Cultivating Healthy Eating Habits in Childhood

Childhood obesity has become one of the most serious public health concerns of the 21st century, and has recently reached epidemic levels in the United States. From the years 2017 till 2020, the prevalence of obesity for adolescents aged 2 to 19 was about 19.7% (Stierman et al., 2021). Overweight children are likely to remain obese into adulthood, and develop life threatening health conditions such as type 2 diabetes, high cholesterol, and cardiovascular disease (Sahoo et al., 2015). There are many factors that contribute to childhood obesity, some including environmental factors, psychological factors, and genetic predispositions. While all of these factors play a role, none of these are the cause of the recent dramatic increase in childhood obesity. The main influence on childrens’ food preferences stems from the eating habits of other members of the household, specifically their caretakers (Perpich et al., 2022). With a better understanding of how infants learn food preferences, public health experts can better develop strategies and interventions aimed at promoting healthy eating habits early in life. This will enable professionals such as dieticians and pediatricians to leverage the innate preferences of infants to make nutritious food more appealing and reduce the risk of childhood obesity.

Childhood obesity is the result of a culmination of different factors. This policy brief is suggesting one solution, which is educating the parents on the importance of eating healthy. Although this will not stop childhood obesity altogether, it will hopefully greatly decrease it for two reasons. The first reason is that if the mother eats healthy while she is pregnant, the fetus will be exposed to those flavors of healthy foods in utero. Many studies have been done to suggest a strong correlation between flavor exposure in utero and food preferences later in life (Ventura et al., 2013). Additionally, the food the mother is eating has been seen to influence the flavor of her breast milk which can also affect food preferences later in life (Ventura et al., 2013). The second reason is that babies' eating habits and food choices are learned socially through watching the people they interact the most with: their parents (Tibbs et al., 2001). Thus, these two beneficial outcomes could be the result of just educating parents on eating healthy. It is often said that a parent would do anything for their child. If parents were taught how impactful nutrition is on their child's success it is reasonable to assume they would try and change their diet for the sake of their child.

Importance of Early Nutrition

Early learning about nutrition plays a crucial role in shaping long-term eating habits and overall health outcomes in children. Dietary habits are established early in life, therefore, it is essential to prioritize nutrition education for young children as early as possible. Making sure that children are informed early on can have a substantial impact on the food choices they make later in life (Suha, 2020). Children develop ideas and form opinions about nutrition from a variety of sources, the main authority being their parents. A study done by Brown and Ogden (2004) examined the eating habits of pairs of parents and children, ages ranging from 5 to 12, using identical surveys. The results of the study concluded that childrens’ eating habits closely resembled that of their parents. Children observe and follow their parents’ behaviors, as this study shows the strong influence that parents have on their childrens’ food choices.

Evolutionary Overview of Infant Food Preferences Learning

Infants' food choices are influenced by a combination of social and genetic factors. Infants are significantly influenced by the maternal diet during pregnancy and breastfeeding. The foods consumed by the mother impact the flavors transmitted through the amniotic fluids and breast milk. For example, research suggests that infants exhibit a strong preference for carrots if their mothers consumed carrot juice while breastfeeding (Ventura & Worobley, 2013). This suggests that altering what the mothers eat during pregnancy and breastfeeding will have long term effects on childrens’ food preferences.

Genetically, infants are predisposed to prefer sweet and savory flavors, which indicate calorie-dense and nutrient-rich foods. As they grow older, their preference expands to include salty foods, as these flavors signify the presence of essential minerals. On the other hand, infants tend to be more sensitive to bitter and sour flavors, as these tastes may indicate potential toxicity or unripeness of the food (Ventura & Worobley, 2013). Although infants have basic taste preferences, they still often make maladaptive food choices, including ingesting inedible substances. Infants are more likely to accidentally poison themselves than any other age group. Additionally, while adults and older children use different perceptual properties to make inferences about food and artifacts, infants do not possess the same abilities. This could be because infants historically relied on caregivers to provide safe and nutritious diets, and they may not need sophisticated mechanisms for reasoning about food until they actively select foods themselves.

Human food selection is complex, and it is suspected that infants may have a specialized system for reasoning about food choices based on social input. A 2016 study done by Liberman et al. involved several experiments conducted with infants to investigate their inferences about food choice based on social relationships, affiliation, and language. They found that infants tend to eat more when others are eating, learn about edibility by observing people eat, and preferentially choose foods associated with native speakers and prosocial individuals. Although eating is a natural drive, humans’ food selection goes beyond mere survival and involves considerations of safety, nutrition, and health. Eating is inherently social, and food preferences are embedded in cultural systems. Food choices not only involve what to eat but also how, when, and with whom to eat. Infants may not be skilled at reasoning about the properties of foods, but may instead be adept at understanding the relationship between food choice and social identity.

Social influences play a substantial role in infants' food choices, particularly through parental modeling. Evidence supports the idea that infants generalize food preferences across individuals who share a common social identity, such as affiliative partners or speakers of the same language. For an infant, their closest social relationship is with their parents or caretakers. Infants observe and imitate the eating behaviors of their parents, leading them to develop preferences for foods commonly consumed within their cultural context. Overall, infants' food choices are shaped by a complex interplay between genetic predispositions, the maternal diet during pregnancy and breastfeeding, and social influences, particularly parental modeling. Understanding these influences can help guide caregivers in promoting healthy eating habits and introducing a diverse range of nutritious foods during the critical early stages of development.

Identifying Effective Strategies

Parents, caretakers, and healthcare professionals can use evidence-based strategies to introduce and promote healthy food choices during the early stages of infancy. It has been found that the largest influence on how a child thinks about food is parental dietary patterns observed by the child. It is recommended that parents role model healthy eating behaviors to their children by providing healthy foods and encouraging healthy eating. Specifically, it is important for caregivers to set aside family mealtime, where children can eat with their parents, their main role-models. A Harvard cohort study found that children who share meals with their parents had lower levels of soft-drink consumption and higher fitness levels, and were twice as likely to eat their daily five servings of fruits and vegetables when compared with families who do not eat meals together (Mahmood et al., 2021). Eating as a family helps young children navigate their eating environment by observing what kind of food is served, how much is eaten per meal, and the lengths and frequency of meals.

Another key strategy to promote healthy dietary habits and prevent obesity among children is a higher frequency of home cooked meals rather than consuming out-of-home foods such as fast food, takeout, and food from vending machines or convenience stores. Food that is prepared outside of the home tends to have higher fat and sugar content, therefore, children who are raised with these eating habits often have lower diet quality and micronutrients intake. Though food eaten out may be more affordable and tastier, cross-sectional studies performed in various countries around the world all concluded that children with obesity had a lower frequency of shared home-made meals (Mahmood et al., 2021). Eating at home is more time for the child to learn what to eat from their parents and for the parents to provide foods that are healthy and help shape their child's food preferences. Additionally, children who eat-in more are more likely to learn the culinary skills of making and preparing food that are required for later in life.

Collaborating With Dieticians and Pediatricians

The responsibility of making sure children are educated about nutrition and make healthy food choices ultimately falls on their parents or caregivers. Many of these parents, however, may not know how to teach their children about eating healthy. It is important for parents to become familiar with the development of child eating habits, and the massive influence it will have on the rest of their life. If necessary, it can be helpful to reach out to dieticians, pediatricians, and other healthcare professionals who can provide comprehensive guidance to parents regarding nutrition, food introduction, and strategies for making healthy foods appealing to infants. Strategies such as a written nutrition plan, meal plans, and learning about food categories can play an important role in promoting lifelong healthy eating. It is extremely important for parents to be equipped with both the knowledge and resources to model healthy habits and provide nutritious food for their children.

Since we established that the mother’s diet during pregnancy greatly influences the child’s future food preferences, a solution to address this would be education about healthy meals to pregnant women by ensuring their diets are balanced with nutrient dense foods such as fruits, vegetables, lean proteins and healthy fats. Moreover, it is important to omit certain foods that would be harmful for both the mother and her child, for instance unpasteurized dairy products, retinol rich foods, and alcohol (Williamson, 2006). This goal can be accomplished through consulting a registered dietician that would be able to develop a personalized meal plan that would satisfy the nutritional needs of pregnant and breastfeeding women, and positively impact the child’s future eating habits. Additionally, there are certain nutrients that are especially important for both pregnant and breastfeeding women, such as folic acid, iron, calcium, and omega-3 fatty acids. (Williamson, 2006) Folic acid is critical for the development of the infant’s brain and spinal cord and could be found in leafy greens, citrus fruits, and fortified grains (Williamson, 2006). Iron is needed to make more blood to support the growing baby, and can be found in beans, lean meat, and fortified cereals. Calcium is important for bone and teeth development, and can be found in dairy products, leafy greens, and fortified tofu. Omega-3 fatty acids can help with brain and eye development, and can be found in fatty fish like salmon, as well as in chia seeds and walnuts. In addition to the physical health benefits for both mother and child, we are essentially constructing the child’s future food preferences. It is important that these healthy eating habits are sustained even after pregnancy and breastfeeding so that as the child grows and learns, they can continue acquiring knowledge about nutritious food choices through her positive example.

Providing parents with an education on nutrition is one of the best options to try to combat childhood obesity because it would result in better food choice in children due to socialization as well as through flavor influence from utero and breastfeeding. Although the benefits of this solution seem promising, there are also some limitations. An obvious downside is that it would be hard to implement mainstream. It could be expensive for a lot of people which could be prohibitive, although, it is hoped that the healthcare provider who is educating the parents would be able to help them find effective strategies around the cost. Other limitations could be that children are not always around their parents and will often have food that is not as healthy pushed on them at schools or daycares, or that they could be formula fed which would take away from the influence of the mother through flavors. The potential benefits of this approach should ideally outweigh any mentioned limitations.

There are several ways to reduce obesity in children, such as promoting healthy eating habits, increasing physical activity, reducing screen time, getting enough sleep, and involving the whole family in making healthier choices. Educating a population where obesity is a threat is the first step in mitigating the problem. The eating habits formulated during childhood greatly influence eating habits as an adult. Raising awareness about the issue of childhood obesity and providing a plan for parents to try and help their children is a step in the right direction.

References

Beckerman, J. P., Alike, Q., Lovin, E., Tamez, M., & Mattei, J. (2017, December 5). The

development and public health implications of food preferences in children. Frontiers. Retrieved May 7, 2023, from https://www.frontiersin.org/ar...

Brown, R., & Ogden, J. (2004). Children’s eating attitudes and behaviour: a study of the

modelling and control theories of parental influence. Health Education Research, 19(3), 261–271. https://doi.org/10.1093/her/cy...

Mahmood, L., Flores-Barrantes, P., Moreno, L. A., Manios, Y., & Gonzalez-Gil, E. M. (2021,

March 30). The influence of parental dietary behaviors and practices on children’s eating habits. Nutrients. https://www.ncbi.nlm.nih.gov/p...

Perpich, K., Russ, R., Rizzolo, D., & Sedrak, M. (2022, December 15). Childhood obesity:

understanding the causes, beginning the conversation. Jaapa. https://journals.lww.com/jaapa...

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015).

Childhood obesity: causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187–192. https://doi.org/10.4103/2249-4...

Stierman, Bryan et al. (2021). National Health and Nutrition Examination Survey 2017–March

2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. (158).

Suha, K., The importance of nutrition for development in early childhood (2020). Electronic

Theses, Projects, and Dissertations. 1158. https://scholarworks.lib.csusb...

Tibbs, T., Haire-Joshu, D., Schechtman, K. B., Brownson, R. C., Nanney, M. S., Houston, C., &

Auslander, W. (2001). The relationship between parental modeling, eating patterns, and dietary intake among African-American parents. Journal of the American Dietetic Association, 101(5), 535-541.

Ventura, A. K., & Worobey, J. (2013). Early influences on the development of food preferences.

Current biology, 23(9), R401-R408. https://doi.org/10.1016/j.cub.2013.02.037 Williamson, C. S. (2006, February 21). Nutrition in pregnancy - williamson - 2006 - wiley online library. Wiley Online Library. https://onlinelibrary.wiley.co...