American Heart Association First-Ever Statement on Children’s Healthy Eating Supports UConn Center Research
/Healthy eating behaviors in childhood may reduce the risk of adult obesity and heart disease, according to a new Scientific Statement from the American Heart Association. The formal statement is the first ever from the Association focused on providing evidence-based strategies for parents and caregivers to create a healthy food environment for young children - with ramifications for a lifetime.
“Caregiver Influences on Eating Behaviors in Young Children,” published this month in the Journal of the American Heart Association, 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. It notes that “There is wide recognition that cardiovascular disease prevention should begin in early childhood, with a component aimed at reducing obesity.”
The American Heart Association’s decision to issue a formal science-based statement has been well received by the Rudd Center for Food Policy & Obesity at the University of Connecticut, a non-profit organization devoted to promoting solutions to childhood obesity, poor diet, and weight bias through research and policy.
“The main takeaway is that there is a two-way relationship between the child and the caregiver when it comes to feeding, said Marlene Schwartz, Ph.D., director of the Rudd Center. “The caregiver’s job is to provide a structured environment where, ideally, there is an array of healthy options available at meal time and snack time. The child’s job is to decide how much to eat. It’s not a good idea to use food as a reward or punishment, or force children to eat when they are not hungry.”
The American Heart Association has been taking a more active role of late in promoting healthy eating among children, stressing the science and the relationships that can influence healthy eating. The abstract included with the publication states that “It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.”
The detailed 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 consider building a positive food environment centered on healthy eating habits, rather than focusing on rigid rules about what and how a child should eat,” said Alexis C. Wood, Ph.D., the writing group chair for the scientific statement and assistant professor at the U.S. Department of Agriculture/Agriculture Research Services Children’s Nutrition Research Center and the department of pediatrics (nutrition section) at Baylor College of Medicine in Houston.
Schwartz also noted that parents and caregivers should be encouraged that over the past several years there have been noteworthy improvements in government supported school meal programs, and more recently, child care food programs, which are reflecting the best practices of providing an array of healthy options for children. The idea of “repeated offering of healthy foods” is reflected in the emphasis of providing both fruit and vegetable choices each day for lunch for students in schools and child care settings, she added.
The American Heart Association statement points out that “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.”
The Statement goes on the explain that “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.”
If there was any aspect absent from the formal statement and the comprehensive research that led to it, it is the lack of reference to the influence of marketing of unhealthy food choices to children. That has been the subject of considerable research and published findings by the Rudd Center, highlighting the impact of marketing on children’s food choices, and particularly in regards to marketing targeting African American and Latino children. The foods most heavily marketed to youth, the Rudd Center has found, are the same foods that we ought to be limiting – fast food, sugary “fruit” drinks, and sugar sweetened cereals, for example.
The American Heart Association statement acknowledges the challenges that parents and caregivers face, indicating that they 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; and
avoiding pressuring children to eat more than they wish to eat
The Statement includes a 2x2 table, comparing various approaches of “demandingness” and “responsiveness, explaining that the upper right quadrant in the table, which includes a “high level” of both, serves children and youth best.
The Scientific Statement points out that “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.”
It goes on to state that “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.”
Schwartz was also pleased to see the American Heart Association statement acknowledge that placing blame on parents or caregivers is not productive.
“It is important to note,” the Statement stressed, “that not all strategies work for all children, and parents and caregivers should not feel undue stress or blame for children’s eating behaviors.”
“It is very clear that each child is an individual and differs in their tendency to make healthy decisions about food as they grow. This is why it is important to focus on creating an environment that encourages decision-making skills and provides exposure to a variety of healthy, nutritious foods throughout childhood, and not place undue attention on the child’s individual decisions,” Wood pointed out.
Caregivers can be a powerful force in helping children develop healthy eating habits, and yet, the statement emphasized, their role is limited by other factors. The statement authors encourage policies that address barriers to implementing the statement’s recommendations within the wider socioeconomic context, including social determinants of health such as socio-economic status, food insecurity and others.
The Statement was written on behalf of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health; Epidemiology and Prevention; and Cardiovascular Disease in the Young; the Council on Cardiovascular Stroke Nursing; and the Stroke Council.
