Appendix 34(A) - Nutrition and supplementation - including vitamin D
Nutritional advice and snack ideas with low sugar
From Laura Southern, nutritionist: Laura Southern DipION mBANT CNHC, London Food Therapy
The main thing to remember is that it's best NOT to snack! (easier said than done, I know!) - Weight control/ loss is achieved by eating just 3 meals a day, with large gaps between the meals. The time we're NOT eating is more important than what we're eating (within reason).
We understand this is difficult, especially with pester power etc. Before they hand out a snack parents need (to try) to get in the habit of asking a few questions:
- Is my child genuinely hungry? (perhaps been a long time since last meal/ long time till next meal) 
- Will this snack provide some extra nutrients to my child's diet (increase their vitamins, protein, good fat quota etc) 
- Has my child already had a lot of sugar/ processed food in their diet today? 
- Is my child just bored? 
- Am I using this snack to keep them quiet (we've all been there!!) 
The idea really is to try and ensure that snacks provide extra nutrition that might be missing from the child's diet, rather than just as a way of giving the child 'nice' food as a treat or reward (there is time for this, but shouldn't be the habit).
There is good information out there now, more and more, for everyone to access. Things I get asked about include: how to read a label to find the hidden sugars, how to reduce and replace the sugar, and what children need for optimum nutrition, snack and meal ideas, specific nutrition for children in all their life stages, specific nutrients for children's growing brains and how certain foods can have a positive and negative effect on mood, concentration and focus.
Reducing Sugar in Your Child’s Diet
Top 20 snack ideas
- Corn thins/ corn cakes/ rice cakes with 100% peanut butter 
- Apple slices with 100% almond butter 
- Cucumber/ carrot/ red pepper sticks with hummus 
- Homemade popcorn with cinnamon 
- Mix of raw unsalted nuts (cashew nuts and pistachio nuts popular with children 
- Strawberries/ raspberries/ Satsuma pieces dipped in melted high cocoa solids (eg 70%) chocolate 
- Pot of natural yoghurt with fresh fruit and/or nuts 
- 1-2 falafels with hummus 
- Packet of Itsu seaweed thins (or other seaweed crisps) 
- Bowl/pot/bag of olives 
- Slice of rye, wholemeal, pitta bread with cheese/nut butter/hummus 
- Steamed edamame beans 
- Snack box with nuts, seeds and chocolate chips 
- Babybel/cheese portion with piece of fruit 
- Mug/flask of soup (vegetable, miso, chicken) 
- Bag of lentil or tortilla chips (with hummus or mashed avocado) 
- Homemade smoothie ice cream (see recipe) 
- Homemade almond biscuits (see recipe) 
- Slice of banana and pear bread (see recipe) 
- Roasted chickpeas (see recipe) 
Top 10 breakfast ideas
- Cereal mix – use a base of Rude Health puffed oats and Kallo puffed rice, add toppings – eg nuts, pumpkin seeds, pomegranate seeds, coconut chips, few raisins, berries etc 
- Porridge, use almond butter, berries or tiny bit black strap molasses 
- Wholemeal toast with nut butter/ cream cheese 
- Mini wholemeal pitta bread filled with hard boiled egg/ or hummus/tomato/ cheese etc 
- Cereal mix with Low Sugar Cheerios or Whole Earth Cornflakes 
- Natural yoghurt with mushed up berries 
- Scrambled eggs with rye bread 
- Homemade granola (see recipe) 
- Bircher Muesli (see recipe) 
- Blueberry and almond pancakes (see recipe) 
- Slice of banana and pear loaf (see recipe) with butter 
Top 10 packed lunches (cold)
Ensure ice packs/ kept out of sun/ fridge if possible
- 2 Chicken drumsticks, pot sweetcorn, cucumber sticks, 2 oat cakes, 2 unsulphured dried apricots, pear 
- Hard boiled egg, brown pitta bread, pot with hummus, baby corn and carrot sticks, frozen yoghurt tube 
- 1-2 salmon rissoles, 3 cold boiled new potatoes (or potato salad), pot sweetcorn, small box raisins 
- Large pot rice salad (brown rice, onions, red peppers, chickpeas, sultanas, garlic, tomato or soy sauce), plum, frozen yoghurt tube 
- Tinned tuna and cucumber sandwich (wholemeal bread/pitta), small pot/bag kale crisps, piece of cheese, Satsuma 
- Mini lamb koftes, pot of hummus, spelt wrap, cherry tomatoes, cucumber, pot of mixed berries 
- Large pot quinoa/ lentil salad (quinoa/ lentils, onions, celery, carrots, peas, ginger, honey, soy), 2 dates, pot of mixed seeds (pumpkin, sunflower, pinenuts) and dried coconut 
- Pot of tinned salmon, cream cheese and sweetcorn mix, 2 corncakes, pot of roasted chickpeas (see recipe), frozen yoghurt tube, apple 
- 1-2 cold baked sausages, brown pitta bread, sugar snap peas, baby corn, small bag home made popcorn 
- Slice of Spanish omelette (tortilla), carrot and cucumber sticks, piece of cheese, pot of coconut pieces. 
Resources:
Obesity
Healthy Weight Nursing Team - email them for a form: solltd.hwnadmin@nhs.net
GroHealth: If you’re a young person aged 13-19 (or up to 25 with SEND) living in Barnet, you could be eligible for free access to Gro Health, the healthy lifestyle programme designed just for young people living in Barnet!
You can refer directly to Gro Health using their referral form.
Complications of Excess Weight clinic (CEW), GOSH:
High priority health complications include (but are not restricted to): Type 2 diabetes, Obstructive Sleep Apnoea, Benign Intracranial Hypertension and Physical Immobility.
We will consider referrals for CYP with less immediate adverse health implications with very severe overweight (BMI > 3.33 Z Score) such as raised liver enzymes and 'fatty liver', features of polycystic ovary syndrome, high blood pressure, high cholesterol and triglycerides.
Key referral criteria:
- Obesity 
- Significant obesity-related medical comorbidity that would benefit from weight loss (eg type 2 diabetes, sleep apnoea, NAFLD with fibrosis) that has not responded to treatment with specialist team 
- Family wants help to change - Or 
- Severe Obesity – BMI is currently set at >3.33 Z Score (although this may increase in the future) 
- Family wants help to change 
CEW services are based on home address and corresponding London borough. Find your borough here