Not surprisingly, a new statement from the American Heart Association (AHA) notes that children who eat healthily grow up to be adults with little risk of obesity and heart disease. The statement was from 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. It is titled, “Caregiver Influences on Eating Behaviors in Young Children A Scientific Statement From the American Heart Association,” was published this week in the Journal of the American Heart Association.
What was the statement about?
The researchers wrote that there is adequate evidence that shows that in order to prevent obesity among children, their diet needs to be targeted. They added that children have different responses to internal triggers of hunger and satiety that lead to overeating, and targeting childhood obesity needs to look at this component as well. Thus not only what they eat, how they eat it is also essential. Hunger and satiety controls are termed as self-regulation, wrote the researchers. This review or statement looked at the “current knowledge regarding how caregivers can be an important influence on children’s eating self-regulation during early childhood.”
What was done?
In this review, the team looked at the association between feeding by caregivers and self-regulation regarding eating in the child. As a next step, they looked at the implications of such studies. The effects of the actions taken by caregivers on self-regulation in eating among children were also studied. Overall the effects of such interventions on broad “social, economic, and cultural context” and the feeding environment association were also studied in the context of the introduction of interventions to change the behaviors of the caregivers.
The experts wrote, “As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children.” They wrote, “Eight percent of infants (0–2 years of age) and 23% of children (2–5 years of age) in the United States suffer from excess adiposity.”
What was found?
The team explains that most children are born with an instinct to stop eating when they feel full. This is called self-regulation. Self-regulation is also influenced by the emotional atmosphere around the child, they wrote. The caregiver plays a significant role in such self-regulation. Often if there is pressure to eat from the caregiver’s end, the child may ignore the internal cues to stop eating and may end up overeating.
Thus it is imperative that the feeding atmosphere created for the child is conducive to self-regulation and listening to the internal signals of the child to stop eating. An environment of healthy eating options also helps the child take control of decision making when it comes to eating and develop healthy eating habits, the team found. They added that this led to a healthy body weight throughout life and keep heart disease at bay.
Alexis C. Wood, Ph.D., who chaired the group for this statement and an 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, said, “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.”
Recommendations and implications
The statement recommends that caregivers need to become positive eating role models for their children and develop a healthy food environment with healthy food choices. There should be a feeding environment focused on healthy eating choices made by the child rather than controlling their feeding behavior based on body weight.
They suggest that meal timings should be consistent, and children should be provided healthy choices and allowed to choose their meals from those healthy options. New healthy food options are to be included in the menu, along with foods that the child already enjoys. Enjoyment of eating healthy foods along with the inclusion of new and healthy food options is recommended for children as well as caregivers. There should be no pressure on the child to eat more than what they wish to eat, and caregivers need to be attentive regarding the verbal and non-verbal signals provided by the children regarding hunger and satiety.
Wood explained that most parents, as well as caregivers, find it difficult to allow children to make their own food choices. They often report children being reluctant to try new foods and children being picky eaters. These are commonly seen among children aged between one and five, the statement says. This also means that the age when children are learning to eat on their own is most vulnerable, write the researchers.
The statement says that rigidity and authority regarding food rules should be discouraged. On the other hand, allowing children to eat whatever they want, whenever they want, is also not conducive to preventing childhood and later adulthood obesity and overweight. This is called the “laissez-faire,” approach, they wrote.
Wood said, “Children’s eating behaviors are influenced by a lot of people in their lives, so ideally, we want the whole family to demonstrate healthy eating habits.” He concluded, “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.”
The authors wrote in conclusion, “efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the life span, it is likely they will be most effective as part of a multilevel, multicomponent prevention strategy.”
Caregiver Influences on Eating Behaviors in Young Children, A Scientific Statement From the American Heart Association, J Am Heart Assoc. 2020;9:e014520. DOI: 10.1161/JAHA/119.014520, Alexis C. Wood, PhD, Chair*; Jacqueline M. Blissett, PhD; Jeffrey M. Brunstrom, PhD; Susan Carnell, PhD; Myles S. Faith, PhD, FAHA; Jennifer O. Fisher, PhD; Laura L. Hayman, PhD, FAHA; Amrik Singh Khalsa, MD, MSc; Sheryl O. Hughes, PhD; Alison L. Miller, PhD; Shabnam R. Momin, PhD; Jean A. Welsh, PhD; Jessica G. Woo, PhD, FAHA; Emma Haycraft, PhD, Co-Chair; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and Stroke Council, http://dx.doi.org/10.1161/JAHA/119.014520