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By Pamela A. Popper, Ph.D., N.D.

Studies consistently show that overweight and obese children have a very high risk of remaining overweight or obese throughout adulthood.  Studies also show that people find it very difficult to lose weight and keep it off, which means that while we must continue to look for methods that are effective for weight loss in overweight and obese adults, we also must work at preventing weight gain in children.

Poor dietary habits leading to weight gain often begin early in childhood, and a recent meta-analysis looked at the various factors that contribute to this weight gain.  The analysis included 20 studies from the U.S., Europe, and Australia with 1067 participants. Several consistent themes were identified.

The first was that children’s taste preferences, attitudes toward food, and likes and dislikes often determined the foods given to them.  Parents of fussy eaters tended to give children what they wanted to eat, but also described strategies that could help children to make better choices, such as negotiation, repeated exposure to healthy food and encouraging children to help with food preparation.  I am compelled to comment here; negotiating with preschool-aged children about food, bedtimes, behavior, or anything else is inappropriate – very young children are not equal partners with their parents in making these types of decisions.  Some likes and dislikes can be considered, but one way to get children to eat better foods is to serve them and to offer no other alternatives.  When they get hungry, they will eat!

Another factor that consistently affected food choices was modeling behavior.  Parents, and other family members and peers influenced children’s dietary choices, and parents who preferred fast food and packaged foods admitted that this stood in the way of healthier choices for their children.

Parents’ lack of knowledge about nutrition, lack of support, and lack of cooking skills were an issue.  Additionally, parents tended to be more concerned about their children being underweight than overweight and overweight parents tended to have inaccurate perceptions of their children’s weight status.

Lack of time was often an issue and parents stated that they felt that they often had to make a choice between healthy eating and facilitating their children’s activities.  Parents also reported resorting to fast food because they worked long hours and did not have time to cook.

Financial considerations influenced food choices, and most studies reported that participants could not afford to purchase healthy food and thought that healthy food was more expensive than unhealthy foods.  Many stated that healthier foods should be cheaper and some said that healthy foods should be subsidized by the government.

Ten studies reported using unhealthy foods as reward for good behavior.  This is a common practice, particularly in schools, where, with good intentions, some teachers reward students with sweet treats for jobs well done or for good behavior.  But I think it is important to establish the idea that good behavior and accomplishment are personal responsibilities, not events requiring constant external rewards, and clearly our kids do not need more reasons to eat junk foods.

Ten studies reported that kids tend to consume junk foods when they are available. On the other hand, controlling the home and school environment was shown to facilitate better choices.

Not surprisingly, advertising, packaging, and food placement in stores influenced choices as well.

The good news here is that all of these impediments to healthy eating are resolvable. It is a myth that healthy eating is more expensive, and also that preparing healthy foods is excessively time consuming.  Stores are packed with convenient healthy foods, ranging from pre-washed greens and sliced mushrooms to microwavable packages of rice and vegetables.  Clearing homes of junk foods is a powerful way to prevent both children and adults from eating these foods.  Educational intervention programs have been proven to result in positive changes in both knowledge about health and in health-promoting habits.  The success of a preschool health education program in Madrid Spain in changing children’s attitudes, and eating and exercise habits should encourage more schools and community organizations to help parents and families by offering similar programs.

Paes V, Ong K, Lakshman R. “Fators influencing obesogenic dietary intake in young children (0-6) years): systematic review of qualitative evidence.”  BMJ Open 2015;5:e007396  doi:10.1136/bmjopen-2014-007396