Diversion
By Natalie Digate Muth
Ten ways to get kids to eat more healthily
"I do not like broccoli. And I haven't liked if since I was a little kid and my mother made me eat it. And I'm President of the United States and I'm not going to eat any more broccoli," the first President Bush infamously stated at a news conference.
His public denunciation of broccoli set off a firestorm and outrage among parents across the US who had been diligently trying to shovel the vegetable into their children's mouths. It's hard to know if his disdain for broccoli would have been so profound had his mother never made him eat it, but certainly she had no idea that her desire for her son to eat his vegetables would lead to such a public lashing. Her well-meaning demands to "Eat your vegetables!" back-fired.
Parents around the world have tried the same tactic with little lasting success. Research suggests that if we want our kids to eat healthfully, we have to rethink our strategies. Here are ten tips based on the latest research and expert opinion that will help even the pickiest of eaters to eat more healthily.
1. Model healthy eating
One of the most important actions adults can take to help children eat more healthily is to eat more healthily themselves. In one study, parental modelling was associated with increased milk, fruit juice and vegetable intake (Young et al, 2004). Another study found that children's intake of a novel food increased at meals during which they witnessed a teacher enthusiastically eat the food (Hendy and Raudenbush, 2000).
2. Eat together
In an era of single parenting and two-parent working families, multiple extracurricular activities to coordinate, and overall hectic lifestyles, family meals are on the decline. Not only are family meals generally more nutritious for children (Gillman et al, 2000), eating together also offers an opportunity to socialise about food and eating, and model healthy behaviours. Even if it is only twice per week, planning family meals into a weekly routine goes a long way toward helping children to develop healthier eating habits.
3. Increase exposure to healthy foods
As stated by Cook in a 2007 review article advocating that children be repeatedly exposed to a variety of healthy foods, "Children like what they know and they eat what they like." One of the best ways that parents can help their children develop healthy eating habits is to repeatedly expose them to a wide variety of foods. While children may not accept the novel food on the first try, with repeated attempts and familiarity with the food, they will become more likely to develop a preference for it. In one study, children exposed to a sweet, salty or plain version of a new food showed increasing preference for the food that became most familiar to them (even the plain version). They showed decreasing preference for the other versions even though children have an innate preference for sweet tastes (Sullivan and Birch, 1990). Just because a child shuns a food once, do not label it "rejected". Instead, continue to reintroduce it and expect that it may take up to 15 times before the child will accept it.
4. Let them choose portion size
Adults can empower children to let their internal cues of hunger and fullness guide how much they eat by allowing children to choose their own portion sizes. Adults are notoriously bad at guessing how much food a child should eat. They typically offer too-big portion sizes and then require kids to "clean their plates". This scenario sets the stage for overeating. In one study, researchers offered preschool-aged children two plates of food: one with an age-appropriate portion and another with double the amount of food.
The children ate about two-thirds of the food from the age-appropriate portion size. They ate 25-29% more food when offered the larger portion size. Notably, they did not even notice the increases in the portion size when given the larger serving (Oriet Fisher et al, 2003). Thus, similar to adults, kids will eat more food when portion sizes are big. And when adults force them to finish these oversized portions, children learn to override their internal hunger cues and develop a tendency for overeating. On the other hand, several studies have shown that when kids are allowed to choose their own portions, they tend to choose appropriate portion sizes and they eat less versus when adults decide how much they should get (Oriet Fisher et al, 2003).
5. Share the control
Several studies have shown that when a child is allowed to self-regulate food intake, free of any adult pressure or influence, total caloric intake and nutritional value differ only minimally from day to day (discussed in Birch and Dietz, 2008). On the other hand, encouraging children to eat by focusing on the amount of food left on the plate promotes more food intake and makes children less able to self-regulate caloric intake (Birch et al, 1987). Furthermore, several studies have confirmed that requiring a child to consume a particular food to receive a 'reward' such as a dessert, led to increased dislike of the food the child was required to eat and increased liking of the typically unhealthy 'reward' food. Higher levels of parental control and pressure to eat are associated with lower fruit and vegetable intake and higher intake of dietary fat (discussed in Birch and Dietz, 2008).
6. Refuse to be 'short order' cook
Picky eaters can wreak havoc on an enjoyable family meal, compelling some parents to make special accommodations for each child just so everyone will have something that they will eat. Parents can promote healthier eating by refusing to accommodate special requests, while at the same time making sure to serve at least one healthy food that the child likes at each mealtime.
Birch and Dietz (2008) promote a "division of responsibility" in which parents are responsible for the types of food that are offered and children are responsible for deciding whether or not to consume those foods and how much to eat. If the children refuse what is offered, it is not up to the parents to offer them something else. Rather, the children can have ready access to the meal later should they become hungry. This may seem like tough love, and many parents may express concern that the child will go hungry, but by consistently following this rule, parents will go a long way toward helping their child to develop a taste for previously rejected foods.
7. Limit television time
While television viewing has been associated with a variety of negative behaviours including poor school performance and childhood obesity, it is also linked to overall worse nutrition. This may largely be due to the enormous amount of advertising for unhealthy foods such as sugary breakfast cereals, soft drinks, candy, salty snack products, and highly processed and fast foods. Research has shown that exposure to advertisements for food products increases children's choice of, and preference for, these advertised foods (reviewed in Birch and Dietz, 2008).
8. Exploit similarities
Susan Roberts and Melvin Heyman, authors of Feeding Your Child for Lifelong Health (1999), suggest that parents exploit similarities to develop a taste preference for new foods. Once a food is accepted, find similarly coloured or flavoured 'food bridges' to expand the variety of foods a child will eat. For example, if a child likes pumpkin pie, try mashed sweet potatoes, and then mashed carrots.
9. Make eating fun
Despite its accompanying demands, stresses, mistakes and disappointments, parenting is supposed to be fun. Adults can make learning about healthy nutrition and physical activity fun and educational. For example, what better way to teach a child about plants and the importance of eating them than having his or her own small garden? Families can grow the plants and then show the child how to use the produce in delicious recipes. Or, parents can take their children to a farmer's market and let them pick out a new vegetable or fruit to try at home. Whatever it is, parents should try to take a break from the mealtime battles, and take advantage of a child's wonderment about the world to teach a lesson about health and fitness.
10. Skip the food fights
A survey published by the American Dietetic Association revealed that the number one eating concerns of mothers are that their children do not eat enough fruits and vegetables (ADA, 2006). Recognising the powerful health-promoting benefits of these nutrient powerhouses, parents insist that their children eat their vegetables. The alternative, they fear, is that their children will be unhealthy and malnourished. The truth is that the more parents pressure their children to eat certain foods, the less likely they will be to develop a taste for them and continue to eat them often as an adult. In fact, several research studies have shown that encouraging children to consume a particular food increases their dislike for that food (reviewed in Birch and Dietz, 2008).
Kids instinctively resist persuasion. If parents want to get their kids to eat vegetables and other healthy foods because the kids like them, then parents will have to employ different strategies - increasing accessibility and exposure, minimising the competition, modelling, vowing to not say anything when a child refuses a food, and helping make food taste good, for starters. In short, the most successful parents of healthy eaters opt to skip the food fights.
About the author: Natalie Digate Muth is a pediatrics resident at the UCLA Mattel Children's Hospital in the US. This article was published in ACE FitnessMatters, January/February 2010. Reprinted with permission.
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Repeated exposure to a wide variety of foods will help children develop healthy eating habits
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