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.

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.

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.

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.