Monday, January 20, 2014

5 Steps to Ending the White Food Diet and 'Picky' Eating

My lapse in blogging has been due in part to a new job I have taken in Early Childhood Obesity Prevention.  It is thrilling to be in this position: it is timely, it is critical and it has a lot of fantastic thinkers working to tackle the issue. It is also interesting to realize that so much of what I write about is part of the obesity equation.  So apologies aside, I will get back to writing about what parents are addressing everyday at their very own tables.

All parents fret about their child's eating, especially if that child is restrictive or picky.  These are usually kids, 10 and under, that will only eat simple carbs with the occasional yogurt tube.  My friend who teaches middle school says that these kids enter middle school and the 'White Food' diet becomes the 'Yellow Food' diet because the kids are fed the same foods just fried.  Parents worry about their getting enough protein or Vitamins. Often those kids are the skinny among us because what they eat is so limited.

Restrictive eating or picky eating is hard on families and the kids themselves. For families it makes eating together challenging when everyone has a different meal and dining out ends up being limited to the 1-2 places that can accommodate these kids. What many parents don't realize is that many of those kids go on to be overweight or obese because of the difficult eating habits they carry with them from childhood into adolescence. These types of eating habits are endlessly frustrating for parents and can lead to poor habits later in life.

Thankfully, picky eating habits are easiest to end when the child is young and new healthier habits can take their place.  Below are the 5 steps.

5-Step Path to Ending the White Food Diet

1. End grazing.
2. Add variety: vary the time of day favorites are served, vary the color of the foods, vary the plates,  vary the setting, vary the texture or smell of favorites, etc.
3. No menus
4. Listen to them and let them serve themselves. Remember--they will be hungry at the next meal if they skimped on this one.
5. Make meals fun: let go of the power struggle.

Go from  To

1. End Grazing:  Grazing started becoming an epidemic about 20 years ago, with the reigning idea that many small meals each day was superior to three larger meals.  This was compounded by food companies capitalizing on snack foods and marketing them heavily, especially to kids.

Grazing takes the edge off a child's hunger, and usually they graze on foods that wouldn't be served at the dinner table. They fill up enough that they don't come to meals hungry.  Grumbly tummies are what we want when we are serving kids more nutritious foods that are not high in salt, fat or sugar like the snack foods that are easy to love (See Palate training, take II:  They need hunger to motivate them and habituate them to eating healthy food at the meals.

For many parents this is most difficult after school, when kids are hungriest, need refueling for afternoon activities and dinner is a couple hours away.  We wrestle with this too, especially with our 5-year-old who has a Robin-sized appetite right now and is full after a handful of pretzels.

For our family two things have worked for the after school appetite. Either we have an after school snack with a big volume of fruit or veg and a little protein.  This is often veggies and hummus or dip with some crackers or dried fruit (raisins, mango, pineapple) and yogurt. This way the kids don't fill up and are getting veg when they are hungriest.
We just have dinner at 4pm. There are a couple afternoons that are so busy, if I have a dinner made, leftovers or something I can throw together quickly, the kids get a bigger meal at 4pm and a snack later. Yes, this doesn't give us a family meal but that flexibility has been important in our busy life.

2. Variety: vary it all (time of day, color of the foods, plates, settings, texture).  This can be the key to ending picky eating with an EXTREMELY PICKY eater.  Picky eating has a lot to do with control and safety.  Simple variations help change this by showing the child that they can cope with variations in their diet.

Start small and then go big.  Begin by offering their favorite foods at different times of the day on different plates than normal or in a different spot at the table, e.g., hot dogs for breakfast, peanut butter toast in a cereal bowl at dinner time.  Be consistent in your inconsistency!  Nothing should be repeated or at the same time everyday.  After about a day of this with their favorite foods, then add small amounts of new colorful foods along side of those. It is amazing what I have found with clients. These small changes open the door for kids to accept foods that were routinely rejected before.

For more help on this, look at the fantastic blog by Dina Rose, It's not about nutrition (

3. No Menus: you sabotage your own hard work when you are a short-order cook for your kids (See  If your ultimate goal is to be able to send kids to their friend's for dinner free of worry about their going hungry or being rude to their host, then you must practice at home first.  Your job is to serve nutritious meals, with 1/2 the offerings being veg and/or fruit.

Ground rule: Only one meal is served and everyone eats the same things. If kids are given an option out of what everyone else is eating, they are not being allowed to learn to cope with this situation (this is why I dislike 'Kid's Menus' at restaurants).

4. Listen to them: Along with serving one meal, it is equally as important that the kids serve themselves - a little of everything.  They must be polite and try everything but let them be in charge of their appetite (See If they decline everything after a tasting, remind them that nothing else is being offered now or in an hour; but DO NOT FORCE THEM TO EAT OR BRIBE THEM WITH DESSERT. One reminder is enough. They will figure out to eat at the meal, eventually, and they won't go hungry.

5. Make meals fun: Drop the power struggle. This is the most important and effective rule.  Offer your meal, pass the bowls, enjoy the food and enjoy the company. What you model they will follow. I have found this to be true even with my teenager.

If you have a little one that is not eating, remind them that if they don't eat what is served, there is no hidden food that will come out later; but more than one reminder and the atmosphere can sour. And when a relaxed, fun atmosphere is served at the table, everyone enjoys the meal more.  To boot when your attention is away from your picky eater, it is often then that they explore the different things on their plate.

 Follow these 5 steps to shake up old habits and change them.  Most importantly- model healthy eating and enjoy the meal with your family.

Saturday, November 30, 2013

Serving themselves, teaching kids to listen to their stomachs.

Our beautiful NC Thanksgiving spread

It is not surprising that research studying the causes of obesity find that babies who feed themselves from an early age are less likely to become obese.  All of us are born with the ability to recognize when we are full but many of us were taught to override this ability.  Most of us 35 and older were indoctrinated into the 'Clean Plate' club being born to a generation believing that their kids should be eating everything in front of them.  Now we are raising kids in an era of large portions (30-40% larger than in the 1970's), cheap junk food abundance and 2-3 snacks each day.  In this new world, we have to help preserve our children's ability to listen to their bodies and recognize their own satiety.

The papers coming out now confirm that babies learning to feed themselves finger food before they are 1, without pressure to eat everything on their tray, eat an appropriate caloric amount. Whereas kids served larger portions, especially kids 4 and older, eat significantly more calories than they need. Studies have compared whether it is better to teach adults to serve appropriate portion sizes for children or let children serve themselves from the serving dish.  They found that children accurately estimate their portions much more than trained adults do - meaning as long as our kids are not perpetual overeaters and can still listen to their stomachs, they will serve themselves an appropriate amount.

What if my child will just serve themselves carbs and skip the other dishes??? This is a great question that I hear often.  There are ground rules to 'self-service' and they are age specific.  

Babies/ 0-6months
Yes, this applies even to those of us not able to yet sit at the table.  Babies have their own way of letting us know from day 1 when they are full. For some babies that is merely dropping the nipple, for one of my sons that was always dropping off to sleep, and for others it is just getting distracted.  No matter what signal the babies use, it is very important to listen to this cue.

Babies 6-12 months
When babies start eating table food expect it to be messy.  It is often our desire for cleanliness that preserves our feeding the babies for too long. Babies can be spoon fed until they are able to eat finger food or feed themselves with a spoon.  However, if you are feeding them be sure that you still listen to their cues.  They will let you know when they are done - they may turn their head, drop the food, or spit the food across the table.  

No games necessary.  If you are making airplane noises or playing a game to encourage eating, you are feeding a baby that is not hungry.  Don't worry they will eat more at the next feeding.  

When your baby becomes able start offering cups, spoons, and even forks.  Initially, they will just play with these items but eventually they will start using them appropriately. This is especially true if they are able to watch you eat with them.

Teach them ASL for 'all done' or some other signal.  My kids loved doing sign language but for most signs it degenerated into something we created to indicate what the child wanted.  For 'all done' all my kids used the sign of wiping their hands against each other. Find a sign your baby likes for 'all done', this will cement the concept of being 'all done' eating with the sensation in their tummies.

Babies 12-24 months
Let babies feed themselves as much as possible, with small portions of finger foods from all the foods served.  Let them tell you if they want more but make sure what you offer has different textures, colors and flavors.

Help your babies focus on their 'tummy' cues by keeping meals undistracted, in both time and place. We all know how eating in front of a TV or other screen can lead us to 'mindless' eating.  Babies are very naturally 'mindful' eaters.  Preserve that by eating as a family without a screen on.

Older kids
Return to family style eating at a table without a screen on but with some rules in place.  
Rule 1 - Serve yourself
Once most kids are 4 and older they are able to serve themselves from a bowl. Encourage them to take small portions. Most kids do this on their own and are pretty excited to be in charge of choosing how much to take.

Rule 2- Polite Bites
Everyone has to have 'polite bites' of everything that is passed around.  They have to take a bit of everything and take a couple bites of that item. This encourages kids to be respectful to the cook for the work they have put into the meal by trying what was cooked. This helps kids cope with eating at friends' houses where meals often look different and this reminds them that their taste buds are maturing along with them. What they didn't like last year they may have a new fondness for this year but they won't know until they try it again.

Rule 3 - No Clean Plate Club
As long as they have their polite bites, no one needs to finish everything on their plate. 

Rule 4 - Appetites Change - day to day, child to child, year to year
At all ages appetites are volatile and differ between kids. I have two kids that wake up ravenous each day and one that only wants a cup of tea in the morning.  I have also learned that their are months where my grocery bills are huge they are eating so much, while other times after I have become accustomed to their huge appetites, they slow down and eat like birds for a bit. Appetites vary and this is normal.  We need to learn to respect this. In turn our kids will be able to continue to listen to their inner cues and eat only what they need.

Friday, October 18, 2013

Caffeine and growing kids

As the weather starts to chill, I return to a coping strategy we adopted when we lived in Scotland.  We drank a lot of tea.  Our Scottish flat was granite cold, the weather was wet and the sky was gray.  Tea combated that chill that surrounded us.  Like our Scottish and English friends, we had our kids drinking tea as well.  Our two kids that spent several years in Scotland acquired a taste for tea and really enjoy drinking it now.


Regular tea consumption is associated with numerous health benefits. It can reduce one's risk for Diabetes, Cancer, heart disease, and Alzheimer's. Tea consumption has been associated with greater weight loss in diet studies, lower cholesterol levels, reduced blood pressure; and all teas have antimicrobial properties. Three studies out of China, late last year, found that among a large population of 80 year olds drinking tea there were greater cognitive abilities, less depression and higher mortality than their non-tea drinking counterparts.

However, the studies on kids and caffeine found in tea and other drinks are generally not favorable. Kids drinking the equivalent of 2-3 cups of coffee/d are more emotional, inattentive, restless, likely to have 'stomach' complaints, iron-deficient and have slower autonomic responses. I can also hear my mom in the background saying, 'it stunts your growth'.  But these studies are very old and the study models are not similar to how kids drink caffeine now. These studies used high amounts of caffeine in their subjects (5mg/kg twice each day) or fed caffeine to rats between 6pm-2am to see the effects on sleep, or told the research subjects if they were in the caffeine-treated groups or had some other large flaw. My mother's warning didn't seem realistic either because Scandinavians have the highest caffeine intake in the world and are very tall.  In addition, I was skeptical because of all the countries I have been to where children drink weak caffeine drinks and those populations do not have uniquely short, restless children. 

Now that my older kids are starting middle school school in the cold and dark, they are asking for tea again regularly. Their friends are avid fans of Starbucks and many of them consume energy drinks that contain caffeine. This made me wonder about the real risks of caffeine for kids. Below is a chart of caffeine concentrations in the drinks adolescents consume (USDA Information).

Serving size                                                                                                                   Caffeine (mg)                                        
8 oz. Black tea brewed                                                     15-60
8 oz. Green Tea brewed                                                   25-40
8 oz. Iced tea                                                                       15-30

1 oz. dark chocolate                                                           15-25
1 oz milk chocolate                                                              5-7

12 oz. soft drinks - coke/Mountain dew                                                           30-50
8 oz. energy drink                                                              50-80
8 oz. coffee                                                                         95-200
I revisited the research and what I found was not surprising - a little caffeine is ok assuming your child doesn't have any mental health issues, its not consumed late in the day and it doesn't come in an energy drink.
1. Stunted growth - despite the pervasive myth, caffeine doesn't seem to stunt children's growth. High caffeine intakes (more than 2 cups of tea or 1 cup of coffee) or caffeinated drinks after 5pm do interfere with sleep. Continual disrupted sleep leads to growth stunting, anxiety and more.
2. Emotional, inattentive, restlessness - caffeine in one cup of coffee or tea is not associated with these behaviors unless the child has an anxiety disorder or the caffeine is from an energy drink. A study in Perth, Australia found that 20 something males drinking just a 1/2 cup daily of Red Bull or a similar energy drink had much greater anxiety. This study was in a population without pre-existing anxiety or depression; but they did not control for the other ingredients in these drinks, including sugar, herbal extracts, etc.
3. Iron - the issue of iron deficiency is specific to tea consumption because of an iron-binding compound in teas. However, this seems to be a real risk in non-Western populations that have low iron levels to begin with and consume large amounts of tea.
4. Energy drinks like sodas are essentially like drinking a Skittles bag with caffeine. These drinks have between 30-40 grams of sugar/can and 30-80 mg of caffeine, think of a weak cup of coffee with 7 or more teaspoons of sugar. It is not surprising that children are emotional, restless, etc. after that type of drink. Energy drinks can also contain numerous herbal extracts that are can increase the stimulant effects of the drinks.  

5. 'Stomach Upset' - caffeine at high levels stimulates the smooth muscles of the gut and can cause intestinal 'activity'. This is generally with concentrated caffeine levels (above 300mg/day) but some individuals have laxative effects closer to what you get with a strong cup of coffee (100 mg or more). These are higher caffeine levels than what is in a cup of tea or a weak coffee.  Most kids that experience this laxative response will decide voluntarily to avoid coffee and the like.
Bottom Line:
If you google 'kids and caffeine' you will pull up a lot of sensationalized information about the dangers of caffeine.  But if you look at the data closely the risk of harm with reasonable use is not there.  
A weak, milky, morning tea contains roughly 30mg of caffeine, similar to children in France having le chocolat chaud, similar to a glass of ice tea or a weak cup of chai. These are reasonable amounts for a child to have.  Even a Starbucks coffee with 100 mg of caffeine is okay every once in awhile.  This is assuming that your child doesn't have anxiety issues, they only add a little bit of sugar and they are having these drinks before 4pm. Energy drinks, like soda, are sugary and unnecessary and not a great choice for kids for many, different reasons.  
Having a cup of warmth each morning can be a wonderful elixir to the cold and the same benefits that tea has for adults are true for children. Like so many kids around the world, my kids will continue to enjoy a milky, warm 'cuppa' in the mornings.

Friday, October 11, 2013

American Diet - Report Card Published. It is time to talk to the kids.

The Center for Science in the Public Interest ( just published a diet 'report card' comparing the average American diet today to that of the 1970's diet.  Not surprisingly, our report card might earn us detention.  Over the past 40 years, We have not increased our fruit, dairy or vegetable consumption. We have decreased our beef intake but haven't increased our fish intake. Our fat and sugar consumption are high.
Liquid Candy: How Softdrinks Are Harming America's Health We have dropped our intake of whole milk and rich ice cream and we are eating more cheese and yogurt (usually a good thing but our yogurts are sweeter than ever before).  We are eating 30 pounds more flour per person per year. The most disturbing trend, however, is the 450 calorie increase per day compared to our 1970's selves. This is 164,250 more calories per year which would result in an extra 46 pounds of fat gained each year.

When, where, how?  The questions are when, where and how are we taking in all these extra calories. 1. The size of our foods have increased.  The most consistent estimate from the USDA is that our portions have increased 12%.
2. We are eating too often. Our calorie per gram of food has decreased but we are eating 5x/d rather than 3.5 in the 1970's.  We are not eating several small meals each day we are just eating several meals each day.
3. Our snacks are fatty and sugary.  Frequent snacking is associated with higher overall calories and higher sugar intake.

3. The amount of food we eat out of the house has increased.
4. The amount of cooking has decreased, leading us to convenient foods that are higher in calories, fat and sugar.
5. The breakdown is we are eating more fat (estimated we eat 200 more fat calories/day than in 1970), 75 more sugar calories/day and 190 more flour calories/day.

What can we do? It is time to talk to our kids.  We need to empower our children but teaching them importance of being healthy and what is needed to get there.  We still need to encourage more activity and exercise; but we clearly also need to teach them do better diet-wise than our generation.

It is time to talk to your kids, no matter their weight, about the following:
1. Well-being comes from putting energy out and putting good things in.  Explain that healthy kids will be healthy adults if they continue to be active and thoughtful about what they put in their bodies.

2. Minimize snacking (see 'Snack Sabbotage' .  Explain that past a certain age, that it is healthful for the body to be hungry between meals (among the 'food-secure').

3. If they need a snack, explain that they should grab fruit or vegetables. Talk to them about 'snack foods' (goldfish, mars bars, cookies, etc.) and explain these are 'treats' or 'sometimes' foods that are rich in things our bodies don't need.

4. When they are sitting down to a meal, teach them to look at their plate.  Is 1/2 their plate vegetables and/or fruit?  Get them used to making adjustments to meet that benchmark.  Only 1 in 10 Americans currently eat enough fruit or vegetables, challenge them to do better.

5. Teach them how to cook. Children as young as 2 can help prepare food. There are many positive correlations between health and eating home-cooked foods, as well as correlations between kids cooking vegetables and eating vegetables.  Cooking is a learned skill and it is no longer taught in our schools.

Finally, be a role model. Whether they adopt the habits now or when they are older, parents and caregivers have a very potent role as a model.  Be active and eat well for your well-being and also for the little people watching you.

Thursday, September 12, 2013

The benefits of Intermittent Fasting - a Mamamia blog for adults

With the Jewish fast of Yom Kippur approaching, I have been thinking about the biological value of fasting.  Fasting is fairly common among the major religions of the world. Muslims observe a month of fasting during Ramadan. Jews have seven major fast days and three minor fasts. Hindus fast during New Moon Days in festival periods. The Greek Orthodox observe three sustained periods of dietary restrictions. The religious motivations for the fasts are variable but all spiritual in nature, including atonement, purification, increased prayer focus. Although fasting is gaining popularity for dieting purposes, I was curious about the wider health benefits of intermittent fasting.

I began thinking about this after reading a recent study conducted in a Muslim population observing Ramadan. The researchers collected subjects' blood before, during and after Ramadan. Their findings indicate that during fasts inflammatory hormones are lower than during periods of normal caloric intake. There are 2 aspects to this study that are interesting. One, it adds to our understanding of why intermittent fasting or caloric restriction might be beneficial.  Two, it compared fasters to themselves in a 'real-world' setting.  Individuals observing Ramadan were observing a short term fast between 13-18 hours long followed by a feast. Despite how short the fast was and that it was followed by a large caloric intake, the fasters still had significantly lower circulating inflammation markers.

Rarely do religions promote intermittent fasting because it is good for your health; but it turns out intermittent fasting is very healthy for today's developed populations. Just as Lent and the laws dictating Kashrut have health benefits or did at the time of their inception, fasting may be valuable with our increasingly sedentary lifestyles.

Many studies, in addition to the Ramadan study, have demonstrated the health benefits of intermittent fasting, such as:
lower glucose and insulin levels
decreased inflammatory response
reduced markers of oxidative stress
increased insulin sensitivity
decreased blood pressure 

Sustained periods of intermittent fasting, when subjects fast every 2nd or 3rd day for 2-10 weeks, has dramatic effects on morbidity and indicators of chronic disease, such as:
reduced vascular disease risk
decreased BMI
slowed cancer cell growth
reduced chemotherapy side effects

How? There are many theories on why intermittent fasting may be beneficial.  The most popular theory suggests intermittent fasting drops circulating blood glucose levels which initiates a cascade of beneficial effects. For example, sustained low blood glucose levels reduces circulating insulin, which then leads to a reduction in other hormones, including inflammatory promoters.

Why? Modern humans are believed to have been genetically selected for primarily during times when we coped with periods of feast alternating with periods of famine.  It may be that because this is the environment we were selected for our bodies are not actually meant to have sustained caloric intakes of 2000 kcal and above.

When?  Intermittent fasts should be just that intermittent. Most studies have looked at fasting that lasts between 15-20 hours and occur as often as 3-4/week.  However, studies analyzing less frequent fasts (i.e. once/week) see a lot of the same benefits.  However, the research has been done on healthy, non-pregnant adults that are drinking water during the fasts.

Whether it is for spiritual reasons or not it, it seems occasional fasting does the body good.
Food for thought......

Some insightful sources:

Faris, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutrition Research, 2012 (32).

Bartke, et al. Effects of dietary restriction on the expression of insulin-signaling related genes in long-lived mutant mice. Interdisciplinary Top Gerontology, 2007 (35).

Varady, et al. Alternate-day fasting and chronic disease prevention: a review of human and animal trials. American Journal of Clinical Nutrition, 2007 (86).

Trepanowski, et al. Impact of caloric and dietary restriction regimens on markers of health and longevity in humans and animals: a summary of available findings. Nutrition Journal, 2011 (10).

Tuesday, August 27, 2013

What to pack for school lunches? No worries, let the kids pack it themselves.

As a mom who can regularly be found at 6am making Dagni-like sandwiches for my 13 yr old to take to school, it is ironic that I am blogging about kids making their own lunches.  However, we are transitioning in our home to our kids packing their own lunch bags.  There are many reasons, several ground rules and many tips that can make this easier.

The Reasons?
In Australia, I admired the confidence and independence the children had there.  This is obviously not just because Aussie kids made their own Kanga Banga sandwiches to bring to school. Aussie kids generally had more freedom. Aussie kids were able to go more places on their own and do more things independently.  This included more expectations at home as well, in terms of sibling care, helping with meals, making their own lunches, etc.

In an attempt to provide our children with a similar confidence in their abilities, we have been liberalizing our rules and increasing responsibilities. One of those new responsibilities is to make their own lunches. This is important for cultivating independence, but is also important for helping a child be healthier. Making their own lunches teaches them how to construct a healthy meal, insures they determine the size of the lunch they usually need and helps them pack food they will eat.

My little one constructed this lunch from all what was in the pantry - seaweed, carrots and pretzels. It was not what I had planned on handing him and I didn't think it was enough.  He ate it all and when I asked him if he needed anything more, he said 'I'm full'.
All healthy children have internal cues telling them to stop eating.  Very often we put ourselves in charge of their eating and override those cues.  This is sometimes appropriate, i.e. sitting down to a homemade dinner it is important they taste what has been served both to be polite and to learn to taste new things. For more details see my previous blog on healthy dinner table eating habits However, the majority of the time we want children to be in charge of how much they need. Lunch is a great time to exercise that ability. Kids learning to eat only till they are full leads to adults that only eat till they are full.

Less waste is another reason to let kids pack their own meals. We have one child that takes less lunch to school now since he prefers to socialize during lunch and another taking two sandwiches to school because she was not getting enough.  However, they both eat the majority of what they bring because they choose it and packed it.

The Rules?
School children of all ages should understand the construction of a healthy meal includes certain items and that lunches need to be different each day.
1. Lunches consist of a:
-1-2 vegetable servings
-fruit serving
-protein serving
-fat and/or fiber source, which is often apart of the protein portion of the lunch, to help them stay full longer
-and it can also contain a carbohydrate serving or occasional treat (this requires portion guidance for most kids).

If you don't have calcium-rich foods at breakfast then lunch should also include dairy or other calcium source as either the protein or the fat serving. See for the best dairy milk alternatives.

2. Lunches need to be varied, avoid repetition within a 3-4 d window.

For a variety of reasons picky-eaters are abundant now-a-days.  In order to keep expanding kids' palates and vary expectations, meals need to be different each day, lunches included. Children need encouragement to expand their palates beyond their  favorites but in order to do this it means variety in all things.  This should be one of the rules so that they know to mix it up.
A great Blog by Dina Rose provides more insight (

The Helpful Tips?
Timing - many parents suggest lunches are packed the night before. This doesn't work well in my family where evenings are a little too busy and mornings are a bit easier for lunch making.  However, make it a consistent ritual whatever the time of day.

Stock the pantry - your job is to have the pantry and fridge stocked with less processed, healthy foods. The occasional goldfish, animal crackers or baggie of chips are fine as long as the portions are small relative to that veggie serving.

Reminders - many families tape up lists of what should be included in a lunch or use pictures from various places that depict what the lunch should look like
(try for simple graphics).

Helping - for kids under 8 or 9 help them cut up or organize what they choose. Be sure to ask them how much they need.

Checking? -  It is hard to resist but try to avoid second guessing their lunches. Give them the rules, stock the pantry with healthy food, tell them why they need variety and let them be the Chef. Check lunch boxes at the end of the day to help them figure out if they had enough food, were they hungry at the end of the day, and what they might need more of in the future.

Don't worry your worst fears will not be realized, the kids will not pack these for school!

Tuesday, July 16, 2013

Paying kids to eat their vegetables? How US school lunches can help kids' health.

A study published in 2010 by Just and Price has gotten a lot of play lately in the media.  These researchers looked at the effectiveness of various incentives used to encourage kids to eat vegetables. In the 2010 study, they analyzed the effectiveness of monetary incentives in schools, such as a quarter for a broccoli bite. The kids ate more veggies for that quarter (not so much for the nickel); however there is debate about whether this would change eating habits long term.

Very few school age kids eat the recommended amount of fruits and vegetables for their age. Eating a sufficient amount of fruit and vegetables is critical to long-term health and maintaining a healthy weight. For many states and counties, increasing pupil's fruit and vegetable intake is a focus in their fight against childhood obesity.

Just and Price are doing critical work investigating what is a cost-effective approach that results in our kids eating healthier. For instance, they analyzed the popular policy requiring pupils to take a certain number of veggie servings at lunch. They compared veggie consumption before and after the policy.  This popular policy only incrementally increased veggie intake but dramatically increased the amount of vegetables put in the trash.  So what works and what is effective long term?

Ideas that work:

1. Displays and accessibility make a large difference.  Cafeterias report increased fruit consumption when they have prominent, appealing, lit displays.  Additionally, when vegetables are easier to reach it increases intake.  Items like trays make it easier for kids to carry their vegetables and fruit, and have been shown to increase purchases of those items.  The rise in cafeteria salad bars, thanks to Michele Obama’s “Let’s Move Salad Bars to Schools”, has dramatically increased the variety and amount of fruits and vegetables that children are seeing at lunch. Also, having produce stationed in multiple places in the cafeteria line has helped increase intake in hospital cafeterias.

2. Serving it first.  In France, where obesity rates are the lowest in the Western world, school lunches are a teaching moment where children learn to appreciate good food.  Often lunches include an appetizer fruit or vegetable serving.  Therefore, the vegetable is offered first when the child is hungriest ( This is instilled in preschool where children are taught to eat in courses, family-style. Similarly, increases in intake are seen in the US in schools where the salad bar is first.

3. Incentives also work. $ for sprouts or the UK's 'Food Dudes' who are super heroes exalting the health benefits of vegetables (considered a social incentive) have been documented as increasing vegetable intake.  Kids eat about 50% more vegetables when they get a sticker or praise for eating them.

I am philosophically hesitant about teaching kids to eat vegetables using external rewards. It seems a short term approach that doesn't lead to long term healthy habits.  More logical would be to teach kids the health value and variety of tastes in produce. However, a recent study on such incentives may justify their use.  In the study incentives (stickers and praise) were provided consistently for two weeks, during which the kids ate more produce.  But interestingly for the following weeks, after the incentives stopped, the kids were still eating more fruits and vegetables. This suggests the change in habits and increased exposure to vegetables during the program increased intake over the long term.

Bottom Line:
Kids will eat more vegetables when they are hungry (see, offered them frequently, can access them easily and are encouraged to eat them.  Short term reward programs might be necessary in the US where we have incurred poor eating habits over the past two decades. Incentives might provide a window to change pupils' habits and increase their vegetable intake for the long term.

All of this is modeled in other countries where kids have lower obesity rates and greater produce consumption. However, we will have to put our money into this system. The Western countries that are succeeding are paying 5-6$/meal versus 2.25-2.80$/meal in the US.

It may be that we pay now to teach our children while they are young how to keep their bodies healthy; or pay later to undo the damage of years poor eating that can lead to obesity and chronic disease.