Jill Landsbaugh Kaar and her daughter Zoe.
(May 2017) Childhood obesity and rates of Type 2 diabetes are rising across the
country. While researchers know some of the main culprits – sugary
foods and inactivity – there is still much to learn.
Landsbaugh Kaar, PhD, an assistant professor of pediatrics at the School
of Medicine, is one of those dedicated researchers contributing to the
effort. She recently helped draft a guideline for the American Heart
Association emphasizing that children should consume no more than six
teaspoons of added sugar per day. Kaar’s research aims to unravel
patterns of behavior that are optimal for a healthy body.
her husband, a chemical engineering professor at CU Boulder, came to
Colorado in 2010, after post-doctoral studies at the UK Medical
Research Council in Cambridge, England. As a mother of a toddler, Kaar
strives to model healthy behavior that her two-year-old daughter, Zoe,
will learn. Her leisure time is spent playing with Zoe, reading books,
going for walks (with Zoe) and spinning classes when she has some
weekend time to herself.
“When I started this journey, I wanted to
help people by learning how nutrition affected obesity, but now I know
that there are so many other variables we need to consider, like the
amount of time you are active, your screen time and sleep,” she said.
“If you exercise for the recommended 60 minutes most days of the week,
but your job or school requires you to sit for eight hours, five days a
week, are you living a healthy lifestyle? It’s one of the questions I
want to unravel.”
How did you choose this career and area of research?
always was interested in why some people are at a healthy weight, but
others struggled with their weight. I wanted to help them. I always
thought the issue was a matter of diet and physical activity. After
obtaining my nutrition degree, I decided to apply to graduate school
and focused on the other side of the energy balance equation, physical
activity. My master’s degree is in exercise physiology and my PhD is in
physical activity epidemiology. My postdoc work looked at maternal and
child health epidemiology, which helped me understand that the issues
don’t always begin with kids, but with parents, who are the
decision-makers. As I learned more and more about obesity, the sleep
component came to the forefront, and that is a new direction I am
taking with my research. It’s not just what you eat or how you
exercise, metabolism is also an outcome of how you sleep. If you aren’t
getting enough sleep, you might not be getting the benefits of eating
healthy and exercising during the day.
What are the biggest roadblocks to restructuring not-so-healthy lifestyles into healthy ones?
When I was growing up, it was more of the norm that
you had one parent who stayed at home, but that is rare now: Most
families need two incomes. This often means that the entire family is
not home at the same time and that together time may be very short. We
still want that important family meal, even if it is fast, so one thing
we can do is educate people and give them the tools they need to plan
ahead. Even if you only have 45 minutes for a meal, you can get a
healthy, affordable meal on the table in 20 minutes and still get out
the door on time with a bit of prep earlier in the week.
learn from their parents, so it is about role-modeling. You can teach
them that dinnertime is an event where you have a well-balanced meal and
all check in with each other. You teach them that this is a nice time
and you make it enjoyable as a family event.
What happens when a
child is no longer under your roof and you don’t have a say when it
comes to eating healthy or balancing life?
Perhaps think of it as
if you are teaching kids values and morals. From the time they are
young, you teach them to say “please” and “thank you.” Your child knows
they have to say these things, and while they might not always do it,
they have learned the importance of manners. The same goes for diet.
I don’t believe in counting calories for any age group because it is an
unrealistic thing to ask families to do. It’s very time-consuming, and
it’s not a lifestyle you are going to be able to maintain. Instead, I
try to instill healthy eating. For breakfast, for instance, we eat
yogurt and fruit and maybe a piece of toast or cereal. My daughter eats
the same thing. I don’t give her sugared cereal or cookies; I chose
healthier options for her to eat. I feel kids will have enough
opportunity for all of the other sugary stuff, and as a parent, I want
to provide her with good tasting, healthier options at home when it is
more in my control. I am sure if I offered my daughter yogurt or a
cookie, she would take the cookie, so I give her more limited choices:
strawberry or vanilla yogurt, apple or orange slices.
activity is the same idea. My daughter doesn’t see me sitting on the
couch and watching TV. We keep the television off and play with her. We
go outdoors whenever we can. At bedtime, we read books. As I delve
deeper into sleep research, I understand the importance of not having
blue light – computers or other screen time – before bedtime. A person
needs more calm time then, and this is a behavior that a parent can
monitor and change for a child.
You recently co-authored new
recommendations for the American Heart Association saying that children
ages 2 to 18 should consume less than six teaspoons of added sugars
each day. How did you and your colleagues reach this figure?
is not a lot of literature on how much sugar is linked to certain
out-comes like obesity or diabetes. This was an invited article by the
American Heart Association, which convened a group of
researchers – both medical doctors and PhDs – to comb the literature and
find out what we know now, where the research gaps are, and where does
research need to move forward. The idea was to recommend a number that
will improve child health.
My contribution was related to
childhood obesity and diabetes. There’s not a lot of literature about
the exact amount of sugar consumed that leads to obesity. So, for
instance, nothing out there says that if you consume X number of sugary
beverages, you are twice as likely to become obese. But what we do know
is how much sugar kids are eating today from detailed food records. We
know that preschoolers have about 12 teaspoons of sugar a day. We also
know that obesity and Type 2 diabetes are increasing, and so we know
that 12 teaspoons may be too much.
We don’t want kids to have more
than one sugar-sweetened beverage, which contains 10 to 12 teaspoons of
sugar, each week. The average kid probably has one of these beverages
You mentioned that your current research deals with how many behaviors affect obesity. What does your research entail?
have a scientist development award from the American Heart Association
to study health behavior patterns of children. These behaviors include
diet, screen time, sleep and activity. I am trying to unravel these
Let’s assume that you have some kids with healthy
behaviors in all of those categories. They get adequate sleep and
physical activity and have limited screen time and they eat well. Other
kids don’t do any of those things well – or at least what we think they
should be doing to maintain good health. Kids with healthy lifestyles
are going to have a good BMI (body mass index), while the poor health
behavior pattern group will most likely be linked to a higher BMI and
therefore have a higher risk of obesity.
We don’t know how
unhealthy the patterns are in-between, those mixed lifestyles of kids
that have some healthy and some unhealthy behaviors. What about a child
who eats OK, and gets some physical activity every day, but has six
hours of screen time? Are they at risk of obesity equivalent to the
child with poor or unhealthy lifestyle behaviors? We need to know the
combinations that lead to the child having an increased risk of obesity.
second part of the study is what happens if you have a healthy
life-style pattern – you eat right and you exercise – but you have poor
sleep. Does this mean you have a higher risk of obesity? My hypothesis
for the research is that if you have poor sleep, you don’t get the same
benefits of having that healthy lifestyle pattern.