Too Much Choice Leaves Kids "Misnourished"

It used to be that the biggest choice students had at school cafeterias was whether to choke down that glob of canned spinach or just dump it out. No longer. By the time children reach middle and high school, they are often allowed to select what goes on their plates. Naturally, many ignore the healthiest options in favor of pizzas and ice cream bars.

“Our students as consumers are a lot more sophisticated,” said Adele LaPoint, an administrative nutritionist in the elementary lunch program for the St. Louis Public School District, which prepares a total of 30,000 meals per day.

Their sophistication stems from independence: About 70 percent of teenagers fix their own dinners, as do a third of children ages 6 to 11. And it’s a rare household where everyone sits down for a hearty family breakfast. As a result, children are often on their own all day long when it comes to making choices about food.

They don’t always choose wisely. In studies of kids’ diets, researchers have found many unhealthy patterns. In comparing the food intake of adolescents to the amounts recommended in the U.S. Department of Agriculture’s Dietary Guidelines for Americans, for example, a study published in May found that 71 percent of teens eat too few vegetables, 55 percent too few fruits and 47 percent too few dairy foods. Another study that compared pre-teens’ diets today to those of 20 years ago showed that less than half of children get enough servings from any group in the USDA’s food pyramid.

That study also found that children are consuming more carbohydrates – including sodas, grain products, fried potatoes, popcorn, juices, candy – as a percentage of their total daily calories. The bad news is, that increase has not been offset by a decrease in their consumption of other energy sources, particularly fat.

In School
It’s not that kids don’t know what’s good for them. Schools offer nutrition education in many guises, said Laurie Varley, who teaches at Hazelwood High School. There’s some in family and consumer sciences (formerly home economics), which Varley has taught for many years. Health classes also cover it, and some schools even offer electives in nutrition and wellness.

And it’s not that schools don’t offer healthy options. Nearly every lunchroom still serves the traditional “Type A” meal, the standard of the National School Lunch Program, in order to be eligible to participate in the government’s free and reduced-price programs, according to LaPoint. By regulation, that meal must be balanced enough to provide at least a third of the child’s nutrition needs for the day.

At the elementary level, the Type A meal is the only one served in St. Louis’ public schools, LaPoint said. Although this balanced meal is available at upper levels, too, it’s not necessarily popular, especially because of the stigma associated with being on the free or reduced-price program. “It’s just like riding the bus. It’s not cool,” a Windsor school board member said during a discussion of that district’s dining services.

The Windsor district in Jefferson County, like about 500 other districts across the country, contracts with Chartwells School Dining Services to supply its cafeterias. Through its parent, Compass Group, the world’s largest foodservice company, Chartwells has access to superb resources in developing educational and marketing strategies, from cartoony Pyramid Pete in elementary schools to the Nurture Our World environmental awareness campaign. The company also works with the Culinary Institute of America on recipes.

Chartwells is not alone in providing nutrition education. Many private and public organizations have their own educational campaigns, and new ones are being introduced all the time. Likewise, each district approaches food services in its own way, Varley said, and their solutions include everything from McDonald’s to airline-style heat-n-eat entrées. One characteristic cafeterias share with each other – and with home kitchens – is the steady decline in the amount of cooking done there. “It’s pretty common that there’s not much food preparation going on in schools,” Varley said. That’s the case with the 19,500 meals served each day in St. Louis’ elementary schools, all of which are prepared at a central facility and delivered, although LaPoint said the city’s high schools prepare their own food on site, because of the wider selection they offer, and middle schools do a combination of both.

At Home
The National School Lunch Program came about to ensure that malnourished children got enough to eat. Nowadays, unhealthy children might more accurately be termed “misnourished,” said Keith-Thomas Ayoob, a prominent New York-based pediatric nutritionist and counselor. Speaking at a Dairy Council-sponsored conference in St. Louis, Ayoob explained his new word by saying children today get enough calories but not necessarily the right nutrients.

Ayoob, who counsels children – and, indirectly, their parents – as director of nutrition for the Rose F. Kennedy Children’s Evaluation and Rehabilitation Center, said that all too often, food is just one more thing to multi-task. In his work with children, Ayoob encourages parents to think of obesity not as a problem in itself, but as the result of many negative factors, including sedentary lifestyle, fast food, working parents, peer pressure, lack of time, vending machines, disposable income, computers, television, snacking and fewer family meals.

“ It’s really important for parents to provide an environment that’s healthful,” Ayoob said. That means banishing snacks from their own diets, buying healthy foods, adding exercise to their routine and forgetting about quick fixes like supplements and diet pills.

Ayoob advocates gradual behavior modification: “Change one habit a month.” Here are some suggestions:

Cook at home and eat family meals. Four out of five families eat out or buy takeout food at least once a week … which is fine, in moderation. But when super-sized portions are involved, children take in more calories than they need, Ayoob said. They also become accustomed to ordering whatever they want, which can have the unintended consequence of limiting their palate to things that taste familiar.

In the study of adolescent eating patterns mentioned above, researchers found that the best way to get teens to boost their consumption of fruits, vegetables and dairy foods was for parents to simply be present at the evening meal. Not only did this encourage better nutrition, but it also decreased the likelihood that adolescents would skip breakfast.

Ayoob would like to see parents not only present at but actively preparing dinner. “People love cooking. People prefer watching cooking,” he said, only half joking. “Look at the proliferation of food shows on TV.” So, in his counseling practice, he first has to convince parents to cook. Then he has to convince them to prepare one – and only one – meal for everyone. “I want to give parents something to make their lives easier, too,” he explained. They should make a healthy, balanced meal. “Then their job ends.”

Don’t force the child to eat, but don’t cook him something else, either. Let him go hungry, Ayoob said, even if it means bedtime arrives and the child still hasn’t eaten. “You didn’t send him to bed without eating. He sent himself. It’s just a matter of setting limits.”

Involve children in menu planning and shopping, because they’re more likely to eat something they’ve had a hand in. By setting an example – eating foods a child has chosen even if you don’t particularly care for them yourself, for instance – you reinforce positive behaviors.

Limit liquid calories. “People, when they get liquid calories, don’t seem to compensate as much” by cutting back on overall consumption as they would if the calories came from foods, Ayoob said. He cringes when children come to his practice carrying quart-size sodas or “fake” juice blends. “It looks like Windex – it’s scary to see that in a baby bottle,” he said.

By age 5, kids consume more soda than juice, according to the Journal of the American Dietetic Association. By age 14, they drink more soda than any other beverage. A long-term study published in the Archives of Diseases of Children found that 11- to 18-year-olds drank 36 percent less milk between the years 1965 and 1996. Their consumption of soft drinks and non-citrus juice, by contrast, shot up 190 percent. Average boys drink about 19 ounces of soda per day; girls drink 13 ounces.

Introduce changes to unhealthy diets (even if it leads to tantrums). Many of the parents Ayoob sees think this is next to impossible, he admitted. They tell him their children will scream and cry “until I just give in.” Ayoob said he actually likes it when children throw food-related fits in his office. “When they have a tantrum, your decision is so easy,” he said. Often the parents are ready to acquiesce to the child’s demands in order to keep the child calm in public, but Ayoob does the opposite. He admitted that the reaction is usually ugly, “but if you don’t give in, the kid will have to come up for some air.”

Then he consoles the child by asking if she feels better and showing that he’s genuinely concerned for her feelings – while reinforcing that he won’t bend his limits just to mollify her.

Pay attention to portion sizes. Up until age 5, children stop eating when they’re full, Ayoob said. After that, environmental cues can cause them to keep going. Parents have the dicey job of judging when a portion is big enough to equal multiple servings – and when it’s simply too much. Although the USDA’s food pyramid gives recommendations on serving sizes, that model has a couple of disadvantages. It lists servings of some foods by weight, others by cupfuls; it has different requirements depending on a child’s age and gender; and its servings are often smaller than those on the Nutrition Facts Labels that appear on food packages.

Recently, in what will perhaps be the start of a trend, Kraft Foods announced plans to cut portion sizes on some of its products, and it has already done so on its healthier line of Lunchables, called Fun Fuel. At schools, standard serving sizes are based on the nutritional needs of children, LaPoint said. In general this means children ages 2 to 6 should have the lowest daily caloric intake (about 1,600), and thus need the fewest servings, followed by older children and teen girls (about 2,200 calories) and teen boys (about 2,800 calories).

Involve other people. Grandparents are an especially valuable resource, Ayoob said, because they often have more time than parents do. They tend to have a routine that involves set mealtimes. And, most importantly, they know how to cook – and have the patience to demonstrate.

If some of these suggestions seem harsh, think of them not as taking away children’s choices but as instilling discipline. Ayoob, for one, thinks letting children go their own way is crueler than cracking down on their poor eating habits. “If I gave a child a 40-pound bag of dog food to carry around 24/7, that sounds really abusive,” he said – yet he often sees children with that much or more extra weight on their frames. “It’s not fair to do that to growing bones.”