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Twelve-year old David is obviously overweight, but he has no idea what to do about it. Paul (10) and Patricia (8) look like shorter versions of their obese parents who consider the children healthy. A college student lives on cigarettes and Cokes; a 64- ounce Coke constitutes breakfast and is a way to stay alert in class. A 15-year old girl skips breakfast and lunch and never eats meat. A mother eats and feeds her children only diet foods. A four-year old child asks, "Mommy am I too fat?" Dieting starts in children as young as 7 years old; some this age have full-blown eating disorders. Up to 81% of 10-year-old girls eat in dysfunctional, disturbed ways. At the same time many youngsters are dieting, more and more youngsters are overweight and obese. Healthful, normal eating habits are becoming rare among young people. And what they are eating is disastrous.
Rates of overweight and obesity among children in the US have doubled and even tripled in some areas over the past 25 years. Depending on definitions, anywhere from one in seven to one in four children and adolescents are overweight. Pulmonary complications can develop including sleep-disordered breathing (sleep apnea), asthma, and exercise intolerance. Serious liver (fatty degeneration), musculoskeletal (including reduced bone mineral content), kidney, and neurological complications as well as hormonal imbalances are increasingly recognized. Children as young as 5 years of age have signs and symptoms of developing diseases such as diabetes, insulin resistance, cardiovascular disease, hypertension, arthritis, cancer, and more. Type 2 diabetes, once virtually unknown in youngsters, has doubled in some populations and is almost entirely attributable to the epidemic of obesity. Chronic disease patterns usually of the elderly are now observed in the young. About 40% of children aged 5 to 8 show at least one risk factor for cardiovascular disease. Factor in psychological and social disturbances of overweight children and the picture is quite grim.
Long-term studies of overweight children show that the degree of excess weight in the family and the degree of excess weight at puberty are the two most important predictors of body weight in adulthood. Genetic causes are sometimes blamed, but "childhood obesity almost never is a result of an underlying genetic disorder." The rising prevalence of obesity among genetically stable populations in recent years indicates that familial components play only a minor role. "Environmental factors" are the predominant culprits. Eating habits are passed down in families, but there is much, much more to the story.
Debilitating clinical eating disorders affect 5% to 10% of adolescents, mostly young women, though the number of young men is steadily rising. These disorders include anorexia nervosa, bulimia nervosa, binge eating, and related disorders which can lead to stomach problems, tooth decay, bone loss, blood and endocrine abnormalities, infertility, heart problems, and ultimately suicide or death from starvation. Genetic tendencies and disrupted brain chemistry may set up a child to develop eating disorders, but there are causes not yet determined. Although considered a psychiatric illness (by whom?), the etiology suggests "biological contributing factors" are even more important. Some research indicates that a component of the serotonin system is "out of whack."
Children are inundated with commercialism and rampant materialism accompanied by increased exposure to "over-sexualized and under-fed images" of carefully picked models in the media which not only create increased dieting and body-image problems, but also contribute to other very serious emotional problems and eating disorders. Children normally gain some extra weight with growth spurts and/or due to surges of hormones in puberty. Though perfectly normal, this may spur them into dieting, especially if they are teased or receive derogatory comments from peers. Dieting usually leads to nutritional deficiencies which can cause an abnormal sense of taste, smell, and the sense of satiety or fullness after eating.
Dysfunctional eating characterized by irregular and chaotic eating patterns (such as dieting, fasting, bingeing, skipping meals, overeating, and under-eating) is becoming increasingly common. This can be very dangerous and cause injury, even death among children. About 28% of young boys and 62% of young girls report that they are dieting. Nearly 24% of middle-school kids consider themselves overweight and over 40% are trying to lose weight. In any six-month period, girls who diet severely are 18 times more likely to develop an eating disorder than non-dieters. Moderate dieters are five times more likely to develop an eating disorder. Half of all white adolescent girls think they are overweight. The reality is that many are actually of normal weight.
A large percentage of youngsters engage in "unhealthy eating behaviors." Only a small percentage of adolescents eat 5 or more servings of fruits and vegetables a day. In 1997, added fat and sugar comprised 50% of the calories consumed by children. Diets of young people are lacking in essential nutrients, in large part because they consume mostly high-calorie, low-nutrient foods. Teenage girls have the poorest nutrition of any group in this country. At least two-thirds are deficient in iron, calcium, and many other important nutrients. Childhood malnutrition is critical and is growing by "epidemic proportions". Unless drastic changes occur, it is possible that "we will have the first generation of children [in the history of the human race] who are not going to live as long as their parents." i What are some causes of dysfunctional eating and malnutrition?
Children's food preferences are influenced by their parent's eating habits for better or worse. "Eating is a habit, and if you're introduced at a young age to poor eating habits, it's difficult to change those habits as you get older." Kids tend to follow in their parent's footsteps. Greater parental knowledge of nutrition is associated with lower prevalence of overweight children. Youngsters who do not receive parental support, who suffer from neglect, who are depressed, whose parents are overly concerned with appearance, or who have other problems in the home environment and/or with parent/child interactions are more likely to engage in severe dieting, be overweight during childhood and later in life, and/or develop eating disorders.
Aiding childhood obesity by using parents as "exclusive agents of change" is far superior to conventional approaches such as educational sessions by a dietitian (who knows next to nothing about nutrition), restrictive diets, and exercise programs. Parental example is an extremely important key tool. Children who sit down and eat dinner with their families on a regular basis are much more likely to eat healthier foods and generally have better diets than children who do not. Prenatal over-eating (maternal obesity) and/or under-nutrition may affect babies by a lifelong tendency for overweight. "Under-nutrition at important stages of fetal development" can induce permanent physiological changes that result in obesity. Children who are bottle fed are at higher risk for obesity later in childhood or adolescence than those who are breastfed. Breastfeeding is associated with reduced risk for childhood obesity. Maternal smoking during pregnancy is associated with increased risk of childhood obesity. ii
Many young people are not getting enough exercise. This is the most inactive generation in the history of the entire human race. Very few - less than 25% - get rigorous physical activity every day. Less than 25% get at least a half hour of ANY type of physical activity every day. Almost one out of four do not attend gym class at all and only one out of three attend every day. Obese adolescents are less physically active than normal-weight adolescents. The automobile, remote control, television, video games, and computers displace physical activity. Children who have active parents are more likely to be active themselves. Young people with eating disorders may over-exercise with resultant overuse injuries, exhaustion, and depletion. iii
Between the ages of 2 and 17, children watch an average of 15,000 to 18,000 hours of TV; however, they are in school only 12,000 hours. The more they watch television, the more the prevalence of overweight and obesity. Obesity risk increases by 12% for each hour per day of television viewing.
Television promotes weight gain not only by reducing time spent in physical activities, but also by increasing food intake. The more children watch TV, the more they eat. Not only are satiety cues interrupted, but they eat more advertised foods - choices are high-calorie, low-nutrient nonfoods. The average American child views as many as 40,000 commercials a year, about 10 food commercials per hour. In the 1960s, advertisers began to target children, so by 1998 $2 billion was spent on such ads, half of them for food. Children and adolescents not only influence their parent's spending ($200 billion a year), but they have their own money to spend ($25 billion a year for children under age 12, $140 billion for teenagers). On Saturday morning TV, up to 71% of commercials are for food; over 90% of these are for sugary cereals, fast food, cookies, chips, candy, soda, or other nutritionally-poor items. Children viewing TV, experience a reduction in metabolic rate of up to 200 calories in an hour while watching cartoons, just as though they were in a trance or stupor. iv
Advertising for "junk food" now appears on book covers, on school buses, in gymnasiums, videos, curriculum guides, reading software, mathematics materials, athletic warm-up suits, cafeteria tray liners, and in restrooms. Over 200 school districts have signed exclusive contracts with soft-drink companies (primarily Coca-Cola and Pepsi) to sell only their drinks in schools. Researchers calculate that, for each additional soda consumed, the risk of obesity increases 1.6 times. From 1985 to 1997, school districts increased purchases of carbonated sodas by 1100%. Children begin drinking soda very early in life and steadily increase the amount they consume through adolescence and young adulthood. Over 25% of teenagers consume 12% to 15% of their caloric needs by soft drinks alone. Snack foods (high in refined sugars and flours and altered fats) are available in most schools from vending machines, snack bars, or student stores. Lunch menus at most school cafeterias commonly offer less-than-nutritious meals including chicken nuggets, pepperoni pizza, hamburgers, whipped potatoes, tater tots and French fries. Only occasionally do green beans or carrots show up. More students are eating lunch out at fast food restaurants.
Students in 25% of middle-schools and high-schools are required to watch Primedia's Channel One, an in-school television program composed of 10 minutes of news and 2 minutes of commercials. Food companies are particularly prominent advertisers. "So many of our school boards have put a ‘For Sale' sign on our kids." "Children inundated with commercialism and surrounded by rampant materialism suffer not only from obesity but also from body-image and other emotional problems, eating disorders, and tendencies toward violence." v
FOOD AND NON-FOOD
The caloric intake of young people has remained basically the same during the last few decades, but the dietary composition and nutritional content has changed. For example, the amount of protein and carbohydrates consumed has increased while the amount of fat has decreased. Eating patterns have also changed. Increases have occurred in the number of meals eaten at restaurants, in food availability, portion sizes, snacking and meal-skipping. The quality of foods eaten by young people has changed; it has deteriorated deplorably. Kids are not getting needed nutrients and are filling their bellies with depleted, denatured, mangled, manufactured, and fake concoctions - nonfoods.
Americans live in a "toxic food environment" containing widely available dangerous agents which cause people to be sick and overweight or underweight. There is an "unprecedented access to a poor diet." Foods are high-calorie, low in cost, heavily promoted, and supposedly "good tasting". Food has tremendous social meaning; young people want to eat like their peers. Food has personal meaning; it can be a friend, it can help one numb out from a difficult world, represent comfort, nurturance, a way to work out frustrations, and provide any number of other services.
Over the last few decades, Americans doubled their intake of foods like crackers, chips, bakery goods, pretzels, desserts, and candy. There has been a sharp increase in consumption of added sugars and sweeteners, soft drinks, and alcohol as well as altered and damaged fats. Larger food portions are offered in restaurants and stores, all-you-can eat buffets, huge servings of French fries, double-scoop ice cream cones, 64-ounce sodas, and more. "Supersize" servings a few years ago are now only "large", "supersize" is now even bigger. Updated cookbooks list the same amount of ingredients but result in fewer servings for larger portions.
Fast-food items, full of refined sugars and flours, damaged fats, and empty calories, are rapidly displacing healthier foods like vegetables and fruits, whole grains, natural fats, etc. The percentage of calories children received from meals eaten at home declined from 80% in the late 1970s to 68% in 1994-1996. The quality of food at home has unfortunately also declined. Often both parents are employed or children are raised in one-parent homes, so lack of time and energy result in use of convenience or prepared foods and fast foods at home. Increased consumption of fast food "parallels the rise in obesity rates among children." Children consume nearly twice as many calories when they eat at restaurants than at home.
Sugar-sweetened drinks "may be a significant factor in childhood weight gain." Drink sizes are larger: 42 to 64 ounces. A 42-ounce Coke contains 410 empty calories, nothing a growing young body can use for building healthy tissues. Artificial sweeteners can be even worse, triggering insulin and blood sugar reactions that lead to serious health problems. There is precious little research about the long-term safety of consuming artificial sweeteners during childhood. Preschoolers who drink more than 12 ounces of so-called "fruit juice" a day are at increased risk of becoming short and obese. Bottled and canned juices have lost most of their nutrients, are often pasteurized (destroying nutrients and enzymes), are acidic, and reduce the appetite for whole foods.
Only one in five children consumes five servings of fruits and vegetables a day. French fries account for almost 25% of all vegetables kids eat. Deep-fried, lipid peroxide, toxin-rich French fries cannot seriously be considered a healthy vegetable, but are counted in the statistics. The top sources of calories in this country are milk (denatured and pasteurized), cola, white bread, sugar, ground beef, white flour, processed American cheese (a fake cheese). Children who are overweight eat fewer servings of fruits and vegetables, drink more soda and fruit drinks, eat more processed snacks, eat more fast food, and are less likely to play sports outside the school gym class. The most popular menu items in school cafeterias include baked desserts, fast foods, potato chips, and frozen desserts. Some teachers use candy or pizza parties as rewards in class.
"Excess" fat in the diet is often blamed for weight gain. Young people with dysfunctional eating are often terrified of fat and avoid it religiously. The diets of many college women consist of only 4% fat, and most of that are trans-fats. Health-anxious, thin-obsessed parents wean their babies on skim milk, often stunting growth. Many teenage girls no longer eat meats or dairy products due to fear of fat. "However, the relation between dietary fat and adiposity [body fat] has been questioned." Equating a low-fat diet with a healthy diet is "a conclusion for which there is no scientific support." Findings of epidemiological studies "do not consistently show an association between dietary fat" and overweight or excess body fat in young people. Besides, the prevalence of excess weight and obesity has greatly increased in spite of a decrease in the amount of dietary fat consumed by US children. It is now admitted that the "type of dietary fat could be of greater importance than total fat consumption." Intake of partially hydrogenated (trans) fats and other altered or damaged fats (found in bakery products, fast foods, fried foods, and other highly-processed foods) is linked with increased or decreased weight as well as increased risks for diabetes, cardiovascular disease, hormonal imbalances, and more. Children raised on margarine and other altered or fake fats mature faster and have compromised secondary sexual differentiations than children given real butter and other natural food fats. "Rapid maturation...should therefore be considered a risk indicator for the development of obesity." Emphasis on dietary fat reduction "has been a serious distraction in efforts to control obesity and improve health in general."
Restriction of dietary fats can worsen bodily status of essential fatty acids (EFAs) and fat-soluble vitamins during a time of increased need for these nutrients in children for growth, tissue storage, endocrine development and endocrine balance, musculoskeletal health, brain and nervous system development, cellular membrane function, and much more. Fats are essential for the repair process of inflammation, to protect against tissue insult and injury. They are building blocks for steroid hormones. Some researchers believe that widespread health problems among children including attention deficit disorder and asthma are at least partly related to poor quality fats. Obese people have low EFA contents in circulating plasma lipids. American children are especially deficient in omega-3 fatty acids. Children consuming low-fat diets (less than 30% of calories) also consume the lowest amounts of fat-soluble vitamins such as vitamin complexes A, E, and D. The vitamin E complex status of children is so low that there is increased risk for development of chronic diseases including atherosclerosis and certain cancers. Intake of water-soluble vitamins, including B vitamins, is also low when fat intake is reduced. Low-fat diets are lower in general nutritional density.
A decrease in dietary fat is accompanied by a compensatory increase in consumption of carbohydrates, especially refined carbohydrates such as white bread, noodles, ready-to-eat cereals, cakes, cookies and soft drinks. Many low-fat foods are high in refined sugars. Eating so many refined carbohydrates induces a sequence of hormonal events that stimulate hunger and cause overeating.
There are sharp rises in blood sugar followed by a crash. This not only triggers hunger, but stresses many glands and organs including the pancreas, liver and adrenals, and depletes the body of needed nutrients including B vitamins, zinc, manganese, chromium, magnesium, vanadium, and others. The more refined the foods, the higher the rapid absorption of sugars and the sequence of hormonal and metabolic changes (including elevated blood glucose and insulin levels) that promote excessive food intake. Reducing consumption of refined carbohydrates alone will produce weight loss in children as well as reduce cholesterol levels.
Often overlooked in issues of weight or health is the pervasion of toxic environmental chemicals. Hormone-disrupting contaminants disrupt weight regulation. Plasticizers used in manufacturing plastics and resins leach from plastic water and soda bottles, tin-can linings, dental sealants and ‘white' fillings, Styrofoam trays and cups, plastic wrap, formula bottles, fumes from plastic mattresses, crib bumpers, and car seats. Basic cell chemistry can be severely damaged by the gradual accumulation of environmental plastics so that, by the time they are teenagers, children can be grossly overweight or suffering with an eating disorder.
Participants in a study were divided into two groups: one increased fruit and vegetable intake and reduced consumption of high-fat and high-sugar foods; the other group only decreased fat and sugar intake. Those in the fruit-and-vegetable group showed significantly greater reductions in overweight than those in the decreased fat-and-sugar group. Teens eating more whole grains than refined grains are leaner and have the least insulin resistance. People placed on a diet of "natural foods" like fruits, vegetables, and whole grains were allowed to eat as much or as little as they wanted and lost an average of eight pounds.
Good health and proper weight have to do with eating less empty calories and more nutrient-dense foods. Consuming nutrient-depleted, incomplete, mutilated, adulterated, or fabricated nonfoods may satisfy hunger only in feeling the belly is "full". But the inner hunger is not satisfied. The hunger for nutrients and other food factors required for health and wellness is not satisfied. Attempts to appease the natural appetite with unwholesome and/or denatured nonfoods can disrupt satiety, thus affecting weight.
The body is crying out for nutrients and real food, but only empty calories are supplied. Young ones, from toddlers to college students, are not consuming sufficient levels of vitamin complexes A, C, D, and E, B vitamins, carotenes, iron, magnesium, potassium, zinc, copper, fiber, omega-3 fatty acids, various amino acids, and a plethora of other nutrients. Eating disorders are associated with numerable deficiencies; while diets of nutrient-dense foods that are free of refined sugar have overcome them.
Young people are suffering from hunger for quality food factors. The grossly overweight and those with eating disorders are actually starving. Youngsters are not getting enough vitamins, minerals, trace minerals, quality proteins, natural fats, enzymes, phytochemicals, and other food constituents. Researchers refer to the "hidden hungry", those children who appear to be adequately fed, but are actually malnourished (starving). Those eating nonfoods lose the natural appetite for wholesome, real foods. When a natural food diet is consumed, an innate sense of what and how much is needed usually develops. vi
Political, social, and cultural changes would ideally alleviate many factors contributing to childhood obesity and eating disorders. In lieu of these, parents and clinicians must act now. Clinicians can spend time with parents and youngsters, teaching them about wholesome, nutrient-dense, natural foods. Parents can learn to recognize what good food is, and be willing to spend time and income on it. People have been led to believe that food should be ready-to-eat, plentiful, and cheap. High-quality, nutrient-dense, natural foods are viewed as time- or work-intensive and more expensive. However, studies indicate that the cost is about the same - processed nonfoods are very costly. Besides, where are parent's values? Are they willing to spend more on clothing, games, and vacations than on good health for themselves and their children?
Even very young children can grasp the concept that some foods will make you grow big and strong, and other foods will make you sick. Young people quickly feel the difference when refined, processed, depleted nonfoods are avoided and real foods are eaten. Children sometimes refuse sugar-laden junk foods after realizing how these items made them feel and act. Kids who have already developed picky palates for refined carbohydrates, damaged fats, and other nonfoods popular with their peers may be difficult to change, but it has been done and as a parent you can and must do it!
Very often, when parents eat well, the children also eat well. "Thus, the single most important thing a parent can do to instill healthy eating habits in their offspring is probably the most difficult: set a good example." If Mom and Dad don't eat vegetables, the child will follow suit. If Mom grabs candy while watching television and Dad downs sodas and chips, the kids will want to do the same.
Guiding good food choices when they are young, not dictating them, gives children the best nutritional foundation for life. "So many studies show that a rigid approach to nutrition leaves you in the end with children who are less able to make wise choices than with children who can choose appropriately for themselves." Foods that children do not like are foods they have not been offered. Food preferences are formed as early as two or three years, and parents who do not expose their youngsters to vegetables early in their lives should not be surprised if they balk at eating them later on. However, even later on, if healthful foods are available to young people, they are much more likely to eat them. Simply forbidding certain foods "may not be the best way to regulate their diets." Offering a variety of nutritious foods and allowing children to pick what and how much to eat within these choices is recommended. Children are capable of learning to like and accept a wide variety of foods. Generally, children tend to prefer foods that are familiar over those that are unfamiliar. New foods are not readily accepted. Many foods children initially reject "will ultimately be accepted if the child has ample opportunity to sample the food under favorable conditions." Too often children do not have repeated opportunities to eat new foods because parents mistakenly interpret the child's initial rejection of a new food as reflecting a fixed and persistent dislike for that food. Parents may become frustrated or anxious and resort to coercive feeding techniques. This can have negative effects on food acceptance. Total disregard for parent's wishes or dysfunctional eating can easily result. Persistence is needed; continue to offer new foods that are initially rejected by children. The child should have the chance to taste foods in an unpressured setting. Parents should set a clear expectation that children try new foods, but there should not be a parent-child power struggle.
For example, when foods are given to children in positive contexts - as rewards or accompanied with positive social interaction - preferences for these foods are enhanced. On the other hand, forcing children to eat "nutritious" foods to obtain rewards may have the opposite effect. Thus, "eat your vegetables and you can watch TV," will tend to reduce the child's liking for the food.
The constantly encountered availability of depleted nonfoods and the consistent association of nonfoods with positive social contexts (eating with friends, as treats, desserts, at a restaurant or the movies or shopping mall or other fun place, etc.) means that clinicians and parents need to teach young people well. The occasional "junk food" treat in certain situations may be allowed, but a consistent habit should not be allowed to develop. The psychological context of specific foods has a strong impact. If there is an occasion to celebrate, taking the kids to McDonald's teaches them to associate praise and feelings of accomplishment with nonfood. If there is a crisis, offering milk and cookies teaches children that food makes you feel better rather than talking the problem over with someone or otherwise expressing and dealing with emotions.
Even young children possess an innate ability to regulate food intake. Not only do they have a capacity to know how much to eat, but when they have a pleasant psychological and physical relationship with wholesome real foods, their innate ability to choose good foods will become fine tuned. Allow children to pick foods for meals (e.g., "what kind of fruit do you want with your lunch?") and let them help prepare meals. Children eat what they have peeled, chopped, grated, heated, or even grown and/or harvested. Get creative and get the kids to be creative; try recipes or original ideas. Dip it and call it a snack. Serve it on a cracker or on a stick. Tell them it must be eaten with the fingers, while standing up, outside, upstairs on a blanket. Make it a game - create a design or build a structure on the plate with sliced and diced foods. Teach young ones about nutrition through the study of other cultures, foods, and cooking. Make it fun. "Turn kids on to food, rather than off of nutrition." Provide a pleasant social and emotional environment for eating. Allow ample time. Eat the same foods with the children; sit and talk with them.
Eliminate empty calories from the diet and find nutritious substitutes. For example, avoid soft drinks but substitute with freshly made juice or real juice combined with sparkling mineral water. Control what is brought into the house. It is not fair to bring home Oreo cookies or Rocky Road ice cream and expect the kids will not eat them. Researchers have observed children who would not eat good, nutritious foods. They discovered the homes of these kids had lots of cookies and candy around; the children would ignore the food at the dinner table and seek out the sweets when nobody was watching them. Children who did not routinely have sweets and other "junk foods" at home generally ate what was served at dinner and enjoyed it. Structure meal times. Children whose families sit down to dinner together tend to eat more healthfully. Cut down on "mindless snacking." If a child is hungry between meals, have available and offer healthy, nutritious snacks like an apple or dried fruits with raw nuts or whole grain bread with organic cheese. Do not place emphasis on weight or appearance. Instead, praise children for eating healthfully and for being more physically active. In other words, teach the child to be healthy and then support the child's endeavors to be healthy.
The truth is almost all young people today are malnourished (starving). The numbers who are overweight, have eating disorders, or eat in dysfunctional ways are only a partial reflection of this fact. There is no single cause for such problems; they are complex issues. But real food nutrition - natural, wholesome, unaltered, foods and (if needed) whole-food supplements that are nutrient-dense are essential tools to activate the healing ability within the child and for shaping wellness for the rest of his/her life. Lifelong health for your child is the goal. An appropriate weight, a glowing appearance, and balanced eating habits are just some of the prizes along the way. vii
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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.