We’re constantly bombarded with information about the UAE’s child obesity epidemic, but advice on what to do if your child is underweight receives much less publicity. One mother with precisely this problem is Nivedita Ghosh*, who has a two-and-a-half-year-old daughter named Anandita* who weighs just 9.6kg. Despite Nivedita’s best efforts to help Anandita move beyond this weight, nothing seems to be working. Luckily, nutritionist Kathleen Farren is on hand to offer some advice.
Kathleen begins by carefully examining the answers Nivedita has given on her pre-appointment questionnaire. These include subjects such as her pregnancy (smooth – ‘And I was huge!’), Anandita’s birth weight (good – 3.39kg), any other issues to be aware of (eczema on the legs and prone to constipation) and, of course, what Anandita’s diet is like. The little lady herself snoozes throughout the entire appointment, occasionally emitting a contented gentle snore.
‘She normally has two handfuls of chocolate cornflakes with about 200ml of milk for breakfast,’ says Nivedita, ‘then we give her shop-bought chicken nuggets to take to nursery for a snack – purely because we know she likes them and will definitely eat them.’
Nivedita continues, ‘For lunch, I’ll give her rice with some pulses and mashed up steamed veggies, to help with her constipation. She then has a glass of milk at about 4.30pm and we have dinner at 7pm.’ Nivedita says that the family, who are originally from India, eat chapatti or roti, which are both made from wheat flour, with rice and some sort of meat – chicken, beef or lamb – and steamed vegetables. Other variations include rice-based dosas, lentil-packed dahl, and puri, which is made from wheat flour-based dough. ‘We do give her a lot of fried stuff, but it’s cooked in canola or cholesterol-free vegetable oil,’ Nivedita adds.
Kathleen nods approvingly, saying, ‘It sounds like overall Anandita has a fairly good diet.’ But one of her first questions is whether Anandita prefers the carbohydrate-rich elements of her meals – namely rice and potatoes – over protein, which is essential in encouraging growth. Nivedita says that she does, but that she tries to ensure Anandita eats all of her meal, not just the plain rice. Kathleen suggests that cutting out the mid-afternoon milk might mean that Anandita is keen to eat larger portions of the protein-rich elements of the meal, such as the chicken, fish and lentils.
In fact, says Kathleen, milk and carbs may well account for the constipation and eczema too, and thus the benefits of reducing them will be two-fold. ‘So she doesn’t need milk at all?’ asks Nivedita in surprise. Kathleen explains that, contrary to popular opinion, as long as kids are getting calcium from elsewhere – canned salmon and broccoli are particularly good sources – milk is actually not needed in children’s diets once they’re Anandita’s age, and it can be replaced with rice milk or soy milk (apparently the brand Silk produces a particularly tasty version).
Like so many children, Anandita is a big fan of junk food (Pringles and chocolate are particular favourites). Nivedita doesn’t think this is too problematic because it doesn’t affect Anandita’s weight. But, Kathleen points out, these types of food provide ‘empty calories’ (ie they’re low in nutritional value), and so giving Anandita healthy snacks like raw, unsalted nuts or chopped-up fruit would be better alternatives. Kathleen also suggests replacing Anandita’s regular chocolate-flavoured breakfast with oats.
‘But will that provide enough calories?’ enquires Nivedita. Kathleen explains that while oats are lower in fat and sugar, the nutrients they contain will more than compensate for the empty calories of chocolate cornflakes. Alternatively, Nivedita and her husband could knock up a batch of home-made muesli with nuts, fruit and yoghurt, or maybe an omelette.
Kathleen also suggests supplementing Anandita’s Omega-3 and acidophilus intake (the former is good for the brain; the latter is a pro-biotic which converts sugars to lactic acid). Nivedita is quick to state that Anandita will only take these in syrup form – no chewy tablets, thank you – and Kathleen acknowledges that children’s likes and dislikes mean that it’s important to adopt the softly-softly approach and make sure that you adapt their diets in a way that won’t be too much of a shock to them.
‘If all else fails,’ says Kathleen, ‘we can do a blood test for allergies, or our naturopath can do a needle-less skin test. But start implementing the changes, keeping a food diary as you go, and see how she is after two weeks. We’ll take things from there.’
To find out how Anandita gets on, buy next month’s issue of Time Out Kids, available from January 1.
Kathleen Farren is a qualified nutritionist at Synergy Integrated Medical Clinic (04 348 5452)
*Names have been changed to protect anonymity