’s perception of how much they should eat. If they don’t eat at this particular meal, there is always the next meal or snack to make up for missed food.
Talk about how bodies come in all different shapes and sizes: Respect other body types and talk about how people look different because everyone is unique and special.
Spread the word: I love movements like “Operation Beautiful”, which spread the message of positive self-esteem and self-worth. Teach children to participate and have fun doing so!

Self-Care Sunday: Standards of Medical Care in Diabetes – 2016 Updates

Posted on February 7, 2016 by Laura Cipullo

Self-Care Sunday: Standards of Medical Care in Diabetes – 2016 Updates

Image via Rotorhead/FreeImages.com

by Holly LoRusso, MS, RD, CDE, CDN

Each year, the American Diabetes Association (ADA) provides an updated version to their standards of care for health care practitioners.

One of the biggest changes is that the ADA is moving away from the term “diabetic” when describing people with diabetes. Instead, they are recommending that everyone refer to these patients as “individuals with diabetes.” As someone with Type 1 diabetes, it has always been a pet peeve of mine when someone defines themselves or a loved one with the term “diabetic.” There is much more to a person than the disease/condition that they live with! Similarly to someone struggling with an eating disorder, one would prefer not to be called a “bulimic” or “anorexic,” but rather someone with the condition. Diabetes does not define the person and it is relieving to see that the ADA recognizes this.

The original Standards of Care are over 100 pages, but the ADA has put out a summary of revisions that I have outlined below to discuss the specific section changes:

Section 1. Strategies for Improving Care: This section now includes recommendations on tailoring treatment to vulnerable populations — such as those with food insecurities, mental illness, HIV, etc.

Section 2. Classification and Diagnosis of Diabetes: The ADA has revised their screening recommendations to test all adults beginning at age 45 years, regardless of weight/history. Testing is now recommended also for all adults who are considered overweight/obese and who may have one or more additional risk factors of diabetes.

Section 3. Foundations of Care and Comprehensive Medical Evaluation: Two sections from the prior 2015 Standards were combined to create this section, which now encompasses medical evaluation, patient engagement, and ongoing care that highlight the importance of lifestyle changes (nutrition, vaccine recommendations, etc.).

Section 4. Prevention or Delay of Type 2 Diabetes: A recommendation was added to encourage the use of new technology, such as phone apps, text messaging, etc., to help prevent diabetes.

Section 5. Glycemic Targets: Since there is a growing number of older adults with insulin-dependent diabetes (yes!) , the ADA recommended that people who use continuous glucose monitors (CGMs) and insulin pumps have access after age 65. Great news!

Section 6. Obesity Management for Treatment of Type 2 Diabetes: This is a new section this year, highlighting prior recommendations that bariatric surgery could be helpful for DM treatment and also includes a list of currently approved medications used for weight management.

Section 7. Approaches to Glycemic Treatment: This year, bariatric surgery was removed from this section and moved to Section 6. While it may not be the ideal treatment for everyone, some patients have seen a dramatic reduction in their blood sugar.

Section 8. Cardiovascular Disease and Risk Management: Atherosclerotic cardiovascular disease (ASCVD) has replaced CVD (cardiovascular disease) for a more specific term. Additionally, new recommendations for pharmacological treatment was added, including aspirin therapy for women aged >50 years, along with new evidence supporting ezetimibe plus statin provides additional benefits for people with diabetes.

Section 9. Microvascular Complications and Foot Care: Nephropathy has been removed and “diabetic kidney disease” has replaced the term. Guidance was also added on when to refer for renal replacement treatment (dialysis) and also when to refer to a physician specializing in this practice.

Section 10. Older Adults: A more detailed version of the last year’s version that encompasses nuances of diabetes care in the older adult population.

Section 11. Children and Adolescents: this section is also more comprehensive now, which includes a new recommendation that addresses self-management education, psychosocial issues, and treatment guidelines for Type 2 DM in youth. Also, the recommendation to obtain a fasting lipid profile in children starting at 2 years old has been changed to 10 years old due to recent research articles findings.

Section 12. Management of Diabetes in Pregnancy: New recommendations on pregestational diabetes, gestational diabetes and general principles for DM management in pregnancy. A section was added to highlight the importance of family planning/contraception with women with diabetes. Also, the A1c target for pregnant women with diabetes was changed to 6.0-6.5% (it used to be <6.0%). Glyburide was de-emphasized given the beneficial effects of insulin and metformin.

Section 13. Diabetes Care in the Hospital: This section now addresses hospital care delivery standards, glycemic targets and antihyperglycemic agents, along with transitions from the acute care setting. There is also a new table that outlines basal and bolus dosing recommendations for enteral/parenteral feedings.

Section 14. Diabetes Advocacy: Position statement on care in the school setting was revised and does not include the daycare setting anymore.

Overall, I believe the changes that were made are improvements that will help all practitioners better treat their patients with diabetes. The complete standards of care are here.

Remember, if you or someone you know needs some education on diabetes and eating properly, call Laura, Holly or Lisa for an appointment!

Remembering Joy: Handling Nutrition through the Holidays and Beyond

Posted on December 1, 2015December 1, 2015 by Laura Cipullo

Remembering Joy: Handling Nutrition through the Holidays and Beyond

Image via Rob’s Guig at freeimages.com

Guest Post by Christie Caggiani, RDN, LDN, CEDRD
Dietitian / Nutrition Therapist
Therapeutic Oasis of the Palm Beaches
caggianirdn@delrayoasis.com
http://www.DelrayOasis.com

Ready or not, it’s here. The holiday season has arrived. No matter how much we said we’d be prepared for it this year, it has still plopped right in our calendar with what seemed like little warning. And we thought back-to-school was a busy time? Rehearsals, play-offs, concerts, school projects and mid-term exams quickly consume days and evenings, leaving precious little time for holiday shopping, card sending, home decorating and, oh, right – regular meals?!?! How in the world can we slow down long enough to consider our family’s need for nutrition?

Yet it may be helpful to think of this another way: We are so incredibly busy, how can we NOT stop to think about our family’s need for fuel? A little bit of forethought prevents many future headaches, both literally and figuratively:

Use those brief seconds of downtime to plan a few moments ahead. While you’re waiting for the concert to begin or are at a standstill in the car line, jot down a few simple meals, then add the ingredients to the grocery list in your phone.

Keep ready-to-assemble meal components in the house at all times: steamer veggies & rice and fast-cooking chicken cutlets can make it to the table in less than 15 minutes.

Take care of you: no skimping, skipping, restricting or dieting. Eat regular and timely meals and snacks on “normal” days as well as on “event” days. Saving up for a holiday meal or party diminishes the enjoyment you will have when you finally eat, and makes it extremely difficult to understand when you’re satisfied. Plus, you’ll be crabby and no fun to be around!

Model connected eating by asking yourself regularly if you’re physically hungry. When the answer is yes, eat. Don’t ignore it, wrap 10 more gifts or bake more cookies. Simply respond to your hunger. The same goes for listening to your kids when they tell you they’re hungry – honor their need for fuel on a regular, consistent basis.

Holiday meals are often filled with flavor and are therefore an amazing opportunity for us to explore and notice satisfaction: let your kids smell the savory stuffing, taste an old family recipe, or try to discover which food has bacon in it!

Do something to connect with your kids every day, and just as importantly, do something just for yourself daily. This will help you remember what’s truly important this season – and always.

When holiday goodies make it to your kitchen, remember not to label food as good or bad. Let your kids have dessert with the meal sometimes, don’t overvalue it, and absolutely keep it around as long as it lasts. And hey, who says you can’t make Christmas cookies in July anyway?

Holidays truly can be a joyful time, if you slow down just long enough to honor your hunger, present food to your family on a regular and timely basis, and enjoy some Christmas cookies and hot chocolate along the way! Cheers!

Holiday Eating is more of an Attitude and an Attunement than it is a rule or a plan.

Fearless Feeding Workshop

Posted on November 13, 2015November 13, 2015 by Laura Cipullo

By Guest Contributor, Jennifer McGurk, RDN, CDN, CDE, CEDRD

The Westchester Rockland Dietetic Association welcomed Jill Castle to our fall meeting to talk about feeding in children. As a dietitian and mom of picky eater, I was equally excited for this workshop professionally and personally. Jill and Maryann Jacobson wrote the book “Fearless Feeding” and the book has helped me figure out how to feed my baby throughout his life so far.

Despite my best effort to do the right things, I’ve made many mistakes feeding my toddler. After all, I’m human! My reality of being a busy working mom sometimes conflicts with the patience and time needed to feed a toddler. But as I learned in her workshop, it takes a lifetime to raise a healthy eater and I am learning as I go.

I learned many lessons for both my professional and personal life. My take-away points from the workshop include:

As parents, we really don’t know what we’re doing! But we have the ability to change. 95% of parents believe healthy eating is important. But 80% of parents believe they have no control over picky eating and 75% give in. 30% of moms give themselves a “C” when it comes to knowing the right mix of nutrition for their baby. We have to switch gears and get out of the “short-term” way of thinking about kids and nutrition (aka getting kids to eat healthy food NOW and parents feeling frustrated in the moment). Rather, we have to think “long-term” and set the foundation for raising healthy eaters.
Food and nutrition (“what” kids eat) is not the only important feeding strategy. The “how” and the “why” are just as important. The “how” is how to teach parents to feed in an authoritative feeding style and keeping it positive. The “why” is because children are in various stages of developmental stages and have different temperaments. The best way to feed a child is with structured meals and snacks with boundaries and limits. But parents should give children choices at meals and never force kids to eat.
Ellyn Satter’s “Division of Responsibility” is the top method of feeding. The parent determines the location of feeding, what to give at the meal or snack and the timing of the food. Parents should serve balanced meals with all food groups, and also 1-2 foods they know their child will eat (even if this is bread and milk, that works fine!) The child determines whether or not they are eating in the first place and then also how much they will eat. When these “jobs” are crossed, problems arise with feeding and eating.
Teach children hunger and fullness. Adults take note! Children are born with the natural ability to self-regulate food intake, especially if meals and snacks are served in a structured environment. As children get older, environmental factors sometimes ruin this ability. Adults should never tell children to “finish their plate”, or “if you don’t eat everything now you get no dessert later”. Rather, we need to put words to our children’s feelings around hunger and fullness to develop an internal sense (“Is your tummy full?” or “Does your tummy feel hungry?”. These natural instincts can get de-regulated if we don’t.
Children have different eating styles and we need to work with them, not against them. The “Eager Eater” is adventurous and will at least “try” most foods and will eat a good variety. These are the kids you always hear about! Don’t worry if this isn’t your child, it’s certainly the opposite of my child too! This is only 10% of children. The “Cautious Eater” is slow to accumulate foods, they may have sensory issues or be “super tasters”. They are resistant and have a limited diet and variety of foods. Most kids are “in between”, in which they accumulate food over time with exposure. It “takes a childhood” to amass a varied diet.

I would highly recommend Jill Castle’s Fearless Feeding workshop for any dietitian or mom! Contact Jill here: http://jillcastle.com/