|This blog post is the second in a month-long series about the bi-directional relationship of family systems and nutrition.|
How can you get kids to eat their veggies? It’s been a stumbling block on the road to parenting healthy children, even before the "obesity epidemic” focused extra attention on parents’ influence on what kids eat. In my work with Cornell Cooperative Extension providing nutrition education to low-income families, I hear about many hurdles that well-intentioned parents face.
He picks out asparagus, and it’s not really something [chuckle] I want to try. I’m like hmm, "Yeah it’s really good,” and then he tried it, and he liked it but I didn’t. How do you get around telling them it’s good for them and you don’t like it yourself? So that’s challenging for me.
With increasing public health concerns about childhood overweight and obesity, parents are being bombarded with advice -- on how to feed the kids, turn off the tv, get active – even on how to be a good parent. Sometimes the implication is that parents are to blame for unhealthy weight gain in children. Even parents of overweight children tend to view other parents of overweight children as neglectful or unhealthy role models(1). The stigma is unproductive and harmful. Moreover, it’s just wrong. While parents influence children in many important ways, we also know that the environments where kids live, learn, and play create many challenges.
It’s hard to make healthy choices while surrounded by cheap, tasty, calorie-laden foods. Most parents will tell you that time constraints, food preferences, and family dynamics impact their best efforts to model healthy habits, set limits, and encourage good choices. And very few children, regardless of weight, eat according to the Dietary Guidelines(2). Disadvantaged neighborhoods offer limited access to healthy food and safe play spaces(3) and low-income parents struggle to make ends meet, pay for housing, food, and medical bills – all the while trying to protect the kids from the stress.
It’s just... going to be hard. The main reason that we get the big things of iced tea is because it'll last us throughout the month. You know, so by the time the end of the month comes and we have nothing, we at least have the iced tea. That's the main reason we get it, so the kids will at least have something to drink.
After they eat, they’ve still got to do their homework, get cleaned up and ready for bed. During the week it's hard for me to get to the store, so it's hard to keep fresh [produce] on hand. It’s got to be something I can buy on the weekend that's going to last.
|At Cooperative Extension, we support families through nutrition education programs funded by the US Department of Agriculture and delivered by paraprofessional community nutrition educators (CNEs) who are connected to local communities and serve as supportive role-models. Healthy Children, Healthy Families: Parents Making a Difference! (HCHF) is a curriculum aimed at helping low-income parents not only learn about healthy eating and activity, but also develop parenting skills to influence kids and create healthy home environments(4). HCHF is for parents of 3-11 year-olds, not just overweight children. And it’s part of a larger initiative to expand nutrition education beyond individual behavior change to also focus on creating healthful community environments(5).||It’s hard to make healthy choices while surrounded by cheap, tasty, calorie-laden foods. |
HCHF promotes recommendations linked to healthy weight and reduced chronic disease risk: replacing sugar-sweetened beverages with water and low fat milk, reducing energy-dense foods, increasing vegetables and fruits, playing actively, and eating only when hungry. While these recommendations are made by countless health professionals every day, HCHF’s hands-on workshops provide time to engage in discussion, develop practical skills, set goals, and support each other’s progress. Selected parenting skills are integrated into the curriculum: teaching by example, building supportive relationships with positive feedback and respect, giving children choices within limits, and creating home environments that make healthy choices easier. The overall theme is to support parents’ efforts to "help make healthy habits happen,” a slogan created by one of the CNEs.
But research evidence on links to child health does not necessarily identify practices that work in real life for low-income families. To learn about acceptability and feasibility of HCHF nutrition and parenting behaviors, we conducted "Trials of Improved Practices” in which parents chose and tried new behaviors, then reported on their experiences(6). The small group of low-income parents we interviewed faced many challenges in their lives, but were motivated enough to enroll in and complete HCHF.
Parents reported success with specific strategies such as offering limited healthy options and they appreciated the value of helping children learn to make decisions on their own.
What I try is, just give them two choices. If I don't want them to have iced tea, I'll just give them a choice of milk or water and I mean, it works... Sometimes they'll throw a fit for a little bit, but I just keep telling them, "These are your only choices,” and it works.
Can-do, that’s like, giving her, giving her choices right? Can do is good because she gets to learn about choosing and decision making.
Most of the recommendations were feasible and acceptable to at least some families and parents saw that despite the challenges, effective parenting strategies were worth the effort.
It's not the easiest thing to be consistent because you know that they don't really want to and you feel bad, but you know what? In the long run it's going to pay off. We've used consistency not just with food -- with his behaviors and his attitudes and his school and with everything. We've learned that you have to be consistent because if you don't you just have chaos.
There were also challenges. Parents were practical and insightful about trade-offs made in the face of conflicting priorities and limited resources. Parents expressed a strong drive to keep kids fed and happy – a drive that could outweigh the health information they received.
It’s hard... we were always indulged with food. Growing up, it was always "eat it, it's there, eat it.” We never had to worry about food. My wife didn’t grow up with cabinets full of food, so she hates to have them empty. I can see some parents, they didn’t have it when they were growing up and they want their kids to have it. Regardless if somebody says it's no good for them or not.
Even when success was not immediate (so often the case with those vegetables!) many parents demonstrated a willingness to communicate and work with their children over time. Food preferences and time constraints were some of the biggest barriers to behavior change. Food costs, insecure living situations and chronic health problems were mentioned by some families. Other adults in the home were sometimes facilitators, sometimes barriers.
He’ll be like, "You and this health thing. Don’t try to… convert me, manipulate me, with your ‘nutrition knowledge’. You go to this class and all of a sudden you come back with this foolishness.” [laughing]
Parents come to HCHF with many good practices in place, yet they also report learning a lot and making positive changes at home. We think HCHF is useful for families –the information provided is not that different from what parents hear in the media and from health professionals, but the focus is on application. Community programs like HCHF offer opportunities to follow up professional consultations with hands-on, accessible programming to help put recommendations into practice. Such programs may exist in your community but be underutilized. Stronger referral relationships with family health professionals would benefit everyone.
What have we learned from parents in HCHF? Parents are trying hard. It’s about health, not weight – all kids need healthy diets. Acceptability and feasibility of practices varies by family – what gets labeled as indulgence from the outside may just look like love inside a family. Parents can enhance behavior change by choosing which recommendations to try. And finally, environments matter. Multifactorial public health problems like childhood obesity require multifactorial solutions. It just may "take a village” to get kids to eat their vegetables. You can be sure that blaming and shaming won’t do the trick.
- Kalinowski A, Krause K, Berdejo C, Harrell K, Rosenblum K, Lumeng JC. Beliefs about the role of parenting in feeding and childhood obesity among mothers of lower socioeconomic status. J Nutr Educ Behav. 2011.
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition ed. Washington, DC: U.S. Government Printing Office; 2010.
- Kumanyika S, Grier S. Targeting interventions for ethnic minority and low-income populations. Future Child. 2006;16(1):187-207.
- Lent M, Hill TF, Dollahite JS, Wolfe WS, Dickin KL. Healthy children, healthy families: Parents making a difference! A curriculum integrating key nutrition, physical activity, and parenting practices to help prevent childhood obesity. J Nutr Educ Behav. 2012;44(1):90-92.
- Food and Nutrition Education in Communities. Collaboration for Health, Activity, and Nutrition in Children’s Environments (CHANCE).2011; http://www.fnec.cornell.edu/Our_Initiatives/CHANCE.cfm. Accessed December 12, 2012.
- Dickin K, Seim G. Adapting the trials of improved practices (tips) approach to explore the acceptability and feasibility of nutrition and parenting recommendations: What works for low-income families? Maternal & Child Nutrition. (in press)
|Kate Dickin, PhD, is a Research Scientist in the Division of Nutritional Sciences at Cornell University. She conducts translational research on child nutrition and parental feeding practices, food security, micronutrient supplementation, and interventions to reduce health disparities in the US and globally. A particular research focus is the interface between programs and communities, exploring factors that influence the motivations, behaviors, and interactions of practitioners and families.|