Wednesday, April 29, 2015

But WHY Is There A Correlation Between TV and Obesity?

I read an article the other day about a study that found (again) a correlation between TV watching and obesity in kindergartners and first graders. According to the article, the study found that these young children who watched more than two hours of TV a day had a much higher risk of being overweight or obese than children who watched less than one hour. But children who watched between one and two hours also had increased risk of obesity, even though the AAP suggests a maximum of two hours of TV per day for that age group. The takeaway here is, more than one hour of TV a day in 5 and 6-year-olds correlates to a greatly increased rate of obesity.

A simple response, then, is, "Kids shouldn't watch TV." But it isn't that simple.

Two things stick out for me.

1) This is a correlation, not a causation. They did not say that watching TV causes obesity. They even stressed that in the article. We see a correlation, but we don't know why. Why does watching more than an hour of TV seem to correlate to higher obesity rates? They also found that using a computer more than an hour a day did not have the same correlation to obesity, so it isn't the use of a screen, or the sitting and staring, that's a problem. It's the TV, specifically.

2) Didn't we already sort of know this? I mean, researchers have been studying TV watching for decades, and every so often they come out with another study that says, basically, "Kids are watching too much TV and it's making them fat." But they still don't know why. They used to think it was simply because TV was replacing physical activity, but that doesn't seem to be the case, exactly (see above).

Another article reported one older theory as to the reason TV watching correlates to obesity: It's the commercials. Kids are exposed to commercials that make them crave unhealthy food, and that contributes to weight gain. This is an interesting theory. To me, it makes sense, then, to study what kind of TV kids are watching, and how. With Netflix and other streaming services enjoying such high popularity these days, lots of kids are avoiding commercials. My kids rarely see commercials because they watch their shows on Netflix and Amazon Prime. So if there were a study that took two groups of kids, one that watches more than two hours of TV per day but exclusively on an internet streaming service, and one that watches more "traditional" network TV and are exposed to commercials, would we see a difference in obesity rates?

I'd like to offer a few other questions that should be asked.

- Are the kids who are sitting and watching TV more likely to be snacking while they watch?

If so, what are they snacking on? Perhaps kids using computers and iPads are not eating, because their parents don't want sticky fingers on the electronics. In this case, there should be a difference between TV-watching and other screen use, but there should not be a difference in Netflix versus network TV.

- Why are these kids watching so much TV?

Maybe the TV-watching and the weight concerns share the same underlying cause, rather than the TV directly causing the obesity. The L.A. Times article linked above said that the researchers controlled for variables such as socioeconomic status and demographics (which were the first variables my own mind jumped to for a possible explanation), but I'd posit that, for example, kids at home in the afternoon watching TV and snacking can cross demographic and socioeconomic lines, so there may be more that can be investigated here. My kids usually get up in the morning and watch some TV while my husband and I get ready. After school, I'm often working or getting dinner together and whatnot, so my kids, again, are watching TV while I do that. I'm lucky enough to live in a neighborhood where I can send my older two outside on their bikes to play most of the time, but there are plenty of kids in all demographics who don't have that luxury. Learning more about the environment these children spend so much of their time in would be helpful.

- What's the difference between using computers and playing video games and watching TV?

Why is computer use not correlated with obesity but TV is? Is it because the child's brain is more actively engaged when playing a video game than when he's sitting passively and watching TV? What is the fundamental difference, here? I watch my 6-year-old play video games and he's jumping up and down and shouting and generally enjoying a full-body experience while he plays. That same 6-year-old will then sprawl on the couch like a lump while watching Ninjago or My Little Pony. There's a clear difference in physical engagement with the media. I feel strongly that this issue requires more study.

My kids watch a lot of TV, so this data concerns me. My kids also play video games and use the computer, so it's not just hours of TV every day, but they do watch a lot of straight-up TV. I know why and how they've ended up watching so much TV, and the ball is squarely in my court to make the change, if a change is needed. Now, while my oldest admittedly is struggling with his weight, my other three are of average weight for their height and age, and I don't think the reason for my oldest's being overweight is that he watches TV. Frankly, my younger three have watched more TV at a younger age than he did. Now, an anecdote is not data, and my family by itself is not statistically significant, but the results of these studies may still affect my parenting. As a parent who likes data and science and evidence-based philosophies, I really want to know more about this phenomenon so that I can make an informed decision about my children's screen use. If I am given a compelling reason as to why there is this correlation between weight and hours of TV, then I can decide if I need to cut way back on the screen use or if there are other factors I can control that will mitigate the effect of the TV itself.

I watched a lot of TV as a child. Even in the 1980s, researchers and doctors were becoming concerned with the strong association between hours in the front of the TV and weight. I was far from an overweight child despite my television watching habits. But there are many more options out there now than when I was a kid, and there are other screen-time possibilities besides simply switching on the tube and watching what's on. There are other ways to watch TV, such as on a tablet, computer, or phone. There are premium and subscription services. There are tablet games and phone games and PlayStations and XBoxes. "Screen time" doesn't just mean TV time anymore, and it's very important to sort out what's the most harmful and why and to figure out what, if anything, can be done to help improve the situation.

Sure, it's easy to say, "Watch less TV." But sometimes that's not as easy as it sounds.

Friday, April 17, 2015

Maybe It's Depression?

Sometimes when I feel vaguely under the weather, I don't really connect all the random "not-quite-right" feelings into one, "Oh, I'm sick!" revelation right away. "Why am I so tired?" I wonder. "I feel thirstier than usual. What's with that?" "I'm kind of cold." And then someone mentions a virus going around, or another member of my family comes down with something, and it'll click. "I must have a cold!" And then the next day or a few days down the line, the stuffy nose, sneezing, cough, and other hallmarks of the cold will begin, as if by realizing I might have contracted a virus, giving it a name, brings it to life.

But it's only once I've decided, "Yep, I'm sick" and allow the symptoms to crash over me, to rest and up my fluids and behave accordingly, that I can then continue on to recover from that minor illness.

A similar experience happened this week, but it's not a cold I realized I have.

It's depression.

And it took about two months for me to link all my various, vaguely unpleasant symptoms, put them all into a box, and label that box "Depression," but once I did, it made total sense.

I've been seeing a therapist for several months now. I wasn't sure what I needed when I first made the phone call and set up the first appointment, but I knew I needed "something." Someone to talk to, someone to help me make sense of what was going through my mind. I wanted to be a better parent. I wanted to understand myself better. And she has helped me with a lot of those questions.

Then why, I wondered, after starting to feel so much better about life and myself and my parenting, why is it so hard for me lately to just be that person?

Why am I so tired? I mean, sure, the baby doesn't sleep extremely well, but it isn't worse than it's ever been, and it's gotten marginally better, and yet I feel so tired all the time.

Why am I eating all the time? I can't get enough sugar. All I want is pasta and bread and snacks and treats, six times a day.

Why can't I just focus on one task and get my work done? I'll sit down to do 20 minutes of work, and three hours later I'm still working on it. Sure, Facebook is engrossing, and Candy Crush is fun, and, yes, the kids keep distracting me and pulling me away. But even with all of that, why does it take all day to do one simple task?

Why am I so irritable? Every little thing any of my kids does just sets me off on an epic rant. I'm cursing more (I try to hold back the worst of it when I'm around my kids, but I've been letting quite a few more of those words slip through than usual). I yell at the drop of a hat. I don't like it.

Why do simple tasks seem so monumental? I have to do laundry. Ugh. Getting it out of the dryer is so annoying. I'll do it tomorrow. Cooking dinner? Forget it. I'll just make pasta. I have to put a check in an envelope and walk all the way to the end of the driveway to mail it? I'll take it out later.

Why is it suddenly so hard for me to run, when I've been running for six months now? I felt so sluggish, slow, like I had no stamina. I turned to hiking up the hill behind my house and staring out at the ocean instead of doing my interval training and working up to a 5K like I had planned.

Why do I feel so detached? Nothing is interesting enough to bother with. Yeah, I have an idea for a story or novel, but it's too much trouble to actually sit down and write anything. I'd like to read that book, but it's so long and big and heavy. I guess we could go to the park, but it sure seems like a lot of effort to get everyone into the car and all. Go to the beach? Nah.

The thing is, I'm functional. I do eventually get work done. I get the dishes washed and the laundry folded and put away. I go out and run/walk three times a week. I make lunch and dinner for the kids and do the shopping. I pick them up from school and get them to Hebrew school on time. I pay the bills and have been keeping up with the budget. I even took on a little extra work and am getting that done, too, albeit more slowly than I'd like.

That's where depression is so sneaky. It takes up residence in the back of your head and plays with your mind, manipulating your emotions and your memory so you don't connect the dots. There's no stuffy nose or vomiting or localized pain to signal exactly what's going on. There's no telltale rash or high fever to broadcast to you and everyone around you that you're sick.

But you are sick.

Depression is an illness. It's a physical problem just like appendicitis or diabetes. And just like those more obvious diseases, in most cases it is treatable. For some people, psychotherapy alone is enough to help them out of the fog of depression and on the way to normal function. For others, medication helps the brain manage hormones appropriately and regain the chemical balance that lets them recover.

I had my suspicions about two weeks ago, that maybe all of this discomfort was related. When my therapist suggested getting a psychiatric evaluation and discuss medications with a psychiatrist, suddenly I was able to throw all those symptoms into a box and put on that label. And even just doing that has helped me feel better. Just putting a name to it, understanding that this isn't the real me. This is an illness. This is the disease talking. I can manage a disease. I can understand it. And I can control myself better knowing that there isn't something horribly wrong with me as a person, but maybe I need a little help finding myself under this pile of symptoms.

It's so, so important to be able to recognize the signs and symptoms of depression. Depression can be mild, but it can still rule your life in a way you're not aware of. When depression is severe, immediate help is vital, but a mild depression can drag on for months without any obvious manifestations except maybe a little irritability, a little sluggishness, a little, "Huh, I'm feeling kind of...not quite me," and you don't have to let yourself feel that way.

It's only once you identify the symptoms, attach the label, and put it all together that you can begin to find your way out. You may not even realize how poorly you were feeling until you start to feel better.


Please note that many common antidepressant and anti-anxiety medications are compatible with breastfeeding. Talk with your prescribing physician about options that will work for your situation.

Wednesday, April 8, 2015

Finding the "Yes" on Passover

This week is Passover. It started with the first seder last Friday evening and ends this Saturday after sundown. In the meantime, we, as Jews, are prohibited from eating any kind of leavened bread, along with other restrictions, which is both more complicated and simpler than it sounds.

It does mean a huge disruption to our routine, a change in the way we handle and plan meals, and me saying "no" to many requests for various snacks and favorite dinners.

My kids' spring break from school happens to coincide exactly with Passover this year, which is quite rare. There is often some overlap, but to have the entire holiday off from school is a luxury. Removing the need to pack school lunches from the already complicated week surely helps.

My husband and I want our kids to form happy memories associated with Passover. Rather than dreading it every year because they can't have pasta, rice, sandwiches, peanut butter, and pancakes, we want them to look forward to macaroons, special desserts, the excitement of the seder meals, and other treats.

But the reality is that kids are far more likely to remember the nos than the yeses. They won't remember that we gave them dessert every night and sometimes after lunch, too. They won't remember that we handed out macaroons randomly throughout the day and had bottles of Dr. Brown's Cream Soda on the table at dinner.

What they'll remember is that they couldn't have chips. They couldn't go out to eat. They couldn't have their hot dog in a bun or their meatballs over spaghetti. There's no pizza, no mac and cheese, and we're trying to make them eat way more vegetables than we normally do (because there's nothing else to eat!). And the only vegetables they're guaranteed to eat, peas and corn, are prohibited on Passover.

It's only a week (well, eight days, really). As adults, we know how short a week really is. We're adaptable. We understand the "why" and the "how." We can get creative. We know how hard we're working to provide a fun and interesting time for the kids, to provide good food and meet their needs. But to them, it feels like all we're doing is saying no.

For the first few days, we thought we could manage on just meat, potatoes, and eggs, but it quickly became clear to me that the kids needed something else. They needed some kind of snacky, non-healthy treat. I took them to a supermarket with a decent-sized kosher-for-Passover selection (45 minutes from our house), and we picked out some treats and easy lunch items to ease the "no" aspect. We had chicken franks for lunch today, to their delight. I also found fish sticks that are potato-crusted instead of breaded, which will be great for lunch tomorrow. We got kosher-for-Passover pasta, which is made from tapioca and potato starch and was surprisingly pasta-like in both taste and texture. I bought turkey lunch meat and some packaged snack items. I came home with much happier kids.

Parenting is always a delicate balance of meeting needs, acknowledging wants, and trying to explain that sometimes things are just the way they are. It's looking for opportunities to say Yes when it feels like all you do is say No. It's teaching and learning, giving and taking. None of this is more clear than on Passover.