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What Lean Means
7 Ways to Trim Baby Fat
Risk Factors For Obesity
16 Ways to Trim Childhood Fat
How You Get Fat
10 Tips to Reduce Dietary Fat
Disease Consequences of Obesity
Eating Right for Your Type

For related topics, see:

We owe it to our children to keep them from being over-fat. The risk of just about every disease increases in proportion to the extra fat the body has to lug around, especially the big three killers: cancer, heart disease, and stroke. The plain fact is: lean people are healthier and live longer. You will notice that we prefer to use the terms "fat control" and "over-fat" rather than "weight control" or "overweight." Fat is the real issue. Many healthy, large-boned, muscular people are "overweight" according to charts and scales, yet they are lean. Muscle and bone weigh more than fat, but being overfat is what harms your health. We don't want you and your family to have the goal of being thin, but rather we want you to be lean.

Scales and charts do not paint a true picture of health, which is why we don't stress the concept of weight control, especially in growing children who naturally must get heavier. Concerning weight control (oops, fat control), here is the master verse:

Lean is the most important health word you will learn.

"Lean" means having the right percentage of body fat for your individual body type. It is feeling just a pinch of fat under your chin or seeing just a bit of pudginess around your middle. Scales tell you little about your leanness, and you can lower that figure on the scale with a crash diet that causes you to lose water and muscle weight rather than fat. You may weigh less, at least for a while, but you won't be any leaner.

Lean is not to be confused with being skinny or scrawny, which implies an unattractively low or even unhealthy percentage of body fat due to undernourishment. Nor does lean mean lanky, which describes a person's bones and muscles, a body build influenced more by genes than diet. Leans means trim, a goal which can be accomplished by anyone, regardless of genetic makeup. (Admittedly, though, some genes make it easier to stay lean than others.)

The five lean factors. Five factors will determine how easy or difficult it is for you to be and stay lean.

1. Lean genes. Kids, look at your parents, and parents look at your grandparents. If they are (or at least in their youth were) trim, you've got a slimmer chance of ever becoming over-fat. If one or both parents or your grandparents were over-fat you can still be lean, but you'll have to work harder at it.

2. Body build. Some body types stay lean more easily than others. Lean and tall (also known as ectomorph) body types are longer and lighter than the average on the growth chart. Ectomorph babies, children, and adults are recognized (even at birth) by spindly "piano fingers" and long, slender feet. Ectomorphs seem to put more calories into height than weight. Persons with ectomorph body types are hyper-metabolizers; they seem to burn off calories more easily and can better adjust their food intake to their activity level. They eat a lot, yet don't gain weight, which is likely to make them the envy of their calorie-watching friends. Stocky children and adults (mesomorphs) have average height and weight, and both height and weight are near the same percentile on the growth chart. These square-shaped bodies have a greater tendency toward being over-fat than their rectangular ectomorph friends. Short and wide persons (endomorphs) have the greatest chance of becoming and staying over-fat. Few persons are pure body types; many have a combination of features.

3. Metabolism. Some people are born with fast metabolisms. We call them burners. They burn fat easily. Others have slower metabolisms and burn fat slowly. We call them storers. Whether you are a fat-burner or fat-storer is, like body build, an inherited tendency. On occasion I will see two children in the same family, one is trim, the other isn't, yet both eat similar diets. "No fair" says Susie Overweight, "My sister gobbles banana-splits, yet I'm a size 16 and she's a size 8."

4. Temperament. Active people with lots of energy burn energy. Couch-sitters store fat. You can spot these tendencies in infancy. A lanky, wiry, very active baby, especially one with active parents, has a slim chance of becoming fat. Mellower, rounder, quieter babies tend to burn fewer calories and are at increased risk of becoming fat.

5. Eating habits. Persons who eat nutrient-dense foods in proportion to their individual energy needs are more likely to stay lean. Persons who eat too much of high-fat, empty calories are less likely to be lean. Any fat control program needs to take into consideration not only the quantity, but the quality of the food.

The three important facts of fat control are:

1. Why you get fat. You eat more calories than you burn.
2. How you get lean. You burn more calories than you eat.
3. How you stay lean. You program your body toward leaner eating habits and set your metabolism higher to promote fat-burning. You can stay lean by eating differently, exercising more, or a bit of both.

For 90 percent of children and adults, fat control is as simple as these three principles. For around 10 percent of people it's not that simple because of their metabolic quirks that don't follow these rules.

Low Fat Risks

• slim genes from parents or grandparents
• naturally slim body build
• a high metabolism (fat burner)
• watches little TV
• lean eating habits

High Fat Risks

• fat genes in family
• stocky body build
• low metabolism (fat storer)
• sedentary temperament and lifestyle
• watches a lot of TV
• fat eating habits

In counseling parents about their children's weight issues, that is, whether or not they need to worry about how much guidance a child needs, I first look at the parents themselves, second at the child, and third at the eating and lifestyle habits of the family. I look at the growth chart and the scale last. Children who are in the low-risk category don't need much fat-control counseling. Families in the high-risk category need a high level of early intervention, which can prevent obesity in childhood. Children and adults do not inherit obesity, they simply inherit the tendency. How they learn to eat and live with this tendency determines whether they will grow up to be fat or lean.

Some of the reasons people are over-fat are under their control, and some aren't. Some reasons are obvious, and some are not so apparent. Here are the facts you should know about your body's fat-storing habits.

Heredity. Do fat parents usually produce fat children? Statistics say yes. Lean parents have only a seven percent chance of having an obese adolescent. If one parent is obese, there is a forty percent chance their child will be obese. If both parents are obese, the probability of the child's being obese may be as high as eighty percent. Genes may actually be a more powerful determinant of obesity than diet. Studies on adopted children show that these children's body weight tends to be more like their biological parents than their adopting ones. Studies of identical twins reared in different environments with different parental eating habits showed a tendency toward similar fatness or leanness. But, don't be too quick to blame your parents. Genes influence whether or not children or adults become fat, but diet and lifestyle, both of which are under your control, also play a role. It's what you do with the genes you inherit that determines whether you will wind up fat or lean.

Are fat children more likely to become fat adults? Yes and no. One study showed that nine out of ten obese infants became lean by the time they were seven. Yet, obese infants are still three times more likely to be fat at age seven than infants who have been lean from the start. Studies have also shown that forty percent of obese seven-year-olds are likely to become obese adults, seventy percent of obese preteens are likely to become obese adults, and around eighty percent of obese adolescents are obese as adults. The fatter children are in the first few years of life and the longer they keep their excess fat, the greater the likelihood they will remain fat into adolescence and adulthood.

Does overeating lead to overfattening? Most studies show that fat children and adults do not eat more than lean ones, some may even eat less. What's significant, however, is that while fat persons do not necessarily eat more food, they do eat more calories than they burn off in exercise. The fat person may also have a slower metabolism than the lean person. Also, studies show that fat persons are more likely than lean persons to eat foods higher in fat. They may get around forty percent of their calories from fat instead of the recommended 20-25 percent.

A fat calorie is heavier than a protein or carb calorie. It's a myth that a calorie is a calorie is a calorie. Calories from fat are more fattening than calories from proteins or carbohydrates. Our bodies tend to store excess calories from fat as fat more readily than they do excess calories from carbohydrates or proteins. Not only does the body store fat calories more easily, it also burns them less readily. The body, plotting to protect itself from starvation, will use up carbohydrate stores for energy before dipping into the fat reserves. And the body must use more energy (or calories) to metabolize carbohydrates and proteins than it uses to burn fats. Fatty foods tend to pack more calories into a smaller volume than do carbohydrate and protein foods. Because the stomach takes its cues for fullness based upon food volume rather than calories, gram for gram fat is less satisfying.

Sugar can make you fat, too. The hormone insulin doesn't just control sugar, it also controls fat. Insulin also helps the body store excess sugar as fat. Junk sugars and other carbohydrates with a high glycemic index are the most likely to be stored as fat. Insulin bursts following the ups and downs of blood sugar also contribute to fat storage, which is why five mini meals a day that keep your blood sugar steady are more likely to keep you lean than three big binges. Once you get overfat from sugar, a vicious cycle may begin according to a new metabolic theory called insulin resistance.

This is how I.R. works: when sugar enters the bloodstream, the pancreas secretes a dose of insulin high enough to usher the sugar into the muscle cells and other organs where it's needed for energy. If a lot of sugar enters the bloodstream, the pancreas releases a lot of insulin. Some people develop a metabolic quirk in which the cells begin to resist the insulin. Since glucose levels in the blood are not dropping, the body secretes even more insulin, which can cause two problems: the overworked pancreas may gradually wear out, resulting in diabetes, and the excess insulin promotes more fat storage. This concept of insulin resistance also explains why some people become fat, even though they really do not take in too many calories. They just eat too many carbohydrates. Not all nutrition experts believe in this concept of insulin resistance. Yet, because we have a child with this metabolic quirk, we have thoroughly researched this issue, and we believe that for some people there really is a possibility that being over-fat is more the result of producing too much insulin than overeating.

Actually fatness produces more fatness. The more you eat, the higher your blood sugar rises, so the more insulin you secrete. This causes the blood sugar to fall, which makes you hungry again, so you eat more and continue the cycle. Interestingly, a diet with adequate amounts of omega 3 fatty acids (found in fish and flax seed oils) will improve insulin efficiency by helping the body use up carbohydrates and fats for fuel. Imagine - a fat that fights fat.

What about endocrine causes? "Doctor, could it be her thyroid?" is a common question of parents seeking counsel for their overweight adolescent. Generally, but not always, endocrine disorders causing obesity usually also cause children to be short. However, children who are obese, especially from over-nutrition, tend to be taller than average, or at least average height. A short, fat child should always undergo a complete medical evaluation.

"But it's my metabolism." New insights into obesity are showing that for an increasing number of persons, obesity is as much a metabolic problem as much as a behavioral problem. True, many people are overfat because of unhealthy eating behaviors, yet new medical discoveries suggest that problems such as insulin resistance and differences in how people metabolize fat are important contributors to obesity.

Another possible explanation comes from differences between white fat and brown fat. White fat is the fat you see padding the body near the surface. It makes up 90 percent of total body fat. Brown fat, which makes up the other ten percent, is located deeper in the body, primarily within the upper back, around the nape of the neck, the armpits, between the shoulder blades and deep in the chest cavity. Brown fat primarily burns calories, whereas white fat stores calories. Some over-fat people either have less brown fat, or what brown fat they have is not as easily triggered into fat burning, so they tend to store fat rather than burn fat.

The fat cell theory. You may have heard that a person is destined to become lean or fat based on the accumulation of fat cells early in life. The fat cell theory states that during the first two years of life (considered to be one of the critical periods for fat cell development), there is normally an increase in fat cell number. Other spurts in the number of fat cells come in middle childhood, around seven years of age, and again during adolescence. After a person is finished growing and reaches adulthood, the number of fat cells remains constant. The sizes of these cells may change, but they will not decrease in number. Thus someone who is overnourished in childhood (or genetically programmed to grow more fat cells), will have an excess number of fat cells, making it more difficult to control his weight as an adult. While there may be some truth to this fat cell theory (one of the reasons we stress the importance of raising a lean child), new insights suggest that neither the number nor the size of the fat cells is genetically fixed or set for life. It is certainly possible for previously overfat children or adults to become lean for the rest of their lives.

Senior fat. As you age your body tends to gain fat. The good news is that this happens only if you let it. One of the reasons why there is more fat in an older body is that people at retirement age may actually have 25 percent less muscle mass than they did in their twenties, especially males. Since muscle burns calories, a 60-year-old person eating the same number of calories as he did in his twenties is going to get fat. Add to this the fact that an older person may not be as active or as able to exercise. Exercising more and eating more wisely will combat this trend, and often by the time a person is sixty years of age, they are more motivated to watch what they eat in order to avoid disease. Unfortunately, many people don't discover the nutrition-disease connection until they've already gotten a disease. As a tribute to the wisdom of the aging body, most persons in their sixties can simply not "stomach" the quantity of junkfood that make up the diet of most young folk. The key to having an older, yet healthier, body is acquiring nutritional wisdom when you are younger.

Just about every organ of the body works less well when you're overweight. Here are the major health problems associated with being over-fat.

• Increased cardiovascular disease. With excess body fat comes higher levels of blood lipids: cholesterol, LDL (the "bad" cholesterol), and total triglyceride levels all increase, while HDL ("good" cholesterol) decreases. These lipid levels lead to bad things for your cardiovascular system. The incidence of high blood pressure also rises when you're overweight.

• Promotes diabetes. Excess fat reduces the efficiency of insulin. As a result, the pancreas needs to produce more insulin and may eventually wear out, leading to diabetes.

• Psychological and emotional problems. Being overweight definitely affects the psycho- social development of the child and adolescent. Our society places less value on fat people. Our culture rewards leanness and penalizes fatness, particularly in women. Studies have shown that obese children are more likely to develop a poor self-image and low self-esteem. They are prone to social isolation and, because they compete poorly in athletics, often choose more sedentary activities, which further increase their weight. Obesity is not just a problem of the body, but also the mind. Obsession with weight and becoming thin presents its own problems, as the anorexia issue confirms.

• Sleep disturbances, namely sleep apnea. A study showed that thirty-three percent of severely obese persons had sleep apnea and severe enough breathing problems during sleep to cause restlessness at night and interfere with the ability to work and think the following day.

• Orthopedic problems. Especially in growing children and adolescents, increased weight bearing on the hips and knee bones tends to cause bowed legs, to the extent that the leg bones are more likely to slip out of the hip bones (a condition called slipped femoral epiphysis). Arthritis is more common in obese persons. Losing weight eases the workload for arthritic joints.

• More infections. One study showed that fat babies get twice as many infections as slim babies. Another study demonstrated that the ability of white blood cells to fight infection is reduced in obese persons.

• Increase in other health problems: Gallstones, headaches, kidney problems, colon cancer - - the risk of nearly all diseases goes up when you're overfat.

Medical studies show that leaner people live longer. Get lean for life and you'll enjoy life longer.

The earlier you start growing a lean child, the greater the chance you'll be the parent of a lean adult. You've heard that the first three years are "formative years" for intellectual and psychological development. Well, these are also important years for forming healthy eating habits. The nutritional habits acquired by the toddler become her norms. This is when she learns what eating is all about and recognizes "This is how my body is supposed to feel." If the toddler grows up lean, with a lean set point, the child is more likely to stay lean. Try these seven ways to start your baby off lean.

1. Breastfeed. Many experts believe that breastfed infants are less likely to become obese than formula-fed infants, but studies comparing the two groups have not produced clear results, partly because of problems with study design and also because many other factors contribute to obesity. Let's approach this question from the common sense point of view. It seems to us that a breastfeeding baby is more likely to learn healthy appetite control habits, a major factor in determining leanness or obesity.

   Breastfeeding leaves the infant in control of the feedings, how much he takes, and with a responsive mother, how often he eats. The bottle-feeding mother can take control of the feeding away from the baby. She counts ounces and watches the clock. A breastfeeding mother is more likely to watch the baby for cues. As she reinforces the baby's cues, he learns to trust his body's signals. An interesting study showed that formula-fed infants, if allowed to determine for themselves how much formula to drink, can self-regulate the total daily calories quite well. Six- week-old infants can adjust their formula intake according to their calorie needs. If the experimenter substituted a more dilute, lower calorie formula, the infants drank more, making adjustments for the lower energy levels. With bottlefeeding, maternal control can override the infant's automatic regulatory ability as mother urges the baby to take "just a little bit more." Baby comes to expect that "stuffed" feeling after a meal and eventually seeks it out for herself.

   A breastfed baby gets custom-calorie milk. The fat content of breastmilk changes during each feeding and also at different periods of the day. At the beginning of a nursing, when a baby is most hungry, she gets a large volume of foremilk, rich in protein and carbohydrates, but low in calories. If the baby is very hungry, he continues sucking and the fat levels in the milk rise (the "hindmilk"), telling the infant that it's time to slow down because his tummy is getting full. When you watch breastfeeding babies at the end of a feeding, you will notice how they radiate contentment, sucking needs and appetite both completely satisfied. When a breastfeeding baby is thirsty rather than hungry, or just wants to soothe himself, baby sucks in a way that makes the breast deliver only the lower calorie foremilk for a quick pick-me-up or some "calm me down" comfort. A formula-fed baby receives the same kind of formula, regardless of whether he is hungry, thirsty, or just needs to suck for comfort. Responding to the baby or toddler's different needs for food and comfort is more complicated with bottle-feedings. Allowing a toddler to walk around with a bottle just to "keep him quiet" or offering formula at every peep from an infant could condition the child to connect eating with comforting. Breastfeeding conditions the child to connect comfort with a person. Developmentally these are known as patterns of association, whereby an infant stores in the file library of their developing brain these associations to be replayed later on.

   The fat content of mother's milk changes as baby's growth decelerates. Breastmilk changes from "whole milk" to "reduced fat" sometime during the second half of the first year, another biological sign that Mother Nature favors leanness. In fact, recent research has shown that breastfed babies, after the first four to six months, are leaner than their formula-fed peers, as they gain proportionally more height than weight. Formula-fed babies tend to get solid foods earlier and gain proportionally more weight than height, suggesting an early tendency away from leanness.

2. Delay solids. The longer you wait to start your baby on solid foods, the lower the risk of your baby getting over-fat, especially a baby who neither looks lean nor has lean parents. When you do begin solids, begin with the most nutrient-dense foods, those which pack the most nutrition in the fewest calories, such as vegetables rather than fruit and whole grains over sweets.

3. Watch for low-cal cues. It's easy to interpret every cry as baby needing food, but maybe baby is thirsty, physically uncomfortable, lonesome, or just wants to be held. Especially if you are formula-feeding, sometimes try to pacify your baby by holding or playing with him rather than simply plugging a bottle into the bored baby. If you are still unable to calm baby, try a bit of water or a pacifier, since baby may just be thirsty or in need of sucking.

4. Don't fill your baby with juice. Juices are not nutrient-dense foods. Fruit juices straight out of the carton contain nearly as many calories as the same volume of milk or formula, but are much less nutritious and filling. Babies can consume a much larger quantity of juice than of breastmilk or formula without feeling full. Excess juice can be a subtle cause of infant obesity. Instead of full-strength juice, dilute the juice by at least half with water or if you feel baby is simply thirsty, use juice simply to flavor the water.

5. Get baby moving. Most babies when awake are in constant motion anyway, so you don't have to put your baby on an exercise program. Yet, some mellow babies are content with visual stimulation. They like to lie and look rather than wiggle and crawl. The plumper the baby, the less baby likes to budge, leading to the cycle of inactivity and fatness. Get down on the floor and play with your baby, or put some music on and dance around with your toddler.

6. Respect tiny tummies. Babies' tummies are about the size of their fists, so that small, frequent feedings (the breastfeeding pattern) are more physiologically correct than larger, less frequent feedings (the bottle-feeding pattern). To appreciate this bottle-tummy-size mismatch, compare a full bottle to baby's fist. You will be less likely to force baby to "finish the bottle."

7. Respect toddler tummies. Just about every day in my pediatric practice, some parent complains, "My toddler is such a picky eater." Over the years I've come to realize that toddlers pick and peck at food because toddlers are made that way. During the first year, babies eat a lot because they grow a lot, tripling their birthweight by one year of age. Yet, the normal toddler may get only one-third heavier between the first and second birthdays. Many toddlers grow proportionally more in height than in weight in the second year, burning off excess baby fat and gradually becoming more lean. If you understand this as a normal stage that most toddlers go through, you will be less obsessed about your toddler's eating patterns.

Obesity affects 1 in 5 children in the United States. The National Health and Nutrition Examination Survey (NHNES) performed between 1988 and 1994 showed that eleven percent of American children and adolescents are over-fat and an additional fourteen percent are at risk of becoming obese. This represents a 30 percent increase in childhood obesity over the last decade. Whereas nutritional deficiency is the most prevalent nutritional problem in developing countries, over-nutrition, or obesity, is the number one nutritional disease of children, adolescents, and adults in the United States. As they get older, keeping children lean becomes more difficult. You have less control over what they eat at home and especially away from home. Peers and television compete with family as models for eating habits. But you are still the most important influence on your child's behavior.

1. Monitor snacks. Children like and need to graze. Grazing on five or six mini meals throughout the day is less likely to make you overfat than packing in three big meals a day. Since children get a large percentage of their calories from between-meal snacks, encourage them to snack on nutrient-dense, low-fat foods rather than foods which pack a lot of calories and little nutrition.

2. Avoid the "clean plate syndrome." Don't feel it is your responsibility to fill your child up, since children need to develop and exercise their own internal appetite control signals. Your job is to make nutritious food available and serve it creatively. The rest is up to the child. The fact is that many children don't empty their plates because parents put too much food on them in the first place. Better to dole out small dollops of food and replenish the plate when the first helping is gone.

3. Discourage boredom eating. Children often turn to the refrigerator for satisfaction, when what they are really craving is something to do and someone to do it with. It is tempting for a caregiver to offer snacks rather than devote time and energy to nurturing the whole child. Discourage your child from eating alone in front of the television set. Encourage activities that boost children's interests rather than their body fat. Keep them busy with things they enjoy doing.

4. Resist using food as a reward. Using food as a reward or as a source of pleasure outside of nutritional needs may instill unwise eating habits in children who are already at risk for becoming obese. It's okay to associate a trip to grandmother's house with chocolate chip cookies or social occasions with special meals. Food for pleasure or food for a reward deserves a PG- rating - "parental guidance" is necessary. A special outing with mom, dad, or a special friend is a more effective reward than a lollipop for a job well done. These events are more likely to feed the child's self-esteem than simply more icing on the cake. You'll also avoid sending confusing signals about food.

5. Encourage impulse control and delayed gratification. Help your child learn to say "no" to that second scoop of ice cream or extra piece of cake. Just say "no" to the candy racks in supermarket checkout counters. Promise a nutritious treat instead or, better still, special time with you when the shopping is done. If your child throws a tantrum about not getting three scoops of ice cream, or even two, talk her through it in terms she can understand: "Your tummy isn't big enough to hold that much ice cream and you'll feel yucky afterwards." Children don't like to wait for anything, especially food, but try this promise, "If you still want another piece of cake later, you may have one." Later the child may be so engrossed in another activity that he forgets about that promised extra piece of cake, or he'll find he just doesn't want it.

6. Trim TV watching. Today's preschool and school-age children watch an average of 25 to 35 hours of TV a week. This contributes to obesity for two reasons: lack of fat-burning exercise and a slowed metabolic rate associated with TV watching. Other concerns about obesity and TV watching are:
   • Studies indicate that for adolescents fatness correlates with the amount of time spent watching TV.

   • TV-watching encourages both inactivity and the consumption of high-calorie snack foods, a double-whammy for getting over-fat. While tuning into the tube it's easy to tune out your body's signals for appetite control. Next thing you know you've downed a whole bag of chips without realizing it, and you probably won't feel like taking a long walk to burn it off either.

   • Advertising definitely affects children's eating habits. The largest share of advertising during children's programming is for food products, and according to one study, 80 percent of these advertisements are for foods with low nutritional value, including highly-sugared cereals and high fat snack foods. And the advertising pays off. Studies show that childrens' requests for foods are related to the frequency with which they see those foods on TV, and children exposed to food advertisements select more sugared foods than children who have not viewed any advertisements. The conclusion of these advertising studies was that repeated exposure to advertising may foster childrens' preferences for high-calorie and nutrient-poor foods, contributing greatly to childhood obesity. Unfortunately, many children believe that commercials are true, especially when they see their parents eating or drinking what's advertised. Commercials teach children that food should be a source of fun and entertainment rather than a source of balanced nutrition. Teach your child to be skeptical about advertising and not to believe something just because it's on television.

7. Model good eating habits. As you eat, so your child eats. If your child sees you overindulge, he most likely will overindulge. It is much easier for your child to learn to discipline his appetite when he sees you eating appropriate amounts of healthy food. Children are very quick to pick up on the ways parents use food for gratification. Studies show that children follow the example of their parents and caregivers when it comes to eating habits. Dieting mothers are more likely to have dieting daughters, and parents with compulsive eating problems are more likely to have children with the same eating patterns. Girls seem to be more influenced by parental eating habits than boys. Parents shape their childrens' behavior in all aspects of life, and they are particularly influential in shaping their childrens' eating habits.

8. Back off on power struggles. Don't make food a control issue. You're likely to lose, if not in the short run, certainly in the long run . Eating and toiletry are two functions children like to control. Eating, like sleeping, is an activity you can't force a child into. Parents have a natural tendency to coerce, beg, threaten, or bribe children to "clean your plate," "eat your veggies," or "don't expect dessert unless you finish your broccoli." To many parents, a clean plate is reassurance that they are doing their job well. The unspoken message may even be "love me, love to eat the food I put in front of you." Studies show that parental attempts to assert control over food habits often backfires. In fact, the more parents encourage a child to eat a particular food, the more a child may dislike that food. Constant pressure to eat veggies makes children less likely to eat their vegetables. Parents can get better results by simply eating the vegetables themselves and letting their children "catch" the good eating habit. Restricting or forbidding a particular food increases the child's desire for that food and even his consumption of it. The occasional use of food as a reward for doing non-food-related jobs may increase the child's appetite for that food. Try this one: "Finish cleaning your room and you can eat all the carrots you want." It may actually work, though some kids certainly would catch onto this kind of trick.

   Even subtle "parent prompts" can shape children's eating habits in unexpected ways. Those "poor starving children in Africa" may get plates cleaned at dinnertime, but these members of the Clean Plate Club may grow up to overeat and be overfat. Studies show that parents who try to exert a high degree of control over a child's eating habits tend to produce children who are unable to control their diet on their own and who eat more high-fat foods. Girls are more likely than boys to be affected by parental dietary controls. Just as in all aspects of discipline, the key is to shape your child's eating behavior, not control it.

9. Take baby steps. Suddenly switching from a junk food family to a bunch of "health nuts" is likely to lead children into temptation at the junk food family next door. Like introducing solids to babies, do it gradually.

10. Get your child moving. The National Health and Nutrition Examination Surveys (NHNES) showed some surprising changes in the American diet between 1988 and 1994. Daily calorie intake in young children and adolescents remained the same, but calorie intake increased in proportion to their level of exercise. Older adolescents and adults, however, did show an increase in daily calorie intake, that is they ate too much. Surprisingly, the percentage of calories from fat in the American diet continued a downward trend. The most disturbing finding was that children exercised less in 1994 than in 1988, and this seems to be one of the most important factors influencing the trend toward obesity in children and adolescents. Obese children more often choose sedentary pastimes and even when they participate in team sports they are less active than their lean teammates.

    Which came first, the inactivity or the obesity? This is a chicken or egg question. Studies suggest that these inactive children are that way from infancy. Infants with only moderate food intake, but with quiet, placid personalities are more likely to become obese. An infant with a very active temperament may not become fat even with a high calorie intake. Unfortunately, with time, a vicious cycle results. The less active the child is, the more chubby he becomes, which leads the child to become less interested in physical activity. His sports skills may have been meager to begin with, and as his abilities fall further behind those of his peers, the less he'll want to participate.

    To help our family stay lean, we have put exercise equipment in the TV room. We have also outlawed snacking TV. Our family TV is now flanked by a treadmill and an exercise bicycle. The children have watched me exercise while watching sports and will occasionally come up and ask, "Daddy can I use your treadmill I while watch TV?" The television-exercise combination results in a good old enjoyable family fat-burn. Maybe a family running or bicycling outing would be even better, but sometimes dad needs his college football fix.

11. Send your child off to school with a good, nutritional start. Studies show that breakfast- skippers tend to overeat the rest of the day, so that the total daily calories go up rather than down. Hunger triggers the neurotransmitters that stimulate eating, so a child who skips breakfast overcompensates in the afternoon and evening. Get your child up early enough in the morning to eat a good breakfast and pack a healthy lunch for him.

12. Water down the sodas. Children, especially teens, are more likely to head to the soda vending machine than the water fountain. Besides having no nutritional benefit, overdosing on soda (even diet sodas) can be a subtle cause of obesity. Softdrinks contain five to nine teaspoons of sugar per serving, and they trigger the sugar-insulin-fat cycle. Offer your child healthy alternatives to soda: bottled water, diluted fruit juice, or fruit juice and soda water mixes.

13. Use positive motivators. You want to trim your child's fat, not her self-esteem. Rather than use phrases like "so you don't get fat" or "to help you lose weight," use more positive messages that focus on fun and what her body can do, not on body image. Offer healthful foods "to help you run faster," or "to help you play basketball better." Market carrots as "good for your eyes" and fruit as an energy food for playing after school.

14. Remove overeating cues. Foods that trigger overeating should be hidden, or maybe left in the supermarket. If a bag of fatty chips stimulates a child to plop down in front of the TV and eat them until they're gone, don't have chips in the house. Most of us weaklings eat what we see. Out of sight keeps it out of the stomach. Buffets, except for salad bars, are off limits for compulsive eaters.

15. Set realistic goals. If your child is overfat, an achievable goal is to stay the same weight for one year. For a growing child, this amounts to a relative fat loss. Enlist your doctor's help in monitoring your child's progress with periodic "health checks," not "weight checks."

16. Serve nutrient-dense foods. Teach children which foods contain more for less. Nutrient- dense foods pack in more nutrition per calorie than junkfoods, which are dense in calories but not in nutrition. A proven approach in teaching children about nutrient-dense foods is known as the traffic light approach. It's more important to teach children what to eat differently than to get them to eat less. If you want your child to be lean, don't put her on a diet, just change her diet.

There are gender differences in how people carry around excess fat. Men tend to be apples, being wider and rounder around the chest and belly; whereas women tend to be pears, wider around the hips and thighs. It's easier to lose weight from the upper body, so apples on the LEAN program may have quicker results than pears.

You can't change the body type you are born with any more than an apple or pear can become a banana. Even tall and lanky people can become more pear- or apple-like if they don't purposely try to stay lean as they age.

No matter how religiously you follow the LEAN program, most often an apple will remain an apple and a pear will remain a pear. The good news, though, is that you can become a leaner apple or pear.

The less fat goes into your mouth, the less fat is deposited in your body. The healthiest diet not only has less total fat, but also has more of the right kind of fats.

1. Eat the right amount and right kinds of fat. How much fat is the right amount depends upon the age of the eater. As a general guide:
   • During the first year, infants need 40-50 percent of their daily calories from fat, since growing brains and bodies needs a lot of extra energy.

   • For most children and teens, 30 percent of daily calories from fat is plenty.

   • Most adults, depending on your general health, activity level, and body type, need 15-25 percent of total calories from fat. As you get older, the percentage of total daily calories you need from fat usually declines.

2. Eat the right kinds of fat. What kind of fats you eat is as important as the total amount of fat you eat. Two-thirds of the fats eaten daily should be unsaturated, and one-third or less saturated. (In fact, it's not essential that you eat any saturated fats, since your body makes all the saturated fats its needs.) In a diet with 30 percent of calories from fat, less than 10 percent of the total daily calories should be in the form of saturated fats. There are 9 calories per gram of fat, so a person needing 2,500 calories a day, with 20 percent of those calories coming from fat (i.e., 500 calories), should consume less than 55 to 60 grams (500 calories ? by 9 grams) of total fat in a day. Of that total, no more than 15 to 20 grams should be saturated fats (i.e., animal fats), and around 40 grams should be unsaturated fats, half of which should be monounsaturated fatty acids (found in vegetable oils) and half polyunsaturated fats (primarily from seafood and plant-food sources).

3. Avoid hydrogenated and partially hydrogenated fats. Fats that flow or swim (primarily monounsaturated fats, such as oil and fish fats) are better for you than fat that just sits there (primarily saturated fats, such as animal fats). Hydrogenated fats have been shown to lower HDL ("good cholesterol), raise LDL ("bad cholesterol"), raise harmful fats in the bloodstream (called "apolipo-protein B"), and generally raise the risk of cardiovascular disease.

4. Emphasize fats from plants rather than animal sources. Fats derived from plants contain more essential fatty acids and are predominantly unsaturated fats. Also, plants contain more fiber than animal foods, which gives you a feeling of fullness sooner and tends to reduce the total number of calories consumed.

5. Use lowfat or nonfat alternatives, especially in dairy products, such as fat-free or lowfat yogurt, frozen yogurt, lowfat cheeses, and skim or one-percent milk. Some kinds of cheese have less fat than others, for example, skim-milk mozzarella. Besides lowfat dairy products, use reduced-fat salad dressings, mayonnaise, and margarine.

6. Choose leaner cuts of meat and poultry. Trim the skin off the poultry before cooking. Choose white meat chicken over dark meat, which contains over twice as much fat as white meat. Turkey meat is lower in fat than chicken. A ground turkey burger tends to contain less fat than a lean ground beef burger. (Read the label to be certain.) To really serve a lower fat beef patty, buy a very lean cut of meat and ask the butcher to grind it up into hamburger.

7. Use lower fat toppings. Opt for yogurt or "lite" sour cream instead of regular sour cream on baked potatoes, and in dips and sauces.

8. Shun fast-food restaurants. Children especially tend to eat more food that has been cooked or saturated with fat. It's up to parents to be in charge of the nutritional content of the meal.

9. Try alternatives to frying. Instead of french fries, sprinkle potato slices (even sweet potato slices) with olive oil and bake. Poach fish and chicken in broth or steam them in the microwave.

10. Avoid fat substitutes. These man-made molecules may taste like fat to the tongue, but they don't act like fat in the intestines, causing consumers to believe they can indulge in fat-laden foods without getting fat. All factory fats do is foster fat cravings instead of lowering the appetite and raising an appreciation for lowfat foods. You can't fool the intestines without paying a nutritional price.

In determining how much of the right kinds of fat to consume, take some tips from your body. Fats make up 15 to 22 percent of your body's weight, so these same percentages should fit your diet. Also, the most important organs (brain, heart, kidneys) contain the most unsaturated fats and essential fatty acid and so should your diet. If your diet fat matches your body fat, you're on the right fat track.