小胖的心事!

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1996 / 10月

文‧張瓊方



胖不是病,但是太胖卻會要人的命。在貧窮的年代,胖被視為富貴的象徵;而今,肥胖卻成了疾病的淵藪。

隨著經濟富裕、社會環境的改變,我們下一代的體重也跟著與日俱增,兒童肥胖症已成為一個值得關切的兒童文明疾病。

民國八怳@年,一項針對台北、高雄國小五年級的學童所做的調查,兒童肥胖盛行率高達百分之二怴C台北醫學院保健營養學研究所所長謝明哲指出,前項調查結果,受調兒童中體重過重(超過理想體重百分之怚H上、二怚H下)與肥胖(超過理想體重百分之二怚H上)共佔百分之五怴A而體重過輕的(低於理想體重百分之怚H上)也高達百分之二怳迭C換句話說,體位正常的兒童只有四分之一。

次年在雲林再作調查,發現鄉間的兒童也未必成長得好。結果顯示,兒童身高與體重的增加不成比例,身高增加得少、體重卻增加得多。換句話說,有些兒童是往橫的發展,也就是俗稱的「矮肥短」。

小時候胖不是胖?

俗話說:「小時候胖不是胖。」但其實胖小孩日後變成胖大人的機會很大。根據研究,七歲時肥胖的兒童,到二怳遠酗斯M肥胖的機率是一般兒童的三•七倍;怢鮈怳T歲肥胖的兒童,三抴X歲時仍然肥胖的機率是一般兒童的六•三倍。誰說小時候胖不是胖呢?

肥胖兒童雖不至於像肥胖大人一樣,立即產生糖尿病、高血壓、腦中風、冠狀動脈心臟病……等肥胖後遺症。但卻已為將來種下危因,將來這些兒童長大成人,不僅罹病率提高,患病年齡也會提早。

更何況,愛美是人的天性,過胖的孩子常會遭同學戲弄、譏笑、取綽號,也會影響孩子的人際關係與人格發展。

馬偕醫院小兒科醫師李燕晉指出,當孩子脂肪囤積超過脂肪細胞所能儲存的能力,體內脂肪細胞的數目就會增加,而脂肪細胞一旦發生增生的現象,數目就無法再減少。這也就是從小就胖的人,長大減肥不容易成功的原因。

預防容易減肥難

一般父母多不以為孩子過胖是病,有些人甚至有「小孩子就是要養得白白胖胖」的錯誤觀念。直到孩子體重超出標準體重百分之四、五怴A已經明顯太胖了,才帶到醫院求診。

但兒童除非胖到有生命危險,一般是不准給減肥藥,也不主張開刀的。兒童減肥只能用飲食控制、運動治療等自然方式。長庚醫院小兒內分泌科醫師趙婷指出,小孩子減肥和大人不同,因為孩子還在成長,必須要顧及他的營養,因此飲食控制要經過營養師根據孩子的年齡、體重、身高和運動量來精算。

一般而言,短期內的減肥效果通常不錯,但要做到維持體重卻不容易,特別是貪嘴的兒童。根據統計,百分之九怐漱H一年內體重就回升了。趙婷指出,除了少部份青春期的孩子懂得愛美較願意配合外,大部份小孩即使跑起來覺得喘、膝蓋覺得酸,都不覺得自己需要減肥。孩子自己沒有減肥的動機,加上其他家人沒有全力配合,成效自然就不彰了。

不患寡、患不均

羅馬不是一天造成的;肥胖也不是一日造成的。趙婷表示,多數肥胖兒童,一年只是比正常兒童胖兩三公斤而已,但日積月累下來就很可觀。李燕晉指出,也有少數肥胖兒童在一年內就胖抴X公斤。因此,肥胖問題要早日處理,不要等到太胖就不容易減肥了。

預防重於治療,兒童肥胖症也是一樣。避免兒童肥胖,父母平常就要注重孩子的飲食。

陽明醫院新陳代謝科主任醫師洪建德指出,我們的營養學教育並沒有跟上文明的腳步,導致飲食觀念普遍錯誤。太過強調蛋白質就是一個不合時宜的觀念。他指出,過去粗茶淡飯的時代,百分之九怳酊漱H缺乏蛋白質,導致營養不良、容易生病。但在大魚大肉的今天,過分強調蛋白質的結果,便容易導致肥胖。因為高蛋白的食物通常也是高脂肪的食物。

謝明哲認為,我國兒童之所以體位不佳,多是飲食不當導致的結果。「我們的兒童也許吃得很多、吃得很好,但是營養不均衡,」他指出,一般兒童的飲食型態普遍有許多缺失(見表一)。

此外,今天的孩子普遍熱中漢堡、薯條等速食,卻不喜歡吃白米飯;也有家長以為,孩子少吃飯可以減肥。洪建德與謝明哲都不約而同地強調米食的重要性。

謝明哲指出,米食是提供熱量、動力的來源,當一個人不吃米食,就沒有體力,懶得動。這樣一來,減少支出就更容易胖。他表示,用米飯提供熱量,可避免把修補組織的蛋白質當成熱量燃燒。如果蛋白質當熱量燃燒,會影響蛋白質製造抗體的功能,小孩子就容易生病。

洪建德也指出,油脂要靠醣類來催化它代謝,否則會產生酮中毒的現象。因此,減肥不是不吃飯,相反的是要養成以五穀類為主食、吃飯配菜的習慣。

只要健康不要胖

總而言之,均衡的飲食是避免肥胖、保持健康的不二法門。近年營養專家們提出一種「健康金字塔」理論(見表二),頗值得參考。

只要遵照「健康金字塔」的原則,提供孩子均衡的營養,要拒絕肥胖並非難事。然而,忙碌的現代父母,能否抽出時間為孩子們打理三餐?滿街生意興隆的速食店、「吃到撐」餐廳,問題的答案已經昭然若揭。

p.19

社會富裕後,營養不良的孩子少了,但營養過剩、飲食不均衡卻又帶來其他的健康問題。(邱瑞金攝)

p.20

(附表一)

一般兒童的飲食缺失:

一,吃太多動物性蛋白質、動物性脂肪。

二,吃太多薯條、炸雞等油炸食物。

三,甜品、加糖飲料喝太多,奶品喝太少。

四,攝取太多膽固醇食品,如:海產類、內臟類食品。

(附表二)

健康金字塔:

油、鹽、糖(少吃)

肉、魚、豆、蛋、奶(足量但不過量)

菜、水果(多吃)

五穀(主食)

李淑玲繪圖

相關文章

近期文章

EN

The Trouble with Fatty

Chang Chiung-fang /tr. by Jonathan Barnard


Being fat isn't a disease, but being too fat can kill you. In the age of scarcity, plumpness symbolized good fortune, but today it has come to be seen as a source of ill health.

Along with affluence and social change, the younger generation is getting fatter all the time, and child obesity has become a problem deserving of our attention.

In 1992 a survey of fifth graders in Taipei and Kaohsiung revealed that 20% of them were fat. Clark Hsieh, the dean of the School of Nutrition and Health Science at Taipei Medical College, notes that the survey discovered that 50% of all students were either overweight (10-20% over ideal weight) or fat (20% or more overweight), and another 25% were underweight (more than 10% under ideal weight). In other words, only one in four children was within 10% of ideal weight.

The next year a survey was carried out in Yunlin County which discovered that children in the countryside weren't necessarily growing up healthy either. The survey results showed lopsided gains in weight over height. Instead of growing up, these children were growing sideways and were aptly described by the phrase "short, fat and stubby."

Baby fat doesn't count?

There's a Chinese expression that "baby fat doesn't count as fat." But the odds are great that fat kids will end up as fat adults. According to research, children who are fat as seven-year-olds are 3.7 times more likely to be fat 26-year-olds, and children who are fat at the age of 10-13 are 6.3 times more likely to be fat 30-year-olds. Who said baby fat doesn't count?

True, fat kids probably won't immediately suffer from fat grown-up diseases like diabetes, high blood pressure, strokes and coronaries. But being overweight as a child does raise the chance of future illness: Not only will more fat children suffer from these diseases later in life, but they will suffer from them earlier.

And it's only natural for people to want to look good. Fat kids often acquire nasty nicknames and become the butt of their classmates' jokes. All this will affect their personalities and how they relate to others.

Li Yen-chin, a pediatrician at Mackay Memorial Hospital, points out that once a child's fat greatly exceeds the storage abilities of his existing fat cells, the number of those cells grows, never to decline. This is why fat kids tend to be unsuccessful dieters as adults.

Prevention is easy, dieting hard

Most parents don't think that being fat is an illness, and some people cling to the misconception that "children are best white and fat," only bringing their children in for treatment when they exceed their ideal weight by 40-50%.

But unless children are so fat that their lives are endangered, most doctors won't give them diet pills and don't recommend surgery. If children are to lose weight they must use the natural methods of exercise and dieting. Chao Ting points out that children, unlike adults on a diet, are still growing, and so they must get proper nutrition. Hence, controls over their food consumption must be carefully calculated by a dietician. She says that 1200-1500 calories of diet fare is usually ideal.

Generally speaking, the short-term results of dieting are usually good, but keeping the pounds off is difficult, especially for gluttonous kids. Ninety percent of dieters gain back all their weight within a year. Chao Ting points out that besides a few teenagers who are really concerned about their looks and willing to work at it, most children-even if they have sore knees from the strain of carrying all that weight and gasp for air when running-aren't self-motivated dieters. When other family members don't make a serious effort to help, it's only natural that the kids' efforts fail.

Balance, not quantity

The rotundas of Rome weren't built in a day, and neither are rotund bellies. Chao Ting says that most overweight kids gain only two or three kilos a year, but they add up. Li Yen-Chin notes that only a few fat kids gain more than 10 kilos a year. The earlier the problem is dealt with the better. When a child gets too fat, losing weight becomes very difficult.

The old adage that prevention is the best cure certainly applies to child obesity. To prevent it, parents need to pay attention to what their children eat.

Hung Chien-te, head of the Department of Metabolism and the Diabetes Center at Taipei Municipal Yang-Ming Hospital, argues that nutrition education hasn't kept pace with modernization, resulting in common misconceptions about nutrition. Back in the days when food was scarce, 95% of people lacked adequate protein, which led to malnutrition and greater susceptibility to disease. But now protein has been overemphasized, and diets are loaded with meat and sea food. This makes becoming fat easy, because most high protein foods are also high fat foods (typically for every 1% of protein in food, there is 3% fat).

Clark Hsieh holds that the children of Taiwan are in poor physical shape because of their poorly rounded diets. "Our children may eat a lot and may eat healthy food, but they don't get balanced nutrition." He says that there are problems with most children's diets. (See Chart I)

Children love fast food like hamburgers and fries and often don't like white rice, so some parents think that children can lose weight by cutting the rice out of their diets. But both Hung Chien-te and Clark Hsieh stress the importance of grains.

Hsieh points out that grains are the body's source of calories and energy. When a person doesn't eat grains, he becomes lethargic, making it even easier to gain weight. By using grains to provide calories, you prevent the need to burn protein as fuel. The problem with burning protein as fuel is that it hampers the process of turning protein into anti-bodies and so makes it easier to get sick.

Hung Chien-te points out that fat needs carbohydrates to be metabolized or will cause ketoacidosis. Hence, don't cut out rice when dieting. Grains should be the staples of a diet, supplemented by other foods.

Healthy, not fat

Generally speaking, a balanced diet is the only way to prevent obesity and maintain good health. Today's nutrition experts have designed a health pyramid (see Chart II), which serves as a good reference.

By providing children nutrition based on the principles outlined in the health pyramid, it's not hard to keep them fit. But can the busy parents of today take time out to prepare three meals for their children? When the streets are full of fast-food franchises and "all-you-can-eat" restaurants, the answer to that question is obvious.

p.19

With social affluence, few children don't get enough nutrition, but overeating and unbalanced diets are causing other health problems. (photo by Diago Chiu)

p.20

Chart I: What's wrong with children's diets

They eat too much protein and fat from animal sources.

They eat too much oily food, such as fried chicken and french fries.

They eat too many sweets and sugar-sweetened drinks and too few dairy products.

They eat too much high-cholesterol food.

Chart II: The Pyramid of Health

Oils, Salt, Sugar

(Eat little of these)

Meat, Fish, Legumes, Eggs, Milk (Get enough of them but not

too much)

Vegetables, Fruit (Eat a lot of these)

Grains (Staples of

a diet)

(Drawn by Lee Su-ling)

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