Family nutrition: Creating a healthier food environment for lifelong wellness

A healthy diet not only protects against overnutrition and malnutrition. It also protects us against noncommunicable diseases (NCDs) such as diabetes, cancer and heart disease ¹.

Scientists have discovered that parents and caregivers play a significant role in teaching their children healthy eating behaviours.  With a solid foundation for healthy eating, the child’s risk for developing NCDs during childhood is reduced. What’s more, the child will be more likely to maintain a healthy diet and healthy food behaviours into adulthood. 

On this basis, it is beneficial to adopt a family nutrition approach. This approach focuses on creating a food environment that considers the nutritional needs of the children, which builds healthy food habits for their lifelong wellness. 

3 strategies to create a healthier food environment at home:

1. Get the basics right

As a general rule, families should follow a healthy diet. The South African Dietary Guidelines and the World Health Organisation (WHO) have stipulated that families should plan their diet around the following recommendations ^{1 & 4}:

• At least 5 portions of fruit & vegetables per day (excluding starchy vegetables), as well as legumes, nuts & whole grains. 
• Limited quantities of free sugars (i.e. those added to food/drinks by manufacturers/cooks, as well as those naturally present in fruit juices, honey and syrups). 
• The specific recommendation is that free sugars should account for less than 10% of the total daily energy intake.
• Energy intake must balance energy expenditure, to avoid weight gain. 
• To this end, fats should also be limited, constituting less than 30% of total daily energy intake. 
• Unsaturated fats (fish, avocado, olive oil, etc) are preferable to saturated fats (butter, cream and fatty meat). 
• Ruminant trans-fats (in the meat and dairy products derived from animals) should constitute less than 1% of total energy intake.
• Trans-fats from manufactured or processed foods (e.g. crisps) should be avoided altogether.
• Salt should be limited to less than 1 teaspoon a day and should be iodised. 

2. Let the child decide what to eat and how much (within a structured framework)

This may seem to be a risky strategy, but researchers are clear that it is effective in teaching the child to be aware of their body’s innate cues (e.g. the cue for satiety) ².   Additionally, this allows children to take ownership of their food choices and to practice making good decisions. 

To support the child, parents must ensure that the options readily available (fridge and pantry) are generally diverse and healthy. ²

Researchers have clarified that this approach is not about allowing total freedom. Rather, there should be a structure in place, with regular and consistent mealtimes, for example. ²

Toddlers and young children need several small but nutrient-dense meals each day, since their nutrient requirements are relatively high while their gastric capacity is comparatively small.  Parents should take this into account when planning the schedule for children at this age, ensuring that there are regular snack breaks. During these breaks, the toddler can choose from a range of fruit, veggies and other nutrient-dense foods.

A further consideration when planning meals and snacks for young children, is that while children are between the ages of 1 and 5 years they may appear picky. However, they are still learning about food tastes and textures. 

To allow for this natural process of learning to take place, but still ensuring the child learns to eat a range of healthy foods, researchers recommend the R’s – repetition, role modelling and rewards. 

Parents should keep exposing the child to the food (i.e. repetition) but should also eat it themselves and role model how tasty the food is ⁶.  When the child does sample the food, the parent should praise them for tasting it (this is the reward).   

There is evidence that when pressured to eat certain foods or to eat when they are not hungry, children become more fussy – not less so ⁷.  Over time, they also become more likely to prefer unhealthy foods. 

3. Work as a team

Researchers found that when involved in meal planning and preparation, children are more likely to have a higher preference for fruit and vegetables. ^{8 & 9}

In homes where the parents have adopted a new diet regimen, and they involve the rest of the family in meal preparation and eating, everyone in the family losses weight together. What’s more, the individuals following the diet, are more likely to stick to the new regimen, when the whole family is involved¹⁰.

Eating meals together as a family, at the table, also has positive effects. It encourages mindful eating and gives parents the opportunity to model positive eating behaviours, including visible enjoyment of healthy foods. Scientists have found that in homes where the family eats together (especially a home cooked meal), the food is usually healthier ³.

Conclusion: To set the foundations for good health, families should embrace a family nutrition approach. Children should be encouraged to decide what they eat (and how much). The whole family should prepare and eat meals together, with the emphasis on an enjoyment of healthy food. 

1. Who.int. 2020. Healthy diet. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/healthy-diet> [Accessed 10 April 2021].
2. ScienceDaily. 2020. Healthy eating behaviors in childhood may reduce the risk of adult obesity and heart disease. [online] Available at: <https://www.sciencedaily.com/releases/2020/05/200511092923.htm> [Accessed 11 April 2021].
3. Jess Haines, Emma Haycraft, Leslie Lytle, Sophie Nicklaus, Frans J. Kok, Mohamed Merdji, Mauro Fisberg, Luis A. Moreno, Olivier Goulet, Sheryl O. Hughes, Nurturing Children's Healthy Eating: Position statement, Appetite, Volume 137, 2019, Pages 124-133, ISSN 0195-6663, [online] Available at: <https://doi.org/10.1016/j.appet.2019.02.007. (https://www.sciencedirect.com/science/article/pii/S0195666318313412)> [Accessed 9 April 2021].
4. 2013. Food-Based Dietary Guidelines for South Africa. [PDF] South African Journal of Clinical Nutrition. Available at: <https://www.growgreat.co.za/wp-content/uploads/2018/10/South-Africa-Food-based-dietary-guidelines.pdf> [Accessed 12 April 2021].
5. Hilger, J., Goerig, T., Weber, P., Hoeft, B., Eggersdorfer, M., Carvalho, N. C., Goldberger, U., & Hoffmann, K. (2015). Micronutrient Intake in Healthy Toddlers: A Multinational Perspective. Nutrients, 7(8), 6938–6955.   [online] Available at: <https://doi.org/10.3390/nu7085316> [Accessed 10 April 2021].
6. Medicalxpress.com. 2015. Research shows how to banish children's fussy eating. [online] Available at: <https://medicalxpress.com/news/2015-06-banish-children-fussy.html> [Accessed 10 April 2021].
7. Physiology & Behavior, 2017. Bi-directional associations between child fussy eating and parents' pressure to eat: Who influences whom?. [online] (176), pp.101-106. Available at: <https://doi.org/10.1016/j.physbeh.2017.02.015.> [Accessed 8 April 2021].
8. van der Horst, K., Ferrage, A. and Rytz, A., 2014. Involving children in meal preparation. Effects on food intake. Appetite, [online] 79, pp.18-24. Available at: <https://www.researchgate.net/publication/261443422_Involving_children_in_meal_preparation_Effects_on_food_intake> [Accessed 11 April 2021].
9. ScienceDaily. 2012. Kids who cook are hungrier for healthy food choices. [online] Available at: <https://www.sciencedaily.com/releases/2012/06/120627103352.htm> [Accessed 13 April 2021].
  Medicalxpress.com. 2021. The benefits of the Mediterranean diet pass on to the families of patients who follow it. [online] Available at: <https://medicalxpress.com/news/2021-03-benefits-mediterranean-diet-families-patients.html> [Accessed 12 April 2021].