Family Fitness Challenge: Twenty-Five Steps Based on Science and Scripture to Guide Your Children to a Healthy Weight

By J’nelle Ruscetti

Jnelle Ruscetti has her masters in science and is a physician assistant in family medicine. She has been practicing medicine since 1997 and did her training in Colorado at the Child Health Associate/Physician Assistant Program. She lives near the beach in Wilmington, North Carolina, where she spends her time outside the office participating in an active lifestyle with her husband, Howard, a family medicine physician in Carolina Beach, and their four children. Since January 2012, she has devoted a couple hours a week as a volunteer instructing the child-obesity intervention and prevention program she developed in her community, the Family Fitness Challenge.

• Language: English
• Publisher: WestBow Press
• Release date: Dec 9, 2013
• ISBN: 9781490817484

J’nelle Ruscetti

J’nelle Ruscetti has her masters in science and is a physician assistant in family medicine. She has been practicing medicine since 1997 and did her training in Colorado at the Child Health Associate/Physician Assistant Program. She lives near the beach in Wilmington, North Carolina, where she spends her time outside the office participating in an active lifestyle with her husband, Howard, a family medicine physician in Carolina Beach, and their four children. Since January 2012, she has devoted a couple hours a week as a volunteer instructing the child-obesity intervention and prevention program she developed in her community, the Family Fitness Challenge.

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Copyright © 2013 J’nelle Ruscetti, MS, PA-C.

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Unless otherwise noted, all biblical quotations are from the New International version of the Bible.

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ISBN: 978-1-4908-1749-1 (sc)

ISBN: 978-1-4908-1750-7 (hc)

ISBN: 978-1-4908-1748-4 (e)

Library of Congress Control Number: 2013921688

WestBow Press rev. date: 12/05/2013

Contents

Foreword: Dr. Jim Jones, MD, past president of the American Academy of Family Physicians

Preface

Introduction

Chapter 1: America’s Surprise Epidemic—the Devastating Impacts of Obesity on Children in the United States

Step 1: Calculate Your Child’s BMI

Step 2: Invest in Pedometers

Step 3: Offer Produce First

Step 4: Change Meal Patterns

Step 5: Limit Caffeine

Chapter 2: Be the Captain of Your Ship! God Empowers Parents to Take Charge of Their Crew

Step 6: Make a Family Activity Pyramid

Step 7: Plan an Exercise for Each Family Member

Step 8: Offer a Snack That Grows

Step 9: Create a Media-Free Night

Step 10: Increase Nutrition in Meals

Chapter 3: Bigger Is Not Always Better—Our Children, the Food Industry’s Business Plan

Step 11: Make Educated Fast-Food Choices

Step 12: Avoid Fructose and Hydrogenated Oils

Step 13: Rid Your Home of Unhealthy Snacks

Step 14: Drink More Water

Step 15: Don’t Be a Sloth

Chapter 4: The Stranger Lurking in Your Home—the Surprising Effects of Media on a Child’s Health

Step 16: Make Media Rules

Step 17: Create a Family Media Basket

Step 18: Re-think the Milk You Drink

Step 19: Make Sure Kids Get Their Shut-Eye

Step 20: Get Strangers Out of the Bedrooms

Chapter 5: Too Many Calories, Too Few Nutrients—Bringing Healthy Food Back onto Children’s Plates

Step 21: Introduce Your Kids to Smoothies

Step 22: Look at the Glycemic Index of Foods

Step 23: Choose Your Proteins and Fats Wisely

Step 24: Start Your Day with Breakfast

Step 25: Post Your Numbers

Afterword

Fast and Healthy Home-Cooked Meals

Free Health-Oriented Mobile Phone Applications

Recommended Websites

About the Author

Figures

Figure 1: BMI Growth Chart for Boys

Figure 2: BMI Growth Chart for Girls

Figure 3: Adult BMI Chart

Figure 4: Healthy Plate Suggested for Kids

Figure 5: Example Family Activity Pyramid

Figure 6: Blank Activity Pyramid

To my amazing husband, Howard, who has been a great co-captain raising our crew; my gifts from God: Nick, Aubrie, Grant, and Drew; and my mother-in-law, Linda Ruscetti, who is a constant support of my efforts in the community.

Foreword

By Jim Jones, MD

A search of the annals of medical history yields probably less than a dozen cultural influences that have had the effect on physical health as has obesity during childhood in the United States. I deliberately use the word cultural because, as Ms. Ruscetti points out in this unique approach to behavioral changes in children, one is confronted with the image of the overweight kid; double-sized is considered normal. From television shows, fashion magazines, kids in marching bands, and every other aspect of American life, it is revealed that our children are overweight or obese.

As Ms. Ruscetti points out in her book, health professionals who care for our children pay more attention to the immunization record than to the growth charts. And when the growth chart is casually observed, the height record appears to get more attention than the weight chart.

Having practiced medicine for more than fifty years in environments varying from rural America to chairing a department of family medicine at a medical university, I find this well-written, practical book, a strategic plan for changing the health behavior of children, to be more influential than dozens of complicated approaches to getting children to diet.

This book is so compelling because it is family-oriented, faith-based, and very practical on a day-to-day basis. It is sad but true that weight control has become more of a money-making business than a health-care strategy. What Ms. Ruscetti has done here is developed a process that is doable, habit-forming, and sustainable. It requires no special food purchases, calorie counting, or useless memorization. Eating the right thing becomes natural, not mechanical. It brings the family together and teaches the divine gift of natural food, exercise, and healthy body.

I believe every parent and every health-care provider should read this superbly crafted natural plan for a healthy lifestyle for children in the context of the family. This book has my strongest endorsement, and I recommend that it be on every parent’s reading list.

James G. Jones, MD

Professor and Chair Emeritus

Department of Family Medicine

Brody School of Medicine

East Carolina University

Past President of American Academy of Family Physicians

Preface

Dear Parents,

There is nothing I enjoy more than raising my four children, but I have found raising healthy children in this society is challenging. I also love being a physician assistant in family medicine and taking care of patients, but there is nothing more heartbreaking to me than watching diseases show up in patients that are easily preventable, especially in innocent children.

There is a health crisis looming in America, and it already is beginning to have a negative impact on our kids. Record numbers of children are already experiencing hypertension, diabetes, and orthopedic problems that a generation ago were primarily observed in adults. Our communities, health-care providers, schools, churches, and friends are all involved in the upbringing of our children, but God calls parents to be the primary guardians over their health. If parents do not take this role seriously, our country could be one generation away from the biggest health crisis this country has ever seen.

In writing this book, I hope to provide to the typical busy American parent a practical way to start making a difference in his or her family’s health. My job as a mother is to encourage my children to make choices that will lead to a happier, healthier life. My job as a health-care provider is to try to educate my patients and help prevent diseases, not just treat them once they develop.

The Bible reminds us that the human body is fearfully and wonderfully made. God created the human body so that mistakes of the past can be reversed through changes in behavior in the future. I am daily grateful for the biology that God gave us and the fact that it gives us second chances. I hope through reading this book, your eyes will be opened to relatively small and simple changes your family can make that will have a huge impact on the health and weight of your family members. I also hope that through this journey to better health, you will begin experiencing an increase in bonds of your family members as you work together as a team to become healthier.

Purchase some family-friendly exercise DVDs or find some fun Zumba workouts you can do with your children on YouTube. My family even put a fun, twenty-minute exercise routine on YouTube called The Ruscetti Family: fun, family work-out. Finding entertaining exercise for your family to do together is such a treat! I get tired of taking one child to soccer, another to dance, another to basketball, while my husband and I play taxi driver and sit around waiting for them to finish. It is such a joy when the whole family gets together and works out as a family. It is the activities that we do with our children that they will remember for a lifetime. Thanks for taking this journey with me!

—J’nelle

Introduction

I was trained at the Child Health Associate Program, a physician assistant program located in Colorado. It is the only physician assistant program in the country with an emphasis on pediatrics, and was one of the pioneers of the profession. Although most of my lectures and rotations during my years of training were in pediatrics, I never received a single lecture on child obesity. In light of this fact, it is not surprising that I did not have the tools to intervene when I started seeing the obesity epidemic in my practice. At the time I was in training (1994–1997), the child obesity epidemic was just starting to become evident, so it was not yet on the national radar as it is today.

Child obesity has tripled in our country since the 1980s, and a multitude of health problems are developing in kids in America because of it! Between the years of 1968 to 1970, the prevalence of obesity in children six to eleven years of age was 4 percent. In contrast, between 1988 and 1994, the prevalence in this age group rose to 11 percent.¹ Obesity has been linked to diabetes, heart disease, orthopedic problems, asthma, and some cancers, as well as a negative self-image for children. How did this happen? How can the United States triple obesity rates in children in just one generation of kids? I am a mother of four and am highly concerned about the health of the kids of this generation. Based on the obesity trends in American children, an article in the New England Journal of Medicine predicted that this generation will be the first to have shorter life spans than their parents due to earlier death from diseases linked to their obesity.² This is a travesty! Since our country was founded in 1776, every generation has had a longer predicted life span, and now our children have life span predictions that have shortened.

As health-care providers, it is clear that we are not doing a very good job of addressing the child-obesity epidemic. A study done in 2012 by the National Heart, Lung, and Blood Institute (NHLBI) showed that when 963 charts were pulled from well-child checks at primary-care offices, 88 percent included a record of the body mass index (BMI) of the child. But only 30 percent included any recommendations for managing the child within the elevated BMI percentile.³ If the study had been done for any other type of acute office visit, the data would have been far worse.

During the well-child check, immunization records are reviewed and this is a time that the height and weight growth charts are commonly reviewed by the health-care provider. During these visits I print out the growth charts and take the time to review them with the parents. It is during a sick visit that this step is most often missed. The American Academy of Pediatrics recommends children get a well-child check annually, but it is not uncommon for a child to go years without one, until a shot is needed for school or a physical form for sports participation is required.

Many children between the ages of six and twelve, the age when most weight problems begin to develop and the age that pediatric obesity interventions are the most effective,⁴ are not coming in for well-child checks. Even though my staff is aware of my passion for intervention in childhood obesity, I still have to remind them almost daily to get a height on a child who is there for a sick visit. Without a height on a child every time he or she walks into the clinic to be seen, I cannot plot his or her BMI in the chart. If I do not plot the BMI, I have missed an opportunity to enlighten the parents and perhaps make a dramatic change in the life of that child.

As I began practicing medicine, I knew a great deal about growth charts in children. Before electronic medical records (EMR), there were pink charts for girls, and blue ones for boys. It took the nurses plenty of time and coordination to get them ready for the health-care provider to review during the check-in process at each well-child visit. Producing an accurate growth chart entailed lining up the dots on the graph with the weight of the child on the vertical aspect of the growth chart, and then lining up the age on the horizontal aspect. After that was done, a dot was placed on a percentile curve, and parents could literally compare their child to every child in the world who was the same gender and had the exact same birthday. Putting those dots on the growth chart was very similar to finding a city when looking at a traditional map (the kids of today will never know how to do this, by the way, just like nurses graduating today will never know how to plot a child on the pink and blue paper growth charts).

The fact that not too long ago, the plotting of the growth chart was as cumbersome as it was, is how the habit began to only plot children on the growth chart at the well-child check. The ease of the EMR now makes plotting the growth chart extremely simple with a click of a button! As long as the check-in staff remembers to get the height and weight on every child and the health-care provider remembers to look at the BMI growth chart and discuss it with families, we can begin to make a difference in this epidemic our children are facing.

Since I am not only a mother of four, but also a health-care provider whose special interest lies in the topic of childhood obesity, I have developed some unique insights as to why our kids are in the mess that they are today. As a Christian, I try to use the truths of the Bible and apply them to my everyday life. As I have spent time in my devotions and reading Scriptures, I have found that many of the principles of parenting that God lays out for us can be readily applied to the topics I cover when I speak with families who attend the Family Fitness Challenge.

The Family Fitness Challenge is a program that I began at my health-care organization after I realized how many families in my practice were struggling with the same issue of weight problems. It dawned on me that if one out of three of the children in my practice had problems with weight it would make more sense to spend an hour after work meeting with four to six families all together at one time, rather than trying to spend an hour at a time with one patient at a time. I also thought if I made it a friendly competition among the families, it would create a team mentality. The list of lifestyle changes for the family is placed on Challenge Sheets given out during the eight weekly meetings, and a point is earned when the entire family makes a specific lifestyle change, that is on the list. These points are added up weekly, and I display them on a scoreboard during each class.

In addition to giving a short lecture every class and listing the challenges for the upcoming week, I engage the families in a fun, upbeat exercise routine. I make sure that each routine is an exercise that easily can be done at home, without fancy equipment required. With each week, just as the challenges become a little more difficult, so do the exercise routines.

I love meeting with several families together. There is so much more that can be accomplished in a group. The Bible states in Proverbs 27:17, As iron sharpens iron, so one person sharpens another. Support groups have been shown to be wildly successful in a variety of health conditions. Why not get groups together in regard to the child-obesity struggle? When you use a group approach, families can come together and share ideas that worked with their children. How were they successful in introducing new foods to their picky eaters? What trails have they have found for their family around town? Families begin to serve as a support for one another. It is not uncommon for children with weight problems to become socially isolated and feel alone. When overweight children come to the challenge, they bond with other children who are also working toward the goal of becoming a healthier weight.

During class, I try to relay some simple and practical steps that parents can take to help their children become a healthier weight, and by default, if the parents take these steps with their children, they become a healthier weight as well! My limitation in regard to mentoring these families is that it is being done in a secular setting, so some of the ideas and concepts that are found in the Bible are not used in the program. This is where my idea for this book for parents was hatched. What if I could share with parents who are struggling with kids with weight problems some of the simple and practical steps that I have already found to be wildly successful in the Family Fitness Challenge, and couple them with some of the parenting guidance that God gives us in the Scriptures as well?

It has been said that your gift is where your passion meets a desperate need. I am passionate about the health of children, and there is a desperate need for us as health-care providers and parents to do something to help reverse the child-obesity epidemic in our country. I am writing this book to help spread the word about what is happening to the children in America, give some insight into why it is happening, share some practical verses from Scripture that apply to the topic, give ideas, and provide some advice to parents on how to combat the environmental influences that are wreaking havoc on our kids’ health.

Many children who are overweight or obese are already experiencing health problems, but many of these diseases are reversible! My concern is not just about the health problems these children already have, but also the health problems they will likely acquire in the years to come if something is not done. The good news is, there is a great deal that can be done!

This book will encourage your family to make small, gradual changes that will lead to a healthier weight if your children are above the healthy weight range; if your children are a healthy weight, these lifestyle changes will help them to maintain it. These small changes are referred to as steps in the book. Your family can take each step at your own pace. For each step taken, there will be a verse to meditate on that applies to the challenge given. Once your family has mastered the challenge, you can move forward to the next step.

I like to tell the families in my class that this program is about gradual changes and that each step should be small and subtle. The change may feel different, but it should not be painful. Once you have completed the challenge, the idea is to continue the steps forward, not to back-step by going back to old habits. It is important if you do the challenges in this book, that you do them with all of your children, not just the ones who are overweight, which can create a sense of isolation. Whether your children are overweight, normal weight, or underweight, the habits this book encourages have been shown to benefit everyone, no matter what size or shape they are.

I have heard it said that first a person makes a habit, and then the habit makes the person. Well, the habits in this country of going out to eat, consuming sweetened beverages, driving everywhere, sleeping less, and spending any downtime on