Children's nutrition education, causes of obesity and glossary of terms in the appendix

Children who dislike vegetables may be told by their parents to eat less meat and more vegetables, but because parents love their children and are reluctant to force them to eat more, coupled with the child's lack of self-control, the child fails to develop healthy eating habits. Therefore, parents must lead by example rather than just words. If parents' own behaviors are often wrong, it's impossible to expect their children to have the same values.

Nowadays, women often believe that eating meat is healthy, and this is also the experience of older generations. However, if parents themselves rarely eat vegetables, their children are even less likely to eat them. Children's eating habits are greatly influenced by adults.

In addition, if adults buy a lot of junk food and cookies for home, children will naturally not be able to eat their regular meals. Therefore, if parents do not have the right mindset and behavior, their children are likely to become both obese and malnourished.

Many young Japanese men in their twenties developed beriberi due to the lack of vitamin B₁ in instant noodles, often eating them during lunch breaks and evenings when they worked overtime. In the 1980s, beriberi was a common occurrence, baffling even young Japanese doctors at the time. They speculated about possible kidney inflammation or heart problems in children, but nothing was found. Later, a retired professor examined the case and diagnosed it as beriberi. This is a rather amusing story that happened in Japan in the 1980s.

In Taiwan, we conducted community surveys and found that the situation of nutrient deficiency among children is becoming more serious.

Causes of obesity

Q: What exactly causes obesity? Is it only related to diet?

A: There are basically two reasons for obesity, similar to many diseases: one is genetics, and the other is acquired.

From a genetic perspective, a study involving over 100 pairs of twins involved having them wear only underwear, stand together, and be photographed from behind. Identical twins appeared almost identical in size from behind, while fraternal twins, like siblings, were easily distinguishable. This is an example of the role of genetics.

But how much influence does genetic factor have on later life? It does have an impact. However, according to research in Denmark, if twins are born and raised in different families, they will still have similar body types, the same toys they like to play with, and almost identical mentalities. In other words, there are certain genetic predispositions within a family that contribute to this.

Q: Does that mean that genetics is more important than nurture?

A: We haven't finished talking about that yet. If they grow up in the same family, the influence they receive from nurture is relatively small. But if we look at Hitler's concentration camps or the Khmer concentration camps, there are no obese people there. That is to say, nurture is also very important. If you give them opportunities to develop and the freedom to eat, they will develop similar results.

Q: Is obesity sometimes inherited across generations, and not necessarily a father-son relationship?

A: This involves a wide range of issues, sometimes including blood relations. Because IVF is now very advanced, the situation for parents can become quite complicated, which is the problem you just mentioned.

Q: According to Dr. Hong, I think genetics is more important. Since it is inherited from one generation, I don't think there is a problem with restricting diet. Modern people can eat whatever they want. If his direct relatives are obese, then he has a much higher chance of being obese than others.

A: Yes, if you follow up on these cases that underwent weight loss treatment, you can find what percentage of them regained their weight after five or ten years. We'll be discussing treatments for those who took medication or ate meat to lose weight and then immediately regained it, excluding those cases. We're referring to cases where, after returning to the treatment, they didn't immediately regain their weight in the first few months, but gradually gained it back after a year or two. That's because they reverted to their old eating habits, and there's nothing that can be done about it.

Another point is that when you ask ordinary people, including doctors, to write down what they do, what they write down is usually not accurate. Everyone usually has a self-protective instinct. They have done some research and found that obese people underreport their calorie intake by 50%. They record it in their notebooks, and normal people underreport their calorie intake by 20%.

Q: Since you said that genetics plays a big role, it's no wonder that many people often joke that people who are destined to be fat will always be fat, even if they just drink water.

A: That's wrong. In fact, when he drinks water in front of you, he's not drinking water when you're not around; he's eaten something and then forgotten about it, unconsciously forgetting it. He'd never admit it, no matter what. So, to conduct dietary research, the usual question-and-answer approach has a large margin of error. To truly conduct research, you must confine the individual to a specific space, record what they eat, and that's the only effective way. The problem is that such research would cost hundreds of millions of dollars, and how many staff would be needed to conduct it?

However, recent studies have shown a trend that most obese people underestimate their calorie intake. In fact, drinking water won't make you fat at all; if you actually made him stay in the hospital and just drink water, he would lose weight.

Q: I once saw someone who ate like crazy, but he just wouldn't gain weight.

A: That could be a medical condition, such as hyperthyroidism or other problems.

Q: Basically, a healthy person will become obese if they eat too much?

A: Everyone is the same. Even cars from the same brand might have different speeds – one might go 10 kilometers on one liter of fuel, while another might only go 7 kilometers. But without fuel, they simply won't move. That's a basic principle. No one can gain weight without eating; that's impossible. The only difference is that our metabolic rates are different. Even a person's metabolic rate can vary at different times and in different jobs. For example, someone might be overweight in their first year of high school but lose weight in their final year due to increased workload. I think most high school students experience this in college – they gradually gain weight in their first year.

Q: Leaving aside genetic factors, what are the causes of obesity acquired later in life?

A: The most fundamental reason for obesity is diet, which is extremely important. Take Native Americans in the United States as an example. They eat hamburgers and drink cola in Native American reservations, so the average weight of Native Americans is almost twice that of Americans.

Looking at other primitive ethnic groups, the people of New Guinea were originally very thin and slender with dark skin, almost black. After they adopted the current culture, everyone became very fat, and their high blood pressure, diabetes, and uric acid levels rose very quickly. They found that only a few young people had normal weight.

This is the result of industrialization; food is the most important factor.

**Appendix**

Noun annotation

1. Planned diet: This is the word "diet" used by the author when referring to illness, weight loss, specific purposes, or modifying diet. It is also called therapeutic diet. It adds consideration of calories and components to the balanced nutrition to facilitate disease management and achieve the purpose of treatment.

2. Clinical medicine, this word comes from the Japanese translation of the European word Clinic during the Meiji Restoration. This word originates from the ancient Greek word meaning "bed". In medicine, it refers to the patient's bed, implying "being with the patient". Therefore, clinical medicine has the simplicity and elegance of the Chinese character.

3. Clinical nutrition refers to nutrition related to disease. Since a patient is a living being composed of many organ systems, this corresponds to clinical medicine, such as internal medicine, surgery, and obstetrics and gynecology. The practice of nutrition also involves close interaction with patients and medical personnel in these specialties.

4. The medical team – this is something the author has been trying to integrate since returning to China. In today's increasingly specialized medical workforce (nurses, social workers, medical lab technicians, psychologists, nutritionists, physical therapists, pharmacists), how to achieve patient-centered "collaboration" is a crucial goal for medical teams.

5. Nutrients refer to the components in food that can be analyzed. Because they can be broken down and synthesized into human tissues, they are called nutrients. On the other hand, these are also the "things" that humans eat, and whether they are sufficient is called whether the nutrition is adequate.

6. Macronutrients are nutrients that produce energy, including carbohydrates, proteins, and fats. Each gram of carbohydrate protein produces approximately 4 calories, while each gram of fat produces approximately 9 calories.

7. Micronutrients refer to two main categories: vitamins and minerals. Vitamins are classified as either fat-soluble or water-soluble; minerals, also known as electrolytes, contain no calories.

8. Basal metabolic rate refers to the amount of energy required for metabolism when the human body is at rest and not exercising. It is calculated by dividing by the unit of time.

9. Body Mass Index (BMI) is calculated by dividing weight in kilograms by the square of height (in meters). The formula is: weight/height².

10. Waist-to-hip ratio, which is the ratio of waist circumference to hip circumference. For women, it is about 0.85, and for men, it is greater than 1.0, which indicates obesity complications.

11. Lean body mass: Total body mass minus fat mass.

12. Balanced nutrition refers to a diet that includes all the nutrients the human body needs. Sometimes people forget their basic physiological needs when they are busy treating a disease. Usually, they need to eat a variety of foods with similar calories.

13. Cocktail therapy, originally a breakthrough in AIDS treatment by Dr. David Ho in the 1990s, is a proper term, but it has been misused to refer to compound weight loss drugs.

14. Fatty acids are components of triglycerides and are composed of various combinations of carbon atoms, such as 12, 14, and 16 carbon atoms. They can also be unsaturated or saturated chains, which have different physiological functions.