Childhood healthy eating could prevent obesity, heart disease

How children are fed may be just as important as what they are fed, according to a new scientific statement published today in the Journal of the American Heart Association.

The statement reviews evidence-based strategies for parents and caregivers to create a healthy food environment for young children that supports the development of positive eating behaviors and the maintenance of a healthy weight in childhood, thereby reducing the risks of overweight, obesity, and cardiovascular disease later in life.

Although many children are born with an innate ability to stop eating when they are full, they are also influenced by the overall emotional atmosphere, including caregiver wishes and demands during mealtimes. If children feel under pressure to eat in response to caregiver wants, it may be harder for them to listen to their individual internal cues that tell them when they are full.

Allowing children to choose what and especially how much to eat within an environment composed of healthy options encourages children to develop and eventually take ownership of their decisions about food and may help them develop eating patterns linked to a healthy weight for a lifetime, according to the statement authors.

The statement suggests that parents and caregivers should be positive role models by creating an environment that demonstrates and supports healthy food choices, rather than an environment focused on controlling children's choices or highlighting body weight. Parents and caregivers should encourage children to eat healthy foods by:

• Providing consistent timing for meals
• Allowing children to select what foods they want to eat from a selection of healthy choices
• Serving healthy or new foods alongside foods children already enjoy
• Regularly eating new, healthy foods while eating with the child and demonstrating enjoyment of the food
• Paying attention to a child's verbal or non-verbal hunger and fullness cues
• Avoiding pressuring children to eat more than they wish to eat

Alexis C. Wood, PhD, lead author of the statement, some parents and caregivers may find it challenging to allow children to make their own food decisions, especially if the children become reluctant to try new foods or become picky eaters. These behaviors are common and considered normal in early childhood, ages 1 to 5 years old, as children are learning about the tastes and textures of solid foods. Imposing rigid, authoritarian rules around eating and using tactics such as rewards or punishments may feel like successful tactics in the short term. However, research does not support this approach. Rather, it may have long-term, negative consequences. An authoritarian eating environment does not allow a child to develop positive decision-making skills and can reduce their sense of control, which are important developmental processes for children.

In addition, the authoritarian approach has been linked to children being more likely to eat when they are not hungry and eating less healthy foods that are likely higher in calories, which increase the risk of overweight and obesity and/or conditions of disordered eating.

On the other hand, an indulgent approach, where a child can eat whatever they want whenever they want, does not provide enough boundaries for children to develop healthy eating habits. Research has also linked this "laissez-faire" approach to a greater risk of children becoming overweight or having obesity.

Research does suggest that some strategies can increase children's dietary variety during the early years if they are "picky" or "fussy" about foods. Repeatedly offering children a wide variety of healthy foods increases the likelihood they will accept them, particularly when served with foods they prefer. In addition, caregivers or parents who enthusiastically eat a food may also help a child accept this food. Modeling eating healthy foods by caregivers, siblings, and peers is a good strategy for helping children to be open to a wider variety of food options, the researchers said.