Three Easy Steps to Make Your Child Behave (or not)

Discipline and behavior issues are a frequent topic of conversation in our office. There are many discipline techniques that are available for children of different ages and in different situations – timeouts, loss of privileges, natural consequences, etc. But none of these approaches will magically make a child behave.

I occasionally will hear parents say something along the lines of “He is too big for me to make him listen.” Hopefully our parental authority is not based on superior physical strength because I would have lost that battle starting about seven or eight years ago. I want my children to listen to me because they respect me, not because they are afraid of me. And now that they are older, I don’t want them to just listen to me. I want them to do the right thing because that is who they have become, something they have internalized.

If a child listens only out of fear, what will they do when that fear is no longer operative? We all have situations in which we could probably get away with doing things we should not. Hopefully we have some internal motivation to do the right thing when the external controls are not present.

I think the internal motivation to behave in appropriate ways starts with modeling of appropriate behavior by the adults in a child’s life and by having relationships with those adults which are based on love and mutual respect. A child is much more likely to listen to an adult who he knows cares about him and wants what is best for him.

Imagine two different children contemplating a forbidden activity. One thinks “I shouldn’t do this because if I get caught I will get whipped.” The other thinks “I shouldn’t do this because this is the type of thing my mother has warned me about and she is generally right about these things.” Which thought process is more likely to produce desirable behaviors in the long run?

I am not talking about just letting kids do whatever. Clear, consistent limits are important and those limits need to be consistently enforced. But they need to be enforced in a way that helps the child to learn and does not demean him as a person.

I have not always done a great job of applying these principles myself but I think I did get better at it over time with successive children (sorry Zach). And clearly not all children react the same. Sometimes parents parent well and the behavior outcomes are not what they had hoped for.

I don’t think there is a magic “just do this” approach to parenting that will make everything turn out well. But I think spending time with your children and showing them that you love them is a good start.

 

Some Thoughts on Thanksgiving Day

2017 has been a crazy year so far in many ways. It seems like there is a lot of anger and anxiety out there. But when I step back and look at the big picture, I have many things for which to be thankful.

Fortunately I do not know any losers or haters, bloviators or fools. I do know a lot of folks who have intrinsic worth and are making their way through life the best they know how, some more gracefully and successfully than others. I am thankful for folks who agree with this view of humankind because they believe that we are all made in the image of God. I am thankful for those who agree because they believe we are all exquisite, inter-related products of cosmic randomness. And I am thankful for those who agree because they believe some combination of those two.

I am thankful for the folks who build and repair the things I use every day, from the house I live in to the computer network at the office. I am thankful for teachers, farmers, mechanics, bankers, nurses, and the people who make sure I have clean drinking water and electricity at my house. I am thankful for my medical colleagues and my friends who hash through my questions and anxieties with me. I am thankful for people who run homeless shelters and food banks.

I am thankful for my friends in Zambia who have helped me develop an expanded perspective on life and the world. I am even thankful for politicians. Someone has to make decisions about how we live our shared lives. I have met some politicians who I think are principled, ethical, good people. We need more of them.

I am thankful for the life and teachings of Jesus which provide us guidance on how to live; loving neighbors and enemies, seeing the best in those who are different from us, healing the sick, feeding the hungry, and clothing the naked. I am thankful for scientific discoveries like those of Robert Guthrie that have made life-changing advances for people I love. I am thankful for books, music, and nature, and a beagle who runs through the woods with me.

I am thankful for Cindy and that we had all three of our children and our soon-to-be daughter-in-law under our roof last night. I am thankful for going to ball games with the boys, hugging Rachel until she is annoyed, and that look that Cindy gives me when I think I have said something clever but she thinks it is stupid. I am thankful for all of my other family members and how they love and support me despite my quirks and "nerdish tendencies."

My hope for the remainder of 2017 is that we can all listen to those with whom we disagree, work for those who are less fortunate than we are, seek justice, love mercy, walk humbly, and each do our part to make the planet we share a better place for everyone.

Life is Hard

I recently had a teenager in the office say to me “Life is hard and I don’t know why I feel this way.” I had two initial reactions. The first was to acknowledge that life can certainly be hard. The second, unspoken one, was that I hear a variation of this far too often from too many young people.

A significant number of adolescents have reasons to feel that life is difficult. Family problems, lack of physical and emotional resources, medical problems, and a host of other issues can make life difficult for young folks. Anyone who thinks every child has an equal opportunity to succeed could be easily disabused of that notion by working in a general pediatric practice.

But there are also some things that I think one can do to help offset the gloom associated with living life. I would put these in my file entitled “Things I Believe but Cannot Prove.”

·         Exercise – My patients probably get tired of hearing this but exercise is good for almost everything, including elevating one’s mood. You do not need to run marathons or play high-level sports but some sort of activity that gets your heart pumping on a regular basis can make a big difference.

·         Spend time with people – If you are feeling down, a surefire way to make it worse is to isolate yourself from other people.

·         Get away from the electronics – I have seen in myself and others that too much time watching TV, playing on some electronic device, or scrolling through social media is a great way to get grumpy.

·         Do not compare yourself to other people – No matter how good you are at something or how handsome you are, you will eventually run into someone better and prettier than you. If your view of yourself is based on how you compare to others, you will eventually, inevitably be let down.

·         Get involved with something bigger than yourself – Be involved in a faith group, work for a good cause, meet with people with similar interests to learn from each other, be part of an athletic team, or do something else that gets you working with others towards a common goal.

·         Spend time outside – Spending time in nature can be therapeutic. If you live in town, find a park to walk in. If there is not a park nearby, observe the plants growing up through the sidewalk and see what the bugs are up to. I enjoy watching stink bugs because they are kind of like tiny dinosaurs (although I have been told that this is weird).

·         Eat real food – Anyone who exists on fast food, snacks, and soda is going to feel bad.

·         Don’t self-medicate with alcohol, marijuana, or other drugs – It may make you feel better temporarily but will make things worse in the long run.

·         Help other people – Looking out for the needs of others is a great way to take the focus off your own problems and helps others in the process.

Clearly some folks have more difficulties than can be solved by eating a good dinner and going for a walk through a park. For those folks, we have other things to offer. But I suspect a lot of people could feel better by trying these suggestions.

Maybe I'm crazy but...

As I was running through the woods with my beagle thinking about the fact that it was time to write another blog post, one part of my brain said to the other, “You are going to write about guns? Are you crazy? Why not write about how it is good to read to your children or the fact that apple pie tastes good?” So maybe I am crazy but I have some honest questions so here goes.

I grew up going hunting with my father and brother. My brother and his friends also used to let me tag along which is an awesome thing for a younger brother. I wasn’t a great hunter but I enjoyed being in the woods, the smell of the leaves, hearing the drumming of a grouse, watching squirrels (especially those big fox squirrels in the mountains of western Virginia), turkeys, and pileated woodpeckers. I enjoyed sleeping in a cabin warmed by a fire, hiking up the ridge in the freezing predawn darkness, falling asleep in the leaves when it got warmer later in the day, the smell of burned gunpowder from a used shotgun shell, and warming up by the woodstove after a long day in the woods. I still have the antlers from my first deer. It was just a spike but my brother mounted them on an expertly finished wood base for me. I also still have a gray squirrel he mounted for me (I have a pretty awesome big brother).

I think it is self-evident that shooting guns can be fun, especially if you have ever had the opportunity to dispose of a partially rotten watermelon by shooting it. I have no idea why it is fun to blow up spoiling melons with a shotgun but it is. But I think anyone who has ever disposed of fruit in this way would agree that an instrument that can do that to a melon is obviously potentially dangerous if not handled carefully. After all, the primary purpose of a gun is to kill.

I have a hard time understanding how discussions of gun safety and whether or not assault weapons should be easily available infringes on the rights of hunters. I am certain that my brother could feed a large number of people with only a bow and a few arrows or a flintlock with some powder and mini balls.

I have never even considered having a gun for self-defense for a variety of reasons (a longer essay for another day). I once walked into a store and the other three customers all had handguns on their hips and I wondered about the wisdom of being somewhere where everyone apparently felt the need to be armed. That doesn’t seem like the type of society I want my family to live in. And since the mass murderers are now using what are essentially automatic weapons, does that mean that soon people will be walking through the grocery store with assault rifles slung over their shoulders to protect themselves from the suspicious-looking guy in the cereal aisle?

I am also puzzled by discussions of the second amendment. I am not a lawyer or constitutional scholar but I don’t think I have ever heard anyone bring up the “well-regulated” part of the second amendment in these discussions. What does that mean? If I go down to the store and buy a rifle and take it home, that does not seem to me to fit into the idea of a “well-regulated militia.” Some folks are not good at self-regulation.

I welcome any calm, well-reasoned responses.

Peace.

On Vaccines and Knowledge

I was recently discussing vaccine recommendations with a parent and it went something like this:

Me: “I see she hasn’t had any vaccines. Can we get some started today?”

Parent: “We don’t like the ingredients in the vaccines.”

Me: “Which ingredients?”

Parent: “Mercury.”

Me: “Okay that’s fine because there is no mercury in any of the immunizations we would recommend giving today.”

Parent: “Well we don’t believe in vaccines.”

I found this confusing. Vaccines aren’t something to “believe in.” I am still not sure what that even means. I wouldn’t tell my mechanic that I believe or don’t believe in rotating my tires. I may ask pros and cons, how much it costs, etc. to learn more about it and help me make an informed decision, but it is not a matter of faith.

Maybe I am just turning into a grumpy old man but it seems that as a society we are losing the ability to differentiate between what we know and what we believe. When the evidence showed that the nasal flu vaccine was not effective, we didn’t cling to some kind of belief in it and keep giving it anyway. We stopped using it. It was the same when the initial Rotavirus vaccine showed a small, but real, increase in the incidence of an intestinal blockage known as intussusception. We stopped giving it.

There is nothing wrong with believing things. There are things that I believe but cannot prove but I am up front with folks about what I believe to be true and what I know to be true and the difference between the two.

But when one equates believing something with knowing something, it shuts down all discussion and opportunity to learn something new. I have learned a lot of new things through the years by listening to different perspectives and being open to new evidence. If I had not been willing to consider that what I believed was not true, I would have missed out on a lot of interesting, important, exciting, life-giving knowledge. Of course, I have also learned some things along the way that I wish I didn’t know, although knowing them makes me a better person.

So believe what you believe, but be open to the possibility that you may be wrong and willing to change your mind if that is where the evidence leads.

The Importance of Meeting Different Types of People

I think one of the most important things we can do to help ourselves and our children grow is to meet and talk to people whose lives and experiences are different from our own.

I recently had the opportunity to travel to Zambia with two of our children. I have been to Zambia before in my work with a small non-profit organization of which I am a part. But each trip resets my perspective, at least temporarily.

Seeing folks with basic medical needs which have not been addressed for years, sometimes for reasons as basic as not having access to transportation, is frustrating. Using a toilet which is basically a hole in the ground inside of a small structure made of mud bricks while children playing just outside are visible through the cracks is humbling. Seeing a plate of dead mice awaiting preparation to be eaten while making a house call to see someone who is in too much pain to make it to our makeshift clinic is sobering. Hearing about the woman who died in childbirth and the child who drowned in an open well the week before we got there is depressing.

On the flip side, seeing folks who have made economic progress with the small opportunities they had is exciting. And teenagers who walk several kilometers to school each day or live in a mud house but take every educational opportunity they get are inspiring. And it was comforting that the Muslim owner of the bush camp we visited, knowing that we had already sliced our spare tire on a rock so no longer had a back-up, volunteered to come and rescue our vehicle full of Christians if we had not made it back to the paved road in three hours.

Not everyone has the opportunity to go to Africa. But there are plenty of people all around us who have different life experiences which we can learn from. This happens for me on a daily basis in my office in the heart of the Shenandoah Valley. We can all learn by seeking out folks who are different from us and hearing their stories. Maybe they have a different type of job or are of a different race or religious or ethnic background.

Hearing the stories of others helps take our focus off ourselves and our problems and helps us understand why others do what they do. As one of the kids said after we got back home, “I feel bad complaining about anything now.” Exactly.

 

A Gift I Received From My Parents

There is an old joke that politicians enjoy using against opponents from the other party: “He was born on third base but he thinks he hit a triple.”

I don’t know exactly where on the base paths I was born, but I know my parents worked hard to make sure my siblings and I were born further along than they were.

My parents started their now 59 years of marriage with virtually nothing financially. My father was expected to contribute all his earnings to his family until age 21 so he had nothing to start his own family with. He worked evenings and weekends while attending college while my mother typed term papers for other students for 10 cents a page on a manual typewriter while watching their two young children, my older sister and brother.

They transferred the importance of work along to us as well. We were expected to help with chores around the house. While I may have grumbled at the time, I now have fond memories of Saturdays spent cutting firewood with my father and brother and of shelling peas in the evening while watching Monday Night Baseball. When I was a child, both of my parents worked full-time away from home so we had a dish-washing schedule through the week so my mother didn’t have to do that as well after a day at work and then making dinner. Those times often turned into a lot of fun as I dried dishes while my father or one of my older siblings washed them. I especially enjoyed when I found something that wasn’t clean enough and handed it back to be re-washed.

As I grew older, my father would sometimes take me to help with jobs on the weekend – reroofing a house, putting up some siding, etc. And I eventually worked for him in the summers. I still get a little surge of pride driving by projects I helped on 30 or 35 years ago. Conversations in our car often go something like this:

Me: “I put that roof on one summer.”

Backseat: “Yes Dad, we know.”

Me: “I helped Grandpa dig the footers for that house.”

Backseat: “Yes Dad, we know.”

My first summer job was when I was thirteen. For 50 cents an hour, I worked in a lawn and garden, scraped and painted a long board fence, and did odd jobs around a farm. A week or so into my tenure there, my boss called me in to speak to him. I wasn’t sure why he wanted to talk to me but I was a little nervous. He said, “Kurtis, when you need something from the shed, you don’t need to run to the shed to get it and then run back to where you are working.” I just thought that is how one worked because that is what my father did. Who knew? At the end of the summer, he gave me a $50 bonus.

These lessons growing up have served me well. I have messed up in a variety of ways through the years but I don’t recall ever being accused of a lack of effort.

I haven’t always done a good job modelling this for my own children. In retrospect, when a soccer game on the screened-in porch left the screens torn and dangling, I should have tried to fix it with them helping. It would have been a good lesson in how it is easier to destroy things than it is to repair them. I think that lesson extends well beyond porches to relationships, people, institutions, and a host of other things. Instead, I just got angry and made other arrangements to have it fixed.

When you are tired and overwhelmed, it is often easier to just do things yourself than to get help from an eight-year-old who will make cleaning out the garage take twice as long. I am sure there are times my “help” slowed my parents down. But helping them is how I learned to work. And that is one of the many ways my parents got me off to a good start running the bases.

A Few Thoughts on Our Healthcare System

I entered medical school in the fall of 1989 and have been intimately involved in the United States' healthcare system in one way or another ever since. And the financial part of it still makes no sense to me so I cannot imagine how confusing and frustrating it must be for folks who do not interact with the system on a daily basis.

In our family, we have two persons with the same diagnosis which has required treatment since early infancy to prevent permanent brain damage. The variations in how this has been covered or not covered through the years seem mostly like an exercise in randomness, even though we have always been fortunate enough to have insurance. There have been times when their treatment was completely covered and free to us. At most other times, it has not been covered and we have often paid more than $10,000 a year for the same treatment.

We recently had a situation in which these two people with the exact same diagnosis and the exact same insurance were prescribed the exact same thing. For one of them, it was considered a covered service by our insurance and cost $27 per month. For the other, it was denied by insurance and the same amount was going to cost more than $1400 per month from the same supplier. After many phone calls and letters by our healthcare providers, the insurance company agreed that it was a covered service for both of them.

The second confusing piece of this is that the insurance company does not actually pay the supplier anything for the prescription. Because it is a covered service, we get the contract price of $27 and the rest of the cost is written off by the supplier. So why are they willing to accept $27 if we have insurance but would charge us $1400 if we didn’t?

We never know from one year to the next whether we are going to get prescriptions filled cheaply or need to pay thousands of dollars for them.

I once participated in a General Assembly committee hearing in Richmond addressing the issue of insurance coverage for treatments for genetic metabolic disorders. After I had spoken, an executive of an insurance company stood at the lectern and assured everyone that his company provided coverage for treatment for a certain disorder. Since we had coverage through his company at the time and were being denied coverage for the disorder in question, I knew this was not true. I do not think he was intentionally lying. I think he just didn’t know. But since the hearing rules said that once a person spoke they were not permitted to speak again, I could not point out this inaccuracy.

I think the helplessness I felt as I sat in my seat in that hearing room probably is shared by many folks as they encounter the illogical behemoth that is the American medical system.

 

 

Some Thoughts on Picky Eaters

Many children are picky eaters, especially in the toddler and preschool years. This is a frequent concern I hear from parents. Often it comes in the form of “Johnny won’t eat anything but chicken nuggets.” Some parents give the child what he wants, fearing that if they don’t, he just won’t end up eating enough. The problem with that approach is that if he knows he can hold out for the nuggets, he is not likely to try other things but will just wait until he gets what he wants.

My advice is usually not to worry too much about it and don’t turn it into a battle. Making the child sit at the table until he cleans his plate never seems to work and just upsets everyone involved. I suggest presenting him with healthy foods and then letting him choose to eat it or not, but not giving him an alternative meal or snack if he turns his nose up at dinner. The response to this is often “But he’s got to eat something!”

Yes, he does, and he will. When he gets hungry enough, he will eat. The key is being comfortable with allowing a child to miss a few meals along the way if necessary. We have a genetic, metabolic condition in our family which has severely limited the food options for several family members. But even with limited options, they always ate enough of what was available to them (and chicken nuggets were not an option). In almost twenty years of practice, I can only think of a couple of otherwise healthy children who refused to eat enough to maintain normal weight gain and growth.

Some children truly have feeding issues that make it difficult for them to eat certain foods. This can be a physical problem with their anatomy or inability to handle certain textures, anxiety, developmental disorders such as autism, or isolated eating disorders. In those cases, referral to feeding specialists can be helpful.

But for most children, I think simply presenting them with healthy options and then letting them decide whether to eat or not is a good option. At some point, when they get hungry enough, they will eat.

Why I Admire My Dog

Sometimes I wish people, myself included, were more like my dog. We got Wags at the SPCA when she was a puppy. She is now 14 or 15 years old and doesn’t move very fast and can’t see or hear very well. But she is the sweetest mammal on the planet.

Sometimes she wanders away from home and we need to go find her. When we do find her, she always trots towards us with her tail wagging, like maybe she was looking for us. The one time she didn’t come right to me, I knew something was wrong even though I couldn’t see her very well in the dark woods with my flashlight. It turned out that a large flap of skin had been torn from her underside and was dangling on the ground. As I carried her back home, she didn’t protest in any way but just nuzzled her nose up under my chin.

Recently as I was letting them in for the night, our other rambunctious beagle just ran into her and knocked her flat on her side. She didn’t make any fuss but just got back up and trotted in with her tail wagging. When she tries to sniff the cat and gets hissed and swiped at, she just turns around and walks away as if nothing happened. When she doesn’t want to go outside and I make her, she doesn’t resist.

When we get home, she trots out to greet us, tail wagging (at least if she is close enough to hear us drive up which needs to be pretty close). She gracefully endures the constant unwanted attention of our other dog.

I think if there was a canine version of “the fruit of the spirit,” she would be the poster child for it. So today I am going to endeavor to be like Wags – no barking or growling at others, lots of tail-wagging, and just getting back up and continuing on if I get knocked down.

Doctors Are People Too

In case anyone wondered, physicians are actual people. We are subject to the usual foibles of humanity – pride, selfishness, impatience, anxiety, fatigue, and our own personal biases to name a few. Hopefully these tendencies are mitigated by professional standards, a desire to help people, and the pursuit of objective evidence.

There was a time in my career when I was working far too hard. I was perpetually exhausted and it wasn’t unusual for me to walk into a room to examine a child and have the mother say “Dr. Sauder, are you OK?” One night I was making hospital rounds after a long day in the office and the grandmother of one of my patients said to me, “Dr. Sauder, you look like you could use a hug.” We must have been an odd sight; an older African American woman and a younger (at the time) white doctor embracing on the pediatric ward late at night. I am sure she never realized how much that buoyed my spirits.

Doctors, being human, make mistakes. Interestingly, I have found that people have often been more forgiving of my actual mistakes than my perceived mistakes. And as with most things in life, circumstances are often not exactly as they appear on the surface. There have been times that I have heard things in public about physicians or events that I knew weren’t true but I could not correct them because I would have needed to compromise a patient’s confidentiality to do so.

Clearly the days of regarding a doctor’s word as gospel truth are long gone, as they should be. We have years of training and experience in our chosen field and are dedicated to doing the best we can for our patients. But we are also human. And it is important for us and for our patients to remember that.

A Thought Experiment on Herd Immunity

You may have heard of the concept of “herd immunity.” I am not referring to anything having to do with groups of large, hoofed animals, although I suspect the concepts would apply to them as well. What this refers to is the resistance of a population to a disease.

Let’s consider a highly-contagious, fictional disease by the name of Sauderosis. Assume we have a vaccine for Sauderosis which is effective in preventing the disease in 90% of the people who are vaccinated and subsequently exposed to the disease.

Imagine a school with one hundred students who have all been vaccinated against Sauderosis. Since the vaccine is 90% effective, ten of the students in the school will be susceptible to Sauderosis if they are exposed. If there are 20 students in each class, that means two students in each class who are susceptible, so there is not likely to be a widespread problem with the illness in the school, even if someone comes to school sick with the disease.

Now consider that same school if only 50% of the students are immunized against Sauderosis. There are now 55 unprotected students in the school, all 50 who were not vaccinated and five who were (10% of the 50 immunized students). That would mean there are, on average, 11 students in each class who are susceptible so there is a significant chance of a large outbreak if the illness is introduced to the school.

Now imagine your child has an underlying medical condition which makes him more likely to have complications of Sauderosis. If he gets this illness, he is likely to end up in the hospital and may even have life-threatening complications. Which school population would you want him to be in?

Random Thoughts While Running

This is another blog post that really doesn’t have anything to do with pediatrics but for some reason was what I was thinking about while running today.

A few months ago, one of our vehicles had a flat tire. For a variety of reasons that I won’t bore you with (in part because I can’t remember them), the only time I had to change the tire was late on a Saturday afternoon. But when I went to take off the flat tire, one of the lug nuts was stripped and the wrench just kept slipping off. I really couldn’t figure out what to do and knew we needed to have the vehicle available Monday morning.

I texted a friend for advice and called around until I found one tire place in town which was open for another 30 minutes. I pumped up the tire with the bicycle tire pump, threw the pump in the back, and headed to town hoping for the best.

After I arrived safely, it took them about ten minutes to remove a nail, patch the tire, and get it pumped up again for me. We chatted about college football while they were doing it and I was ready to leave in no time. When I went to pay, the charge was $10. Forty-five minutes earlier I had been in a panic trying to figure out what to do and these guys saved me. I told them to charge me more but they insisted $10 was the charge.

That made me think about how we determine the value of things. The guys who fixed my tire possess equipment and knowledge to know how to patch a tire. That is a valuable thing to a guy like me who does not know how to do it himself.

We all have our own niche and expertise and need to value that in each other. When I have a patient who needs more help than I can provide, I refer them to a doctor who specializes in the problem they have. When an oak tree fell on our garage roof, I called guys who could remove it safely. If I want to understand a scientific issue, I read things written by the scientists who work on it. If I have a problem with the house, I call a contractor. When my snowblower quit working, I called folks who know how to fix snowblowers. If I don’t know which E&M code to use for a visit, I ask our office manager.

We all depend on each other for different things. I know some really handy and talented people but I don’t know anyone who can get through life all on their own. At the risk of sounding preachy, it reminds me of I Corinthians 12:14 and following which talks about the need for every part of the body to do its job for the body to function properly.

So look for the value in others and acknowledge it. It will make their day and it will help you appreciate them more.

What's the Deal with Artificial Sweeteners?

One topic which seems to be talked about a lot without much definitive data is the effect of artificial sweeteners.

There are six low-calorie, artificial sweeteners approved by the FDA – saccharin (Sweet’N Low), aspartame (Nutrasweet), Ace-K, sucralose (Splenda), neotame, and advantame. These compounds work by stimulating human sweet-taste receptors while providing minimal to no calories. They are excreted unchanged from the body so have been considered to have no direct physiologic effect.

However, there have been concerns about indirect effects such as alteration of the gut microbiome (the bacteria living in the intestinal tract) and the dissociation of sweetness from calories. It is hypothesized that these alterations could result in changes in the way our bodies process nutrients and govern our sense of hunger and satiety.

There are studies which have shown weight controls benefits when drinking beverages with artificial sweeteners instead of sugar. Other studies suggest that artificial sweeteners may actually increase the risk of weight gain and type 2 diabetes. Results differ depending on the study group and it is difficult to tell how the results in one study group apply or do not apply to groups with other characteristics.

So it is difficult to draw any definite conclusions. But there are two things I know for sure on this topic. Drinking sweet drinks such as soda, sweet tea, and sports drinks add a lot of unnecessary calories. A 16 ounce soda has around 250 calories in it. To burn that many calories, one would need to walk or run approximately two miles. It is much easier to skip the soda than to add two extra miles to your daily workout. The second thing I know for sure is that water has no calories and is great at quenching thirst.

So next time, reach for the water instead (assuming your water source is clean and free of harmful substances which is another topic for another day).