胖小子與體重的戰爭

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1989 / 2月

文‧林麗雪 圖‧本刊攝影小組董氏基金會


「天氣漸漸冷了,我的食慾也一天天大增。媽媽為我準備的低脂高纖餅乾,那裡夠我解饞……。

這一兩星期,我又胖了半公斤;天啊!暑假裡的一番心血,眼看就要前功盡棄了。」

這是小胖子烏惟新的肺腑之言,也是小胖媽媽們的共同的煩惱。兒童正在成長,理當需要充分的營養,那么兒童減肥該與成人節食有何不同?要注意那些事?


去年暑假,台北市大直國小四年級學生烏惟新參加了一個很特別的「兒童營養夏令營」。其實,這是董氏基金會特別為「小胖子」設的「減肥班」。

烏惟新今年十歲,身高一百卅三公分,體重卻足有四十七公斤。外婆常笑呵呵地說,新新都比那些十七、八歲愛漂亮的大姐姐們還重;這也使得爸爸媽媽下定決心要送他上夏令營。

「我是不情不願的」,烏惟新回想第一天到基金會的情形說,因為他知道一定要做最討人厭的事——量體重。但是,小傢伙超過標準體重卅二公斤已有百分之五十七了,於是「光榮入伍」。

和「體重」的戰爭

讓烏惟新心甘情願參加減肥活動,是在作了抽血檢驗之後。

聽了檢查報告時,新新和媽媽同樣地又急又害怕。「他竟然有四十多歲中年人的毛病——膽固醇過高、肝功能異常的現象」,烏媽媽至今仍心有餘悸地說。

於是,烏惟新和其他的卅多位胖寶寶,在家人和基金會老師的支持下,開始了和「體重」的戰爭。

大胖憂心,小胖得寵

擔任營養指導的譚克麗也曾協助許多成人減肥,她表示,從參加減肥的成年人和兒童的問卷調查中,可以發現他們對於肥胖的態度各有不同。幾乎有百分之九十以上的「大」胖,非常在意別人說他胖;相反的,夏令營的胖寶寶卻有百分之九十四,根本不在意自己的體重和別人的觀感。「絕大多數的成人減肥是『自己』決定,而小孩子則是由『媽媽』下命令的」,譚克麗說。

譚克麗進一步分析,廿、卅歲以上的肥胖者,往往已親身體驗到肥胖所造成的心理壓迫,或對健康的威脅。例如他們可能結交不到異性朋友、在工作上遭到上司的另眼看待;或者是心臟病、高血壓等毛病已經出現;所以迫切地渴望享受瘦下來的好處。然而,大部分的小胖子一向頗得長輩的愛寵,在同學之間的人緣也不錯,再加上許多疾病的徵兆仍是潛伏著,未對生命造成直接的威脅。因此,他們覺得維持「現狀」並沒有什麼損失。

「小朋友減肥的動機和意願都不是很強烈」,營養夏令營主要負責人許惠玉強調說,兒童減肥的原動力是家人,必需要靠家長的耐心和恆心,才可能有效果。

「少吃」是要吃多少?

根據醫學研究發現,成人體重的增加,主要是脂肪組織重量的增加。但是,正在成長的兒童、青少年體重的增加,除了脂肪組織以外,還包括發育成肌肉的蛋白質和健全骨骼的礦物質的重量。

「所以兒童減肥,除了要注意到他們身體的基礎代謝、活動所需的熱量外,還要加上維繫生長發育所需的熱量,不可以一味地減少攝取熱量」,陽明醫院新陳代謝科醫師洪建德以他的減肥門診經驗表示,成人肥胖者是經得起「挨餓」的,如果每天限制熱量攝取量在五百卡左右,在一星期以內,並不會影響身體器官的正常機能。但是,如果讓孩子如法炮製,那麼他們體內的肌肉和蛋白質就會被消耗掉,影響到小孩的生長發育,而使得他們的身高增加速度緩慢下來。

那麼減肥中的孩子,一天到底要吃多少才恰當呢?

「煩惱的媽媽常常不自覺地,一天到晚叮嚀小胖,『這不能吃、那不能吃』」,許惠玉對求「瘦」心切的媽媽們建議是,給減肥中的孩子有選擇的機會,而不是強迫他們像成人那樣物物忌口,反而讓他變成一個不快樂的孩子。

譚克麗也表示,兒童減肥不代表孩子必需整天餓肚子,而是注意他們營養的均衡。比方說,果汁、汽水之類的碳水化合物吃進肚子後,最容易轉化為脂肪,要儘量節制;像青菜、魚肉等食物營養豐富、熱量低,應該多吃。

但是孩子們的嘴巴往往不聽話,這就得靠大人不斷地解釋、提醒了。

不餓肚子也能「瘦」?

董氏基金會營養夏令營的做法是,帶著小朋友到超級市場,去認識各式各樣的食物,讓他們知道那些食物可以放心地吃。即使嘴饞,也可以找吃來味道差不多的代替品。像牛奶,可以選擇脫脂奶,因為喝牛奶最重要的是要吸收鈣質;而一小盒的脫脂牛奶,鈣質完全和全脂奶相同,另外因為還少了十公克的脂肪,也就少了八十七卡的熱量。

大部分的小胖子都不喜歡吃青菜,營養老師就告訴他們,青菜裡有一種叫做「纖維素」的神奇東西,多吃青菜,纖維素就會排成一支很大的掃把,將小朋友身體媕Y不乾淨的雜物和多餘的脂肪,打掃得清潔溜溜。

有趣故事,往往能讓孩子不但印象深刻,也樂意去試。而對於他們的確必需節制的東西,也要用充足的理由,打消他的念頭。像胖寶寶最愛吃的漢堡,為了要好吃,速食店的叔叔就要用許多的牛油去煎肥肉比較多的牛肉,再夾上兩片充滿澱粉質的麵包,如果吃下去的話,得至少花三小時以上的運動來消化它。

祭出「運動」這個殺手煄A大多數的胖娃娃寧可在口慾上讓步。

不是我不肯運動

「不是我不喜歡運動,如果你們像我這樣胖,就會知道我為什麼喜歡斜躺著看電視、吃零食了」,這是他們的共同心聲。

小胖子不愛動,從醫學角度來看,其實是其情可憫。

洪建德醫師表示,胖寶寶的腹部脂肪厚而且向上鼓起,使得橫隔膜向上升,因而壓迫到心肺的正常功能,造成肺部換氣不足,血液循環自然不好;所以稍微動一下,就容易疲倦。

然而,運動偏就是減肥能否成功的重要關鍵;除了持之以恆,也要行之有道。

「劇烈而時間短的運動,只能消耗肝臟和肌肉中所貯存的肝醣;中度而時間較長的運動才能消耗體內的脂肪」,台大醫學院院長黃伯超建議想減肥的小朋友,每週至少應有三次以上廿至卅分鐘的運動,才能有效的控制體重。

「但是,超重百分之四十以上的小朋友,因為腳關節的負擔很重,所以不適宜做像短跑,拳擊等過於激烈的運動,以避免運動傷害」,他提醒說。

以烏惟新為例,去年在學校堙A他被分配在民俗體育組。「我胖胖的腿不靈活也不容易彎,所以我實在無法跳繩和踢鍵子;只好玩不用又跑又跳的扯鈴」,烏惟新說。但是烏家爸媽擔心兒子扯鈴的運動量仍嫌不夠大,所以又每天陪他穿上溜冰鞋,在家裡附近的小公園溜上一百圈。

許惠玉則建議父母不妨多陪陪孩子走路。搭公車的時候,可以在不定的站牌下車,一路走下來可以看不同的市景,既不會枯燥,也不像其它的運動,需要特別撥出時間和尋找場地。

一人減肥,全家受益

在三個月夏令營裡,減重四公斤的小學生李卓翰和在行政院大陸工作會報室工作的李媽媽,就從走路當中自得其樂。

「每天晚上,全家有一個固定走路時間,邊走邊聊天」,李媽媽「走」出心得地說,以卓翰近四十公斤的體重來說,每天以時速四、五公里的速度走路一小時,大約能消耗一百六十卡的熱量,一個月就消耗四千八百卡,一年計算下來,大概就能除掉七公斤的贅肉。

「小孩子覺得好玩的事物,永遠比運動身體來得多,而大人也往往因工作忙碌,任孩子一曝十寒」,洪建德醫師提醒小胖子和父母們要有恆心。

「其實孩子減肥,使我們全家都學習到健康的生活方式」,幫助兒子戴漢聲在夏令營裡減輕九公斤的戴媽媽心滿意足地說,兒子減肥,沒想到全家受益。

從參加夏令營開始,戴媽媽每天用圖表詳細記錄孩子吃下所有食物,然後就六大營養素檢查是否均衡攝取營養。

當了十多年的家庭「煮」婦之後,她終於知道如何為家人選擇熱量低而又營養高的食物;進了廚房以後,也改用蒸、煮、生食,而不用費時又耗油的煎炸烹調方式。戴家也儘量不外食,讓全家一起在餐桌上吃晚飯,飯後則盡可能一起散散步……,「結果中年發福的戴爸爸也瘦了將近十公斤」,戴媽媽得意萬分。

一定要成功

「天氣一天比一天冷了,我的胃口比夏天好很多。有時候我的嘴巴實在忍不住,趁著媽媽不在時,偷吃冰箱堛瑤旍奶」,烏惟新在歲暮寒天堙u苦戰」愛吃蟲說,「哎呀,在冬天裡,小胖子要減肥實在很辛苦。」

減輕體重,需要時間,也要有耐性,董氏基金會的叔叔阿姨鼓勵胖寶寶們:「縱使在寒冷的冬天堙A和『體重』的戰鬥,絕對不要用『試試看沒關係』這個字眼,而要用『一定要成功』這五個字。」

〔圖片說明〕

P.91

烏惟新喜孜孜地吃著外婆特別為他準備的「去油」青菜雞湯麵。(陳品君攝)

P.92

經由抽血檢驗,小胖子可以知道自己是否有膽固醇過高等潛在病因。(董事基金會提供)

P.92

董氏基金會營養夏令營的老師們帶著胖小子到超市認識各種食物,還教他們如何選擇營養高熱量低的食物。(董氏基金會提供)

P.93

除了節制飲食外,經常而持久的運動,也是減肥的不二法門。(董氏基金會提供)

P.94

可不可以先帶他們去減肥,再帶來拍照,否則畫面放不進去。

P.96

蔬菜水果不僅熱量低,還含有豐富的維生素和纖維素,胖小子應該多吃。(張良綱攝)

P.97

多利用學校體育課時間,「追趕跑跳碰」活動身體,又舒暢又快樂。(鄭元慶攝)

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EN

Children's Battle of the Bulge

Sophia Lin /photos courtesy of Sinorama and courtesy of Tung's Foundation /tr. by Phil Newell

"The weather's getting colder, and my appetite seems to grow daily. Mother prepares some low-fat high-fiber biscuits, but what good are these?"

"Heavens! I've put on another pound in the last week. All that effort in the summer, all for nought."

These are the heartfelt words of Wu Wei-hsin, an overweight child. These are also the concerns of mothers of overweight children. In growing up, kids need a lot of nutritious foods, so how is children's weight loss different from adult dieting? What should you look out for?


Last summer, Wu Wei-hsin, a fourth grader at the Tachih elementary school, took part in a special "children's nutrition summer camp." In fact, this was a lesson in losing weight arranged by the Tung's Foundation.

Tan Ko-lee, former lecturer in the Department of Health and Nutrition at the Taipei Medical College, says that survey data shows that adults and kids have different views about being fat. Over 90% of the "very overweight" adults said that they cared very much whether others said they were fat. But 94% of the kids at the camp said they didn't care at all about their weight or others' opinions. Says Ms. Tan, "For most adults the decision to lose weight is their own, but for most kids it's 'mother's orders.'"

Tan Ko-lee points out that most adults in their twenties or thirties have experienced the psychological pressures or threats to health of being obese: trouble making friends with the opposite sex, or problems of high blood pressure and so on. These create urgent desires to slim down. But most fat children are pampered at home, can get along OK with schoolmates, and their health problems are not yet life-threatening. They feel there is no loss in maintaining the status quo.

"The motivation and willingness of our little friends to lose weight is not strong," says Hsu Hui-yu, the main figure in charge of the nutrition camp. The original motivators--the family--must have patience and a long-term commitment, only then can weight loss be effective.

According to medical research, adult weight gain is due mostly to an increase in weight of fat cells. But for growing kids, weight increase also includes protein for muscle development and minerals for a healthy skeleton.

"Therefore, aside from paying attention to the calories required for basic sustenance, and those used up in activities, you must also add in the calories needed in growing, so you can't just reduce calories indiscriminately," says Hong Chien-teh of the Yang Ming Medical College. Based on his experience in the weight loss clinic, he notes that adults can tolerate periods of hunger. A reduction of 500 calories a day for a week is not likely to harm normal organ functions. But if you do the same with children, their muscle and protein will be expended, slowing their rate of growth and development.

So how much should the weight-conscious child eat daily?

Tan Ko-lee says that dieting doesn't mean a child has to go hungry all day; it means paying attention to balanced nutrition. For example, carbonated beverages easily turn to fat and should be limited; green vegetables and fish--low in calories and rich with nutrition--should be eaten more often.

But kids' mouths are not so easily tamed. Adults have to constantly explain and remind.

The method used at the nutrition camp is to take kids to a supermarket and teach them what can be eaten with no problem, and substitutes that taste almost the same, like low fat milk.

Most children don't especially like green veggies, so a nutrition teacher tells them the vegetables include a magic thing called "fiber," which sweeps all the unclean things and excess fat out of their system. Making things interesting not only leaves a deep impression, it even gets kids to try things quite happily.

And as for things that should be proscribed, they need a substantial reason to wipe out their preconceptions. For example, they may be told that it will take three hours of exercise to work off all that fat and starch in a hamburger. Bringing up the dreaded word "exercise" can make most chunky kids lose a little of their appetite.

Chubby kids think, "It's not that I don't like exercise, but if you were shaped like me, you can understand why I'd rather lay on the couch and eat."

There is a medical reason why exercise is so distasteful for the overweight. Dr. Hong explains that as the stomach bulges, it presses up the diaphragm, which interferes with the normal functioning of the heart and lungs. Air exchange in the lungs is inadequate, and circulation of blood poor. Even a little exercise can be exhausting.

Nevertheless, the biggest key is whether or not exercise works. "Intense exercise over a short time just consumes hepatine in the liver and muscles. Only moderate exercise over a relatively longer time can consume fat," notes Dr. Huang Po-chao, Dean of the National Taiwan University Medical College. Little friends wishing to lose weight must exercise for twenty or thirty minutes at least three times a week to control body weight. However, for those more than forty percent overweight, because the strain on foot joints is so severe, it is best not to do sprinting, boxing, or other intense exercise, in order to avoid injury.

Hsu Hui-yu suggests that there is no harm in parents accompanying the kids for strolls. When taking the bus, get off at a different stop than your destination and walk. You can see some different things in the city and get some exercise, all without setting aside a special time or place.

"Children can think of a lot of things more interesting than exercise. And adults are often so busy they let the kids avoid following through," notes Dr. Hong. "In fact," says the mother of Tai Han-sheng, who helped her son lose nine kilos at the summer camp, "when the child is on a diet, it makes everybody in the family learn about health and lifestyle." She never expected the whole family to benefit.

When her son began at the camp, Mrs. Tai recorded every day in detail everything he ate, making sure his diet was balanced. Having cooked for her family for more than ten years, she finally learned how to buy low-calorie, high-nutrition food, and to prepare it with much less fat frying. The family rarely ate out, but ate together and even went out for walks together after dinner. "As a result the middle-aged, 'prosperous' Mr. Tai lost nearly ten kilos," relates Mrs. Tai.

Wu Wei-hsin confesses. "The weather is colder every day, and my appetite gets bigger and bigger. Sometimes my mouth just won't wait, and I sneak into the fridge when Mom's not home." To lose weight requires patience and time. One of the nannies at the camp advises the kids, "Even in the cold of winter, when you are doing battle with your body weight, absolutely never use the phrase 'I'll just try it; it doesn't matter.' You must say, 'I will certainly succeed.'"

Could you put them on a diet before they have their picture taken?

Otherwise they won't all fit in!

[Picture]

[Picture Expalin]

Wu Wei-hsin going at some of his grandmother's specially made "fat remov er" --green vegetables and chicken noodle soup. (photo by P. J. Chen)

A simple blood test can tell an overweight child if he/she has too much cholesterol or other potential illnesses. (photo courtesy of Tung's Foundation)

Teachers from the Tung's Foundation Nutrition Summer Camp take their students to the supermarket to introduce all kinds of food, and teach them how to choose high-nutrition, low-calorie items. (photo courtesy of Tung's Foundation)

Aside from restricting edibles, frequent exercise is the only other way to drop excess poundage. (photo courtesy of Tung's Foundation)

Fruits and vegetables are not only low in calories, they are high in vitamins and fiber--highly recommended for the unpleasantly plump. (photo by Vincent Chang)

Using gym time at school for racing around is something kids can do comf ortably and happily. (photo by Arthur Cheng)

 

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