Teach Your Children Well 

Jil Landsbaugh Kaar seeks to unravel mysteries of healthy lifestyles for kids

Cynthia Pasquale

(May 2017) Childhood obesity and rates of Type 2 diabetes are rising across the country. While researchers know some of the main culprits – sugary foods and inactivity – there is still much to learn.

Jill Landsbaugh Kaar, PhD, an assistant professor of pediatrics at the School of Medicine, is one of those dedicated researchers contributing to the effort. She recently helped draft a guideline for the American Heart Association emphasizing that children should consume no more than six teaspoons of added sugar per day. Kaar’s research aims to unravel patterns of behavior that are optimal for a healthy body.

She and her husband, a chemical engineering professor at CU Boulder, came to Colorado in 2010, after post-doctoral studies at the UK Medical Research Council in Cambridge, England. As a mother of a toddler, Kaar strives to model healthy behavior that her two-year-old daughter, Zoe, will learn. Her leisure time is spent playing with Zoe, reading books, going for walks (with Zoe) and spinning classes when she has some weekend time to herself.

“When I started this journey, I wanted to help people by learning how nutrition affected obesity, but now I know that there are so many other variables we need to consider, like the amount of time you are active, your screen time and sleep,” she said. “If you exercise for the recommended 60 minutes most days of the week, but your job or school requires you to sit for eight hours, five days a week, are you living a healthy lifestyle? It’s one of the questions I want to unravel.”

How did you choose this career and area of research?

I always was interested in why some people are at a healthy weight, but others struggled with their weight. I wanted to help them. I always thought the issue was a matter of diet and physical activity. After obtaining my nutrition degree, I decided to apply to graduate school and focused on the other side of the energy balance equation, physical activity. My master’s degree is in exercise physiology and my PhD is in physical activity epidemiology. My postdoc work looked at maternal and child health epidemiology, which helped me understand that the issues don’t always begin with kids, but with parents, who are the decision-makers. As I learned more and more about obesity, the sleep component came to the forefront, and that is a new direction I am taking with my research. It’s not just what you eat or how you exercise, metabolism is also an outcome of how you sleep. If you aren’t getting enough sleep, you might not be getting the benefits of eating healthy and exercising during the day.

What are the biggest roadblocks to restructuring not-so-healthy lifestyles into healthy ones?

When I was growing up, it was more of the norm that you had one parent who stayed at home, but that is rare now: Most families need two incomes. This often means that the entire family is not home at the same time and that together time may be very short. We still want that important family meal, even if it is fast, so one thing we can do is educate people and give them the tools they need to plan ahead. Even if you only have 45 minutes for a meal, you can get a healthy, affordable meal on the table in 20 minutes and still get out the door on time with a bit of prep earlier in the week.

Kids learn from their parents, so it is about role-modeling. You can teach them that dinnertime is an event where you have a well-balanced meal and all check in with each other. You teach them that this is a nice time and you make it enjoyable as a family event.

What happens when a child is no longer under your roof and you don’t have a say when it comes to eating healthy or balancing life?

Perhaps think of it as if you are teaching kids values and morals. From the time they are young, you teach them to say “please” and “thank you.” Your child knows they have to say these things, and while they might not always do it, they have learned the importance of manners. The same goes for diet.

I don’t believe in counting calories for any age group because it is an unrealistic thing to ask families to do. It’s very time-consuming, and it’s not a lifestyle you are going to be able to maintain. Instead, I try to instill healthy eating. For breakfast, for instance, we eat yogurt and fruit and maybe a piece of toast or cereal. My daughter eats the same thing. I don’t give her sugared cereal or cookies; I chose healthier options for her to eat. I feel kids will have enough opportunity for all of the other sugary stuff, and as a parent, I want to provide her with good tasting, healthier options at home when it is more in my control. I am sure if I offered my daughter yogurt or a cookie, she would take the cookie, so I give her more limited choices: strawberry or vanilla yogurt, apple or orange slices.

Physical activity is the same idea. My daughter doesn’t see me sitting on the couch and watching TV. We keep the television off and play with her. We go outdoors whenever we can. At bedtime, we read books. As I delve deeper into sleep research, I understand the importance of not having blue light – computers or other screen time – before bedtime. A person needs more calm time then, and this is a behavior that a parent can monitor and change for a child.

You recently co-authored new recommendations for the American Heart Association saying that children ages 2 to 18 should consume less than six teaspoons of added sugars each day. How did you and your colleagues reach this figure?

There is not a lot of literature on how much sugar is linked to certain out-comes like obesity or diabetes. This was an invited article by the American Heart Association, which convened a group of researchers – both medical doctors and PhDs – to comb the literature and find out what we know now, where the research gaps are, and where does research need to move forward. The idea was to recommend a number that will improve child health.

My contribution was related to childhood obesity and diabetes. There’s not a lot of literature about the exact amount of sugar consumed that leads to obesity. So, for instance, nothing out there says that if you consume X number of sugary beverages, you are twice as likely to become obese. But what we do know is how much sugar kids are eating today from detailed food records. We know that preschoolers have about 12 teaspoons of sugar a day. We also know that obesity and Type 2 diabetes are increasing, and so we know that 12 teaspoons may be too much.

We don’t want kids to have more than one sugar-sweetened beverage, which contains 10 to 12 teaspoons of sugar, each week. The average kid probably has one of these beverages each day.

You mentioned that your current research deals with how many behaviors affect obesity. What does your research entail?

I have a scientist development award from the American Heart Association to study health behavior patterns of children. These behaviors include diet, screen time, sleep and activity. I am trying to unravel these patterns.

Let’s assume that you have some kids with healthy behaviors in all of those categories. They get adequate sleep and physical activity and have limited screen time and they eat well. Other kids don’t do any of those things well – or at least what we think they should be doing to maintain good health. Kids with healthy lifestyles are going to have a good BMI (body mass index), while the poor health behavior pattern group will most likely be linked to a higher BMI and therefore have a higher risk of obesity.

We don’t know how unhealthy the patterns are in-between, those mixed lifestyles of kids that have some healthy and some unhealthy behaviors. What about a child who eats OK, and gets some physical activity every day, but has six hours of screen time? Are they at risk of obesity equivalent to the child with poor or unhealthy lifestyle behaviors? We need to know the combinations that lead to the child having an increased risk of obesity.

The second part of the study is what happens if you have a healthy life-style pattern – you eat right and you exercise – but you have poor sleep. Does this mean you have a higher risk of obesity? My hypothesis for the research is that if you have poor sleep, you don’t get the same benefits of having that healthy lifestyle pattern.