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Helping children develop good eating habits

Carol Ottley
BSc SRD RPHNutr
State Registered Dietitian and Registered Public Health Nutritionist
E:cao.foodcomm@virgin.net

A recent study investigating children's attitudes towards food found that UK children associated eating healthily with a "goody two-shoes" image that ran contrary to what they really wanted to do.(1) This appeared to lead to feelings of guilt when consuming "bad" foods while disliking eating foods that were "good for you". Research also shows a worrying increase in the number of overweight and obese children in the UK,(2) and that more and more children, at an increasingly young age, are following slimming diets that may be adversely affecting their growth and development.(3)
Clearly this is an unhealthy situation, and parents need advice on how to help their children develop a healthy relationship with food, follow a balanced diet and maintain a healthy weight. This article explores how these goals might be achieved.

Mother as role model
It has been shown that parental attitudes to food and eating are commonly passed on to their children. Mothers who diet regularly and have an uneasy relationship with food tend to exert a high level of control over their children's food choices.(4) This undermines the child's ability to self-regulate their intake and leaves them vulnerable to over- or undereating. Studies have also shown that restriction of palatable foods in young children increases their desirability and may even promote their consumption.(5)
Mothers have also been shown to be the main role model when it comes to food choices.(1) Children in Italy, Spain and the UK all reported that their most trusted and habitual nutritional expert was their mother. At the same time, women underestimated their influence. Italian mothers' own pleasure in eating and cooking appeared to instil a positive relationship with food among their children, which was lacking in British and Spanish children.
Children enjoy both formal and informal eating occasions. Informal eating occasions offer children the chance to choose and control their own foods, socialise with peers or integrate foods in their play. Formal eating occasions such as family meals can be used to demonstrate eating etiquette and balanced nutrition. Taking children's wishes into account in meal selection and preparation and getting the children actively involved in the discovery of new foods can help facilitate dietary balance and diversity. A flexible approach offering children a selection of foods and adapting cooking methods to children's preferences is vital.
 
Children's understanding of a healthy diet
Compared with their Spanish and Italian peers, UK children have a more simplistic view of healthy eating.(1) Spanish and Italian children divided foods by frequency of consumption and could distinguish between everyday staples like bread or pasta and more occasional foods. This also allowed for moderate indulgence without feelings of guilt, within their concept of a good diet. UK children focused on the nutritional attributes of individual foods as being "good" or "bad" and paradoxically preferred the bad foods over the good ones. This suggests that rather than focusing on foods that are good or bad for you, highlighting the sensual properties of foods may increase consumption of a wider range of foods and a more balanced attitude towards food choice.
 
Children lead increasingly sedentary lifestyles
The most recent dietary survey of children aged between four and 18 found that children of all ages are consuming less calories compared with earlier surveys despite being taller and heavier.(6) At the same time children (and adults) are becoming increasingly inactive.(7) For example, children aged between eight and 15 spend about three hours a day engaged in sedentary activities, such as playing computer games and watching TV and videos (see Figure 1). Opportunities for daily activity are also commonly reduced, and children are less likely to walk or cycle to school or play outside because of concerns over safety.

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There is now a growing belief that environment, rather than biology, plays the greater role in the development of obesity.(8) Low-cost, energy-dense foods and large portion sizes combined with reductions in physical activity at school, at home and at play mean that it is increasingly easy for children to eat more than they need.
 
Cutting calories not the best approach
Although it may seem obvious to balance shrinking calorie needs by consuming even fewer calories, there is an important reason why this is not the best approach, especially for children. As children are growing, it is vital that they have all the nutrients they need for proper development. The less food consumed or the more restricted the diet, the harder it becomes to meet requirements for these key nutrients. Many UK children already consume inadequate amounts of iron and zinc,(6) with other minerals such as calcium being borderline in older children. All these nutrients are vital for growth, and so restricting their diets would undoubtedly exacerbate the problem.
The more physically active children are, the more calories they need. This means they can enjoy eating a wide range of foods (making it easier to get all the nutrients they need) without gaining weight. As physical activity also confers many other health benefits, helping children to develop and sustain a physically active lifestyle is a clear priority.

A healthy diet for children
After about the age of two, the transition from the high-fat diet (50% of calories) needed by babies and toddlers to a lower-fat diet (35% of calories) begins. After about age five there is no difference between a healthy diet for children and that for adults;(9) the whole family can eat the same healthy food. But it is important to note that this does not mean extreme diets devoid of fat and containing vast quantities of fibre. This type of diet would be dangerous for a growing child as it is too bulky and would make it very difficult for children to meet their calorie and nutrient needs.
The same priorities for adults apply to children, and the focus should be on boosting the intake of starchy foods such as bread, pasta, rice and potatoes. Lower-fat dairy produce is safe for children as it contains similar quantities of micronutrients to full-fat versions. Meat, especially red meat, is a good source of iron and zinc, two of the nutrients currently lacking in UK children's diets, and lean cuts of meat should be recommended.
The fat intake of children in the UK is already very close to the recommended level of 35% of calories,(6) but the level of saturated fat is still above recommended. Swapping to mono- and polyunsaturated cooking oils and spreads should be advised. Fruit and vegetable intake in the UK is still well below the five-a-day target and needs to be encouraged. One in five 4-18 year olds do not eat any fruit at all, and the average amount consumed is one portion of fruit and one portion of vegetables per day.

Benefits of a healthy lifestyle
Many studies have examined perceived barriers to healthier lifestyles, but one recent paper has taken a more positive approach.(10) Children and adolescents were asked to identify the benefits of being physically active and eating healthily. Participants in the study were clear that exercise and eating well had an energising effect and improved performance of both body and mind. Other benefits such as appearance, weight control and future health were ranked as moderately important. Older children also suggested a number of strategies for overcoming barriers to a healthy lifestyle (see Table 1).

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The way forward
With increasingly sedentary lifestyles and an abundance of attractive food available, this is a challenging time for parents who want their offspring to follow a balanced diet and achieve a normal healthy weight. It is necessary to build physical activity into the family routine from an early stage, and parents must not underestimate their importance as role models. With regard to eating healthily, the focus should be on the sensual pleasures of eating, as this is the main determinant of food choice in children. Children should also be encouraged to taste a wide range of foods and develop an understanding of balance, rather than categorising foods as "good" or "bad". See the green box opposite for some practical tips to pass on to parents with young children or teenagers.

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References

  1. HPI Research Group. A ­pan-European survey of children's attitudes towards healthy eating. Eur Nutr Res Summaries Update 2002;Issue 3. Available at URL: http://www. kellogshealthzone.co.uk
  2. Chinn S, Rona R. Prevalence and trends in overweight and obesity in three cross sectional studies of British children. BMJ 2001;322:24-6.
  3. Davison KK, Markey CN, Birch LL. A longitudinal examination of patterns in girls weight concerns and body dissatisfaction from ages 5-9 years.Int J Eat Disorder 2003;33:320-32.
  4. Birch LL, Fisher JO. Mother's ­­child-feeding practices influence daughters eating and weight. Am J Clin Nutr 2000;71:1054-61.
  5. Fisher JO, Birch LL. Restricting access to palatable foods affects ­children behavioural response, food selection and intake. Am J Clin Nutr 1999;69:1264-72.
  6. Gregory J, Lowe S. National diet and nutrition survey: young people aged 4-18. London: The Stationery Office; 2000.
  7. The UK 2000 Time Use Survey 2002. Available at URL: http://www.statistics.gov.uk
  8. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science 2003;299:853-5.
  9. Department of Health. Nutritional aspects of cardiovascular disease. London: HMSO; 1994.
  10. O'Dea JA. Why do kids eat ­healthful food? Perceived benefits of and barriers to healthful eating and physical activity among children and adolescents. J Am Diet Assoc 2003;103:497-501.

Resources
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