Weight is one of the most personal things people carry and one of the hardest topics to talk about, especially for kids growing up and still learning who they are. When weight gain or fluctuations are out of one’s control, it can also become overwhelming and cause feelings of hopelessness. In those times, often the best action to take is to seek medical support. 

That’s exactly what Leslie Tewell did for her now 15-year-old son, Blain Tewell. Seeing Amani Terrell, M.D., Board Certified Pediatrician and Obesity Medicine Specialist with Cook Children’s Pediatrics Keller Parkway changed Blain’s life.

Obesity Medicine Care at Cook Children's - Keller Parkway

After 12 years of helping patients at Cook Children’s Pediatrics Keller Parkway, Dr. Terrell’s recent transition into obesity medicine felt natural. Year after year during routine checkups, she noticed children struggle with their weight and knew that many providers lacked the tools to truly help them. Too often, the advice was “exercise and eat healthy” and she wanted to do more. Now board-certified by the American Board of Obesity Medicine, she brings specialized expertise to every patient she sees.

“The sad reality is that 1 of every 4 children in North Texas has an obesity diagnosis,” Dr. Terrell said. “And most people don’t realize that obesity is a biological response.”

This perspective helps her patients understand their weight challenges go far beyond diet choices. Blain has been seeing Dr. Terrell for more than 10 years now and appreciates her thoughtful approach, not just focusing on one aspect of his health.

“Dr. Terrell’s consistency has been the most helpful and the way she takes time to understand me as a whole person,” Blain said.

Learning Throughout the Weight Loss Journey

Blain and Leslie have learned that weight loss takes time and that it’s important to focus on Blain’s well-being and health, not just numbers.

“I’ve learned more about making balanced choices and listening to my body,” Blain said. “My mom and I both learned the importance of patience and the encouragement I’ve needed along the way.”

Dr. Terrell has also helped Blain build his confidence and self-awareness.

“Blain is a very sweet young man,” Dr. Terrell said. “Awareness is important and with his biology and family history of health challenges, he’s at a higher risk for heart disease and type 2 diabetes. He’s now maintaining healthy lifestyle habits, and he feels a lot better and is happier with his progress.”

Paying attention to his nutrition, exercising, and learning about medication options including GLP-1 (Glucagon-Like Peptide-1) have also helped Blain.

GLP-1 is a naturally occurring hormone that helps regulate blood sugar and appetite. The medications reduce hunger, increase feeling full, and improve blood sugar control and have become common as an effective way to help patients lose weight.

Developing New Habits and Everyday Routines

Throughout the last year, Blain has been focusing on small habits that are easier to sustain -regular routines, being mindful of calories, and staying active in ways that are more manageable for him.

Having parental guidance, support and understanding makes it easier for kids to take steps and reach their goals. Leslie has tried to keep things balanced and not overwhelming. Her goal as a parent has been to support Blain and help him build lifelong habits, ensuring he feels encouraged and capable of his hopes and aspirations.

“Kids are looking for a better quality of life,” Dr. Terrell said.  “And the kids that are most successful in their goals are the ones who have their whole family involved.”

Kids often do better when their parents exercise with them, help them make healthier eating choices, and set goals together that are challenging but attainable.

Healthy Advice for Families

A lot of kids feel pressure about their weight challenges. They can even be afraid to talk with close relatives. It’s important for kids to feel safe opening up about their weight and what they are experiencing in school, and during regular daily activities.

“Take things one step at a time and focus on progress, not perfection,” Leslie said. “Most importantly, keep the focus on encouragement and overall well-being rather than pressure.”

Dr. Terrell also wants parents to understand that obesity is often a biological factor, not a result of willpower or poor parenting. She encourages parents to speak up and to share their concerns about their child’s weight with their doctor. They can even ask their doctor to speak with them in private.

“Sometimes talking about weight is triggering and we want to make sure everyone feels comfortable so we can learn about what their concerns are,” Dr. Terrell said.

Although it’s often difficult in the moment, it’s worth taking the time to have the conversation, especially when it can drastically improve a child’s health and well-being and even have a positive effect on the whole family.

What played a role? In some cases, junk food and lack of exercise as the COVID-19 pandemic wears on.

Childhood obesity was already a concern in the United States. In 2018, the Centers for Disease Control (CDC) reported that 19.3% of the 2-19 age group were considered obese. That’s about 14.4 million children and adolescents with excessive weight that could lead to other medical problems like diabetes, heart disease, high blood pressure, and joint pain.

But doctors and dietitians fear obesity has gotten worse due to habits that changed during the COVID-19 lockdown and afterward, continuing today. A study cited by the National Institutes of Health (NIH) even uses the term “covibesity” to describe the phenomenon of rapid weight gain that resulted when people changed their eating and exercise routines during the pandemic.

If the early months of the pandemic set the stage for higher obesity rates, the toll on health is current and ongoing. Consider diabetes, for instance: Cook Children’s has seen 91 new cases of Type 2 diabetes diagnosed already this year.

Escalation in childhood obesity becomes an even more relevant and urgent concern given reports of higher risk of severe COVID-19 symptoms for those with obesity. The CDC points out that excessive weight can cause impaired immune function and decreased lung capacity, which may worsen the illness. The CDC cites one study that linked obesity in pediatric patients to higher rates of hospitalization, admission to intensive care, invasive mechanical ventilation and death from COVID-19. At Cook Children’s Medical Center, this rings true. Many of the patients admitted to the COVID-19 ICU are obese are require life-saving measures.

Alice Phillips, M.D., a pediatrician at Cook Children’s, described the accelerated rise in childhood obesity as an outcome of the dramatic lifestyle changes brought on by the COVID-19 lockdown beginning in 2020. Multiple times a day, Dr. Phillips encounters and counsels patients whose body mass index (BMI) has surged since their last checkup.

When the schools were closed, lots of homebound kids began to snack out of boredom. They watched more TV and did online learning in front of a computer – no walking required. Recess, PE classes and team sports were canceled.

“Parents have been trying to nurture their children during a very difficult time. Food remains a cultural norm of nurture for families, and we are seeing the unexpected consequences,” she said.

Dr. Phillips emphasized it’s appropriate to expect a child to pick up some weight during a growth spurt. Pediatricians track the curve using the BMI calculations, which take a patient’s age, height and gender into consideration. Obesity by definition occurs when BMI reaches the 95^th percentile or higher.

Dr. Phillips and her colleagues at Cook Children’s point out two trends: an increase in patients whose recent weight gain put their BMIs in the 95^th percentile for the first time, and previously obese patients who became even heavier.

“When you see an acute change in the BMI from the 75^th percentile to the 99^th percentile, that’s when it catches your eye and you say, ‘What was different this year that caused that change?’” she said. “All too often during the pandemic the families will say, ‘We haven’t been getting any exercise, and our eating habits are maybe a little worse.’”

She worries about the long-term consequences on their health. When she raises the subject of obesity with her patients, she speaks with sensitivity and tries to help the families feel empowered to set goals they can achieve.

“You have to be very careful that you handle that conversation in an empathetic way,” Dr. Phillips said. “I don’t want how I handle it to be part of the problem for this child.”

Here’s what’s important to know:

• Obesity commonly begins between the ages of 5 and 6, or during adolescence. The causes include overeating, genetic predisposition, stressful life events (such as divorce or a move), depression and low self-esteem.
• Obesity is a chronic disease that adversely affects both physical and mental health. It’s easy to diagnose but hard to treat – potentially setting up a lifetime of complications.
• Studies referenced by the NIH show that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an adult with obesity.

Susan Hsieh, M.D., a pediatric endocrinologist at Cook Children’s, is seeing more patients diagnosed with obesity-related spinoffs that used to be considered adult diseases: hypertension, high cholesterol and Type 2 diabetes. She also points to the COVID-19 lockdown as a tipping point for kids who gained 30-40 pounds since last year. “The body isn’t designed to take on that much weight in such a short period of time,” Dr. Hsieh said.

She explained that obesity causes insulin resistance, impeding the body’s ability to control the blood sugar. It used to be rare, she said, to see an 8- or 9-year-old diagnosed with Type 2 diabetes. Not anymore.

Data at Cook Children’s show that Type 2 diabetes has been on the rise, with 55 new diagnosed cases in 2018, 107 new cases in 2019, and 126 new cases in 2020. The count so far for 2021 is 91 new cases through early September.

Early onset diabetes, if hyperglycemia is mild, can be treated with oral medications. For those patients who require insulin injections, Dr. Hsieh encourages weight loss as a motivation to wean themselves off the injections. She urges families to address their child’s escalating obesity sooner rather than later.

“In general, it’s easy to gain weight and very hard to lose weight,” Dr. Hsieh said. “The more we educate, the better, because prevention goes a long way.”

The Endocrine Clinic at Cook Children’s offers a program called Risk Evaluation to Achieve Cardiovascular Health (REACH), targeting kids affected by cardiovascular diseases caused by obesity or other factors.

Since the start of the pandemic, registered dietitian Lauren Williams found that her REACH patients and their parents often report more junk food consumption and less physical activity. She counsels them to treat food as a source of nourishment.

Williams’ main message? “We need a healthy relationship with food. We don’t snack throughout the day when we’re not hungry. We move our bodies because our bodies were made to move. Exercise helps our mind; it helps our sleep. Get out and run and play even if it’s just with your siblings in your backyard, having fun.”

Cook Children’s also offers a one-time, free-of-charge class called Healthy Weight Healthy You, which promotes the MyPlate nutrition guide and other tools to eat right. The class is offered in both English and Spanish for children ages 5-18 and their parents. A physician’s referral is needed.

Another resource to fight obesity is the Cook Children’s Outpatient Nutrition Services, available only through referral from physicians in the network. Jean Mankin, a registered dietitian in the outpatient clinic, said the incidence of childhood obesity “exploded” during the COVID-19 pandemic.

“Almost every patient that I’ve seen will admit to boredom eating. And the parents will agree,” Mankin said. “The parents will say ‘I was trying to work… I was there for emergencies but the kids were left to their own devices and they were grazing all day on chips and cookies and crackers.’”

Now she works with families to undo the damage. Bad habits – constant snacking, inactivity -- can be corrected. But it starts with recognizing the problem.

The patients Mankin meets with often arrive with complications tied to the excess weight on their bodies. She lists orthopedic problems, respiratory issues, elevated lipids, elevated liver enzymes and sleep apnea among the ailments.

A one-hour consultation with Mankin encompasses a review of the family’s journal of food intake over several days; guidance on problems she identifies; a packet of information to take home; and lots of encouragement. No one is forced to get on the scale. Mankin says she frames the conversation around the proper nutrition necessary for growth and development -- avoiding the word “obesity” out of sensitivity.

“Some of these little ones and adolescents can easily get their feelings hurt. And when that happens, they shut down. I also encourage parents to be mindful of the language used at home,” she said. “I work really hard to focus on overall health and to keep a positive vibe in my office. Initially, many kids that come to me are somewhat fearful or trepidatious, but most leave with a smile on their face.”

She emphasized that parents must be committed to making changes in the family’s approach to meals and exercise. Improvements don’t usually happen right away. A follow-up visit with the dietitian might be needed after the initial consultation.

If you have a concern about your child’s weight, contact your pediatrician.

The report published in The Lancet states the amount of children and adolescents rose to 124 million in 2016, compared to 11 million in 1975.

More than 20 percent of children in the United States were found to be obese in the age groups of ages 5 to 19 years of age.

While the study focuses on children, experts at Cook Children’s say the parents have to take accountability in keeping their children healthy.

Joel Steelman, M.D., an endocrinologist at Cook Children’s, said unhealthy food choices are more accessible with the increase of fast food choices across the world. These foods are usually higher in sugar and lower in not only nutrition, but cost of the food.

The other factor in the increase in obesity is sedentary behavior. But Dr. Steelman said increasing activity is easier said than done for many families, who are faced with children relying more on electronic media for entertainment and parents facing unsafe environments to let their kids go outside and play. Still, he said changes begin with the entire family making as many health changes as possible.

“Families have to be involved in helping a child with weight management,” Dr. Steelman said. “Often times this is not just a child issue, but a family-wide issue that needs to be addressed. I think that the biggest issue for families though is not to become militant and overly rigid in trying to help a child with weight management. Definitely, no shaming. The things you can do right now are pretty basic. That is changing your diet and encouraging more physical activity. I know it sounds simple, but this seems to be the best solution.”

Don Wilson, M.D., an endocrinologist at Cook Children’s, is the medical director of the Risk Evaluation to Achieve Cardiovascular Health (REACH) Clinic. The clinic is committed to improving the lives and well-being of children who are at risk or affected by obesity.

“The only way to be successful in the struggle with obesity is for all adults and children (with the assistance and encouragement of their parent/caregiver) is to embrace therapeutic lifestyle changes,” Dr. Wilson said. “Success starts with a positive self-image and a ‘can do’ attitude. We in the medical profession can help educate and encourage, but need to avoid blame and comments that demean the victim. Obesity is, and always has been, a disease. It should be treated as such. In general the public needs to understand the short-term and long-term consequences of obesity, including diabetes, premature heart disease, and several forms of obesity-related cancer. Only then will successful management/prevention be achievable.”

Virginia Landrum, a dietitian in clinical nutrition in Gastroenterology at Cook Children’s, said she stresses to parents and children that the entire family must be involved in making changes.

She lets her patients who are working to lose weight not to look at their changes as diet, but as a lifestyle change.

Landrum advises parents to help their kids get healthier by taking these steps:

1. Help your children be involved in the meal. Let them pick out some healthier food options that they may want to try.
2. If they are old enough, let them be involved in food prep.
3. Offer new foods. Studies show it can take as much as 20 times for some children to accept new food options. Landrum said parents may have to start by simply placing the new food item on the plate.
4. Parents have to set the example. Eat the healthy foods with your child. Let your child watch you eat vegetable. Go outside and walk with your child, play a sport or ride a bike.
5. Turn off the TV, video games and eat together as a family.

Obesity? That's one.

Car accidents? That's a big risk too.

But would you guess the number one issue is asthma?

In Tarrant County, 19.5 percent of children suffer from asthma, according to data gathered in a survey sent to parents by The Center for Children's Health led by Cook Children's. The Community-wide Children's Health Assessment and Planning Survey (CCHAPS) was completed by more than 8,600 parents in Tarrant, Denton, Hood, Wise, Parker and Johnson counties.

"We questioned parents on everything from how often their child is buckled in properly to how many grocery stores in their neighborhood sell fresh fruits and vegetables," said Larry Tubb, senior vice president of the Center for Children’s Health. "The information we are gathering is extremely valuable when it comes to measuring the overall health of children in our region."

Overwhelmingly, parents in Tarrant County (and all of the surveyed counties) reported their children are dealing with asthma. In fact, children in this area ages 6-9 are three times more likely to have asthma than children living in other parts of Texas. While we don't know why the numbers are so high, we do know people with asthma have varying triggers, and what affects one person will not necessarily affect another. Those triggers include, but are not limited to, cigarette smoke, indoor and outdoor mold, pet dander, air pollution, dust mites, cockroaches, pollen, smoke and strong odors.

The second biggest health issue on parents minds is obesity, with 17.8 percent reporting concerns about their child's weight, activity level and access to healthy foods.

Accidental injuries rings in third. In Tarrant County, 11.9 percent of parents reported their children had been injured and required medical care. Those injuries range from car and ATV-related incidents to drowning, bicycle falls and crashes.

The fourth issue on the list is a lack of dental care for children. Parents reported 9.7 percent of children either didn't see a dentist regularly, didn't brush their teeth enough or some even reported their child didn't have their own toothbrush.

Finally, mental illness is the fifth biggest issue concerning parents in Tarrant County. Behavioral and emotional development is on the minds of 8.5 percent of respondents. Many reported their children have suffered sleep problems, self-esteem issues or have tried to harm themselves.

The survey used to gather this data is part of a Cook Children's initiative to improve the health and well-being of every child in our six-county region by 2020. This initiative launched in 2009 with the very first survey of its kind sent to parents. Since then, the surveys have been sent out every three years.

"The information provided by parents in our community is available on-line and being used by a host of organizations, including Cook Children’s, to build programs and services. There isn’t one perfect answer, but, together we are making solid progress in improving the health of the children in our community by putting the child and family at the center of our planning," said Tubb.

About The Center for Children's Health

The Center for Children's Health, led by Cook Children's, is home to the Community-wide Children's Health Assessment & Planning Survey (CCHAPS), Community Health Outreach and Community Health Research. The center's goal is to create aligned collaborations that will allow us to make our North Texas region one of the healthiest places to raise a child.

When I advise my 3 year old patients to wear helmets on their tricycles, then I end up with 10 year old patients who wear their helmets. It’s near impossible to convince my 10 year olds to START wearing a helmet.

Why do you think so many ED doctors end up advocating for car seat safety? They see the results of horrible car accidents that could have been prevented.

That’s how I feel about obesity prevention. Far and away, poor diet and a sedentary lifestyle wreak havoc on the mental and physical health of my patients – from young to old – those with poor lifestyle choices have a decreased quality of life. They come to see me with more illnesses, more headaches and most certainly more abdominal pain.

When I start talking to my families about diet, I try to give anticipatory guidance about offering fruits and vegetables and limiting processed foods. Toddlers and young children do two things really well – they don’t eat when they are not hungry and they stop eating when they are full.

We as parents, and grandparents, mess up their satiety cues by trying to get them to eat when they are not hungry and trying to get them to keep eating when they are full. Allowing children to control the amount of food they eat leads to a long term healthy relationship with food. Parents have control over what is offered but should not try to control how much is eaten.

Along those same lines, children are naturally conditioned to be outside and to be active. We as parents mess that up by keeping them inside in front of an iPad or video game. We have control over their media time.

I think focusing on healthy behaviors rather than BMI is a positive way to talk to parents. Most parents are doing 1 or more things right in the 5-2-1-0 recommendations. Kids are motivated to follow these recommendations, but they need their parents to create an environment at home that allows them to do so. This goes along with the thinking of the Blue Zones.

I do think there is value for using BMI as a tool. I usually show growth charts to families as an objective measurement of what is happening and then we turn to talking about healthy behaviors. But I do see a flattening of BMI with improved diet/activity choices. It is also not uncommon for me to see an increase in BMI and ask what has changed, and families are usually able to say – oh yeah, he quit playing soccer, or he doesn’t have PE this year….etc.

When you look at guidelines for treatment of obesity, the first thing you must have is motivation for change. If that is not there, you really can’t go forward. What if we don’t have to motivate people to change because they have been feeding their children correctly from the beginning?

At least not yet, but both school districts are considering adopting a policy and Dallas ISD could have one by the end of the day.

That news makes Kim Mangham, M.D., a Cook Children’s pediatrician in Keller, both relieved and happy. Dr. Mangham focuses on nutrition and activity with her patient families and she believes this is a good start for area schools to get kids moving.

As early as January 2007, A Clinical Report in the Journal of Pediatrics emphasized the benefits of free play for children, “but since that time it seems we have drifted farther and farther away from this concept,” Dr. Mangham said. “Kindergarten and even preschool curriculums are emphasizing academics over social and emotional development, and kids are presenting at younger ages with anxiety and depression due to academic pressures.”

For all children, especially those with ADHD, Dr. Mangham said it is vital that they are offered unstructured free time to allow them to process the information they have learned and to get their exercise. Only then can they return to the classroom and focus.

Children have an innate need to be outside and run and play, according to Dr. Mangham. This helps them to connect socially with their peers and allows them to settle back down in the classroom and learn again.

“I hear from so many of my parents that their children do so much better with homework if they are allowed to play outside after school,” Dr. Mangham said. “Kids are so worn out by the end of the day, they need to decompress and let their brains rest before they can focus again on school work. I tell my parents that if they want well behaved children, to let them run and play outside and to burn off all of their energy. “

Why not focus on the things that are free from side effects and cost nothing? We have so much to gain, says Dr. Mangham.

Children have so much adult-directed time – in the classroom, with sports, with extracurricular activities and with chores in the home. Adults even try to interfere with free play. Children need that free time to learn to share, play nicely, make up games, follow rules, get along and just enjoy friends.

As reported in December 2015 by KERA news and a recent segment on the Today show, schools are starting to see the benefits of recess.

Cook Children’s offers Go Noodle to 18 ISDs (including public, private and charter elementary schools in Cook Children’s six-county region) and 515 schools. The 120,619 students and 4,918 teachers have logged over 35 million aggregate minutes of physical activity.

“My 12 year old daughter started sixth grade this year,” Dr. Mangham said. “Her biggest complaint is not being able to be outside all day. Their only break is the four minute transition time between classes and lunch. “She says, ‘I miss being outside and seeing the sky and the trees.’ My 8 year old son loves climbing trees. The reflection and relaxation he gets while sitting in the top of his tree is just as important as the exercise he gets while climbing.”

About the source

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

I order a kid’s meal for my son at a seafood restaurant in Galveston, Texas. I tell the waiter to hold the fries. He gets a very odd look on his face and replies “But they come free with the meal." My response. “I understand that, but we don’t want them.”  

There is good evidence that meals eaten at home are healthier. One way we can improve the nutrition choices we make when we eat out is to avoid the pitfall of accepting the free choices that come with a meal and worse – encouraging our kids to finish them. 

I know I’ve had the experience of wanting only the sandwich at a restaurant, yet ordering the entire meal is actually cheaper. This comes with chips or fries and a drink that I don’t even really want, yet I end up picking a soft drink instead of a water because it is “free,” and also eating the chips that I didn’t plan to order.

I heard a news clip on the radio the other day about all inclusive restaurants and how many calories we tend to consume on these trips. I think we definitely get caught trying to get our money’s worth at all you can eat buffets. 

The excess calories consumed and the subsequent health consequences for ourselves and for our children can be quite costly in terms of our overall health. So the next time we try to find the best value in our meals while eating out – it might be in saying no to the free extras.

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

We know that children who are overweight or obese often continue their unhealthy habits into adulthood which may predispose them to heart disease, diabetes, and many other health problems. The HCCPC adopted “5-2-1-0 Let’s Go!” as their program to address this problem in Parker County. The evidence-based program encourages healthy nutrition and fitness in schools, after-school settings, and at home. Emphasis is placed on regular exercise and incorporating healthy foods into everyday life. HCCPC has been working with community and educational leaders to step foot into elementary schools to implement the program.  Here is how it works:

5-2-1-0 Every Day! 

5 or more fruits and vegetables 

2 hours or less recreational screen time    

1 hour or more of physical activity                     

 sugary drinks, more water and low-fat milk

I, and I’m sure many others who care for children, were excited by the news. It was with great interest that I read the news article and began to examine the story more closely. The news while exciting deals with a relatively small number and specific population of children.

The study examined obesity rates in pre-school children, age 2-4 years old whose families received WIC assistance (The Special Supplemental Nutrition Program for Women, Infants, and Children). Not all of the states submitted information. Of the 41 participating states, 18 states showed modest declines in the number of obese preschoolers from information collected from 2008-2011. The remainder of the 41 states showed no change or even increases in obesity rates.

The challenge is understanding what this information means and placing it in the proper perspective. Experts in the field of childhood obesity believe the positive numbers reflect changes in the WIC program beginning in 2008. The program was changed in an effort to increase fresh fruits and vegetable purchases as well as other health options such as whole grains and low fat foods. Additionally, encouragement of breastfeeding is thought to help contribute the improvements.

The news validates the central importance of healthy eating in weight management. I believe that fresh ingredients and home preparation of meals is a major key in overall health and weight management. I have slowly continued reading the book, Salt, Sugar, and Fat, and am increasingly convinced of this belief.

As discussed in the article, challenges remain. One in eight pre-schoolers remain obese. And unfortunately, the likelihood is high for these children that obesity will persist into adulthood.

For more information:

• Cook Children’s Endocrinology and Diabetes Program
• Obesity where we live
• The Center For Children’s Health
• Checkup Kitchen
• Overweight and Obesity
• Keeping Portions Under Control
• How Can Families Be Healthier?

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to the Physician Perspective page on the Cook Children’s Web site.

I was immediatley interested when I chanced on a recent radio interview with the author, Michael Moss, who has written a new book about the inner workings of the processed food industry. The book deals specifically with the reasons that these companies use three key additives – salt, sugar and fat – in the processed food they create and market.

The term processed foods sounds somewhat sinister, but some of the ways that food is processed such as pasteurization or freezing are quite beneficial to people for both health reasons and convenience. The primary goal in most processing of foods is creation of a food product that is near ready to eat and is stable on the shelf or in our homes for a long period of time. This particular goal and the goal of making tasty processed foods according to Mr. Moss is where the problem begins.

In the book, Moss interviews food scientists in many of the large processed food companies. These scientists are tasked with making tasty food products that apeal to a large group of people. Moss describes the use of the three key additives to mask odd or bitter flavors that develop during manufacturing and to hook consumers on taste.

Moss argues that company pressures to create new appealing snacks, grow market share and improve profitability often result in unhealthy foods that contribute to the U.S. and global obesity epidemic.

The interview concluded with the debate about what steps can be taken to reduce these activities and make healthier foods. The debate no doubt will continue between different philosophies of strict government regulation and independence of consumer choice.

I’ve downloaded the eBook and look forward to learning more and examining different viewpoints. In the meantime, my family and I will continue to see fresh ingredients and discover new recipes.

More information is available if you are interested with links to the NPR interview and the book.