:iagree:

Yeah, when I looked at the McDonald's salads, several of the "premium" salads were hovering around 200 calories. For many people, that's just not going to provide enough calories for a major meal, particularly dinner. Some people can manage on that, but I'm a small-framed woman, and like I said...I would be hungry before too long after eating a 190 calorie salad. And I'm guessing those salads are not cheap.

I like Motivated Moms. I'm in a season of life with a 7yo, a 4yo, and a 15 month old. I can't do a full-fledged Fly Lady routine without burning out. MM doesn't include *every* possible thing that can be cleaned, but it really is helpful and motivating to me. It breaks things into manageable chunks, which works well for me in this season of life. Instead of cleaning the entire fridge in one day, you clean one shelf one week, another shelf the next week, etc. and then cycle back around agan. The upside to that is that it lets me bite off things I can handle in 5 min chunks, which is great with 3 kids underfoot. It also includes silly but helpful things like "cut children's fingernails" once a week ;) http://www.motivatedmoms.com/ The first time I purchased, it was in the fall and I think I only had to pay 2-3 bucks to try out the rest of the year (prorated). Right now it is probably about $4 or less for the rest of the year. My DH likes it because he finds it helps him figure out how to help me if he finds himself with a few extra minutes.

Yep, I'm not a big antibiotic fan but I'm going to guess they'll want her on some form of antibiotic ASAP. They may even want to do it via injection or IV to get it in her faster. I would probably head into urgent care/ER or at the very least call your regular physician. Neosporin and such may be helpful, but it could be a drug-resistant strain, etc. Staph can get bad very quickly, for ex. YOu don't want to mess w/ a risk of sepsis.

Some others I thought of: a few simple blocks to stack nesting cups (can stack or nest)

Simple puzzle with 3 large shapes (triangle, circle, square for example) Ring stacker Things that can be pushed simple musical instruments playsilks ball for reciprocal play (rolling back and forth) crayon and paper

Abdominal fat (being "apple" shaped or having more of a "beer gut" type look) can be a marker of insulin resistance. Does the pediasure come in a can? Can linings usually contain BPA, and BPA has been linked to central adiposity (belly fat) and insulin resistance. I'm a smaller framed woman with a normal BMI (about 20-21), but when I gain weight, I gain it in my stomach. I have PCOS and IR.

Wasn't it at the Summerhill school? I'm trying to find a link. eta: It was actually Sudbury.

I am sure that every poster here is in favor of education. I wonder how much guidance these folks are getting from their PCPs and so forth. Again, that's assuming they have access to medical care. Even if they have access to medical care, it may be at a clinic where they see a different nurse or doctor each time. IME there is often not good continuity of care, and that's assuming someone is getting healthcare in the first place. IME, many PCPs are woefully uneducated (or under educated) and misinformed on basic nutrition, and do a poor job of really helping patients. They don't have the time, and sometimes they lack the education needed. My parents have a neighbor who is a very middle class middle aged male. He is severely overweight and was recently dx'd with diabetes. In conversation, he told my mother that he had no idea that he shouldn't be eating so many carbs. He thought potatoes and the like were fine as long as he wasn't eating sugar :confused: . This is a male with access to health care, and who is college-educated. PB&J may or may not be more affordable than McDonald's, but again, I don't know that it is necessarily going to make a positive impact on an already obese (and likely IR) child. In one of your posts you mentioned HFCS-free bread and jam, etc. I usually shop at WFs and the like, and recently ran to the chain grocery that is 5 mins away. I was buying bread for my kids, and I looked at about 10 loaves of bread before I found one without HFCS. I don't think the bodega is going to stock that type of thing. More likely Wonderbread and HFCS-containing jam, and sweetened PB with hydrogenated oils.

Well, I guess we have to agree to disagree, because honestly I don't think most of these parents are feeding their kids 4 big macs, fries and a shake. I'm sure those parents are out there, but I don't think that's happening with the majority of obese children.

Nutrition info on Bacon Ranch salad w crispy chicken: Calories 390 Fat 22 grams Carbs 24 g Fiber 4 g Sugars 7 g Bacon Ranch salad w/ grilled chicken Calories 230 Fat 9g Carbs 10 g Fiber 4 g sugar 5g Premium caesar salad with grilled chicken Calories 190 Fat 5 g Carbs 10g Fiber 4 g sugar 5g Quarter Pounder with cheese: Calories 510 Fat 26 g Carbs 40g Fiber 3 g sugar 9g edited to add "big n' tasty" 460 cal Fat 24 g Carbs 37 g Fiber 3 g sugar 9 g Something like the Quarter Pounder or the Big N' Tasty isn't all that strikingly different in nutritional content than the bacon ranch salad w/ crispy chicken. You could argue that at least it has veggies, but I wonder how much nutrition they really render at that point. Again, there are probably "healthier" salads than the premium bacon ranch w/ crispy chicken, but again, we come back to literacy and education. Most people are taught to focus on fat and calories and those two really don't look that different on paper. And that's assuming education and literacy allow the person to make a comparison. A bacon ranch salad w/ grilled chicken is only 230 calories. I can tell you that I am a smaller framed woman and I would be hungry shortly after eating that. 230 calories isn't much if we're talking dinner, and the salad is probably not among the cheapest menu options. A premium caesar salad w/ grilled chicken is under 200 calories. I would be hungry. It wouldn't keep me full for that long.

Well said. :iagree:

None of it is going to fix obesity, IMO. I don't think either is a great option. Yes, they'll keep someone fed. Yes, that's preferable to starving. Maybe they'll be less expensive than fast food (although I'm not certain). But I don't think wonderbread and canned fruit are going to make great strides toward making an obese child less obese.

Canned products lined w/ BPA have been linked to central adiposity and insulin resistance. I toss that out there because I often think about the people eating from food banks, etc. and how this is another case of how poverty really disadvantages people from a health standpoint. Certainly it is preferable to not eating, but it certainly comes w/ challenges. Relying heavily on canned goods for your fruit/veggie intake could potentially exacerbate a problem with insulin resistance. If they could find tuna in the local bodega, I wonder what the markup would be? If they are marking sugar up from 1.50 a package at the regular full-service supermarket to 4.50/bag at the bodega...I think it stands to reason things like tuna (if someone could find it) might be substantially marked up. One can of tuna doesn't go very far when feeding a family, so any mark up would be felt even more since the family would really need 2 or 3 cans of tuna to get any substantial protein. If bread is available, I'm going to guess it is going to be something more like wonderbread. I worked in early intervention when I was fresh out of graduate school. It was positively shocking to me as a new grad (from a middle class family) how many of the families I worked with lived. I'll admit I was frustrated when people wouldn't call to cancel their appts and I would knock on their door several weeks in a row with no answer. It took time for me to realize some of these families didn't know where the rent money was coming from next week, or how they were going to pay the heating bill that month. Their priorities were different, because they were often functioning strictly in survival mode. I worked w/ families where the parents were trying to heat the house using the oven. That kind of poverty is what makes it hard to schlep all over to find healthy groceries (with several kids in tow) when you don't have a car. It is so intertwined w/ literacy, etc. as well like the PP said.

and lugging multiple kids on the subway or bus while carrying groceries. Maybe doable with one kid, but I wouldn't want to take my 3 kids grocery shopping via the subway, personally. Heck, I don't even like taking them in the van grocery shopping and usually wait for DH to be home so I can grocery shop w/ help (or go on my own). ;)

Our meals are pretty much all LC (often a meat/protein plus 2-3 veggies). Sometimes the kids get things like pizza (and I make a low carb version for DH and me). I don't limit their fruit or veggie consumption, and my kids eat sprouted bread (like Ezekial). They like the one minute muffin made w/ almond flour (pretty calorie dense). They eat berries and homemade whipped cream, etc. I would make sure to have extra snacks on hand but I wouldn't necessarily go out of my way to offer rice, etc. just because. Sweet potatoes, unlimited veggies, fruit, etc. will take care of her carb needs quite well.

From NYT in 2006: http://www.nytimes.com/2006/01/20/nyregion/20bodega.html -only 21 percent of the bodegas in Bedford-Stuyvesant offered apples, oranges and bananas. Supermarkets were four times more likely to carry all three. -Leafy green vegetables like spinach and kale were found in only 6 percent of the bodegas surveyed. Bodega owners said an important reason they did not carry healthier foods was that they are not very popular. -Even when healthy food is available, bodegas often charge more for it than supermarkets do. In Bedford-Stuyvesant, the average cost of a gallon of milk was 79 cents more in a bodega than in a supermarket. eta: and even if they could find apples, bananas, and oranges more regularly, these really aren't ideal foods for someone who is insulin-resistant. All 3 are still rather high in sugar and carbs. Better than McDonalds, but not necessarily ideal foods for an IR individual. Fresh veggies? Leafy greens? Berries? Better choices for an IR individual but much tougher to come by in a very urban area w/ limited shopping options.

The prices most middle class folks are paying at their full-service grocery are not the same prices for produce, etc. that the bodegas charge. You can search for pieces online about this very issue. If a family can find a bodega stocking fresh produce, it is often poor quality or relatively expensive compared to what a fully stocked grocery store charges. I don't think our comparisons of what we pay vs. what some bodegas charge are necessarily fair. NYC is trying to get more grocery stores into urban areas lacking them: http://www.nytimes.com/2009/09/24/nyregion/24super.html?adxnnl=1&src=twr&adxnnlx=1310760230-1mwnXONjlYRR9ikBJtTrpg Getting fresher, healthier foods into bodegas: http://www.nyc.gov/html/ceo/html/programs/bodegas.shtml This cites bodegas having a lack of buying power. Sugar is obviously not what we want people looking for, but this article says a bag of sugar runs about 4.50/lb at the bodega vs. 1.45 at a regular grocery store. http://www.thenewjournalatyale.com/2011/04/a-trip-to-the-corner-store/ Since produce is perishable, I can imagine the prices are quite jacked up, if one can even *find* any selection of worthwhile produce.

:iagree:

I'll offer the flip side of waiting. The 0-3 early intervention system is much more cozy, warm, fuzzy, and family-centered than the system at 3+. Many times people hold off until 2 or so to get an eval. At that point they decide to schedule the eval, which can take several weeks, and then if the child qualifies, it ends up being several more weeks until services start (in some areas speech is really, really in demand). The child may need to see an audiologist somewhere in there, etc. It becomes easy for a child to end up being a few months past 2 until that all falls into place and services actually start. If there is a delay that is going to take a while to address, the child then ages out of the 0-3 EI system at age 3. At 3, everything goes through the school system and it can be more complicated to get services and it is often much less warm and fuzzy than the 0-3 EI system (speaking in generalities). For 0-3, services are usually done in the child's natural environment (daycare or home), so the therapist comes to you. At 3, that is no longer the case. Just something to consider.

Yep, agreeing w/ PPs. DH has a PhD in analytical chemistry and took calc 4 and I'm sure some other math classes that I'm not remembering (differential equations, etc.) I believe it was a requirement for him in undergrad to pursue upper level math courses.

In an urban area without full-fledged grocery stores, I think if you can even find much in the way of fresh produce, you are going to pay a premium for it. I think this is where it is tough for people who haven't BTDT to understand. A middle class existence w/ access to a car and a fully stocked, full-service grocery is very different from living in an urban area without a car, where shopping is mostly done at bodega-type stores. eta: I am guessing what I discussed above isn't really what they were talking about in your link, (I'm off to read it) but just tossing that out there again.

I guess where I struggle with this is that in order to "fix" a child who is IR it takes eating healthy, unprocessed, whole foods. Some families simply cannot afford proteins and lots of produce (sadly). Unlike a RX medication, I don't think many of these families are going to receive any financial assistance in addressing the problem from a dietary standpoint. They may not have access to a car to get to a full-blown grocery store, and need to rely on public transit. Even if they want to fix the problem, they may not have the resources to adequately address it. JMO, but I think this is where poverty and obesity are so often intertwined to the point that it is tough to fix the problem. Obviously there are lots of middle class children, etc. who are obese as well. I guess I feel for the families that don't have the resources to address the problem. I have insulin resistance, and my DH had Ha1c numbers that were creeping up, so we eat lower carb. It isn't inexpensive, and we are not hurting financially. I also don't think many doctors do a great job of educating families. The advice seems to be have these kids exercise more, and eat less. It would be nice if there was more parent-education and coaching. Some people have access to that, but IME, many people do not.

Yes. I have PCOS and am IR. I was told I needed to *gain* weight when I was in the lower end of normal BMI in my mid-20s. My OB/GYN didn't diagnose me w/ pcos despite higher end of normal hormone levels, etc. because I "didn't look like" I had PCOS. He assumed all women w/ PCOS were overweight with obvious hair growth on their body I guess. I was later diagnosed by a top notch university reproductive endocrinology dept. Lots of women with PCOS are of normal weight, and many people who are insulin resistant are also of normal weight. I've never been overweight. I didn't "cause" my insulin resistance. While I don't enjoy having it, I'm glad I got diagnosed. There are many people out there who are thinner to normal weight who aren't getting diagnosed. I had fertility problems and that lead me down the path to a diagnosis. That's the bright side of it all-I have the information, and I know how to work with my body now. Many people don't find out soon enough, when they could be taking proactive steps.

I would go ahead and schedule an evaluation at this time. I worked in early intervention as a physical therapist but have experience in screening speech and working on evaluation teams. Two things that jump out at me that would cause me to go ahead and schedule now are 1)the history of delays and the medical concerns in infancy (low tone, weight loss, etc.) and and 2) the fact that you aren't hearing a lot of varied sounds/babbling. Not having more than a word or two at 18 months would have me watching closely and debating when to schedule an eval. However, not hearing a variety of sounds in babbled speech, and having a child with a history of delays would make me go ahead and get the evaluation scheduled. I agree w/ PP that it often takes a few weeks to get the eval, and then sometimes another few weeks until services start, etc. Having the receptive piece gives a therapist a lot to work with, and that's great. However, like a PP said, receptive and expressive speech are evaluated as separate domains. Having worked in EI, I can say that many kids would catch up in their own time. The catch to that is that even experienced therapists can't always determine who will or won't catch up without intervention. The expressive piece could be related to things like low oral muscle tone, poor oral motor coordination, etc. and those are things that you really need a professional to look at. Given the history of delays in general, I would say it is important to have those things looked at. HTH. Hopefully your DC will make great strides and catch up quickly, but I would go ahead and schedule now.