Childhood Obesity: After-school exercise and nutrition programs

Research has shown that children from low-income neighbourhoods are at higher risk of being obese and overweight than children from affluent neighbourhoods; in fact, one-third of low-income children enter kindergarten either overweight or obese.

In an effort to address this issue, UCLA researchers implemented and evaluated the effectiveness of a pilot after-school health-promotion program that focused on increasing students' opportunities for physical activity and healthy snacks—and boosting their knowledge about physical activity and nutrition—at four low-income, diverse elementary schools in Los Angeles County (four additional school sites were used as comparisons). The study involved students in grades 3 through 5.

After-school staff members were trained by UCLA researchers to implement the evidence-based, sequential nutrition and physical activity curriculum.

Data were collected by researchers on students' nutrition and physical activity knowledge and behavior, and their height and weight measurements, at the beginning and end of the academic year.

Results showed that the proportion of children who were obese or overweight in the intervention group decreased by 3.1 percent by the end of the school year, compared with a 2.0 percent reduction among children in the comparison group. The study found mixed results regarding diet and physical activity knowledge and behaviour.

The authors conclude that enhancing after-school physical activity opportunities through evidence-based programs can potentially benefit low-income children who are overweight or obese.

Findings from this study indicate that after-school programs have the potential to provide opportunities for enhanced physical activity and the development of healthy habits in children from socioeconomically disadvantaged families who may have limited access to nutritious foods and environments conducive to physical activity outside of school.

More information: muse.jhu.edu/journals/journal_of_healt_care

Do diet changes help ADHD children?

Dylan Jerrell was having a tough time in kindergarten. The energetic, outgoing Bigfoot fan was easily frustrated, and he responded to challenges with disruptive meltdowns.

He wouldn't hit anyone, but he'd break down and cry or yell at his teachers. For a week in mid-September, he was in the principal's office every single day.

His mom, Jacqueline Fellows, considered home schooling. His pediatrician offered medication for attention deficit hyperactivity disorder (ADHD). But then Fellows, a health writer in McKinney, Texas, put Dylan on the Feingold diet, which eliminates artificial colours and flavours and some preservatives.

"I started the Feingold diet on a Saturday, the weekend after he'd been in the principal's office every day, and he's only been back to the principal's office once, and that was when (someone) fed him a hot dog," Fellows says.

"It was amazing. It's not a silver bullet, but it's the most powerful tool that I have for him." Parents of children with attention deficit hyperactivity disorder (ADHD) have been reporting marked behavioural improvements due to diets eliminating artificial food colouring and other additives for decades now, but those reports have gained traction in the past decade, with recent studies suggesting that scientists may have been too quick to dismiss dietary triggers for ADHD in the 1980s and '90s.

In 2007, a landmark British study published in The Lancet medical journal found that artificial food colours and preservatives increase hyperactivity in children, leading the European Union to require warning labels on foods containing any of six specific food colors.

This set off renewed debate in the U.S., but the Food and Drug Administration (FDA) declined to take regulatory action.

Now, scientists are getting intriguing results from sophisticated analysis techniques that allow them to pool findings from multiple studies.

A meta-analysis of 34 studies that appeared in the Journal of the American Academy of Child and Adolescent Psychiatry in 2012 found that artificial food colours had a small but significant effect on ADHD symptoms.

Joel Nigg

The overall effect was equivalent to about one-fifteenth to one-thirtieth the effect of medication, according to study co-author Joel Nigg, a professor of psychiatry at Oregon Health & Science University in Portland.

And when patients followed broader elimination diets - excluding not just artificial colours and preservatives, but other suspected triggers such as eggs - the effect was larger: about one-third to one-sixth the effect of medication, Nigg says.

The authors of the 2012 study estimated that as many as 8 percent of kids with ADHD may have symptoms related to artificial food colours and 30 percent of kids with ADHD may have symptoms that improve when they follow more comprehensive diets that eliminate suspected allergens as well.

"The take-away is, it's not a waste of time," Nigg says of dietary restrictions for kids with ADHD. "It has a chance of working - a less than 50-50 chance, but it's a chance. It's going to take some effort, so (if you want to try it) get a good nutritionist to advise you and talk to your child and give it a couple of months of effort."

L. Eugene Arnold

L. Eugene Arnold, a professor emeritus of psychiatry at Ohio State University, points out that the British study found that artificial food dyes and preservatives increase hyperactivity in the general population of children, not just kids with ADHD.

"It makes sense for all kids to reduce the amount of dye they take in," says Arnold, who says that per capita consumption of artificial food dyes has quadrupled in the last 50 years.

But in 2011 an advisory panel for the FDA concluded that although artificial food dyes may trigger hyperactivity in a small percentage of children with behavioural problems such as ADHD, there isn't enough evidence to claim that food dyes cause hyperactivity in the general population.

The panel voted against recommending warning labels on foods with artificial dyes and called for more research.

According to a recent statement released by the FDA, "the agency continues to study the matter in various populations, including children, and will report its findings."

Benjamin Feingold

The FDA did not say when those findings would be reported. Popularised in Benjamin Feingold's best-selling 1974 book, "Why Your Child Is Hyperactive," the Feingold diet eliminates artificial colours and flavours and three preservatives, and it temporarily removes foods containing natural salicylates, such as oranges and apples. The foods with natural salicylates may later be reintroduced.

The diet fell out of favour with scientists after a 1983 meta-analysis concluding that the overall effect was too small to be important, according to a 2012 article in Neurotherapeutics.

Fellows says that before she put her son on the diet, she was your typical suburban mom, treating her son to cherry limeades and never really questioning the chemical additives in foods.

But she had a friend whose son had seen a marked improvement in a behavioural tick - involuntarily sniffing - on the Feingold diet, and, with Dylan's pediatrician saying her son was a candidate for medication, Fellows figured she had nothing to lose.

Seven months later, she says, Dylan can still be a handful - he's 6, after all - but his behaviour is much better.

Before the dietary changes, Fellows volunteered regularly in his school cafeteria and saw Dylan popping up and down, spinning in his seat, yelling and not really eating his lunch.

She dropped by during lunch time a few months after the dietary change, and he was sitting down, eating his lunch and talking quietly to the little girl next to him.

"He didn't go from 'wild man' to calm," Fellows says. "He was just able to really listen and comprehend what you said. He could learn. Before he would get really agitated if he couldn't do it the first time or you asked him to do something he really didn't want to do. When he started doing Feingold, he was a reasonable child to parent. He was an easier child to parent."

Accounts such as Fellows' are plausible, says Nigg, particularly when the effect lasts over a period of months and it's observed by teachers as well as parents.

Nigg's analysis applies to the entire group studied; both kids who responded to dietary restrictions and the ones who didn't.

He says the data don't really lend themselves to analyzing the range of effects on individual kids, but it appears that some kids were getting something close to full recovery from ADHD symptoms from dietary restrictions alone.

"I think it is possible that, for some kids, you would get a dramatic effect," he said. "And probably for a lot of kids, you'll get some effect."

WHAT'S AN ADHD DIET? 
ADHD diets are basically elimination diets; you remove the foods or ingredients most likely to trigger or heighten symptoms, and if you see an improvement, you try adding back foods one by one, nixing the ones that bring back symptoms.

The chief suspects are artificial food colourings and preservatives, but the authors of a recent research analysis in the Journal of the American Academy of Child and Adolescent Psychiatry found diets are more effective when they restrict other foods as well.

The authors estimated that 30 percent of kids with ADHD experienced a reduction in symptoms when they initially eliminated foods such as wheat, rye, barley, eggs, dairy, corn, yeast, soy, citrus, eggs, chocolate and peanuts.

Study co-author Joel Nigg recommends consulting with a nutritionist before embarking on this type of diet.

BEAT: Eating Disorders - Information

BEAT Information resources 
Download a range of information sheets, leaflets and booklets to help you beat your eating disorder or simply to provide support.

If you would prefer to have hard copies sent to you, download and complete the literature order form and return it to BEAT by post.

All information sheets are available to download free of charge so you can get the help you need.

BEAT's work is funded by donations, fundraising and grants - if you would like to make a gift to support Beat please call 01603 753308 or donate online using the website.

Leaflets
Beat - changing the way people think about eating disorders Information leaflet about Beat.
Beat - beating eating disorders Information on the range of eating disorders and where you can go for help.

Booklets
The Beat Guide to Understanding Eating Disorders This 24 page booklet brings together much of what BEAT have learned over the past 22 years working with families, professionals and people with eating disorders.

Sections include causes of eating disorders, different types of eating disorders, what to do if you're worried about someone, treatment and eating disorders in education and the workplace.

The booklet is available to buy in the Beat online shop.

Recovery Guide - This booklet will help you understand more about recovery and how you can take steps towards it.

The Path Through Treatment - This guide will help to assist you with taking the fear out of treatment and assist your journey through it.

Poster 
About Beat services poster - put up the poster in your local GP surgery, or display it at your workplace, school or at your own fundraising event.

Sorry but Parents' diet choice knowledge doesn't prevent Child Obesity

A study of the families of 150 preschoolers suggests that parents of healthy-weight and overweight preschoolers are generally well aware of dietary risk factors that fuel childhood obesity.

The research, conducted by the Johns Hopkins Children's Center and the All Children's Hospital in Florida, suggests that awareness alone is not enough to effect meaningful weight change, and that pediatricians should help parents with specific and tailored guidance on how to apply their knowledge in daily practice, the researchers said.

The study, published ahead of print on April 11 in the journal Clinical Pediatrics, also illuminates the gap between what parents know about the root causes of obesity and what they can actually do to maintain healthy diets for preschoolers, a group generally overlooked in obesity research and prevention.

"When it comes to obesity prevention, the focus tends to be on school-age children and teens, but a growing body of research has found a link between poor life-long health and being overweight as early as 2 years of age," said lead investigator Raquel Hernandez, M.D. M.P.H., a pediatrician at Johns Hopkins.

The Centers for Disease Control and Prevention define children with a body-mass index at or above the 85th percentile for their age as overweight. One-third of the 150 children in the current study were overweight, most from low-income urban homes, and more than 90 percent African-American.

"Childhood obesity is a complex, multi-factorial phenomenon but our findings reveal that, for the most part, lack of parental awareness of nutritional risk factors is not one of the drivers behind it," Hernandez said.

The investigators set out to identify parental perceptions of risk factors for childhood obesity and barriers to healthy weight and to determine whether the parents of healthy-weight preschoolers viewed such risks and barriers differently from the parents of overweight children. They didn't. The study found minimal to non-existent differences between the two groups.

One important risk factor remained seriously overlooked by parents in both groups: physical activity. Only 7 percent of parents in the healthy-weight group and 8 percent in the overweight group cited lack of physical activity as a top driver of unhealthy weight.

Recent studies have shown that few preschoolers achieve healthy levels of activity, and most remain sedentary 85 percent of the time, the investigators say. The results of the study suggest that parents undervalue physical activity in an age group often perceived as "active enough," and alerting parents to the risks of inactivity is critical in obesity prevention, according to Janet Serwint, M.D., of Johns Hopkins Children's Center.

"The importance of physical activity and age-appropriate exercise is one area where we could step up educational efforts," Serwint said. "Pediatricians should discuss specific and age-appropriate activity goals during well-child visits."

Nearly 40 percent of parents in both groups identified buying and preparing unhealthy food as the top contributor to weight problems at an early age. Similar numbers of parents in both groups (23 percent and 31 percent) cited using food as a reward for good behaviour as a risk factor for weight problems. A nearly equal proportion of parents in both groups (25 percent and 23 percent) said that asking the child to finish food on the plate was the most critical contributor to overweight or obesity.

Importantly, one-third of parents from both groups (35 percent and 33 percent) identified lack of control over the child's food choices as the top barrier to healthy weight -- a notable finding, the researchers say, given that most preschool children spend most of their waking hours in daycare or with alternate caregivers.

"Daycare providers, grandparents and others involved in a child's care are often just as important in achieving healthy-weight goals as the parents themselves, and parents should be encouraged to provide specific dietary and activity instructions to these influential caregivers," Hernandez said.

Co-investigators on the study included Tina Cheng, M.D. M.P.H., and Darcy Thompson, M.D. M.P.H., both of Johns Hopkins.

The research was funded by The Thomas Wilson Sanitarium for Children of Baltimore City.

Children's Sugar Consumption Too High

U.S. children and teens are getting too much sugar in their diets, mostly from processed and prepared foods, according to a new study.

Sugar consumption decreased since 1999, although added sugars make up 16 percent of youth diets and contribute to the ongoing problem of childhood obesity.

Researchers followed 7,100 children and teens between 1999 and 2008 and found the majority of them had unhealthy eating habits.

Boys consumed 362 calories and girls consumed 282 calories from added sugar daily, a number that increased as the children got older. Forty-one percent of calories from additional sugar came from soda and other beverages, according to the study.

"If you look at individual items, the one that has the biggest contribution [to added sugar consumption] is soda," Cynthia Ogden, lead study researcher and epidemiologist of the Centers for Disease Control and Prevention, said.

The U.S. Department of Agriculture recommends that between 5 and 15 percent of daily calories come from sugars and fats combined.

The National Center for Health Statistics Data Brief published the study on Wednesday.

Lessening the number of calories children consume is imperative to curb childhood obesity. Over 12.5 million children ages 2-19 are obese, according to the CDC. The number has tripled since 1980.

In addition, childhood obesity-related healthcare costs $3 billion annually, according to a 2009 study published in Nature.

Parents need to watch what they buy and cook more at home to curb the calories their children eat, one dietician said.

"Whoever is the gatekeeper for the family food supply needs to take a good, hard look at their choices. Obviously, junk foods, cookies, desserts and sodas are high in sugar and non-nutritive calories," Samantha Heller, a dietitian and nutritionist based in Connecticut, reported.

However, many unexpected foods are high in sugars. Parents need to check ingredient lists for hidden sugars such as brown rice syrup, dextrose, fructose, molasses, sucrose, corn sweetener, barley malt syrup, fruit juice concentrates, glucose, cane juice syrup and sorghum, reported.

Baby knows best: Baby-led weaning promotes healthy food preferences

A new study by psychologists has shown that babies who are weaned using solid finger food are more likely to develop healthier food preferences and are less likely to become overweight as children than those who are spoon-fed pureed food. (Credit: © Anna Omelchenko / Fotolia)

A new study by psychologists at The University of Nottingham has shown that babies who are weaned using solid finger food are more likely to develop healthier food preferences and are less likely to become overweight as children than those who are spoon-fed pureed food.

The research just published by BMJ Open set out to examine the impact of weaning style on food preferences and Body Mass Index in early childhood in a sample of 155 children.

Co-author of the study, Associate Professor in the School of Psychology, Dr Ellen Townsend, said: "Although numerous studies have focused on when to introduce solid foods into an infant's diet there is a dearth of evidence concerning the impact of different weaning methods on food preferences and health prospects.

We believe our report is the first piece of research to examine whether weaning method can influence food preferences and the future health of the child."

Co-researcher Dr Nicola Pitchford, added: "Our study has produced some very interesting findings. The research suggests that baby-led weaning has a positive impact on the liking of foods that form the building blocks of healthy nutrition, such as carbohydrates.

Baby-led weaning promotes healthy food preferences in early childhood which may protect against obesity."

The researchers enlisted the Nottingham Toddler Lab, based in the School of Psychology, and various relevant websites to recruit parent volunteers for the study.

They all had children between the ages of 20 months and 6½ years and agreed to complete a questionnaire about their experiences of infant feeding and weaning style. 92 parents used baby-led weaning in which the baby is allowed to feed him or herself from a range of solid finger food after the age of 6 months.

63 parents surveyed used traditional spoon-feeding in which they fed their babies smooth purees and increased the texture and range of foods as they grew.

The study also examined the child's preference for 151 different types of food in the common food categories of carbohydrates, proteins and dairy etc. It also took into account the frequency of consumption of each food type and the effect of age on food preference.

Between the two weaning groups, significant differences in preference were found for only one food category -- the baby-led group liked carbohydrates more than the spoon-fed group.

In fact, carbohydrates was the most liked food category for the baby-led group whereas sweet foods was most liked by the spoon-fed group.

The psychologists believe that understanding the factors that contribute to healthy nutrition in early childhood is crucial as this could be the best time to modify food preferences to encourage healthy diets.

The findings show that baby-led weaning has a positive impact on the liking of carbohydrates -- foods that form the building blocks of healthy nutrition. This is a significant result since, up to now, the factors thought to be most influential on early food preferences are sweetness and frequency of exposure.

It was found that children's preference and rate of exposure to foods were not influenced by socially desirable responding, i.e. parents putting down what they think they should report, or socio-economic status, although an increased liking of vegetables was associated with higher social class.

There was an increased incidence of underweight children in the baby-led group and higher obesity rates in the spoon-fed group. But, no difference in picky eating was found between the two weaning groups.

The research project concludes that weaning style does have an impact on food preferences and health in early childhood.

The results suggest that infants weaned through the baby-led method learn to regulate their food intake in a way which leads to a lower BMI and a preference for healthy foods like carbohydrates.

The research team believe their work has important implications for combating the well-documented rise of obesity in contemporary society.

The full report 'Baby knows best? The impact of weaning style on food preferences and Body Mass Index in early childhood in a case-controlled sample' can be found at bmjopen.bmj.com

Parental influence on children's feeding habits

As primary caregivers, parents are often believed to have a strong influence on children’s eating habits and behaviours. However, previous findings on parent-child resemblance in dietary intakes are mixed.

Researchers from the Johns Hopkins Bloomberg School of Public Health reviewed and assessed the degree of association and similarity between children’s and their parents’ dietary intake based on worldwide studies published since 1980. The meta-analysis is featured in the December issue of the Journal of Epidemiology and Community Health.

“Contrary to popular belief, many studies from different countries, including the United States, have found a weak association between parent-child dietary intake,” said Youfa Wang, MD, PhD, MS, lead author of the study and an associate professor with the Bloomberg School’s Department of International Health.

“This is likely because young people’s eating patterns are influenced by many complex factors, and the family environment plays only a partial role.

More attention should be given to the influence of the other players on children’s eating patterns such as that of schools, the local food environment and peer influence, government guidelines and policies that regulate school meals, and the broader food environment that is influenced by food production, distribution and advertising.”

He added, “Parents need to be better empowered to be good role models and help their children eat a healthy diet.”

More on this story at Science Blog

Western diet link to ADHD - Australian study

Leader of Nutrition studies at the Institute, Associate Professor Wendy Oddy, said the study examined the dietary patterns of 1800 adolescents from the long-term Raine Study and classified diets into ‘Healthy’ or ‘Western’ patterns.

“We found a diet high in the Western pattern of foods was associated with more than double the risk of having an ADHD diagnosis compared with a diet low in the Western pattern, after adjusting for numerous other social and family influences,” Dr Oddy said.

“We looked at the dietary patterns amongst the adolescents and compared the diet information against whether or not the adolescent had received a diagnosis of ADHD by the age of 14 years. In our study, 115 adolescents had been diagnosed with ADHD, 91 boys and 24 girls.”

A “healthy” pattern is a diet high in fresh fruit and vegetables, whole grains and fish. It tends to be higher in omega-3 fatty acids, folate and fibre. A “Western” pattern is a diet with a trend towards takeaway foods, confectionary, processed, fried and refined foods. These diets tend to be higher in total fat, saturated fat, refined sugar and sodium.

“When we looked at specific foods, having an ADHD diagnosis was associated with a diet high in takeaway foods, processed meats, red meat, high fat dairy products and confectionary,” Dr Oddy said.

“We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function.

“It also may be that the Western dietary pattern doesn’t provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colours, flavours and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry.”

Dr Oddy said that whilst this study suggests that diet may be implicated in ADHD, more research is needed to determine the nature of the relationship.

“This is a cross-sectional study so we cannot be sure whether a poor diet leads to ADHD or whether ADHD leads to poor dietary choices and cravings,” Dr Oddy said.

ADHD is the most commonly diagnosed childhood mental health disorder and has a prevalence of approximately 5%. ADHD is known to be more common in boys.

Autism: Digestive Problems are not more common in affected children

Autism
Autism is a spectrum of disorders affecting a person's ability to communicate and interact with others. Children with autism may make poor eye contact or exhibit repetitive movements such as rocking or hand-flapping. About 1 in 110 U.S. children have autism, according to a recent government estimate.

More than 25 experts met in Boston in 2008 to write the consensus report after reviewing medical research. The Autism Society and other autism groups funded the effort, but gave no input.

Scientific Report
A panel of scientific expert says; 'There is no rigorous evidence to support the concern that digestive problems are more common in children with Autism compared to other children, or that special diets are effective in treating the condition.' This is contrary to claims made by product sponsors, celebrities and anti-vaccine protestors.

Digestive Problems
Painful digestive problems can trigger problem behaviour in children with Autism and should be treated medically, according to the panel's report published in the January issue of Paediatrics.

"There are a lot of barriers to medical care to children with autism," said the report's lead author, Dr. Timothy Buie of Harvard Medical School. "They can be destructive and unruly in the office, or they can't sit still. The nature of their condition often prevents them from getting standard medical care."

Pain and behaviour
Some pediatricians' offices "can't handle those kids," Buie said, especially if children are in pain or discomfort because of bloating or stomach cramps. Pain can set off problem behavior, further complicating diagnosis, especially if the child has trouble communicating — as is the case for children with autism.

Leaky Gut hypothesis
The report refutes the controversial idea that there's a digestive problem specific to autism called "leaky gut" or "autistic enterocolitis." The hypothesis was first floated in 1998 in a now-discredited study by British physician Dr. Andrew Wakefield. His paper tied a particular type of autism and bowel disease to the measles vaccine.

The new report says the existence of autistic enterocolitis "has not been established." Buie said researchers and doctors have avoided digestive issues in autism because of their connection with Wakefield's disputed research, which set off a backlash against vaccines that continues to this day.

Report claims
The new report calls for more rigorous research into the prevalence of digestive problems and whether special diets might help some children. For now, the report states, available information doesn't support special diets for autism.

Celebrity Diets
Diets have been promoted by actress Jenny McCarthy, whose best-seller "Louder Than Words" detailed her search for treatments for her autistic son.

Nearly 1 in 5 of children with autism are on a special diet, according to a project that tracks what treatments parents are trying. Most of them were on diets that eliminate gluten, found in many grains, or casein, a protein in milk, or both, according to the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Md.

Nutritional Balance
The new report advises doctors to watch for nutritional deficiencies in patients with autism. It recommends a nutritionist get involved if a patient is on a special diet or only eats certain foods.

The report drew praise from Rebecca Estepp of Poway, Calif., who believes a special diet is helping her autistic son. She said the paper gives pediatricians credible recommendations they've needed.

"I'm filled with hope after reading this report," said Estepp of the support group Talk About Curing Autism. "I wish this report would have come out 10 years ago when my son was diagnosed."

Autism Society
Lee Grossman, president of the Autism Society, a funder, said many doctors have written off autistic children's digestive problems as untreatable. "I think we still have a lot to learn about the gut and how it contributes to behavioural symptoms," Grossman said. "We have a lot to learn about how to treat this."

Clinical visits
Buie said his clinic has various techniques for treating children with problem behaviour. They schedule early morning appointments so children aren't delayed unecessarily in the waiting room. As a last resort, they do use a mild anesthesia.

"If a child is going to be asleep because of a dental evaluation or an MRI study, we will do our endoscopy, our blood work, spinal tap, haircuts or teeth cleaning at the same time," Buie said. "Our nurses do beautiful haircuts."

Further Reading on ASD and Digestive Disorders

The full report from the Pediatrics Journal in PDF format

Autism: Digestive Problems are not more common in affected children

Autism
Autism is a spectrum of disorders affecting a person's ability to communicate and interact with others. Children with autism may make poor eye contact or exhibit repetitive movements such as rocking or hand-flapping. About 1 in 110 U.S. children have autism, according to a recent government estimate.

More than 25 experts met in Boston in 2008 to write the consensus report after reviewing medical research. The Autism Society and other autism groups funded the effort, but gave no input.

Scientific Report
A panel of scientific expert says; 'There is no rigorous evidence to support the concern that digestive problems are more common in children with Autism compared to other children, or that special diets are effective in treating the condition.' This is contrary to claims made by product sponsors, celebrities and anti-vaccine protestors.

Digestive Problems
Painful digestive problems can trigger problem behaviour in children with Autism and should be treated medically, according to the panel's report published in the January issue of Paediatrics.

"There are a lot of barriers to medical care to children with autism," said the report's lead author, Dr. Timothy Buie of Harvard Medical School. "They can be destructive and unruly in the office, or they can't sit still. The nature of their condition often prevents them from getting standard medical care."

Pain and behaviour
Some pediatricians' offices "can't handle those kids," Buie said, especially if children are in pain or discomfort because of bloating or stomach cramps. Pain can set off problem behavior, further complicating diagnosis, especially if the child has trouble communicating — as is the case for children with autism.

Leaky Gut hypothesis
The report refutes the controversial idea that there's a digestive problem specific to autism called "leaky gut" or "autistic enterocolitis." The hypothesis was first floated in 1998 in a now-discredited study by British physician Dr. Andrew Wakefield. His paper tied a particular type of autism and bowel disease to the measles vaccine.

The new report says the existence of autistic enterocolitis "has not been established." Buie said researchers and doctors have avoided digestive issues in autism because of their connection with Wakefield's disputed research, which set off a backlash against vaccines that continues to this day.

Report claims
The new report calls for more rigorous research into the prevalence of digestive problems and whether special diets might help some children. For now, the report states, available information doesn't support special diets for autism.

Celebrity Diets
Diets have been promoted by actress Jenny McCarthy, whose best-seller "Louder Than Words" detailed her search for treatments for her autistic son.

Nearly 1 in 5 of children with autism are on a special diet, according to a project that tracks what treatments parents are trying. Most of them were on diets that eliminate gluten, found in many grains, or casein, a protein in milk, or both, according to the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Md.

Nutritional Balance
The new report advises doctors to watch for nutritional deficiencies in patients with autism. It recommends a nutritionist get involved if a patient is on a special diet or only eats certain foods.

The report drew praise from Rebecca Estepp of Poway, Calif., who believes a special diet is helping her autistic son. She said the paper gives pediatricians credible recommendations they've needed.

"I'm filled with hope after reading this report," said Estepp of the support group Talk About Curing Autism. "I wish this report would have come out 10 years ago when my son was diagnosed."

Autism Society
Lee Grossman, president of the Autism Society, a funder, said many doctors have written off autistic children's digestive problems as untreatable. "I think we still have a lot to learn about the gut and how it contributes to behavioural symptoms," Grossman said. "We have a lot to learn about how to treat this."

Clinical visits
Buie said his clinic has various techniques for treating children with problem behaviour. They schedule early morning appointments so children aren't delayed unecessarily in the waiting room. As a last resort, they do use a mild anesthesia.

"If a child is going to be asleep because of a dental evaluation or an MRI study, we will do our endoscopy, our blood work, spinal tap, haircuts or teeth cleaning at the same time," Buie said. "Our nurses do beautiful haircuts."

Further Reading on Digestive Disorders

Children's Health Magazine and The New American Diet

Children's Health Magazine : Babies : The New American Diet

Exposure to pesticides and other toxins in pregnancy and early childhood can set your baby up for obesity later in life. Here's your stay-safe plan.

Of all the scary things to worry about when you're pregnant, there's one that's probably not on your radar, even though it affects almost every baby born: exposure to endocrine-disrupting chemicals (EDCs).

When we began researching the forthcoming book The New American Diet (Rodale, 2009), we knew that traditional diet advice just wasn't working anymore. Simple principles--eat less fat, choose chicken or fish over beef, eat plenty of vegetables--were based on science from the middle of last century, and the world has changed since then.

From the hidden calories in many processed products to the way our meat and produce are being raised, today's food is very different from what we ate 50 years ago, and traditional diet advice simply doesn't take those factors into consideration.

But the deeper we dug, the more we realized that America's obesity epidemic had a sneaky underlying cause few of us consider in making our nutritional choices: Simply put, we're eating and drinking too many EDCs.

They enter our food chain through pesticides on produce, and through plastics that leach into our food and water. In a recent statement by the Endocrine Society, the largest organization of experts devoted to research on hormones and the clinical practice of endocrinology, researchers noted that the rise in the incidence of obesity matches the rise in the use and distribution of EDCs, and concluded that they may be linked to the obesity epidemic.