白胖小子有福相?

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1989 / 2月

文‧林麗雪 圖‧陳品君


在國人「白胖小子有福相」的傳統觀念影響之下,孩子當然是養得愈胖愈好。

數年前,由國內一家嬰兒奶粉公司贊助的「健康寶寶」比賽,被醫學界比喻成「論斤行賞」大會——那位可人兒的噸位最重,就最有可能奪魁。

曾幾何時,奶粉公司的廣告卻紛紛強調,他們的配方絕不會養出過胖的寶寶。

是什麼改變了消費者的觀念?小兒白胖真是福嗎?


林玫延和一般八歲的小女孩沒兩樣,她愛吃奶油蛋糕而不吃全麥麵包;喜歡喝可樂而不喝脫脂牛奶;最高興一面看卡通影片「莎拉公主」,一面吃巧克力。

不過,自從她在去年一年間,體重暴增十二公斤、如今已達卅五公斤以後,她這許多快樂的嗜好,都成了別人嘮叨的煩惱事。

在學校同學喊她「小胖」,在家堸韞S弟姐妹叫她「小肥豬」,而且還警告她:假如繼續胖下去,將來一定「嫁不出去」。「真傷腦筋」,林玫延嘟著小嘴憂心地說。

從「排骨梅」到「小胖妹」

看著女兒小小年紀就要為「是否節食」煩惱,林媽媽好生為難。從小,林媽媽自己是在別人「排骨梅」的綽號中長大。縱使已生過三個孩子,如今她的體重不過比八歲的女兒多九公斤而已!她還記得娘家的左鄰右坊最愛跟母親開玩笑:「李太太,你好吃的東西都藏起來自己吃嗎?否則怎麼會養了一窩『皮連骨』的孩子呢?」

現在輪到了自己生養兒女,也不過短短的廿餘年,「育兒經」似乎已被全面推翻,而再重新定過了。

「以前母親用盡心力也補不肥我們姊弟四人;而現在我是達成她的心願,終於替她養了一個白白胖胖的外孫女。但是,為什麼我仍有一番說不出的自卑感呢?」這位年輕媽媽無可奈何地解釋,在親友聚會場合中,女兒圓滾滾的身材,無可避免地成為小焦點,「好像我根本不懂如何養小孩,所以許多人都會提供善意警告和減肥秘方」,她說。

近年來,愈來愈多的年輕媽媽有著和林太太同樣煩惱。

傍晚時分,如果你站在國內最大的一所國民小學——台北縣永和市秀朗國小校門口,看著像沙丁魚般的學童邁向回家的路上,其中就不乏兩頰圓滾滾、小手胖嘟嘟的可人兒。已經在這所小學任教達十三年的輔導室主任劉遼萍提出她多年觀察:「十年前,一班有一、兩個小胖就很令人矚目,現在有七、八位還是見怪不怪。」

胖小子愈來愈多

而醫學界的調查也吻合這樣的觀察。

五年前,台灣大學醫學院院長黃伯超對台灣地區二千多名八歲至十五歲的學生作營養和體位調查時發現,超過標準體重百分之廿的八歲學童佔百分之八,而肥胖情形最嚴重的是十二歲,發生率佔百分之十五。

三年前,黃伯超教授再度研究台北市八百多名中小學生體位,結果發現小學生肥胖的情形更嚴重,在這群都市兒童中,超重百分之廿以上的有百分之十至十八;而超重百分之十至廿,也就是輕微超重更多,佔有百分之廿至廿九。

黃伯超院長指出,人類肥胖的原因不外三種:一是遺傳體質的關係;二是環境,其中包括飲食攝取的形態、生活空間的安排等;三是年齡的因素,嬰兒期和青春期是被醫學界以為引起肥胖的轉機年齡。

如果照一般人的說法,兒童過胖的原因,則簡單歸於現在的孩子「命太好了」。

民國六十年以後出生的孩子,成長的環境大不同於廿年前他們的父母親。物質環境是前所未有的豐裕,父母將自己那個時代因物質缺乏而無法實現的願望與享受,迫不及待地供應給他們的下一代。

和老祖宗的經驗不一樣,現代年輕父母在育兒的過程當中,受到太多商業廣告的影響。而這些廣告的背後,或許多少隱藏有「我們都是這樣長胖」的原因。

以一對年輕夫婦選擇如何哺育新生兒為例,從媽媽懷孕開始,他們每天在電視上接受不同廠牌的奶粉廣告。牌子雖然不同,但是推銷的重點都是以白皙可愛、胖胖柔柔的嬰兒為主,美妙的畫面告訴即將為人父母者:「只要吃這種奶粉,就能像我這樣。」多少父母不會為之心動呢?

根據台大醫院小兒科的一項研究報告顯示,目前台灣地區的媽媽純粹以母乳餵育幼兒的比率不及百分之三,而這樣的數字遠不及美、日兩國的百分之五十左右。

牛奶不宜過量

「牛奶本來就是牛媽媽替牛寶寶特別預備的」,台大醫院小兒科醫師陳炯霖比喻,許多醫學研究證實,吃母乳的孩子學習能力較優;如果以六大營養素的含量來比較,母奶的蛋白質、鈣等含量優於牛奶;脂肪數卻遠低於牛奶,幼兒吃了較結實而不是虛胖。

另方面,母奶每天約有八百西西的產量,已經足夠四個月以內嬰兒的需求。但是,年輕媽媽為了工作或維持體態等因素,捨母乳而就牛奶。再加上孩子多半請保母或外婆奶奶幫忙照顧,於是嬰兒在人為因素中更可能吃了太多牛奶。

一位住在內湖的中年保母說出她替人照顧孩子的難為處:孩子是人家的命根子,除了要盡心不要讓他生病以外;你是否賣力、真心照顧疼愛他,孩子的公婆爹娘所能看得到的就是他胖了,還是瘦。

「胖當然是比瘦好囉」,這位已照顧過不下十位嬰兒的婦人笑瞇瞇地說,所以奶粉罐上說是一次一百廿西西、一天餵六次,我就用盡方法,希望孩子一天能喝七次的一百卅西西牛奶。

其實,這位教育程度不高的保母是衷心希望,能養出一個體格強健的孩子。但是,她在不知不覺間育成了一位小胖子。

一項有關於兒童肥胖的研究指出,如果在嬰兒時期喝奶過量造成肥胖,使得脂肪細胞數目增生,長大以後想要減肥,就很難成功了。「孩子的胃是『橡皮囊』,不要過分撐大它」,黃伯超教授警告說。

都是零食惹的禍

陽明醫院新陳代謝科主任洪建德在一千多個減肥門診案例中,約有六十餘例是兒童。「家有肥胖兒,媽媽要負最大的責任」,他指出,在接觸過的小胖子病人中,絕大部分的母親都是受過高等教育的職業婦女,這些媽媽經濟情況好,但是營養觀念不正確,於是經常買回一些沒有太多營養素的高卡洛里食物,像汽水、洋芋片、可樂等。

有的母親甚至在一種對兒女的補償心理之下進行購物。在一家貿易公司工作的烏太太覺得,自己實在是太忙了。「愛孩子的表現方式之一,就是帶一盒巧克力、餅干送給孩子」,她說,這些東西都是自己小時候的夢想。

不少食品營養學家也認為西方速食引進寶島,不但改變國內兒童、青少年的飲食習慣,也是造成兒童肥胖的原因之一。

西式速食改變體質?

台北醫學院前營養保健系講師譚克麗表示,當西式速食以清潔、品質、衛生、服務等新觀念,進軍國內飲食市場時,許多營養學家在推薦它的管理方式與高效率時,反而忽略了它的營養品質。

一般說,西方速食以含有澱粉、牛肉、脂肪的漢堡為主,而配食通常是可樂、奶昔、薯條等。「這些都是維持苗條身材的大敵,這種飲食方式最嚴重的缺點,是缺乏高纖維的綠色蔬菜」,譚克麗說。

在董氏基金會一項對過重兒童飲食習慣問卷調查結果也發現,這些胖寶寶對「吃」的共同點是:晚餐吃得最多,而且是一面看電視一面吃;最喜歡到西式速食店,都愛喝汽水、可樂、奶昔、吃漢堡;最討厭吃米飯、青菜、豆腐、魚類等。

「長期這樣下去,西方速食高脂肪、高熱量的飲食方式,會改變我們下一代的體質」,洪建德醫師憂心忡忡地說,孩子的父母要注意了。

從行政院衛生署的台灣地區膳食營養狀況調查中,也可以發現近廿年來,住在都市地區的國人,油脂攝取量佔總熱量的百分之卅以上,與我國飲食指標建議的百分之廿至卅,已經有超出的情形。

吃的太好,動的太少

「多吃」已經成為我們生活中很難避免的事實。因此,國小學童的皮下脂肪厚度超過標準的,也由民國四十三年的完全沒有,增至五十九年的百分之二,如今是早已超過百分之十了。

很顯然,嬰兒吃得太多、兒童吃得太好,是造成目前兒童肥胖的主要「元凶」;飽食之後,「動得太少」也不無推波助瀾之嫌。

年過卅的人回憶兒時情景,應是記憶猶新——蹣跚學步是在偌大的庭院或車輛稀落的馬路上;步行半小時上學校很是稀鬆平常。放學回家以後,屋外的天地廣闊得很,打彈珠、跳房子、捉青蛙、捕麻雀,非得媽媽拿著棍子,邊追邊打不進家門;肚子餓時,沒有冰箱、沒有銅板,最好的方法是走了好遠的路,去烤張家的甘薯、摘李家的芭樂……。這樣的孩子能「胖」到那堨h呢?

如今,呱呱落地就在「高處不勝寒」的大廈;學步是在傢具滿滿的鴿子房;上下學娃娃車接送、擠得伸手抬腿的地方也沒有。傍晚時刻,爸爸媽媽還在公司忙,最近綁匪叔叔多,小公園也別去逛,所以還是一面看電視、打電動玩具,一面吃零食比較安全;加上才藝班趕場:鋼琴、心算、英文加作文……;這樣的孩子生活節奏緊,活像是一些「小小上班族」;吃下去的食物,全無消耗之處,焉能不胖?

小時胖胖,大未必肥?

過去,在國人「白胖小子有福相」的傳統觀念影響下,兒童肥胖似乎不但不成問題,還逗得老一輩眉開眼笑。

然而,隨著醫學界不斷地研究「不同程度超重與成人死亡率」發現,肥胖若不及早防範、治療,很可能為日後種下心臟血管疾病、糖尿病、高血壓、中風等禍根;而這些疾病一直是名列中國人十大死亡病因當中。因此白胖並不是福氣,而是對人體健康的警示器。

問題是,胖嘟嘟的小孩子,在長大以後會不會「恢復正常」?黃伯超教授指出,因為國內缺乏長期追蹤嬰兒期至成年人體位的研究,所以並沒有實際的科學數據來解開這謎題。不過歐美、日本的研究結果,或許可以透露其中的玄機,「如果在兒童期超過標準體重百分之廿以上,至少有百分之六十以上的人,在成年時仍會是個胖子」,黃伯超教授說,這樣的統計結果值得家有小胖的父母注意。

在醫學界不斷對肥胖者提出各種警告的今天,老一輩「白胖才是福」的觀念顯然該修正了。

〔圖片說明〕

P.85

圓滾滾的小胖腿多麼惹人憐愛!(張良綱攝)

P.86

職業婦女的比例日益增加,爺爺奶奶照顧養育第三代的情形也就多了。(本刊資料圖片)

P.87

根據醫學研究顯示,吃母乳的孩子較不會癡肥;而且母奶一天八百西西的產量,已足夠四個月內嬰兒的生長發育需要。

P.88

除了環境飲食之外,遺傳也是造成肥胖的主要原因。

P.89

由於生長環境的差異,鄉下多的是田野,水圳,讓孩子奔跑游水,而城市的休閒活動大多為靜態,這也難怪都市肥胖兒比率高於鄉村了。(上圖本刊資料圖片)

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近期文章

EN

Chubby Children: The Look of Fortune?

Sophia Lin /photos courtesy of Vincent Chang /tr. by Phil Newell

Five years ago, in a nutrition and fitness survey of more than 2,000 eight- to fifteen-year-olds on Taiwan, Huang Po-chao, Dean of the College of Medicine at National Taiwan University, discovered that eight percent of eight-year-olds exceeded their standard body weight by 20 percent. The most serious problems were among twelve-year-olds, where 15 percent had the same problem.


Three years ago, Dr. Huang did a study of 800 middle and primary school students in Taipei, and discovered the percentage of overweight kids nearly double the previous survey. Between ten and eighteen percent of the different age groups were 20 percent over the standard, while between 20 and 29 percent were 10 to 20 percent overweight.

"If you want to explore the problem of obesity, then you should start research before puberty, or even in the period of early childhood," Dr. Huang advises, noting three basic causes of obesity: One is related to one's genetically determined constitution; the second is environment, including the pattern of food consumption, arrangement of living space, and so on; and the third is age, with infancy and puberty considered by the medical profession as the decisive ages.

Today, many believe that the reason for most of the overweight children is that "life is too good."

The environment of those born after 1970 differs radically from that of their mothers and fathers twenty years ago. The material environment is prosperous to an unprece-dented degree. Parents are now rushing to give to their children what they could not afford to enjoy.

And today's parents are greatly affected by advertising in the process of child-rearing. And within these advertisements may be concealed one of the reasons why this generation "grows out" together.

Take the case of a young couple deciding how they should feed their baby. From the start of the pregnancy, the couple is exposed to ads for powdered milk, with one thing in common: they all use a cute, soft, very plump infant, which seems to say, "Just use this kind of powdered milk and you can be like me!" What parents can resist?

According to a study done at the Pediatrics Department of the National Taiwan University Hospital, fewer than three percent of babies in the Taiwan area are purely breast fed, far from the near fifty percent in both the U.S. and Japan. Ordinarily 800 cc of mother's milk is produced daily, enough to fulfill the needs of children under four months old. But many younger mothers--to get to work or maintain their figures--use powdered milk instead. And with baby-sitters and grandmothers taking care of most children, the possibility to drink too much milk is even greater.

One middle-aged baby-sitter from Neihu explained her difficulty: Children are the future of the family. Besides illness, the only way the parents can tell if you are lovingly caring for the child is whether the child is fat or thin. "Naturally fat is better," laughs this woman, who has taken care of at least ten infants. The powdered milk directions call for 120 cc six times a day, so to be on the safe side she gives the infant 130 cc seven times a day.

One study of child obesity points out that the excessive drinking of milk in infancy can cause the number of fat cells to increase, making losing weight after growing up extremely difficult. "A child's stomach is like a rubber band, you don't want to stretch it too much," warns Professor Huang.

The Chairman of the Metabolism Clinic at National Yang Ming Medical College, Hong Chien-teh, says that more than 6O of his 1,000-plus weight loss cases have been children. "If the child is obese, then the mother must take most of the blame." He says most of the mothers of the overweight child patients he has come in contact with are highly educated career women. Their economic situation is good, but their views on nutrition are incorrect, so they often bring home junk food like soda and potato chips.

Some mothers even see this as a kind of compensation. Mrs. Wu, who works in a trading company, feels that she is so busy, and "one way to express my love for the children is to bring them a box of chocolate or cookies." She adds that these things were the stuff dreams were made of when she was a child.

Not a few food and nutrition experts believe that the entrance into Taiwan of the Western fast food industry has not only changed the eating habits of young people, it is also one of the reasons for childhood obesity.

Tan Ko-lee, a former lecturer in the Health and Nutrition Department of the Taipei Medical College points out that when Western fast food arrived with its concepts of cleanliness, hygiene, quality, and service, many nutrition specialists praised the quality of management and efficiency. But they omitted its nutritional quality. Burgers, shakes, and fries "are the enemies of a slender body, and the most serious shortcoming of this type of food is that it lacks high-fiber green vegetables," says Tan.

Eating more is already a fact. Because of this, the percentage of primary school students whose fat exceeded the standard depth has risen from zero in 1954 to two in 1970 to over ten today. But besides eating too much, exercising too little is also a prime suspect.

People over thirty have vivid memories of childhood: half-hour walks to school ware the norm; after school came marbles, hopscotch, or catching frogs in the great outdoors. Mother had to chase you with a stick to make you go in the house. If you were hungry there was no fridge and no money. The only recourse was to walk a long time to indulge in a yam or a guava lifted from a distant farm. How are kids like these supposed to get fat?

Today's kids get to school and come home by vehicle. In the evening parents are still at work; its safer to stay at home snacking and playing video games than to go to the park alone. This kind of lifestyle is hectic, and there's no place to expend all those calories.

In the Chinese tradition "a fat child has the look of wealth." Obesity is not a vice, it is a virtue! But medical studies show that if obesity is not stopped early, it can increase the risk of heart disease, arteriosclerosis, diabetes, high blood pressure, stroke, and other major killers of Chinese.

The key is whether or not the fat child will be a fat adult. Dr. Huang says no studies have been done in the ROC from childhood to adulthood, so no scientifically based conclusions can be drawn. From studies abroad, however, we know that over 60 percent of children 20 percent or more overweight grow up to be overweight adults.

Given the evidence, perhaps it is time for Chinese to change the traditionai equation of fat with fortune.

[Picture Caption]

How people love babies' fat little legs! (photo by Vincent Chang)

With the rapid increase in working mothers, there are also more cases of grandma and grandpa raising the third generation. (Sinorama file photo)

According to medical studies, children breast fed on mother's milk are less likely to get fat; moreover the daily 800 cc. provided by the mother are enough to meet the needs of infants under four months.

Besides environment and food, genetics are also a major factor in obesity.

Environment matters. The countryside is open space, with room to run. Urban activities are by necessity mostly passive. No wonder a higher ratio of urban kids than rural kids become obese. (Sinorama file photo)

 

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