New food pyramid geared to children

In its continuing effort to combat the nation's obesity epidemic, the U.S. Dept. of Agriculture is setting its sights on kids.

On Sept. 28, the agency released a version of the food pyramid -- My Pyramid for Kids -- specifically tailored to children between the ages of 6 and 11. Complete with posters, a coloring page, tips for families and even an interactive video game -- all available on the Internet -- the overall message is in sync with the updated adult food pyramid and the 2005 Dietary Guidelines released earlier this year.

Physicians and other public health advocates generally considered the approach to be a positive step, but they also see room for more.

It provides "useful information, recommendations and tools," said AMA Trustee Ron Davis, MD. But its success will depend heavily on the motivation of parents and teachers. "I have a hard time imagining kids on their own accord spending much time on this instructional material," he said.

According to the Centers for Disease Control and Prevention, the prevalence of overweight among children ages 6 to 11 more than doubled in the past 20 years, going from 7% in 1980 to 16% in 2002. For adolescents ages 12 to 19 it more than tripled, increasing from 5% to 16%.

And approximately 9 million children older than 6 are considered obese, based on a 2004 Institute of Medicine report.

These figures continue to translate into significant public health concerns. An estimated 61% of overweight young people have at least one additional risk factor for heart disease. And these children are at greater risk for bone and joint problems, sleep apnea and poor self-esteem.

Additionally, overweight kids are more likely than those of normal weight to become overweight or obese adults. They are also more at risk for associated adult health problems, ranging from stroke and several types of cancer to osteoarthritis and type 2 diabetes. The latter is rapidly becoming a disease of children and adolescents.

The IOM document points out that in case reports from the 1990s, type 2 diabetes accounted for 8% to 45% of all new pediatric cases of diabetes. This figure contrasts with fewer than 4% before that decade.

Blocks of the pyramid

The kids' food pyramid focuses on the importance of eating more fruits, vegetables, whole grains, low-fat dairy products and lean protein. It urges limiting intake of processed and high-calorie food and drinks as well as unhealthful fat and added sugar in such products as soft drinks and fried fast food. The materials provide guidance on the appropriate proportion of food from each food group.

Daily exercise is also prominent. Children are encouraged to be physically active for at least 60 minutes a day -- twice the minimum recommended for adults at a healthy weight.

"This is a fun approach to addressing the very serious problem of childhood obesity," said Agriculture Secretary Mike Johanns, in a statement.

But the Center for Science in the Public Interest, a Washington, D.C.-based nutrition and health advocacy group that publishes the Nutrition Action Healthletter, considers it as missing the mark.

"My Pyramid for Kids doesn't dare to discourage children from consuming so much soda, fast food, candy and other junk food," said CSPI Executive Director Michael F. Jacobson. Instead, CSPI calls for more aggressive promotion of increased consumption of fruits, vegetables and whole grains; removal of soda and junk foods from schools; preventing junk food advertising during children's television; and requiring the inclusion of calorie counts on fast-food menu boards.

Dr. Davis also said strong policies regarding nutrition are critical. For example, the AMA encourages physician and community collaboration on the issue of childhood overweight and obesity, including working with a broad partnership to develop and implement a school health advocacy agenda. This agenda would include advocating for policies that promote healthier options in vending machines and healthier standards for a la carte cafeteria food.

"I worry that kids given a choice will make a bad choice," Dr. Davis said. "We need to push hard for getting unhealthy choices out of schools and making physical education and physical activity an important part of the school day -- kindergarten through grade 12."

Meanwhile, My Pyramid for Kids also has been criticized because of its heavy reliance on the Internet -- which means that it will not reach children whose families either do not have computers or cannot afford Internet access.

Dr. Davis agreed that this digital divide was a limitation because children in at-risk groups might not benefit. He noted that it is important to take advantage of the Internet, but strategies need to go beyond it.

"Schools will help. Community outreach will help. And mass media campaigns can be very influential," he added. "That's where the federal government can be very helpful."