Healthy Habits: Fostering Physical Health in a Digital World

Hi and welcome. I am Dr. Pam Hurst-Della Pietra, president and founder of Children and Screens: Institute of Digital Media and Child Development and host of today’s Ask the Experts Webinar. Thanks for joining us. Do your kids munch on snacks when they are bingeing Vampire Diaries or frozen?

 

Is your family sedentary on screens more than they used to be? Do your kids ask for a Coke and some chips they see advertised on a children’s channel? Last week, the CDC reported that the rate of BMI increase among two to 19 year olds has approximately doubled during the pandemic compared to a pre pandemic period.

 

This is a disturbing statistic that adds to a growing concern about the implications are increasingly digital and sedentary lives. The good news is, though, that there are easy changes that you and your families can make to your routines and eating habits to foster and promote healthy lifestyles.

 

We have convened an excellent group of experts to share their insights, expertize and advice about how to go about making weight wise lifestyle choices from a media diet, teaching critical thinking skills around food advertisements to ensuring your kids have the nutrition they need every day.

 

The panel has reviewed the questions you submitted, including inquiries around the risks of eating dinner in front of a movie, the benefits of extra gaming, how to plan a balanced meal, how to talk with your kids about about why it’s important to get exercise every day and more.

 

They will answer as many questions as possible during and after their presentations. If you have additional questions during the workshop, please type them into the Q&A box at the bottom of your screen when you do. Please indicate whether or not you’d like to ask your questions live on camera if time permits or if you would prefer that

 

the moderator read your question. We are recording today’s workshop and will upload a video to YouTube in the coming days. All registrants will receive a link to our YouTube channel, where you will find videos from our past thirty four webinars, which we hope you’ll watch as you wait for this video to be posted.

 

Is now my great pleasure to introduce our first moderator, Dr. Corey Cross, as a board who is a board certified pediatrician and has been serving the Los Angeles community since 2004. In 2017, she won an outstanding achievement and innovation award from the AARP for her work in creating the Family Media Use Plan, Tool Kit and Healthy Children

 

Board, and is the co-founder of the Fit to Play and Learn Obesity Prevention Curriculum. We are so glad that she’s with us today. Welcome, Corey. Hi, thank you for having me. I am excited to do this, I think this is a really important topic, as we just heard.

 

The pandemic has had real devastating effects on particularly children, while adults as well. And obesity, the lockdowns, keeping people inside, not really being able to go on your sports teams as a child or Haskey. And the increase in screentime that children had has led to an increase in BMY.

 

So body mass index that basically is double than what we normally see on a month to month basis. This has been especially true for six to 11 year olds. And it’s a very concerning trend. As we were just talking about, the CDC came out with data, with a study that showed a lot of very concerning effects that

 

the pandemic has had. And in some states and this is I bring this up because I want us to realize as we talk about this topic, that this isn’t just a child issue, this is a family issue. So in a lot of states, there have been an increase in obesity, not just in children, but in adults.

 

And so there are 16 states right now who have obesity rates for adults that are over. Thirty five percent of their population are obese. So we really need to, as a society and as families, figure out what we can do to combat this.

 

And it’s important not just for our overall health, but, of course, for our overall health, because these are the bodies we have for life. But it’s also important in this time of Covid, because Covid and obesity just don’t mix well.

 

So we know that obesity is an independent risk factor. That means that if you are obese or overweight and you get Covid, you have a much higher chance of ending up in the hospital, ending up with severe complications or even ending up dead.

 

So we really want to do what we can to control weight and to have healthy lifestyle choices in this time period, and particularly for children who, as we all know, children under 12 yet cannot be vaccinated. So one of the best things we can do for our children is to really make their little bodies as healthy as

 

possible. And so one of the ways we do that is by making sure that they’re getting enough exercise, by making sure that they’re eating correctly and by making sure that they’re not spending a ton of time on screens.

 

So screens are not all bad. I don’t hate screens. It’s one of the ways that we made it through the pandemic. It’s one of the ways that we stayed connected with the people we love. It’s one of the ways that we pass time.

 

It really at times I felt like the entire nation were watching some of the same TV shows. And it really made us feel connected in a time when we were really separated from one another. But screens have a time and a place.

 

And I think what we need to realize, particularly as parents, and that’s for our own use and for our children’s use, is that the use of screen displaces other activities. So the time that you’re spending on a screen is time that you’re spending not doing something else.

 

And while that might be OK, if that time you were going to spend where, say, your child bothering your brother or your sister, it’s not so good. If the time you were going to spend was outside running around or was doing something, that is maybe a healthier lifestyle choice.

 

So I think with anything as a parent, we want our kids to be happy. But we also need to parent and we need to parent actively. We need to every day take stock of what happened to that day.

 

And was it a good day, a bad day? And how do we make improvements for the future? We can’t be too hard on ourselves. And I speak to you as a mother of three, that you’re not parenting really on a day to day basis, but on a week to week basis or month to month basis.

 

And when you look at that whole thing, how are you doing overall? Because we all have some days where it’s just you can’t even handle it. Yes. You know, it was a bad day. I don’t know how that got away from me.

 

But you pick up the next day and you try to make improvements. So what this panel is going to talk about is that wherever you feel like you are in your sort of journey with your children, with your diet, with your exercise, with your screens, take stock of that.

 

Don’t beat yourself up. But figure out ways to make improvements, because we all know that these bodies and these lifestyle choices that we make and that we have our children make are going to be choices that affect them down the line.

 

And so we want to set them up for success. We are really lucky today. We have an amazing piano. I’ve been looking over the breadth of the experience and. Who we have here and who the. The questions that we have that we can get answered today are really just great.

 

We have dietitians, we have pediatricians, we have researchers, we have researchers that specialize in just screens. We have researchers that specialize in how parents can interact better with their children. We just have a real deep breath of knowledge here.

 

And I urge you to send your questions in to really have a conversation and a discussion about this at the end after we’ve heard all these presentations. So I want to make sure that we have time for all of that.

 

So I’m not going to spend too much time talking, but I want to encourage you to not just sit there in your homes, but to reach out and to enter the chat and just share your questions, because we’d love to hear them.

 

So moving on, I think we have Erica’s presentation first. And so that is Dr. Erica Kenney. She is an assistant professor of public health and nutrition in the Department of Nutrition at Harvard Chan School of Public Health. She serves as the director of the Ph.D. program in the public in public health and nutrition.

 

So her work is really interesting. She investigates how children’s environments can feasibly be changed to promote healthy eating habits through policy change and community action. So she also one of her main lines of research is in how exposure to food marketing influences children’s dietary intake and how food marketing landscape is changing.

 

And we all know that to be true, right? Children used to only watch television and now they have all of these mobile devices. And we know that marketers and developers are really smart and they’re changing strategies. And as parents, we remember what we needed, what we were exposed to.

 

And we need to know what our children are exposed to. And what they need to know is is different. And so, Dr. Kenney, she looks at this and she’s going to be able to talk to us about how media and marketing and screens affect our children and then as parents, what we can do about it.

 

I’m going to turn it over to her now. Thanks so much, Corey, for that introduction, and thanks for setting us up today for this webinar and thinking about the big picture of what’s going on, it’s really parents. We’re living in a very and caregivers were living in a very challenging world at the moment in terms of helping

 

to keep our kids healthy and setting them up for help in the long term. So hopefully today we can kind of delve into some topics that might help help you out. I’m going to talk specifically today about food marketing and sort of kick us off a little bit on on this.

 

So what do we know so far about screentime food marketing and healthy weight in kids? Now, this isn’t a super intuitive idea, right? It’s like how can screentime kind of magically impact kids? Why is it that having lots of screen time seems to be linked with sort of excess weight gain or not healthy growth?

 

And there are a couple of key pathways that I think a lot of us are going to be talking about today. So I just wanted to tee this up. You know, one is clearly the sort of the sort of obvious one of physical activity.

 

Right? Like if you were sitting and watching TV or playing a video game, then you’re probably not being active. And that’s, I think, the first thing that many of us go to. Another is less sleep. So there are some linkages, although it’s not totally clear which way it goes, but there are some links between not having enough

 

sleep and gaining a little bit more weight or over eating a little bit. The women I really want to focus on is dietary intake and nutrition and how that is related to excess screen time for kids, because it turns out that when we’ve done when researchers have done sort of these randomized controlled trials where they’ve reduced kids

 

screen time and it turns out to actually reduce their BMI or their body mass index of their risk of gaining too much weight as they’re growing is reduced. And what they have found when that happens is that the pathway for that really seems to be through changing what they eat.

 

So I want to talk about that a little bit more today. So how does screentime affect eating habits? This also seems like a little bit magical, right? Like how could this possibly happen? Well, one pathway that I think many of us probably have experienced is this pathway of distracted or mindless eating.

 

Right. If you are watching a movie or watching a show and you have a bowl of snacks, you’re not necessarily as able to pay attention to whether you’re actually still hungry or not, whether you actually even still like the taste of what you’re eating.

 

It’s harder to sort of pay attention to those cues from your own body for how much you’re actually consuming. And that can lead to overconsumption of foods. And most of the time, unfortunately, too, like when we’re snacking, a lot of our snack foods that we have available to us are blessed are things that are go through our

 

body quickly and we digest them quickly. They’re high and sugars are a fine grained. So we kind of like our bodies don’t realize how many calories we’re taking in or sugary drinks where there’s a lot of sugar in those.

 

And we’re not really conscious. Our bodies aren’t kind of aware of how much we’re actually eating. So that can lead to overeating. Another kind of key pathway is through these food and beverage ads, which are extremely powerful. There’s a lot of research still going over the past several decades that really focused on TV and is now moving

 

more into these newer forms of advertising on on digital media, that these ads are enormously effective at changing the kinds of foods that kids eat. They’re really enormously effective at changing kids food preferences. So this is just sort of showing sort of the plastic link, you know, of kids seeing an ad for something like a sugary cereal

 

on one of their games. They see the ad repeatedly and it’s like, I want that, especially if it’s linked to like a cartoon character or a sports celebrity or something like that. You end up in the grocery store with your kid and there’s pester power going on.

 

So I have to admit that until I was a parent myself, I did not appreciate how strong the pester power can be in terms of kids really, really asking for things or threatening to throw tantrums. And like you’re exhausted as a parent, you throw it in the car and you all of a sudden you’ve got a cereal

 

or a snack or a sugary drink that you didn’t intend to buy. And then kids end up eating it. So and when you have adolescence, you have more control over their food choices. This is an even more direct pathway, right.

 

Where they can actually choose for themselves to eat the things that are advertised to them. So it is an extremely strong influence and a lot of food as food and beverage ads every year in the in the US.

 

So it’s declining on television as kids. Regular TV viewing is declining, but it’s definitely increasing elsewhere. So as Corey was mentioning, there are sort of new strategies going into sort of the new forms or new ish forms of media that kids are using.

 

And it’s a little bit hard for us to keep up with what’s going on. So on TV, the most recent estimate is that kids are still seeing about 3000 food and beverage ads per year for two to 17 year olds.

 

And in public health, we care a lot about health equity. This definitely has a health equity component to it, where kids of color and lower income kids are more likely to see more ads than higher income or weight kids so that their exposure is uneven and unequal.

 

So three thousand a year. And most of those ads are for like fast food and snacks and sugary drinks. There’s not a ton of ads for like here. It’s on YouTube. One of my colleagues at New York University, Marie Bragg, her research group, did this really cool study where they looked at videos of kid influencers on YouTube

 

, and they found that these videos that had hit influencers in them had food and drinks in them. They were viewed one billion times in the course of a year. And most of the foods and drinks that they showed in these kids influencer videos were branded unhealthy.

 

So things that like a snack food or fast food that had the brand right on it. So it’s sort of not the same as like these traditional, like packaged ads that you might see run on a show, but more like embedded in the videos that kids are watching.

 

And then there’s social media. So on social media, you know, 70 percent of adolescents have been found to be engaging with the food or beverage brand on social media. And most of those are fast food, sugary drinks, candy or snacks.

 

So just as a sort of quick look through some of the things that are going on in digital media, you have like on Tick Tock, like Dunkin Donuts has partnered actually with this tick tock influencer who’s super, super popular.

 

And they have a drink that’s like super sugary that is linked with her. So she’s kind of promoting it and promoting it on her channel, obviously, like Facebook. You know, there’s all these brands that have these ads, and a lot of them sort of engage with kids as if they’re their friends.

 

And so it makes it harder for kids to separate out their experience with friends versus advertising. And then there’s product placement. So a lot of ads, again, like aren’t traditional, but they might just be sneaking up in the in the shows themselves in terms of what we can do is sort of for public policy or public health

 

approaches. There are some countries that have actually limited how much kids can see ad so companies aren’t allowed to advertise or use cartoons for children at child focused ads in Chile. The U.K. has limited the hours that you can show junk food ads in in there.

 

The US, we can’t really do that, it seems. But there is a voluntary initiative that some food industries have for the food companies have signed on to to not advertise to kids, although kids are still seeing quite a lot in terms of sort of a more public health approach.

 

You know, there’s been limits to how much screen time is available. And childcare is sort of one strategy. Leveraging the work program where families meet with nutrition counselors and dietitians to help families set screentime goals has been shown to be pretty effective.

 

School and childcare based curricula to help families reduce their screentime are also pretty effective, as well as sort of clinic based action planning as well to help families set better goals. So there are these sort of like community programs that we can also do to help support this in terms of what you can do as a family

 

, just trying different strategies to limit your exposure. So if you can afford it, paying for streaming service subscriptions that allow you to view things without ads or use a DVR so you can skip them, have your kids view videos on YouTube kids instead of regular YouTube because there are less ads on YouTube.

 

Kids talk to your kids about what they’re seeing and how they’re being sort of trying to be influenced to buy certain foods. And there are some great resources on common sense media for how to do this and how to talk to your kids about this, and also using automatic time limits on kids’ mobile devices.

 

So just their total screen time is limited. So you may not be able to ditch the ads, but you can at least limit that total exposure. And that is it for my presentation today, Erica. That was that was wonderful.

 

I’m sure everybody learned something. I wanted to I want to just touch base a little bit on what you said about the influencers. So I recently read the common sense media consensus that they put out a zero two eight report every year.

 

And the most recent one I found amazing, because there they asked families how much time or how often their kids actually watched influencers. And it was surprising to see that in the five to eight year old age range.

 

Twenty seven percent reported watching influencers somewhat regularly. And in the two to four year old age range, 16 percent watched influencers. So I think that when we when we are parents and we’re giving our kids an iPad and we think that they’re just watching an unboxing video or this or that to understand that, I mean, they actually

 

call it an influencer. So who do we want influencing our children? I think it really should be our parents and people we choose, not random people from outside our families, because we don’t know what what ads are going to pop up.

 

We don’t know what they’re going to be saying. So I think parents need to be a little bit more savvy with what their children are doing and understand that the purpose of these people and they’re getting paid to influence our children and to create a want and a need for certain products.

 

And that is, as you said, very, very difficult. Once you get into the grocery store and you have them asking you, because they’ve basically been programed to ask you those things. So we need to be mindful of that.

 

So we have some great questions for you. One of them touches on what you just talked about, so limiting how much screen time children have when they’re in a daycare or a school setting. And so our first question comes from educator who has babies that she’s responsible for.

 

It seems like between the hours of eight and six thirty, and she wants to know during this time is it appropriate to use screens and if so, for how long and in what way? That is a great question, because screentime and child care is certainly a very challenging issue because especially if you’re a family child care provider

 

or you’re a nanny, sometimes it can be hard if you need to sort of like go fix a meal for while your kids are playing, you may need to have them something to help occupied unless if you don’t have help.

 

And so it can be very difficult. The the recommendation from the Caring for our Children standards, which is a sort of national set of standards for child care programs that’s put out by the American Academy of Pediatrics and the American Public Health Association.

 

They suggest 30 minutes per week as a as a hard limit for for screen time in child care. That, again, it can be challenging for that’s usually an easy thing for child care centers to reach. And most research has found that child care centers do a pretty good job of limiting screen time.

 

But again, for those family based childcare or nanny situations, that might be tricky. So one thing to do would be to try and at least limit if you do have to have screen time going on because of having to fix meals or things like that, try and limit to things that are educational and don’t have any advertising

 

in them, and or try and have them be things where they can help kids get active, physically active, which I think we’re going to be learning a little bit more about later. I think that’s I think that’s great advice.

 

Thank you. So moving on to our next presenter, we have Dr Jason Nagara, who is a pediatrician and researcher specializing in adolescent and young adult medicine at the University of California, San Francisco. He researches associations between screen use and health among teenagers.

 

He is co-founder and co-chair of the International Association for Adolescent Health Young Professionals Network. And so today, he is going to talk to us about digital media and obesity. Thank you so much for having me today. And yes, this presentation will focus on screentime weight and eating and mostly focus on findings from the adolescent brain and cognitive

 

development study, which is a national study of 11000 pre adolescents who are followed into their adolescent years. So today, I wanted to share our findings from our recent research studies that address the following three research questions. First, how is screentime related to body mass index?

 

Second, how is screentime related to eating and body image? And third, how has screen time changed in adolescence during the pandemic? For each of these questions, we analyzed data. As I mentioned, from over 11000 private teams around the US who are followed into their adolescent years.

 

The first study examined screen usage and body mass index and preteens in this adolescent brain cognitive development or ABCDE study. Children were asked about their daily time spent on six contemporary screen modalities and their heights and weights were measured to calculate BMI percentile at baseline, and one year later, BMI percentile is the metric by which we define

 

childhood overweight and obesity. On average, preteens reported an average of four hours of total recreational screentime per day. We found that each additional hour of screen time per day was associated with a higher BMI percentile. One year later.

 

And in particular, each additional hour of texting, video chat and video games were the most strongly associated with BMI games from the six different modalities. In our second study, we examined links between screentime and binge eating disorder. Binge eating disorder is characterized by eating large quantities of food in a short period of time, a feeling of loss

 

of control during the binge and then experiencing shame or guilt afterwards. We found that each additional hour of screen time per day was associated with higher odds of development of binge eating disorder. One year later. Specifically, each additional hour of social media was associated with a sixty two percent higher odds of binge eating disorder.

 

Each additional hour of texting was associated with a 40 percent higher odds of binge eating disorder. And each additional hour of television was associated with the thirty nine percent higher odds of binge eating disorder. So what are some of the mechanisms that explain these links between screentime and obesity or binge eating?

 

Similar to what Dr. Kenney just mentioned, screentime can lead to more sedentary time and less physical activity. Children can also be more prone to snacking or overeating even in the absence of hunger while they’re distracted in front of screens.

 

There are also exposed to more food advertisements on television or other media. And there are links also in the mechanisms between binge watching television, especially during the pandemic, and then binge eating. Binge eating disorder is one form of an eating disorder.

 

But I also wanted to briefly address links between screen time and body image and restrictive eating disorders. Research has shown a link, particularly between social media and body dissatisfaction. Exposure to social media may lead to unattainable body ideals and images that children are exposed to, and particularly social comparisons between photos and videos of other teens or young

 

people, and especially during the pandemic. Children’s bodies are constantly in videos or video conferencing like Zoom, which may lead to more appearance concerns as they can see themselves in the camera all the time. Teams may also rely more on social media for keeping connected with their friends.

 

Given social distancing recommendations and be more prone to posting content during the pandemic and sharing with others. I wanted to show some data from the ABCDE study on recreational use during the COVID 19 pandemic. We previously mentioned that in two thousand sixteen to twenty eighteen, the baseline of the study, the average daily screen use was reported as

 

four hours per day. As of May twenty twenty during the pandemic, this number rose to seven point seven hours in the same cohort of children, excluding screen time spent on schoolwork. So this represents an approximate doubling and recreational screen time among these 11000 teenagers now across the US.

 

The most common modalities that they reported weren’t screaming or watching television, followed by video gaming, both multiplayer and single player gaming. So as you can see, the average was about two point four, four hours a day of television, one point four hours multiplayer, and one point two hours of single player gaming per day.

 

As was mentioned earlier by Dr Cross. I think that especially during the pandemic, as parents, we have to give ourselves a little bit of a break. Prior recommendations from the American Academy of Pediatrics and other organizations had recommended limiting screen time to less than two hours per day.

 

But especially in the era of remote learning work and activities. This isn’t really possible. And I think that one way to really address screentime during the pandemic is not necessarily to say that it’s all bad, but really to try to promote some beneficial uses of screen time while mitigating known risks.

 

And so just a few thoughts that I had was while we have seen that a lot of screen time can be associated with sedentary behavior, it doesn’t have to be. As you know, a lot of physical education classes have moved to zoom or there are YouTube videos or other physical activity apps or even video gaming, like extra

 

gaming that can promote physical activity. And I think actually, Dr. Lu, our next speaker, will be talking about that a little bit more, but trying to maybe limit the sedentary screen time ball, promoting screen time as a way of promoting physical activity.

 

Second, leveraging the digital technology to screen time for social support and connections with families and friends while still trying to mitigate addiction or excess body image pressures. And finally, one of the recommendations in the media use plan is to try to promote some screen three times, and particularly for the prevention of eating disorders.

 

Can be having family meals together without screens or watching television. And then also maybe some time before bed to promote good sleep hygiene. With that, I will be happy to take any questions. Thank you. That was, again, really interesting.

 

I don’t know who saw the recent Wall Street Journal article, but to piggyback on what you just said, for anybody who didn’t see Facebook owns Instagram and Facebook apparently has internal discussions as to how their social media sites affect children.

 

And they internally discussed how they know that one in three girls, teen girls feel worse about their body image after using their social media platforms. So this is something that’s well known. I think it’s something as parents we need to think about.

 

And as a pediatrician, one of the recommendations, in addition to what Jason just told us, is I think turning off the notifications so that the phone doesn’t ding, ding, ding, ding, ding. Every time you get something is is a good way to try to help kids pull back, because when they hear that sound, they just want to

 

answer it and move forward. So we need to give them ways to separate themselves. Now, Jason, there is a question that came in and I’m just trying to get the wording right. But it is you mentioned a link between screen time and eating disorders.

 

And I just wanted to have you sort of flesh this out a little bit more. How has the pandemic affected eating disorders in teens? Yeah. Thanks so much for that question and my specialty as an adolescent and young adult medicine, and actually we take care of a lot of teenagers who have really developed or eating disorders or

 

their existing eating disorders have gotten a lot worse during the pandemic. It’s actually been really heartbreaking that at our hospital in San Francisco, we’ve had more than a doubling of teenagers who needed to be hospitalized for eating disorders during the pandemic.

 

And that’s reflective of national data around the country and even around the world. I do think a lot of that has to do with the social isolation because teens are such social beings. But I do think that just like what you were mentioning, I do think that screen time has implications in terms of this rise of eating

 

disorders. You know, given as you were mentioning, people are maybe using social media to connect more with peers. And given these pressures of body image, especially given this potential weight issues like weight gain during the pandemic, people are even more conscious about their weight and then they resort to more disordered or kind of unhealthy weight control behaviors

 

to try to control that. So I think it’s very complex. I mean, obviously, every teen has is different. But I do think that, you know, screen time and digital media use has had a role in this rise in eating disorders and a pandemic that was that was really thoughtful answer.

 

And I agree. I feel like as a pediatrician, I’m seeing very similar things to what you’re reporting, and it is extremely concerning. So thank you for that. We are going to move on to Dr. Laura Bellows, who is an associate professor in the division of Nutrition and Sciences at Cornell.

 

Her research is focused on the development of eating habits and a physical activity in early childhood. She specializes in intervention in early care settings and the influence of parental behaviors and the home environment on the development of these behaviors.

 

Much of her work is focused on the health disparate populations, including those with limited resources or of Latino heritage and living in rural communities. So I think that she’s really going to add an important part to this puzzle for us.

 

Great. Thanks so much for the introduction and appreciative of the opportunity to be here to share with you, what I was going to talk about today is setting routines and using mealtime as an example of what we know about family meal times and how that can transcend into screens and physical activity.

 

And so just to rid ourselves and what our family routines, those are basically anything that we do, the activities we do each day, from the time we wake up to the time we go to sleep. And with kids, we’re really good at routines early in childhood.

 

And then they seem to go in different directions as as kids get older. But routines provide structure and security and stability that have positive developmental outcomes related to academic achievement. They also provide a predictable environment which can be important for some kids and learning through both experience and choice.

 

And when we think about routines and physical health, certainly it relates to eating. But we we have routines related to sleeping and bedtime bathing, physical activity. Screen time, I think, is emerging where we’re trying to establish routines and we have our pre Covid routines, our Covid routines.

 

And I think we’re now transitioning to posta Covid and school activities, as well as transportation to and from can also play a role in our routines. But screens can also disrupt routines, especially as kids get a little older, so as we start with screens in early childhood and we can limit as they get older, they kind of

 

, as what’s been mentioned before, become very focused on it. They can start to bring it to the dinner table. And the next thing you know, you’re communicating through your screens about how your day was. But we can really kind of dial back and think about the positives related to meal time and mealtime.

 

The elements of meal time that we can, it’s not just about the food and the nutrients for eating, but the structure it provides, the planning that goes into it for children. They they thrive in predictable predictability. It’s an opportunity for emotional connectedness.

 

And it’s really an opportunity to establish positive parent child interactions and that effective communication that we can link. So as some families struggle to have routine family meals. It’s really for me taking apart what is it about the meal time?

 

It’s an opportunity to model whether positive or neutral. I hope it’s an opportunity to check in, plan those activities and monitor. And when you look at pictures, I also struggle with the pictures that are available because mealtimes are typically pictures of white, middle class Americans.

 

And when we see some ethnic representation, here’s where you’ve got a child on the phone, the mom’s on the phone and the dad’s got the remote control. And this is where the screentime can speak into mealtime. What we know about family meals and diet is that for families that eat three or more meals, we see a reduction

 

in weight to overweight or obesity. We see a reduction in disordered eating and reduction in unhealthy foods and an increase in healthful foods. So collectively and a lot of these studies have been done with older kids, we see that kids who eat regular family meals do better in school, have better weight status, less likely to partake in

 

risky behaviors such as drugs and alcohol, and can consume more fruits and vegetables. As I mentioned, there are key ingredients that we can take out of mealtime that I think can be applied to screen time. And that is that positive parent child interaction, because those positive parent actions, interactions actually help with promoting smooth transition between routines or

 

less power struggles and consistency of those routines is also critical as those tend to promote those pro social norms. The you know, the the development of kids does as helpers and engaging in healthful behaviors and less so in those risky behaviors.

 

So beyond mealtimes, how is it that we can apply this to activity and screen thinking as a parent about establishing routines and not treating all screen time as the same? We have different purposes in how we use screens and in doing some formative research or needs assessment with parents of young children.

 

They had different views, as well as different rules and regulations related to whether the screen time was focused on education, entertainment or communication. And as space time has become a more ubiquitous with how we communicate with grandparents and other family members and friends, they are on the screens more versus being on a phone as we older folks

 

define a phone. We also have to recognize that screens aren’t going away. They have become such a central part of our daily lives. And so how can we how can we play off those positive active screen time is certainly something that we can engage kids in.

 

This is picture here is of a study that we did. We developed for apps for obesity prevention program for Headstart. Children and families had access to these apps. And what we saw for this population, they only got 30 minutes of moderate to vigorous physical activity a day.

 

And their screen time was quite large. When we put accelerometers on these kids, we saw that they were getting 80 percent of NBPA by by partaking in the seven minute app. And so if they played that app twice, they would get more NBPA than they would in just their daily habits.

 

So it’s an opportunity to switch out sedentary screen time for active screen time. The other piece that we taught parents was how do you bring the virtual into the real world? And so this app is called Jungle Gym, and they go on adventures through the jungle.

 

And we would talk to parents about, well, how how can you bring that into play and use their imagination? So when you go for a walk in the neighborhood, can you pretend you’re in the jungle? And can you balance on the pretend log and can you leap over the lily pads and can you hop like a frog

 

? And so how do you build activity and that creativity and imagination that the apps can give ideas. So for some parents, they just need strategies of how to incorporate that. We also encourage doing it together. So I know during Covid I did a lot of just dance.

 

I look like an absolute idiot and I don’t care. But it’s a fun time that I’m interacting with my child and I’m getting some physical activity. We encourage parents to do this with their kids, too. It was an opportunity for them to bond.

 

It was an opportunity for positive parent child interaction. The other piece is, you know, as part of being present and mindful in interacting with kids is letting them teach you. You don’t always have to be the expert. What is it that they just viewed on YouTube?

 

What is it that they can tell you? It gives them an opportunity to teach you. It gives them an opportunity to process and articulate what it is that they’re learning. So I think the parents role, these are for kind of standing strategies that we encourage our parents to, to work with their kids, you know, your role is

 

to encourage to encourage curiosity and learning and discovery. And how can you do that through food activity and even screen time engaging with your kids and being present? And one of my favorite things is, listen, more talk less, because you have two years and one mouth.

 

So you should be listening twice as much as you should be talking and hearing what kids have to say and engaging them in their decisions as well can be helpful, modeling positive as well as neutral behaviors, but also acknowledging negative behaviors.

 

So I learned with my own son that he didn’t think I read. And when I was trying to get him to read more, he goes, Mommy, you’re on your phone all the time. Well, I was reading the news on my phone or I was reading a book on my iPad, but he didn’t see it that way.

 

He saw me on my device all the time. So I had to transition to reading a newspaper and going to the library and getting a hard copy of books. And so some of our own behaviors related to screen time, we don’t know what message that’s sending to our kids.

 

So I think it’s really important to not just model, but also talk about what it is that you’re modeling or trying to model, then setting expectations and setting clear expectations and as best we can. Being persistent and consistent.

 

And on those days that we’re really, really tired and we just want to give our kid a cookie so they don’t complain or we just want them to watch their iPad. We really need to come back to setting those routines and being consistent and persistent with those.

 

And I just wanted to end with as a parent, you know, don’t forget to pause and take the view and ideally take the view in through your own eyes and not through your screen and through your camera. And really just it goes by in a flash.

 

And so how can we pause and take that in and look for our little successes as we talk about establishing routines or even around family meal times? I think we’re kind of hard on ourselves about what can we focus on, what didn’t go right.

 

So it shouldn’t be kind of nice to yourself, because as parents are trying our best and establishing routines related to some challenging behaviors, and I think coming off of Covid in relation to screen time, kids have been on screens a lot.

 

And so how do we recalibrate and reset with that? And with that, I’m open to any questions. Thank you so much. That was excellent. I wanted to add to what you said about the importance of meal times and devices being present.

 

There is a study that I often talk to parents about that talks about how even having a device basically face down at a table affects how the communication at that meal and whether you keep the communication casual or you have more meaningful discussions.

 

And I think as parents, when we want our kids to be able to talk to us about just about anything and open up to us, I think it’s important for us to know that if we have the phone turned upside down just there for an emergency purpose, we’re still inhibiting their ability to feel that we’re present for

 

them. And they’re not going to tell us their deepest, darkest secrets. They’re going to keep it super casual because they know at any moment we can be pulled away. So I think parents need to really make the hard will no screens at the table.

 

Even if they’re on silent, even if they’re upside down, it still has an effect. I wanted to ask you a question about basically assigning moral value to foods as good and bad and how parents, I think, sometimes don’t want to approach this topic because they’re afraid that they’re going to give their kids a diet mentality.

 

And I want you to talk to how we can talk about foods without really making it pejorative. Yeah, it’s a great question. And one I think I get quite a bit. My philosophy is there are no good or bad foods, only bad quantities and even healthful foods we can get too much of.

 

So I think we need to not label them as that. And as I my area is in two to five year olds. And so when we’re talking about establishing healthy behaviors, getting kids over picky eating or food phobia, it’s really about talking to them about the food and the the characteristics of the food and building vocabulary related

 

to food. So it’s orange, it’s crunchy, it’s not bad. It’s a vegetable, but it’s not good. It’s not bad. It’s not good for you or bad for you. I also we really focused on processed praise, too, as well of, you know, thank you for trying that.

 

Not you’re a good girl for trying the carrot. So I think the good and the bad can be. Attributed to the food, but also the behaviors related to food, and that can set up, I think some some downstream are older or later years disordered eating issues with it.

 

So I’ll stop there because I could keep going. No, I think that that’s a really good point. Is that what you’re trying to teach is behavior not really about the foods itself. Thank you so much for that. And we can follow up with more questions later.

 

I know there have been a lot of questions. We’re going to move on to Dr. Amy Sharon Lou, who is an associate professor of communication studies and health sciences at Northeastern. She directs the health technology lab, where she studies the psychological, physiological and behavioral modification mechanisms and effects of media technologies for health promotion, with the goal to

 

design and evaluate innovative digital interventions that are theory guided and evidence based. I think her talk is going to be really interesting about how screens in our bodies basically interact. So I’m excited to hear it. Thank you, Amy.

 

Thank you for the invitation. Thanks for the introduction. This is Amy New. Today I’d like to talk about taking advantage of physically active screen time. So I know that the previous speakers, I think Dr. Nakata and Dr. Bellows have mentioned that.

 

And this is actually going to be what I’m going to be spending on. And this is also what my lab has been doing. So basically, that’s a little bit. Yep. So basically, when we talk about screen time, a lot of people tend to think about that.

 

It’s completely sedentary and therefore it’s something that. So I would like to call for a more dialectic perspective regarding this concept. So there are two types of screen time, sedentary or physically inactive screen time versus physically active screen time.

 

I think parents should take this perspective into consideration. We regulate their children, screen media. So my talk will focus primarily on the potential benefits of the physically active screen time. There are two main means to achieve this physically active time, especially during the current pandemic, because they can provide exercise opportunities for children who do not have safe

 

and regular outdoor exercise to exercise facilities or could not attend school regular P.E. activity classes. The first one is called active video games or extra games. There are interactive video games that require the player’s physical activities and also physical movements to play so active video games with gaming by the components of exercise.

 

And children are more likely to associate exercise with fun. Some of the examples include dense pads from the dance dance revolution. We balance board. Weemote. Sony Toy. The app called Pokémon Go. Microsoft Kinect. Nintendo switch rink fit the venture.

 

And emerging virtual reality devices such as oculist, which children over 12 or 13 years of age can try things away. Although some of these might really be all like historical relics that some of the parents have played when they were kids.

 

You can still purchase fully functional working units from the aftermarket. The other Covid include mainly videos that encourage audiences to move along. So they’re called active media channels. You can find some of them on YouTube like Go Nudo, Cosmic Kids Yoga Adventures and the body coach TV, which used to Hoess Pee Joe Serious doing the pandemic time

 

for children and also acts like Lazy Monster, seven minute workout. These are usually less interactive, but they may work well with younger children. So over the years, my lab has conducted a series of experimental research on the effects of playing active video games among children and young adults across different kind of platforms.

 

And our projects have been sponsored by National Cancer Institute, a national institute of diabetes and digestive Fantini diseases. We have found that active video games can effectively induce moderate to vigorous physical activities among children. This has been validated by heart rate monitor, metabolic heart and accelerometer measures coupled with no screen exercise activities.

 

This can enable children to meet the recommendations of the 12 and 18 physical activity guidelines for Americans, which is also endorsed by the American Heart Association and the World Health Organization, that children should engage in at least 60 minutes of moderate to vigorous physical activity every day.

 

In addition, we have found that sometimes a simple 30 minute bouts of active video game play help to improve their cognitive capacities like executive function. We have observed significant improvement of inhibitory control and working memory improvement after the play.

 

And also the effects are actually more significant and more pronounced for children with obesity and overweight than children with normal weight. So what details I will share that on my Web link at the end of my presentation in terms of the tips for parents or what they can do.

 

I think parents should not simply view screen time as threats to their children’s health and well-being. Instead, by selecting quality, physically active screen products to replace their sedentary screen media time, they should be able to actually effectively reduce nonproductive, sedentary screen time, to much of which would actually harm and also have negative impact on their children.

 

So these are the first two tips. But I also would like to add some qualification that this does not mean that physically active time can completely replace regular Aldor exercise and school activities. Ideally, children should engage in physical activities in fresh air with friends on a regular basis.

 

However, during the current pandemic era, this politically active screentime could really help and make up for the interruptions and disruption to the regular exercise time. And also, in addition, I think parents should be able to enjoy physically active screen time with their children by playing games and watching videos exercise together.

 

On one hand, it will be able to ensure that their children are indeed exercising instead of cheating the game system by only moving their risk. On the other hand, this is also a great bonding opportunity with our children.

 

And when they get enough exercise, children probably will sleep better and also less likely to engage in the non productive, sedentary swing time. And in addition, I think they can take advantage of this gaming or watching opportunity to use them as gateways, to introduce their children to actual sports themselves.

 

They can start by explaining the rules of some of those sports like tennis, basketball, baseball, rock climbing, skateboarding, etc. and then they may have more meaningful conversations with their children after playing these games or watching these videos about potential future participation will be sports themselves.

 

So this is the link to my website and the publications and the studies I mentioned. And this is my contact information. Thank you very much. That was wonderful, thank you. I think that the question that I’d like to ask both as a parent and as a pediatrician is if you could you so you talked about how certain

 

games and certain physical activity requires devices to actually use, that you need to purchase those devices. And then some of them, you can actually just watch a video or all you really need is your own device and nothing additional.

 

And then there’s the actual non device activity, like joining a soccer team or going and running your bike outside. Could you discuss sort of the exercise outcomes and if one’s better or worse in the pros and cons? Sure.

 

I think this is a great question that with the technological development over the past couple of decades, we have seen so many types of. Methods and products that would help people exercise. So it seems that most of the empirical studies that I have read and also my lab has done have been involving those that involve some kind

 

of special purchase device like Kinect or we sometimes virtual reality devices. And I think in terms of the exercise outcome, potentially at the current technological development stage, this might potentially be more effective and engaging than those that doesn’t require a lot of extra device purchase.

 

One reason is that a lot of these devices have been developed and designed specifically to encourage people to move around. And a lot of them can be down actually on a bigger screen than a smaller screen. So comparing, you know, bigger TV screen versus like pulling that on the iPad sometimes, you know, from the media research perspective

 

, bigger screen increase, people’s engagement and also potentially could be more interesting and involving more people to participate altogether. So I think we need some kind of really additional empirical research to make sure that all of these intensive exercise for these folks can be continuous over time.

 

But on the other hand, I do think that this kind of ubiquitous access of the smart device will be able to actually help pushing this kind of potential exercise potential through interactive media to more population, because it’s like a lower threshold for people to get access to them.

 

And then with the engagement and also involvement of more creative technological team and also advancement of technology, potentially the engagement level and intensity brought about by those exercise apps will also go along or increase over time. So over the time, people will be able to pick either from the antique market or some of the older exercise equipment

 

using exercise video game back in the 90s versus some of the contemporary exercise equipment using the latest app or some kind of virtual reality altogether. And ultimately, I think this lies with developers ability to integrate fun and engagement into physical activities.

 

I think that’s a great answer and a really great point. I think that we are going to see how it’s not going to be just one or the other that they sort of they they merged, that he can be physically active and on your screen, and that screens can help you exercise or even just remind you to

 

do it in the future. I think this will be much more common as a pediatrician. I do also, though, encourage parents to balance that with trying to get their kids involved in outdoor activity, to actually go outside and to join teams, because I think that there is and I know you would agree a lot of benefit to

 

being part of a community and to getting the fresh air and the vitamin D and all of that. So I think parents should see this as if they’re going to have screentime. This is the better screen time, but there is still a place for outdoor physical activity, too.

 

So moving on, we are going to go to someone I’m very interested in hearing speak. It’s Melissa Hallis, and she is a registered dietitian and nutritionist and a nationally recognized pediatric nutritionist and plant based photo nutrient expert. She has a passion for making good nutrition come to life for kids through hands on learning and tasting inspiration, whether

 

speaking as a keynote to industry experts or providing an interdisciplinary approach to care with other pediatric professionals and conducting nutrition workshops for parents, Melissa helps overcome mealtime struggles with practical solutions. So take it away, Melissa. Awesome. I’m so excited just showing my screen.

 

I have to say, Doctor Who, I have many great memories late on a Friday night when it’s too dark to go outside doing we dance dance revolution with my daughter in our younger days. So, yes, there’s it’s we all have to get moving more by standing sitting desks.

 

I’m working off of today, so I’m going to share how to create a positive mood environment. And whether you’re starting early with the thott or you’ve got a tween, you can begin with working towards creating balanced meals, snacking mindfully, eating more colors, and also just really making good nutrition and come to light.

 

And I’m hoping this is showing in full view. It’s never too late to start. You know, you’ve heard some amazing experts today. So think about one small goal to focus on this week. Write it down. And then so it doesn’t become some disappearing attention that floats off to the good intention of bad and start small.

 

It’s just one small change can add up to a really big difference. It’s important to examine meal time balance. So if you’re envisioning what your plate looks like, whether it’s, you know, lunch, dinner or a bento box, try to see where you could be filling in some gaps.

 

Is it fruits? Is it whole grains? Is it vegetables? Is it lean protein? And really imagining that it’s pretty simple. It’s about one fourth for each. You can have a milk as a side or even a planting’s milk aiming for regular meals.

 

You heard Dr. Bellows talk about how Borton family meal time is. I can tell you, working with my clients is one of the things that makes the biggest difference in their eating habits and willingness to try new foods.

 

So you might look at that as a parent and think, well, OK, all right, I saw my plate, but how am I going to make that happen? Because my kid’s a picky eater or they don’t want to eat their vegetables.

 

And one of the tricks that I tell my clients is to use hunger as your friend. So whether you’re packing a snack for after school daycare or you’re picking them up in, Carlyn, having something readily available that hopefully you made one and it has three servings.

 

Cook once, eat three times because we’re busy and it’s hard to get everything organized. Right. And so when you pull up and you’ve got your snack ready to go, it could be, you know, red peppers or carrots or hummus or watermelon that you cut up for three days.

 

But because they’re hungry and you are you have it ready and you’re serving it, they’re more likely to eat that healthy food than, you know, heading when they get in, having right to that kitchen cabinet that’s got your less nutrient dense food that fit since there’s no good or bad foods.

 

But we want to help steer them towards healthier foods. The other trick that works all the time with my clients is serving veggie appetizers. So you have kids come into the kitchen and they’re ravenous, you know, having something that, you know, that they like.

 

Like, for example, long frozen string beans, you know, that you cook up with garlic and soy sauce. Maybe your kids like that or maybe they like spicy, hegemonistic. But putting that vegetable out first, which can help help them build their hunger, but is helping boost their vegetable intake and they’re fighting nutrients.

 

Keep it up. And remember, it’s about consistency and being consistent. And it takes time. You know, when you when you get your kids to try and you give yourself a pat on the back, it’s a huge win. One small change can add up to a big change in their diet over time.

 

It increases their willingness to try new foods. The other thing is, don’t let them see you sweat. You know, if you’re if you’re looking disappointed and they don’t eat the vegetable or you’re bribing or coercing, you know, they’re going to pick up and they’re going to resist.

 

Keep in mind that mealtimes do not have to be extravagant. I mean, one of my favorite meals I make as a family is just opening up a can of refried beans, you know, saying, hey, kids, put the tortillas in the microwave to give that nice, crunchy taco taste.

 

You know, add in some low sodium sauce, low fat cheese, little cabbage side vallet. You got yourself a meal, a family meal in 15 minutes. Also getting your kids involved in the process. So, for example, you could take like an every day meal item.

 

Let’s say you make mac and cheese once a week and say, hey, how can we make this more colorful if your kid’s like frozen peas, adding frozen peas in there? I’d like to puree big sweet potatoes with the cheese to give it a Premiere taste.

 

But looking at everyday foods and how can we kind of add a little more color and get the kid involved, not telling your child, oh, let’s make it healthier, but how can we make it tasty or how can we make it more colorful?

 

How can we change the texture? For snack time wins. I think we’ve covered this a little bit already, but it’s so important to be mindful. Dr. Kenny talked about that. I can tell you when I work with families, they probably consume up to 30 percent more.

 

If they’re not sitting at a table, they’re eating in front of the TV. It can really start to add up getting your kids involved in snack preparation. I often hear from parents, oh, you’re telling me to cook with the kids, but it’s so overwhelming.

 

And I’m like, I know I’m there with you in the trenches. It can get so tough. But snack time is an easy way to get your kids involved because you can just say something like, hey, can you scrub this cucumber?

 

Let’s cut it up in three different ways. Cubed round little circles, Julian style. Which way does it taste best? What kind of dip do you like with it and make you think again about the flavors, the texture, the shape, the temperature, because all of those can influence if a kid’s going to like it or not.

 

The other thing is to boost your colors. Always be looking at, hey, how can I make this meal more colorful and make your kids involving involved in creating a really nice, easy to go snack. So you already have snacks that they’ve approved.

 

They’re in power. They’ve been part of that list. And then don’t keep it around forever. You’ll get snack for it and then you’ll have that resistance. So update it together. Find some recipes online that you like. Remember, that kid’s taste buds are under construction.

 

So this is a sliding scale goes all over the place. You know, one day your kid likes bananas, the next day they’re like, what? I never eat bananas. What are you talking about? And, you know, keep in mind that their hunger, their moods, their individual taste preferences, their affinity towards bitter, all these things can impact it.

 

But so does taste temperature, size or texture. You know, kids might say, I hate corn, but you give it to a frozen. And they love frozen corn just pulled right out of the freezer. And then the other thing to keep in mind is that all of these foods, plant based foods especially come in different colors and every

 

different color has a different phytonutrient. My characters in supercool called phyto nutrients because they fight off disease. And these are essentially body protectors. And so if you get your kids involved in something like tracking your colors and these are free activity, download’s, I found that even the picky eaters like this now even know the super crew has

 

been a focus group. Tested your research for three to 11. I’ve done this activity with sixth and seventh graders, and they want to color in the circles that they tried the purple cabbage or a food that they were more resistant to.

 

And it’s an easy tool to use to say, hey, let’s get let’s try some more colors at dinner. Oh, you had strawberries at breakfast. What about carrots that ate dinner? And it’s just the way to kind of get them involved.

 

And I know I needed to cover outdoor exercise as well as extra gaming. So there’s a free printable activity where you can kind of teach your kids about doing exercise that’s good for their heart, their muscles and their bones.

 

These are my books, the super. I’m hoping that you check them out and they make good nutrition, fun and most importantly, choose one goal per week. And you know what? It could be your goal week two. It could be the single week three.

 

It takes time to make a positive health change. And when you do make it, give yourself a pat on the back. It’s a process. It takes time. But definitely, if you’ve learned something today, write it down, schedule it in, share that goal with your friend or family member.

 

And remember that good nutrition and healthy choices being more active, cutting down screen time. It’s it’s a process. And I love how Forry heads that are Dr Cross said it’s not how you parent one day, it’s how you parent over a week or a month.

 

And just really trying to don’t judge yourself in the process, let go of perfection and slowly work towards these health goals. Thank you. That was that was excellent. I we do have time for question answers after after this.

 

I wanted to ask you one question that as a pediatrician, I get a lot. So you have a lot of health issues, whether they be ADHD or behavioral problems or learning difficulties or pandas. There’s a lot of things where parents will try different dietary approaches and sometimes they want to know what they can use.

 

That’s a dietary aide or changing their child’s diet, cutting out sugar or cutting out gluten, giving fatty acids or DHEA or whatever. And I find that a lot of parents are doing this piecemeal. They’re reading something on the Internet.

 

They’re implementing it. And sometimes I would say it’s at the detriment to their child’s health, but sometimes it’s to the detriment of their child’s mental well-being because they feel like they have all of these things going on. Is there a resource that parents can use to because diet does affect our our beings.

 

Is there a way that they can do this in a more systematic approach and with some help? Well, it’s definitely it takes the team, right. So I work closely with pediatricians and physicians and really come up with a plan.

 

I think it’s important that they work with a registered dietitian, especially somebody with that expertize. So if it’s food allergies or gastrointestinal that they’re working with the pediatric dietitian who’s aware of those issues and not a generalist, just like you would go to an endocrinologist or a urologist.

 

So I think that that’s really important. And, you know, you can go to eat right dot org and you can find a dietitian in your area. You can talk to your doctor and say, I need to find a dietitian, and then they should interview the dietitian, just like you asked questions of your physician to find out, you

 

know, if they’re the best fit for you. For example, if a child has ADHD, they should ask a dietician, what’s your. Are you familiar with the research on that? Do you know how to choose a safe supplement? I mean, I personally go for the food first approach, but I do recommend supplements.

 

And you know, it just because it has good marketing doesn’t mean that it’s safe. The Food and Drug Administration isn’t regulating it. It you know, we have to find out something’s harmful and then the FDA has to prove that it’s safe.

 

So it’s really important that it’s a team approach and your your pediatricians communicating with the physician and vice versa. Thank you. That was great. And so I think at this point, we are going to do a general question and answer.

 

We have gotten a ton of questions in the chat while we’ve been talking. Melissa actually answered two of them as she went along. She talked about there was one question that was how when you’re really busy, how do you busy parents, parents who work, parents who are low income, how do they find the time to prepare three

 

meals a day? And I think you really touched on it, Melissa, with your response that you cook once, eat three times. And I would say that I think that’s for all meals. I know that I make if I’m going to hard boiled egg, I’m going to hard boiled.

 

You know, there is no reason to do something once and to serve things I’ve gotten away from. You know, how old fashioned you put it in a petri dish to put it on the table? I just put it in something that I can then put a cover on it and put it right back in the refrigerator so

 

that that same thing can come out the next time we eat it. And so I think that we need to think like that as parents. And sometimes, you know, when you have leftovers and you don’t have enough for the whole family, then you can have left overnight and everybody can eat what they want.

 

That’s a different leftover. So I think you really touched on that, and I think that’s great. Another question that we got was about textures and having kids try different foods. And from experience, I think your your advice about eating the different colors and making it a little bit of a challenge.

 

I think that big and little kids respond to challenges. Everybody likes it, particularly when the whole family does it. So I think that you answered both of those questions. I am going to move on to a question and see who would who would feel like this is the best.

 

Best question for them. But I think that there’s a question says like, how do I make this part of my family life? So sometimes, you know, it’s the right thing to do. But your husband or your spouse or the grandparent who’s watching your child, how do you get the whole team on board?

 

So does anybody want to address how we make changes when we have more than one caregiver? I can deal with that every day in counseling, but I’ll keep my response or in case anybody else wants to jump in.

 

So I think what helps is when you make an appointment that you’re there together, whether it be with your pediatrician or the dietitian, whoever, whoever you’re working with. One of the things that I do is I kind of go over this parenting approach and it talks about the different types of parenting styles.

 

And once, if I’m in place, the non judgment, you know, because we all have our parenting styles. And once the parents can identify, oh, wow, we’re we have totally different parenting styles, you know, just identifying that first and then finding some common ground to work with, you know, and showing what the research is can help them on

 

that journey. But you have to have both parents involved and say, I’d love I’d love to I’d love for you to come to the appointment. And address these concerns with me, and then they feel like they’re part of the solution.

 

I think that’s great advice, because I think sometimes you can’t even. Think about how someone else’s is viewing the same situation, so I think that that’s really important and I think having them in the same room to discuss it and now we’ve got these virtual rooms, it’s it’s actually a lot easier to get parents together and speak

 

to them. So I think in a way, we can use screens to our benefit in that in that situation. There’s another question about kids being depressed, and I think that we’ve seen this a lot, both in the younger and the older age groups, particularly during Covid and having been inside and sometimes being a little more nervous to

 

go outside. And also, they’ve gotten into their eating habits that maybe aren’t the best. Are there solutions that anyone can give to parents to help with children who aren’t just battling inactivity or not making the right food choices, but also a depression component?

 

I mean, I can start this with the depression component. I think that, yeah, unfortunately there in addition to the doubling and eating disorders that we’ve seen, like we’ve seen a doubling in suicides among teens that I think also related to social isolation.

 

The stressors that young people are facing. And so with that component, obviously, mental health can affect all aspects of your health. But you’re saying like a symptom of depression can be like loss of appetite or a gain of appetite or loss of sort of goals of wanting to go outside.

 

And so it can really affect your physical health and a lot of ways. So I do think that if people are concerned about their children experiencing depression or other mental illnesses, certainly it would be worthwhile to get help.

 

I see your pediatrician or primary care doctor and try to get them into therapy if you know, if indicated. I think one other interesting silver lining of the pandemic. I know we’ve we’ve talked you know, I think one of the interesting benefits of screen time, in addition to sort of remote learning opportunities, actually, like telehealth or, you

 

know, the ability to see a therapist, you know, across the state or depending on different regions. And so, for instance, like in San Francisco, you know, there is a shortage of like eating disorder or a therapist. But because of telehealth, people can actually see a therapist from, you know, if it’s just a zoom, meaning it doesn’t really

 

make a difference where they’re zooming in from. And so we have had like a larger pool of providers that are potentially able to help with therapy. So I think that’s just one that’s just the depression component. But I will defer to others about some of these contests.

 

No, I think that that’s a great point is that it has made care a little bit more accessible and that when you are dealing with someone who is depressed and if as the person who sent the question and really is having trouble getting their child to motivate, I think calling in a specialist is is the right is

 

the right move. I wanted to touch on we’ve talked a lot about getting little kids to eat the right things. And and Laura was great, really setting the stage for that. I wanted to talk about when when tweens and teens go out on their own and they’re able to make their own food choices.

 

And this also goes to the marketing that Eric was talking about, because I see a lot of marketing for fancy coffee drinks and for Bobba. And I wanted to know if anybody could talk to really how to have kids make the right choices when they’re out and about in the community buying their own food and how to

 

set them up for success there. Would anybody like to take that? I can start with it, and I’m going to start with it from a developmental perspective and really trying to like looking at that as why are they doing it?

 

And food is something that people can control. And at the tween stage, it’s about independence, autonomy, and they are venturing out on their own without mom and dad. And that that is what they are choosing to do and that’s how they demonstrate autonomy.

 

And so if you can redirect the autonomy and independence to something else, I think that’s one way to look at it. But it’s almost a rite of passage to be able to go to the convenience store and buy your own food.

 

They’re not going to choose what we would want them to choose. So then it comes down to controlling the home environment and the foods that you have in the home environment so that you’re not adding more sugar and fat and highly sociable foods on top of what it is they might be wanting to go enjoy with their

 

friends. So it’s a it’s a developmental phase where I think we have to take it at what it’s worth, but then controlled the pieces we can control. I would agree with you having two twins myself. I’ve also found that talking to them about why it concerns me does help.

 

I say, I know you’re going to make these choices and you’re gonna make them yourself. But I want you to see what’s actually inside of these. And while you can make this choice for yourself, maybe make it that every once in a while you have it.

 

But understand that if you have it every day, there is no way around how much extra sugar you’re getting. So I’ve tried that, too. I don’t really know what’s happening when I’m not around. So I hope it’s working.

 

So another question that we have and Jason, maybe this is more for you, is that if if we look at the the slide you showed, there is a real strong correlation between social media and texting and increased obesity.

 

Yet we know that that is how children are communicating these days. Right. That’s that’s just almost like the third arm. It’s like it is what they they they do. It’s how they do everything. How can parents sort of marry the fact that this is how kids communicate and yet this is what’s what’s going on in their bodies

 

? Yeah, that’s a great question. I think that the one thing that I’ll note is that I think the reason why we saw that really strong association with texting in this particular sample was just a reminder that the study that we looked at were like nine and 10 year olds.

 

And so they’re like a little bit. Certainly some nine and 10 year olds are texting, but maybe less so than older teenagers. And also, that was like an exposure in terms of hours per day. So that’s like I think in general, people spend even if they’re texting about like it, it’s not necessarily going to add up to

 

the same amount of exposure as like a television or video game. So it’s just when you expand that texting to an hour per day, that’s what that that’s why the association was higher. So I don’t necessarily. I just think there are different modalities, but to your point, I think we’ve talked about how I don’t think that screens

 

or any of these modes are like inherently bad or good. Like, I think there are benefits to texting, like being connected or just logistical benefits of being able to keep in touch with even your parents or communicate things like that.

 

So, yeah, it’s not something that we’re going to necessarily get rid of. But certainly I think, as you were mentioning earlier, like maybe getting rid of or having some time when you’re not getting notifications like late at night or during screening periods, or if it is getting to a point where all these notifications are really becoming addictive

 

and just like notifications, protect staff or other updates are really like kind of impairing your ability to do anything else. You know that I think that there are there are certain ways that we can still keep the texting, but really try to use it more for the ways to enrich our lives and keep connected, whereas maybe, you

 

know, limiting some of the more addictive related behaviors. And then, as Amy was mentioning, like, you know, perhaps there are ways of leveraging some of these, you know, texting, often having the public, you know, leveraging those devices for more beneficial things like physical activity.

 

And that’s a great answer, and I think that it plays to the fact that as parents, you do have to sometimes you might seem like you’re being the bad guy, but you’re being the good guy because not everybody can control their own sort of screen use.

 

So sometimes you have to be one and say, OK, we’re going to turn off the notifications now before you go to bed and then you can turn them back on in the morning. OK, so I think we need to wrap it up.

 

This has been just so educational, even for me. I’ve learned so much that I’m going to put into my own health with my children and in my practice. And I’d love to hear final thoughts from everybody. So maybe we could start with Dr Lou.

 

Thank you. I guess. Parents should set good examples for children before trying to regulate children. It’s my thought that they should participating exercise together with children themselves and also have a good and healthy balance of immediate use to begin with.

 

So this will make their regulatory. Behavior. More respected. I think that’s great advice and Dr. Kenny. Sure, I think just going back to talk to your kids about marketing and talk to your kids about what’s happening when they see influencers kind of promoting these foods and beverages and and and sort of a theme that I think we’ve

 

been talking about today a little bit. You know, it’s OK if you don’t do it every single day. Right. It’s OK if you try to take this as a practice, but recognize that you’re also in an environment that’s kind of set up to work against you.

 

And it’s not your necessarily your fault. So, so advocate for things in your community and your schools. And that help also limit kids screen time, too, so that it’s not just you fighting the battle every day, but definitely make sure that you know as much as you can in your home environment, like try to try to just

 

limit those ads that kids are seeing. I love that. It’s empowerment. There you go. And Dr. Bellows. Yeah, I would add just the acknowledgment parenting is hard and it’s exhausting, and we have two parents around so many different things, and so be present when you can be, you know, try to avoid that.

 

Yeah. Yeah. And I’m multitasking. I think kids, regardless of whether it screens food activity, if you engage, it makes the the interactions more enjoyable, but also giving yourself a break because it’s hard work and we’re going to fail sometime and we’re going to succeed some.

 

And ultimately, we’re going our kids are going to turn out just fine. I can’t agree more. And Dr. Nagata. Yeah, building on that, I think, especially during the pandemic, when there is unprecedented exposure to screentime, like giving yourselves a break as a parent, you know, like these are this is like a new environment, but and screentime is

 

universally bad or good. But I think really trying to leverage skiing’s for all the potential benefits like education, you know, promoting physical activity, social connectedness, while being aware of the potential risks like addiction or sedentary behavior or poor sleep and not necessarily feeling guilty about it all, but really trying to maximize its use while mitigating risks.

 

I would agree it’s a tool and we should be conscious when we use it and use it for a purpose. And last, Melissa, I’d say make good nutrition fun, you know, talk about taste. Bring in adventure. And even if you, you know, committed to cooking one recipe a month with your child, that’s actually that’s a huge accomplishment

 

. Sometimes what I’ll do with my daughter is on Saturdays. Well, bulk cook together in a letter, put Harry Potter on in the background. And we just like massively cook for a few days. And, you know, it’s an incentive.

 

So screens can be good at times, too. So just embrace and engage them around the mass when you’re in the kitchen. And over time, it will work itself out. It’ll be interesting. Thank you and thank you to all of our panelists.

 

This has been amazing. I want to turn it back over to Pamela and just thank her for hosting this and putting children’s and screams together. I think you bring great information to parents out there, and it’s just a wonderful forum to be able to discuss and to learn.

 

So I’m going to hand it back over to Pam and just say thank you for having me as well. Well, thank you. And as well, Erica, Amy, Jason, Allura and Melissa for really a truly terrific webinar and for taking the time to share such great and useful information and advice.

 

And at minimum, if you can get the screens out of the out of the kitchen and, you know, screen free meals and out of the bedroom, that will be a big help. Thanks to all of you are astute participants for joining us as well.

 

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Our Ask the Experts webinar series continues on Wednesday, October six. Mark your calendar. When we will discuss what we’ve learned during the pandemic with regard to digital media use and family life, as well as where we go from here.

 

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