Never Too Early to Learn about Lowfat?

I am pleased to welcome Pam Schoenfeld MS RD as a guest blogger.  Pam has been inspiration to me for many years; she was the person who convinced me I could go back to school and get a degree in nutrition.  She works with individuals and families in a clinical setting and has become increasingly concerned about the messages about “healthy food” that are being given to young children.  Although the science on the dangers of dietary saturated fat and cholesterol has been hotly contested for decades, mainstream nutrition is now targeting preschoolers with messages about the evils of eggs and whole milk.  Pam shares her experiences and insights on this issue.  

As for me, I love my new PhD program in Communication, Rhetoric, and Digital Media, but it is kicking my butt.  Who knew critical cultural theory was harder than biochemistry?  I’m glad to have someone take over blogging duties for me as I am sleep-deprived, overworked, overwhelmed–and happier than a pig in slop.  Pam promises more to come, so stay tuned.

Samantha was in most ways a typical patient, slightly round in the middle but otherwise healthy. She knew a few things about healthy eating; she ate cereal with nonfat milk for breakfast, and made an effort to eat her fruits and vegetables. When I asked if she liked eggs, she said “yes, but only the whites.” When I asked why, she answered rather matter-of-factly, “the white is better for you than the yellow.” Her answer came as a surprise to me. Many of my patients are still concerned about eating egg yolks, but Samantha was only eight years old! Already she had somehow internalized the message that certain foods were best to avoid if you want to be healthy. She did not know that egg yolks were high in cholesterol; just that they were not good for her to eat. She did not know that nonfat milk was low in saturated fat; just that it was what her family always poured on their cereal and what she drank at school.

Despite the lack of science to support the claim, kids are increasingly being given the message that fat-free milk–even the kind with added sugar–is the healthiest choice.

The avoidance of egg yolks and the choice of low-fat or nonfat milk are so common among my patients that if she were just 5-10 years older, her answer would be completely expected. But she was so young, so eager to do the right thing, and yet so unaware that some of what she was being taught about nutrition was not evidence-based. So while I helped her plan meal choices that better met her needs, I gave her my best third-grader explanation about why whole eggs are actually one of the best foods she could eat. I left the subject of dairy fat for another day, as I suspected her mother and pediatrician wouldn’t agree with my view on this and I wanted to ensure that Sam would continue to see me.

I had assumed that these nutrition messages are so prevalent in our adult culture and media that young children simply absorb them by osmosis. But it turns out that more and more children as young as 3 are being targeted with nutrition information.

Nutrition information that adheres to controversial government dietary recommendations is targeting preschoolers with low-fat, grain-based dietary advice.

The latest issue of my professional dietetics journal arrived in the mail last month, and as usual, I skimmed the abstracts of poster presentations scheduled for the annual dietetics conference, aka “FNCE,” that will be held in Houston over the next 5 days. To my surprise, a few dozen of these abstracts described research on children’s diets, with eight reporting outcomes from programs targeted for preschool or grade-school age groups. (1) FNCE is by far the largest annual gathering of registered dietitians; it is at this venue that many RDs become informed on the research and practice recommendations in our field.

One group of researchers stated that because 75% of children are in organized childcare, it is the ideal setting for promoting healthy behaviors; a second group agreed that childcare settings are a prime environment for early intervention. I was reminded of my own dietetic internship, where I had to sing to Head Start pupils about the merits of low-fat milk while entertaining them with a cow puppet. Nutrition and health lessons directed to preschoolers are commonly delivered in the form of games and songs, but researchers are now studying the effectiveness of other methods.

I guess this should not surprise me, considering a 2011 Institute of Medicine (IOM) Report entitled “Early Childhood Obesity Prevention Policies.” The expert committee authoring the report stated “there is a growing awareness that efforts to prevent childhood obesity must begin before children even enter the school system.” Their “hope” is that this report will find its way to government policy makers who work in areas that impact young children in infancy and early childhood. In this report, nutritious and healthy foods for ages 2 and older are defined to be consistent with the Dietary Guidelines, which specify lean protein foods and low-fat or nonfat dairy products. (2)

Traditionally, the family has been the key environment where young children learn to develop eating habits and food preferences. But once children start school, teachers and peers gradually become the greatest influence. (3) Most people would undoubtedly be supportive of any initiative to educate young children about nutrition. After all, there has been an almost 2.5-fold increase in obesity in children ages 2-5 from 1980 to 2010, from 5% to 12.1% of this age group, and similar increases in older children. (4) So it would appear necessary to begin preventative measures at an early age.

Despite considerable evidence that shows that saturated fats are not linked to heart disease, the American Heart Association uses cartoon figures to teach kids that both whole (saturated) fats from animal products and transfats from processed oils are “the Bad Fats Brothers.”

It also appears that initiatives directed at young children are effective. In a recent study of 4-year olds given structured nutrition lessons in preschool, the children were able to correctly answer that “high-fat foods are bad for you and make you fat” even 5 months after the lessons ended. These lessons were only 10-15 minutes long, and the information wasn’t reviewed during the 5-month period, so the children’s ability to retain that lesson long-term indicates their receptivity to simple nutrition messages. (5) While it is unknown if the children consistently acted on this knowledge, it is clear they can and do retain simple “food rules,” even at the tender age of 4. The IOM committee would likely agree: “During infancy and early childhood, lifestyle behaviors that promote obesity are just being learned, and it is easier to establish new behaviors than to change existing ones.” (2)

So if childhood obesity is a huge problem and these early nutrition programs are effective in teaching children, why am I concerned? One reason is that the very same saturated fat- and cholesterol-containing foods that are negatively targeted in these nutrition lessons actually contain critical nutrients for growing children. Another reason is that if done improperly, nutrition lessons directed at children could easily pave the way for unhealthy relationships with food and issues with body image, among other unintended effects.

I will discuss these possibilities in more depth in upcoming posts, with further discussion on some disturbing recommendations from the IOM Early Childhood Obesity Prevention report.

References:

1. Journal of the Academy of Nutrition and Dietetics; 2013:113(9), A1-A120, suppl.

2. Institute of Medicine (IOM). 2011. Early Childhood Obesity Prevention Policies.Washington, DC: The National Academies Press.

3. Perez-Rodrigo C, Aranceta J. Public Health Nutrition. 2001;4(1A), 131-139.

4. Ogden CL, Carroll MD, Kit BK, Flegal KM. JAMA. 2012;307(5):483-490.

5. Nguyen SP, McCullough MB, Noble A. J Educ Psychol. 2011; 103(3): 594–606.

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9 comments on “Never Too Early to Learn about Lowfat?

  1. luanabee says:

    I’ve been appalled over the news that some big school districts’ lunch programs are introducing vegetarianism by limiting kids to food without animal products one day a week (like, “Meat-free Monday”). Don’t they have enough problems with kids falling asleep in class? Not to mention the needs of growing bodies and minds. Can we do an intervention with these veg zealots, for the kids?

    • You make a good point Luana. Personally, I don’t think that in general one day per week with a vegetarian meal will have a negative impact for most kids, at least not on that very day. I would take issue with a vegan day, yet this could be next: a meatless/eggless/dairyless Monday. But the real problem is that children are being taught that this is a healthier way of eating, and this could change their perceptions on whether they should eat flesh foods at all. I see so many young people that are eating vegetarian and they really believe it is healthy, although many do so because they don’t want to be a part of animal cruelty.

      • luanabee says:

        Yes, Pam, that’s the problem: sending the message that this is a special “healthy” day, when it’s not at all. Especially for growing kids. A few years ago at dinner out, my 13-year-old grandson said he didn’t like the idea of eating animals, though he liked the taste of meat. I explained to him that I wasn’t wild about the idea either but the reality is that meat is an important part of a healthy balanced diet. I also told him the health problems I had when I gave up eating meat for a decade. He felt better about eating his burger then. He eats lots of healthy vegetables too.

        The most important thing kids (and all of us!) should be learning about diets is how a good balance of all the different foods work together to keep us healthy. Some foods have certain vitamins that help us absorb nutrients in other foods so for optimal health, we should have them both. In fact, the more variety, the better.

        Instead, what kids learn from “meatless Mondays” is what’s the “bad food du jour” or the “magic healthy food du jour.” In fact, we all learn this, through our warped diet culture. Michael Pollan says it best in “Omnivore’s Dilemma”: “Today, buffeted by one food fad after another, America is suffering from what can only be described as a national eating disorder.” I couldn’t agree more.

  2. Sean says:

    Thank you, kids form life long habits in there youngest years.

    America is so dam busy, working parents can not be expected to keep up with the onslot of new information regarding diet and health. This is why we have schools. The mis infomation is shameful, an incredible disrespect to parents working to create a better life for their families.

    A child go to school and are told to avoid fats and sugar, they go home to media saturated with ads for foods that embody the oppsite in the poorest quality. Thier heads must be spinning like tops

    • Great point – parents do largely trust the public school systems to be delivering a science-based curriculum to their children. Little do they know that the curriculum is flawed because the source (USDA/HHS) has . Interesting that you comment on how parents can’t keep up with the new information. Strange irony when you realize that the old nutrition information is really what we are talking about, yet the old will be new to the current generations of parents, thanks to being raised on the Food Pyramid.

  3. Todd Baum says:

    Thank you. Keep up the good work.

    Sent from my iPad

    >

  4. abqandrea says:

    This is a key point that Pam makes, “While it is unknown if the children consistently acted on this knowledge, it is clear they can and do retain simple “food rules,” even at the tender age of 4″.

    As time goes on, two of the possible outcomes with negative side effects are: 1) not eating the foods that are actually real and healthy because of misguided beliefs, 2) not eating the recommended foods that you’ve been taught are healthy and having guilt or stress about THAT.

    Argh!

  5. Thanks Fred. It is pretty disturbing what is going on. It seems that most RDs and pediatricians feel they are doing the right thing however. Makes me sad for the young children.

  6. Good job Pam! In NYC public schools, full fat milk is not allowed but fat free chocolate milk is. Sick.

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