Thursday, December 15, 2011

Because My Baby Likes It

A dietician had just discussed nutritional needs at length with a young mother of an obese, diebetic toddler at a clinic. After the appointment had concluded, the nurse watched the mother reach into her purse and hand her toddler a candy bar, a deep fried chicken nugget, and a bottle of soda from an earlier to-go order. Dismayed, the nurse called the mother over and asked, "Do you remember what we just talked about? Why did you just give him that?" The mother blinked and simply said, "Because my baby likes it."

Jen Johnson Livsey,  a cattlewoman colleague of mine, shared this story with me of her former roommate's disheartening experience as a registered dietician in South Texas. Even after decades of public health education, why the bad choices still? Below are some dietetic studies about what food habits American children and adults make and the complex environments in which they are birthed:

  • Diet Quality of American School-Age Children by School Lunch Participation Status: Data from the National Health and Nutrition Examination Survey, 1999 – 2004. USDA Report No. CN-08-NH, 2008. In this study on the dietary habits of school-aged children, the most concerning issues were that sodium, solid (saturated) fats, and added sugars were being excessively consumed whereas whole fruits, dark green and deep yellow vegetables, legumes, and whole grains were inadequately consumed. Sandwiches, hamburgers, cheeseburgers, pepperoni pizza, whole milk and ice cream were the greatest contributors to the dietary imbalance. Over 90% of children were eating too much salt, and over 70% of children’s diets were considered by dietitians foods “to be consumed only occasionally.”

  • The most commonly consumed vegetable was the potato, served fried. What frustrates me about the potato being officially considered a vegetable and not a starch is the misleading information about the mineral, fiber, and vitamin content of potatoes. Most websites that list potato nutrition content will say that the vast majority of nutrients are contained in the skin of the potato, which contains 46% of our needed Vitamin C and 18% of the recommended Potassium intake. It says that nowhere in the National Potato Council website’s nutrition facts! We all know potatoes are usually served, prepared, or eaten without the skins. For a website that can give you access to the nutritional breakdown of nearly all supermarket products, visit The USDA National Nutrient Database.

  • Children who were enrolled in the National School Lunch Program (which provides free breakfasts and lunches to children of low income households) consumed higher energy (more sugary, fatty) breakfasts, they were more likely to consume milk, meat, and beans than non-participants, and they were also more likely to consume vegetables, fruits, milk and milk products, and mixed dishes. This makes me think that there is some interplay between being poor and not having financial access to a variety of healthy foods, but also simply being more likely to make a few bad food choices because of a lack of education or because of a lack of parental enforcement. Funding or subsidizing health foods apparently only solves half the problem. 

  • McCable-Sellers et al., 2008, in the American Journal of Clinical Nutrition published the study “Assessment of the diet quality of US adults in the Lower Mississippi Delta”. They found that the prevalence of poverty, as you probably know, and of young households, are both highly associated with obesity and low Healthy Eating Indexes. High HEIs come from high dietary inclusions of whole grains, vegetables, fruits, dairy products, meat, and a variety of different foods within those categories. They speculated that the low HEI in poor communities have limited supermarket access, also having less nutritional knowledge to help them identify healthy foods from unhealthy foods. Those who face food insecurity are less likely to include foods that translate to high HEI scores. Non-perishable, thus more affordable, food is more prevalent in the diet, which makes little room for milk, meat, vegetables, etc. Starches, oils, salts and sugars understandably make up the majority of the diet for those that are food-insecure.

  • USDA’s June 2006 Report: “Americans Consume Too Many Calories From Solid Fat, Alcohol, and Added Sugar”. Enough said. If only all articles could be as informative as their titles! One thing though, did you know that a gram of fat has 9 calories, a gram of alcohol has 7 calories, and a gram of carbohydrate has 4 calories?

  • USDA Agricultural Research Service, 2003. “Trends in Food and Nutrient Intakes by Adolescents in the United States”. Since the late 1970s, adolescents have been increasing their intake of soft drinks, crackers/popcorn/pretzels, French fries, juices, milk, cheese, and candy. Thirty years ago, adolescents were eating more yeast breads and rolls, green beans and peas, corn, beef, and pork. Think of the explosion of food and snack products that have hit the scene since 1977!

  • USDA Economic research report “The Impact of Food Away from Home on Adult Diet Quality” by Jessica E. Todd et al. (February, 2010). Eating out increases caloric intake through extra added sugars and fats that restaurants use to overly enhance their food, creating a memorable savory experience. Meanwhile, portion sizes at restaurants are often larger than ones of homemade meals, thus contributing to a customer’s satisfying experience. This study found that on average, eating one meal per week from a restaurant rather than prepared at home corresponds to TWO extra pounds a year! The average meal eaten away from home contains 134 more calories than a meal produced at home.

  • A study entitled “How Major Restaurant Chains Plan Their Menus” by Glanz et al. (American Journal of Preventative Medicine, 2007) found, unshockingly, that restaurants only add menu items which are lower in fat or calories (denoted as “healthy choices”) if it favors their profit goals. This only works for restaurants if consumers increase their demand for healthy choices, and for many chains, they are not. However, McDonald’s, Applebees, and other chains have responded to consumer demand for healthier choices and have fared well. In the end, restaurants don’t necessarily lead the way for Americans’ eating habits, rather, they follow them.  

    Another friend of mine has begun to care for an impoverished single mother and her children. Since the mother’s car broke down, my friend has been taxiing the family to school and to work. She also makes balanced and nutritious meals for them to have when everyone arrives at home, given that the mother works long shifts and has no time (and not enough money) to make homemade healthy meals. Once one of the children pointed at a dish my friend made and said, “What’s that?” She answered, “Those are vegetables! When my children were young, they couldn’t leave the dinner table until they had eaten all their vegetables!” The child answered, “Will you do that for us?” 

    It seems that an interaction of expenses, poor parenting, and lack of education is to blame for the negative eating habits of impoverished Americans. I will also infer that the average American, compared to earlier generations, spends less time at a family dinner table and buys more highly-marketed convenient snack products. I wholeheartedly agree with Michael Pollan and several pop foodies on this specific issue, that food deserves more respect for its role it plays in keeping us alive, healthy, and in communion with one another. Slower, conversation-filled eating has a comeback to make in our culture.

    I hope to see and be a part of more intervention in broken, struggling, homes to restore intentionality and discipline (e.g., nightly TV-free family dinners and the command to "Eat your vegetables!") and integrity to family structures (monogamous couples who share child support and workload burdens). With that, I believe we can work miracles in all aspects of a child's life, beyond just the diet. As another aside, I do not believe that taxing or banning certain foods which the government deems "unhealthy" is the way to resolve the obesity issues of poor communities. Such nannying (or Big Brother-ing) is ridiculous. My own mother should be telling me to eat my vegetables and to quit eating junk, not the government. 

    Alas, to a struggling young mother, so what if a meal is unhealthy if “my baby likes it”? What do you Think?

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