Although there are many aspects of a child's day that parents cannot control, they can influence some of the behaviors that impact a child's risk of excessive weight gain. Other adults who work with children are also very important, since children spend a lot of time in child care, school, and after-school settings. This section recommends strategies for parents and adults who work with children to promote healthful eating and physical activity in children.
Note that none of these recommendations address child weight directly. Encouraging children to diet to lose weight can be detrimental both physically and socially. Rather, the focus should be on strategies that encourage healthy eating and activity behaviors in all children, regardless of weight status.
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Societal changes over the past 20-30 years have dramatically influenced the way people live, eat, and play. Single parents, two working parents, and one or more parents with multiple jobs all are more common.1, 2
Time constraints make it hard for parents to provide healthful snacks and meals. Americans consume one-third of their calories as food prepared away from home.3 The availability of quick, accessible food has increased dramatically, but nutrient-dense foods and beverages such as fruits, vegetables, dairy, and fiber-rich foods, are not readily available and are more costly than low-nutrient, high calorie items.4
Time constraints, concerns about the safety of children playing outside unsupervised, and the ready availability of sedentary distractions such as TV and video games also make it hard for parents to enable their children to be physically active.
Despite these challenges, there are things parents and adults can do:5
Make physical activity fun show details
Parents and other adults can help children be more active by increasing access to fun and achievable physical activity. Parental encouragement, support, involvement in, and modeling of activity all positively affect activity in children, as does time spent outdoors, a factor largely determined by adults.6 It's important to stress a fun lifestyle full of physical activities rather than trying to make kids "exercise." Encouraging lifestyle activities such as walking to school and dancing and positively reinforcing kids for reducing sedentary pastimes like TV viewing (without emphasizing exercise), have been shown to be more effective for long-term child weight control than more structured exercise programs.7 For example, many children could walk or bike to school if safety issues were addressed. Only about a third of children who live within one mile of school walk to school.8
It's also important to find noncompetitive activities that kids of all body sizes and abilities can enjoy doing, and to emphasize the positive aspects of being active, like how good it feels afterwards or how much more energy it provides. Children are naturally active if given the chance, but increased opportunities are needed that are easy to get to, schedule, and afford.
Limit children's television and video game time show details
Most parents set no limits on television viewing time8—and many don't realize how many hours of TV their kids are watching. Yet reducing television time is an effective strategy to reduce childhood obesity9, 10 and may be more effective than focusing directly on physical activity. When overweight children were encouraged to decrease TV time, their attitudes toward vigorous physical activity were more positive than when they were encouraged to increase their physical activity.7
Parents and childcare providers should be encouraged to limit screen time to 2 hours per day or less (television, computers, and video games).11 One way to do this is to remove TVs from children's bedrooms (or not put them in). Two-thirds of 8-18 year olds have TVs in their bedrooms, as do 39% of 5-7 year olds and 26% of 2-4 year olds.12 Children who have televisions in their bedrooms watch an average of 5-1/2 hours more each week than children who don't.13 Many parents find that when they limit TV, their children will find something active to do, even without their providing structured physical activity.
Offer a variety of healthy foods show details
Parents and other adults can provide children with ample access to nutrient-dense foods and beverages as well as to high-fiber foods both at meals and snack time. Humans are born with a "sweet tooth," so kids have to learn to eat nonsweet foods such as vegetables. Parents and adults can introduce and model a variety of vegetables and other healthy foods and encourage kids to taste them, but they should not force them to be eaten. Young children need 8-15 tastes of a new food on average before they increase their acceptance of it.14
Exposing children and youth to healthy food in fun, interesting ways such as teaching them to prepare their own snacks or grow vegetables may encourage increased acceptance of those foods. For example, youth involvement has been key to the successes some schools have had in increasing healthy options.
Limit access to high-calorie, low-nutrient beverages and foods show details
Parents and adults should limit access to high-calorie, low-nutrient beverages and foods, both at home and when eating away from home, but need to avoid excessive restriction when nutrient-poor foods are available. The ideal is not to be too permissive or too authoritarian, but to use an "authoritative" parenting style, setting limits but offering choices within those limits.15 The most appropriate strategy is not to purchase such foods, rather than having them in the child's environment while restricting access to them.8 Parents can also promote and model healthy meal choices and portion sizes when eating away from home.
Help children listen to body signals of hunger and fullness:
Don't excessively control intake show details
Parents must walk a fine line when trying to promote healthful eating in their children. Both too much control and too little control around food can negatively influence dietary intake.
Research shows that a) encouraging children to eat may paradoxically decrease intake of the food that is being encouraged (e.g., a specific vegetable),16 b) restricting children's access to palatable foods that are in their eating environment may actually promote over-consumption of such foods when children are given the opportunity to make their own choices,17, 18 and c) a high degree of parental control over a child's dietary intake (e.g., "clean your plate") may disrupt natural systems of self-regulation, causing dysregulation of energy intake.19
These observations suggest the importance of a division of responsibility between parents/adults and children around eating. Parents and other adults are responsible for what children are offered, when, and where, but children decide whether to eat and how much to eat of each food.20 Offering small first servings and allowing second helpings as needed can help.
Model healthful eating and physical activity practices show details
Role modeling is key. Children do what key adults in their lives do, not what those adults say to do! Parents and adults can set a good example by being physically active and eating healthfully themselves. Children whose parents are physically active tend to be active. Children whose parents eat vegetables are more likely to eat them also, although it may take time.
Serving meals and snacks at regularly scheduled times can discourage overeating since kids know another eating opportunity is forthcoming. Encouraging and enabling children to eat breakfast, and leading by example, is particularly important. Eating meals together as a family is also recommended. Family meals are linked to healthier eating, as well as less alcohol and drug abuse.21 Youth who eat dinner with their families consume more fruits and vegetables, fewer fried foods at and away from home, and less soda than those who do not.22, 23 Turning off the TV during dinner and other eating occasions may also encourage healthier eating.24
Avoid using food as a reward show details
Using food as a reward increases a child's preference for that food and may contribute to overeating.25 This practice encourages eating for reasons other than hunger, so kids may lose touch with their hunger and fullness cues. It is important to find ways other than food to reward children.
Focus on lifestyle and not weight show details
Parents should not put their child on a diet. It may not be safe, and withholding food may make a child overeat when food is available. When there is concern about a child's weight, the whole family needs to focus on eating well and being physically active.
It's also important to show respect for all children and adults, regardless of body size or shape.
Breastfeed show details
Although not conclusive, there is some evidence that breastfeeding may reduce the risk of obesity later in life. There are two suggested mechanisms for this. First, compared to bottle feeding, breastfeeding more easily allows the baby to assume control over the amount of milk consumed and learn self-regulation of intake.26 Secondly, breast milk varies in flavor, while formula does not, which may make breastfed infants more open to new flavors and encourage better diets.27
For more information and resources, go to Tools for You and More Info for this course on the Cornell NutritionWorks website at www.nutritionworks.cornell.edu.
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19 Johnson SL, Birch LL. Parents' and children's adiposity and eating style. Pediatrics. 1994;94:653-661.
20 Satter E. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005.
21 Eisenberg M, Olson R, Neumark-Sztainer D, M S, Bearinger L. Correlations between family meals and psychosocial well-being among adolescents. Arch Pediatr Adolesc Med. 2004;158(8):792-796.
22 Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103(3):317-322.
23 Gillman MW, Rifas-Shiman SL, Frazier AL, et al. Family dinner and diet quality among older children and adolescents. Arch Fam Med. 2000;9:235-240.
24 Coon KA, Goldberg J, Rogers BL, Tucker KL. Relationships between use of television during meals and children's food consumption patterns. Pediatrics. 2001;107(1):e7.
25 Birch LL. Development of food preferences. Annu Rev Nutr. 1999;19:41-62.
26 Fisher JO, Birch LL, Smiciklas-Wright H. Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes. J Am Diet Assoc. 2000;100:641-646.
27 Mennella JA. Mother's milk: A medium for early flavor experiences. J Hum Lact. 1995:1:39-45.
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