November 2011 Issue

Healthful Holiday Treats — Top 10 Strategies to Fight Childhood Obesity While Keeping the Season Festive
By Juliann Schaeffer
Today’s Dietitian
Vol. 13 No. 11 P. 22

Now that the month of November is here, the mounds of Halloween candy that children have stored in the pantry are probably starting to dwindle. But even though the candy is disappearing, Thanksgiving is just around the corner—a fun-filled day of family, friends, food, and lots of calorie-laden treats.

While the Thanksgiving holiday is a time for family gatherings and celebrations, it can be an especially tough time for overweight or obese children who’ve developed more healthful eating habits throughout the year and have begun to lose weight. For them, all it may take is a few extra plates of food and desserts, and they’ll pack on some—if not all—of the unwanted pounds they’ve worked so hard to lose.

As dietitians, you know full well about the rising rates of childhood obesity. According to the Robert Wood Johnson Foundation, more than 20 million U.S. children and teens are overweight or obese. In the past four decades, the prevalence of obesity has more than doubled among U.S. preschoolers and teens and tripled among children aged 6 to 11, according to the Institute of Medicine. In 2003 to 2004, 17.1% of children aged 2 to 19 were at or above the 95th percentile of BMI compared with 5% to 6% in the 1970s, and these percentages are higher in non-Hispanic blacks and Mexican Americans (20% and 19.2%, respectively) than in whites (16.3%).1

Needless to say, childhood obesity is an epidemic of astronomical proportions in this country, and while much is being done at the federal and state levels to end its scourge, there’s much parents can do at home to reverse the trend—despite the inherent obstacles of the holiday season.

According to Karin Testa, MS, RD, LDN, a pediatric dietitian at La Rabida Children’s Hospital in Chicago, an abundance of high-fat snacks and extra-large portions at holiday parties are two common pitfalls that can lead weight-conscious kids to gain back the pounds.

A third pitfall: Children are home from school, which disrupts their normal schedules and routines. “During the holidays, school day routines are replaced with more freedom and increased time for sedentary activities,” says Sasson Moulavi, MD, medical director of Children tend to sleep later, watch TV, and play video games for hours. “[Such disruptions] contribute to their lack of exercise and participation in organized sports activities,” he adds.

Lauren Cromer, MS, RD, LDN, an instructor at Middle Tennessee State University, says, “Children are no different from adults when it comes to overindulging during the holidays,” adding that unlike adults, most children don’t have the understanding of how choosing a sugar cookie over broccoli can lead to weight gain.

Nonetheless, a season that brings the joys of family gatherings and gift giving doesn’t have to be a smorgasbord of high-fat, sugary cakes, cookies, pies, and candy. Following are 10 proven strategies for helping overweight and obese children navigate the season with a smile—but without the extra pounds.

1. Use Healthful Substitutions
According to Barbara Crosby and Mindy Gorman of The Motivational Center in New York City, “Holidays don’t have to be an excuse to throw healthful eating habits out with the crumpled gift wrap.” Both suggest simple substitutions to keep nutrition goals in place while maintaining the traditions of holiday meals. They say children will never notice the absence of fat- and sugar-laden foods if presented in a positive manner. Their suggestions for modifying traditional holiday dishes include the following:

• Use either evaporated milk or chicken or vegetable broth as an alternative to cream in mashed potatoes.

• Substitute wild rice, kasha, or quinoa as a healthier whole grain stuffing.

• Use chopped nuts and dried fruit as stuffing extras.

Sharon Richter, MS, RD, CDN, a dietitian in New York City, suggests parents trade fat- and sodium-laden chips for whole grain varieties. She recommends Kashi TLC Pita Crisps or Food Should Taste Good Multigrain chips.

Many beverages are notorious for containing large amounts of sugar, so Testa advises that parents nix the punch and try a kid-friendly fruit spritzer that skimps on sugar but not flavor. “This is club soda with a dash—just enough to add some color—of 100% juice, such as pomegranate or grape, garnished with a cherry,” she says.

“Flavored soda water—lemon, lime, berry—is another way to get the fizz and flavor without the extra sugar,” Testa adds. “Skip the [egg] nog and drink skim milk instead. And using skim in place of whole or 2% milk to make the occasional hot chocolate will reduce the fat and calories as well.”

While cutting out sweets entirely can make anyone a little grumpy (kids included), Crosby and Gorman recommend simple ingredient substitutions to allow kids to partake in the sweetness of the season.

“When baking, use part whole grain flour, unrefined sugar, and quality ingredients,” they say. “Most kids associate holidays with desserts, so be sure to make a fun dessert with the children. Oatmeal nut cookies or meringues are fun cookies to bake with the children. They’re high in protein and low in sugar.”

2. Watch Those Portions
Because of the excitement surrounding the holidays, children’s eyes tend to be bigger than their bellies, “especially at family events when there’s food everywhere and everyone’s filling up their plates,” Testa says. Since children require fewer calories than adults, a typical meat portion for a child should be 1 to 2 oz, which is smaller than the 3-oz size recommended for adults.

Testa suggests parents keep portion sizes in check to ensure children don’t overindulge unnecessarily. “One strategy is to use smaller plates for the kids,” she says. “It’s also always a good idea to fill up half the plate with fruit and vegetables.”

For younger children, Testa recommends parents serve the appropriate portions—and steer clear of seconds and thirds. “One filled plate, usually accompanied by appetizers and dessert, should be plenty,” she says.

For holiday parties, she recommends a combination approach for all guests that involves using skim milk and half the butter for mashed potatoes and baking dishes instead of frying them, especially if the ingredients and cooking method aren’t essential to the dish.

“But using half the butter in your family’s secret pie crust recipe isn’t going to be the same. In these cases, portion control is key. You want to enjoy your food and your traditions, so don’t compromise on that. But know that you must be especially mindful of portions of the high-calorie foods and enjoy every bite,” she says.

3. Prep Meals With the Kids
Involving children of all ages in preparing a healthful meal takes the emphasis off calories and makes them feel “part of the celebration,” Crosby and Gorman say.

Depending on the children’s age, you can ask for their input when developing the menu, encourage them to be shoppers’ assistants at the grocery store, or ask them to help you cook and set the table.

Older kids can “set the table, clear the table, or play with younger children while the adults set up. These activities not only burn calories and help take the attention off of food, it also positions the child as a thoughtful, hard working person,” says Philadelphia-based dietitian and nutrition consultant Carol Meerschaert, MBA, RD.

Scott A. Becker, MD, pediatric functional medicine specialist at Sanctuary Medical Aesthetic Center in Boca Raton, Fla., agrees, noting that holiday meals are the perfect time to involve youngsters in the preparation of a meal. “It’s during that time we create priceless memories of what the holidays are all about: family,” he says.

While they’re occupied in the kitchen, Becker says this is also the perfect opportunity for a bit of nutrition education. “Children are notorious for their desire to jump at any opportunity to help, and a holiday meal is the perfect venue to begin these life-altering messages,” he adds. “This can be the chance to teach about calorie counting and staying away from the four Ws: white sugar, white flour, white salt, and white rice.”

Jackie Keller, founder of NutriFit, agrees that children love being Santa’s little kitchen helpers—and parents should love the lessons it teaches them.

“Helping in the kitchen teaches children important lifelong skills and techniques,” she says. “During your holiday meal preparations, let kids help out so they can learn how to measure, follow recipes, prepare food, and set the table. Giving them hands-on experience also allows them to become familiar with healthful ingredients that nature has to offer.”

Getting children involved with food preparation also can help prevent them from overindulging at holiday parties at school. “When classroom treats are requested for the holidays, a parent can foster excitement by encouraging the child to create a delicious dish of her own to share,” Becker says. “This also avoids issues of feeling different or having strange food they’re not comfortable with.”

While Cromer says many schools have policies in place to limit unhealthy snacks, she advises parents to inquire about any special parties that may be planned and then discuss them with their child.

“If an activity is planned where cupcakes and cookies will be served, involve your child in making a plan for healthful eating that day. Let them know how you would strategize, [saying,] ‘I would aim to have either two cookies or one cupcake vs. both,’ and then listen to the plan they suggest.” That way, children are much more likely to make healthful choices, since they were involved in the decision-making process, Cromer says.

4. Avoid Singling Out Children
If parents have a normal weight and an overweight child within the family, they shouldn’t single out one child over another.

“It’s never a good idea to single out an overweight child,” Testa says. “This can lead to insecurity, sneaking food, poor self-esteem, and even eating disorders. Healthy eating isn’t only important for overweight kids; it’s important for all kids and adults.”

Testa says allowing one child to eat a particular food while forbidding it to another is a recipe for disaster. “Talk to all the kids about having sensible portions,” she says.

According to Moulavi, parents should reward overweight children with “continued health and the avoidance of feeling ostracized and possibly bullied at school because of their size. Family support is crucial for an obese child, and he must never be treated differently because he looks differently.”

5. Get Parents Involved
Moulavi says getting parents involved in the nutritional and physical well-being of their children is absolutely crucial, as they’re the true gatekeepers of their children’s healthful (or unhealthful) habits.

“[Parents should] keep healthful foods and treats around and schedule holiday sports activities,” Moulavi says, adding that the “holidays are the perfect time for family and friends to plan fun outdoor activities as a form of exercise.”

In addition, parents should be active in their children’s school activities. Volunteering on party-planning committees, scheduling fun games that aren’t focused entirely on food, and providing healthier food choices are all great ways to get involved in school events.

“Remember, it’s still a party and understand you’ll also be dealing with parents that may not be as nutrition conscious as you. It’s one day and probably just for one hour,” Moulavi says. So if a child happens to eat a few more bites of cake than usual, advise parents to take it in stride and make up for it later instead of making a scene. “At home, simply balance it out with healthful food choices and fun physical activities,” he says.

Testa advises clients to speak with their child’s teacher about the foods that will be served at events. She recommends they volunteer to bring some healthful dishes so their child has more healthful options.

“With childhood obesity being such a huge concern, your child probably isn’t the only one with weight issues, and schools won’t be able to ignore this for much longer,” she says. “If the teacher isn’t receptive, talk to the PTA or school principal about starting some healthful initiatives at school and finding healthier ways to celebrate.”

Sarah Matheny, author of Peas and Thank You, has firsthand experience getting involved. She recommends her clients do the same to foster healthful habits not just for their child but classmates as well.

“I volunteer in my daughters’ classrooms, not to act as food police, but to make sure there’s a good option for all of the kids, not just mine,” she explains. “We’ve prepared nonconventional treats, like build-your-own trail mix or make-your-own fruit kabobs, and they’ve gone over really well with the kids and the grown-ups.”

6. Urge Parents to Become Role Models
Holidays that revolve around food can be challenging for any family, let alone those that have children with weight concerns. But to make healthful choices easier for children, Cromer says parents should ensure they’re acting as role models themselves.

“An effective strategy for preventing your child from overeating is to not overeat yourself,” she says. “When a child sees Mom or Dad eating an extra dinner roll or a second helping of pie, they may think it’s OK for them to do the same. By setting a good example, a parent can help a child learn how to avoid overindulging.”

Matheny says if everyone in a family is eating healthfully, it isn’t an issue. “No one in our family has a ‘special diet,’” she says. “We all eat delicious, nutritious food.”

Moulavi says if parents provide mostly healthful choices with limited holiday treats for all, then no one feels left out and deprived. “It’s the [parents’] responsibility to talk to [their] kids and educate them about their bodies and how their food choices may negatively affect their lives and, most importantly, set an example by following a healthful lifestyle. Kids will ultimately follow [their parents’] lead.”

7. Take the Focus off Food
While Cromer recognizes the importance of food at family celebrations, she also believes the holidays should be about more than just food. “Taking time to plan other activities for the family will help get everyone out of the kitchen and away from the leftovers,” she says.

Matheny says giving kids something nonfood related to look forward to can do wonders for children who may snack out of boredom if there’s sweets lying around and nothing else holding their attention. “Let them choose a holiday movie to watch after dinner or let them open one gift early. It’s not about bribery, but it’s about shifting the focus,” she says.

In addition to conversing around a game of cards or a board game, she says renting a karaoke machine or a Wii, or even volunteering at a soup kitchen or shelter, can make for a richer holiday gathering. “These experiences will make far more lasting memories than any batch of gravy,” she says.

Weather permitting, Cromer favors outdoor or other activities that get the whole family moving. “Activities that involve exercise could include a game of soccer, a walk through the neighborhood, ice skating, or even a family tournament of Dance Dance Revolution on the Wii,” Cromer says. “Other fun [activities] can include putting a puzzle together, or planning an arts and craft activity.”

Meerschaert says adding activities to any celebration can do the most to decrease the emphasis on food. “Thanksgiving is about being grateful for what you have, not just stuffing yourself,” she says. “Create the holiday celebrations with more than just food. Have the kids make paper chains to decorate the tree and the house. On Thanksgiving Day, play a football game, not just watch one on TV. Add a stroll to see the Christmas lights during your Christmas parties. Go caroling.”

8. Don’t Skip Meals
Parents often skip meals to save calories for the big Thanksgiving day feast, but Testa says this isn’t a good idea for them or their children because it can lead to overeating during the big meal. “Family parties and holiday dinners can easily interrupt a child’s typical schedule, so make sure they have something to eat at their regularly scheduled meal and snack times. “If you’re having a big family dinner during their usual afternoon snack time, change lunch to something lighter, but never skip it entirely,” she recommends.

Moulavi agrees: “What happens when we schedule a holiday meal—like Thanksgiving—is that we tend to do away with breakfast or lunch. That’s not OK for adults, so it’s really a problem for kids. Just because it’s Thanksgiving, you shouldn’t go without eating all day.”

9. Watch the Extras
Whipped cream and extra helpings of cake and ice cream are mainstays of holiday parties, but Testa says children are more vulnerable than most to these extra calories since they don’t require as many to begin with.

“Since young kids don’t need as many calories as adults, they don’t have as much room for extras like whipped cream, gravy, etc. And even 100 extra calories a day over their requirements can send them soaring off the growth chart,” she says.

“A good approach is to take out the extras when they aren’t necessary. For example, have the pie without the ice cream, the hot chocolate without the whipped cream; make the sweet potatoes without the marshmallows, and the green beans without the cream soup and onion strings,” she suggests.

Also, she tells parents of weight-conscious children, “Don’t add more butter to your already buttery biscuit, and try to steer clear of adding gravy all over your child’s plate—just one small ladleful should be plenty.”

10. Continue Healthful Eating Habits
Whether you have a toddler or a teen, Moulavi says parents should instill healthful eating practices throughout the year, not just during the holiday season. Having regular family meals, serving a variety of healthful foods and snacks, and not using food as a punishment, bribe, or reward are strategies he says should be used year-round.

“If your child or teen is obese, holiday time isn’t the time to blatantly start creating healthful eating habits,” he says. “There’s no great secret to healthful eating and that even applies during the holidays. If healthful eating, nutrition, and lifestyles are practiced throughout the year, holidays will be like any other time. Celebrations will be treated simply as a celebration and once it passes, it’s back to normal.”

— Juliann Schaeffer is an associate editor at Great Valley Publishing Company and a regular contributor to Today’s Dietitian.

1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549-1555.


Seventeen-year-old Reed Alexander, who portrays Nevel Papperman on Nickelodeon’s TV show iCarly, knows what kid-friendly foods look like. After adopting healthful eating habits for himself, he created an interactive website called to give other kids ideas on how to eat for health and taste.

Regarding holiday party treats that kids will love, he says, “The goal is to create a dish that’s delicious and fun for everyone, with the added consideration that it won’t derail me or the other guests.”

For parents looking to celebrate the holidays healthfully, you might want to suggest this kid-approved treat from Alexander:

Kewl Chocolate Fudge Brownie Cookies

Yields about 36 cookies

1 (11.5-oz) bag dark chocolate chips
1 cup raw sugar
3 egg whites (KewlTip: While store-bought, precracked, jarred egg whites are often amazing choices for a variety of recipes, it’s best to crack fresh, whole large eggs and use only the whites for these Kewl Chocolate Fudge Brownie Cookies.)
2 T canola oil
2 T organic nonfat plain yogurt
2 tsp vanilla extract
1/2 cup all-purpose flour
1/4 tsp baking powder
1 pinch sea salt

1. Preheat oven to 350˚F. Line two large baking sheets with parchment paper. Set aside.

2. Place a small quantity of water into a saucepan. Set a heatproof glass bowl over the pan in order to create a “double boiler,” ensuring that the surface of the water doesn’t come into contact with the bottom of the bowl. Place the chocolate chips into the bowl and set the double boiler on the stovetop on medium-low to medium heat. Bring the water to a gentle simmer and, stirring occasionally, heat the chocolate until completely melted and smooth, about 5 to 8 minutes. (KewlTip: A double boiler, such as this easy homemade version utilizing the heatproof glass bowl set over the saucepan containing the lightly simmering water, cooks the ingredients in the bowl gently without burning or scorching them. Thanks to this effective technique, the chocolate will melt, retaining optimum flavor and texture in the process.)

3. Meanwhile, in a large mixing bowl, combine the sugar, egg whites, oil, yogurt, and vanilla extract.

4. Once the chocolate in the double boiler has melted, carefully remove the bowl from the saucepan and pour the chocolate into the larger bowl containing the ingredients mixed in Step #3 (see above). Stir until thoroughly combined.

5. In a separate, smaller mixing bowl combine the dry ingredients—flour, baking powder, and salt.

6. Add the dry ingredients to the liquid combination of ingredients in the larger mixing bowl, and combine with a spatula or wooden spoon until completely smooth, being careful not to over mix.

7. Drop 36 individual rounded tablespoons of batter onto the prepared baking sheets, leaving about 11/2 inches of space in between each. Each tablespoon will yield one cookie.

8. Bake on center rack in the oven for approximately 10 to 12 minutes, or until cooked through but still tender in the center.

9. Remove from the oven and allow to cool on wire racks.
10. Serve and enjoy

Nutrient Analysis per serving
Calories: 85; Total fat: 4 g; Sat fat: 2 g; Trans fat: 0 g; Cholesterol: 1 mg; Sodium: 8 mg; Total carbohydrate: 12 g; Dietary fiber: 1 g; Sugar: 10 g; Protein: 1 g

Recipe courtesy of KewlBites


Stuffed Banana Smiles

Serves 1

During the holidays, invite pint-sized guests to prepare their own banana smile for a treat sure to rate high on the health and fun meter.

1 medium banana with peel on
1 T Sun-Maid Natural Raisins or Sun-Maid Golden Raisins
1 T semi-sweet milk or white chocolate chip baking pieces

Place banana, with peel on, flat on its side on a microwave-safe plate. Starting and ending 1/4-inch from the ends of the banana, cut a slit lengthwise through the banana up to the skin on the other side. Gently open the banana. Use your fingers to stuff the banana with raisins then add chocolate chips. Microwave banana uncovered on high for 40 to 60 seconds or until chocolate begins to melt and banana is still firm. Banana skin may darken slightly. Eat immediately, scooping with a spoon right out of the banana peel.

Nutrient Analysis per serving
Calories: 220; Protein: 2 g; Fat: 4.5 g; Sat fat: 2 g; Carbohydrate: 44 g; Dietary fiber: 6 g; Cholesterol: 0 mg; Sodium: 5 mg

Recipe courtesy of Sun-Maid