Esta carta al editor la enviamos a diversas revistas pero no hemos recibido respuesta, ni aceptándola ni rechazándola. He decidido publicarla aquí porque, tanto el Dr. Drobnic como yo, creemos que es una buena idea que, en las etiquetas nutricionales cualquier producto, aparezcan las calorías con el equivalente en subir y bajar escalones para perderlas. Así es fácil saber la magnitud de las calorías ingeridas.
Childhood obesity predisposes to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and renal disease, and reproductive dysfunction. It also increases the risk of adult-onset obesity and cardiovascular diseases and has emerged as the number 1 health problem in the United States and another countries (1). Physicians and parents should encourage children to participate in vigorous physical activity throughout adolescence and young adulthood and to limit time spent watching television and videos and playing computer games. An energy-restricted and balanced diet, together with patient and parent education, behavioral changes and exercise, can limit weight gain in many pediatric patients who have mild or moderate obesity.
The experts suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family (2). A major educational barrier for both parents and children is the understanding of the simple equivalence between calorie intake and the exercise required to use this energy. Obesity prevention must clarify to caregivers and children the nutritional value associated with food and with the promotion of physical activity. Not all exercise demands the same energy expenditure. There are numerous tables showing the heat loss produced by the exercise performed. We believe this method is not very educational because it is difficult to learn and teach.
The new proposal is based on the opposite reasoning. It pretends to teach the number of steps that should be walked up or down depending on the child’s calorie intake. Several studies (3-5) about the heart rate and oxygen uptake responses and the intensity and caloric cost of ascending and descending a public-access staircase, have showed that the caloric cost of stepping up and down a step were 0.11 and 0.05 kcal, respectively. The steps of the stairs have been standardized (6,7) With our method, it is possible to know the number of steps a child needs to walk up or down in order to burn the calories of the product he is about to eat. For educational purposes we have called it the Step-Cal Meter.
Nowadays, information on caloric values is available on the packaging and labelling of all foodstuffs. However, the public does not see on these labels the amount of effort it would take to burn those calories. Our simple tool transforms calories into steps, for educational purposes and the equivalence should be printed on all nutrition labels. For example, one McDonald’s Biscuit (Breads), which is 84 gm in weight and has 290 calories, is equivalent to walking up and down 1812 steps, a bit more than going up and down the Empire State Building, which has 1576 stairs up to the 86th floor.
Santiago Garcia – Tornel, MD, PhD
Dept. of Pediatrics
Hospital Sant Joan de Deu
Barcelona (Spain)
stornel@hsjdbcn.org
Franchek Drobnic, MD
Department of Physiology
Olympic High Performance Center
Sant Cugat del Vallés (Spain)
drobnic@car.edu
.
References;
1. Moss BG, Yeaton WH. Young children's weight trajectories and associated risk factors: results from the Early Childhood Longitudinal Study-Birth Cohort. Am J Health Promot 2011; 25:190-8
2. Spear BA, Barlow SE, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120 (Suppl): S254-S288
3. Arvidsson D, Slinde F. Larsson S, Hulthe´n L. Energy cost in children assessed by multisensor activity monitors. Med. Sci Sports Exerc 2009: 41, 603–611
4. Ridley K, Ods TS. Assigning energy cost to activivies in children: A review and sythesis. Med Sci Sports Exerc 2009; 40:1439-1446
5. Teh KC, Aziz AR. Heart rate, oxygen uptake, and energy cost of ascending and descending the stairs. Med Sci Sports Exerc. 2002 Apr;34(4):695-9
6. Chiang C, Carter C. The Backstage Handbook: An Illustrated Almanac of Technical Information. Broadway Pr. 1994
7. The American Institute of Architects Architectural Graphic Standards, 11th Edition. Wiley 2007
