Nutritional Literacy for Kids... Teaching them how to eat.

One of the biggest concerns amongst parents is the health and wellbeing of their children. What we eat and do has such a huge impact on our kids that it simply cannot be ignored.

Obesity is widely understood as one of the major contributing factors to nutrition-related chronic disease such as cardiovascular disease and Type 2 Diabetes; and as such poses significant burden on the health system due to increased incidence and presentation of obesity related comorbidities(Doak, 2002).

The cost of that obesity burden in Australia alone is projected to reach $25million by the year 2025, with obesity being the second ranking cause of preventable disease and hospitalisation in the country(PHAIWA, 2016).

In the 2014-2015 National Health Survey, Western Australia in particular reported an alarming average of 60.3% of adults and 24.6% of children being identified as overweight or obese; with 6% of adults and only 5% of children reporting that they met daily intake guidelines of fruits and vegetables(Australian Bureau of Statistics, 2018). The correlation between undernutrition and obesity (the double burden), highlighting a very apparent need for public perceptions of nutrition to be made a priority(Doak, 2002).

Healthy living initiatives and activity programs are of high importance to local governance, emphasising the need of regular physical activity for the prevention of disease, however, these plans appear less focussed on nutritional literacy; this being the possession of nutrition related skills and knowledge in a health sustaining, and disease preventative context (Dobbins & Tirilis, 2011). Programs such as the Sports Australia “Find your 30” and The Department of Health’s own “Move it” campaigns, emphasising physical exercise as a disease preventative measure without equal emphasis on nutritional factors as either disease promoting or preventative in themselves(Australian Sports Commission, 2018).

An issue further emphasized by Western Australian  National Health Survey data indicating that over 50% of individuals undertook regular exercise(Australian Bureau of Statistics, 2018) and as such state obesity statistics were still at two-thirds of the population.

Historically considered a disease of affluence, in more recent times research indicates that obesity statistics have shifted towards the poor(Popkin & Gordon-Larsen, 2004) with its largest influence on Low-Socioeconomic Status (SES) demographics. This link being further supported with national nutrition data making significant correlations between the highest obesity rates in Australia with the lowest SES regions(Wang, Patterson, & Hills, 2002); and as a side effect of this shift, the significant potential of children of obese parents to  become obese themselves; unable to differentiate between healthful or unhealthful foods (Simmonds, Llewellyn, Owen, & Woolacott, 2016), through modelled food behaviour within the family environment.

The question then presents, that if obesity is resultant to the food knowledge and behaviours modelled by our parents (Savage, Fisher, & Birch, 2007); Is it not therefore important to build the foundation of preventative knowledge at this level also?

The answer is in my opinion a resounding, YES.
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We must appreciate the depth at which nutrition plays a role in health and disease and factor this into a fully encompassed disease prevention program rather than one that promotes lifestyle modification, exercise or dietary guidelines alone. It must be considered when raising our children, the next generation, how our behaviours will shape the lessons they teach as parents themselves. 
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There are many factors in which the incidence of nutrition related preventable disease is related to low income, inclusive of;

1.  Impact of food price on choice.

• Family size, quantity over quality, budget restriction and the increased cost of living.

2.  The impact of choice on supply.

•  Demand driven supply, lack of availability or overpriced healthy options and over saturation of fast food chains in low SES demographics.

3.  Opportunity of exposure to healthier options.
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• Education level and food exposure
• Family dynamic, culture, tradition, priorities and practices.

4.  No exposure to critical aspects of health and wellness.      

• Cultural or physical barriers to access.
• Education or familiarity to health issues.

 
However, the largest influencer to income impacted nutrition related disease in Low SES communities is poor nutritional literacy.

Nutritional literacy; being the knowledge and application of nutritional awareness and skills; and obesity and obesity related comorbidities, are intrinsically linked, influencing and impacting each other bidirectionally. This means that how one eats directly influences their health, and one’s health has direct influence on how they eat(Berman & Lavizzo-Mourey, 2008).
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Those same social determinants that influence health outcomes, also influence the level at which an individual has opportunity to be exposed to education and skills in a nutritional context(Pampel, Denney, & Krueger, 2012).
People simply do not know, what they do not know.

It is undeniable that nutrition is an important factor towards the prevention of obesity and obesity related disease, however, as discussed, healthy living and activity initiatives seldom provide adequate focus on the role of nutrition in a practical and social demographically relevant way. Generalised guidelines provided can be broad and fail to provide sufficient explanation on their application or do not offer alternatives to those facing barriers of finance or accessibility(Bazerghi, McKay, & Dunn, 2016).
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So what can we do to model better food behaviours and teach our children the 'right' way to health and well being?

Here are some ideas.

1. Take an interest in your own health and wellbeing and lead by example. Your actions speak volumes to your children.  If you use food as an emotional crutch, think of the lessons you may be failing to teach them in emotional resilience. Children learn from us, to you it may be 'junk food' you are addicted to, to your kids they know it as JUST FOOD.

2. Take a cooking class, the more you know about preparation, the better your will be equipped to impart these skills to your children. Kids more often than not learn by doing, and you showing them not only  teaches them important independence skills but also will strengthen your bonds. 

3. Get yourself nutritional counselling and learn about nutrition from a professional, so that you may impart your wisdom on your children. Don't go stabbing in the dark, get some foundation knowledge for yourself. Whether you take a short course, buy some books or link up with a nutritionist, its always handy to have an answer to "why are fruits and vegetables better for me?"

4. Encourage your children to join you in the kitchen to prepare the meals, you underestimate the power of involvement and choice when it comes to children. A little "power to decide/create" can go a long way. Studies have shown that children are more likely to eat healthy when they prepare it themselves. 

5. Grow your own. get the kids involved in a home garden project. Show them the value of growing it yourself and help them prepare it "farm to table". 

6. Involve the children in the shopping experience from menu planning, to shopping list writing to budgeting and then the preparation of the meal. Show them the work that goes into creating meals and teach them valuable lessons in independence along the way. 

7. Praise your children for their choices when they choice healthier options, but don't berate them for unhealthy options. We want to stop demonising food, but rather teach better behaviours. Make "junk" a "sometimes food".

8. Keep a variety of "healthy snacks" available for the children. i.e. Two boxes full of meal-prepped Ziploc baggies; one in the fridge containing carrot sticks, celery sticks, mandarins, apples etc and the other one in the cupboard containing nuts and dried fruit, some with air popped popcorn, a small serve of rice crackers etc.

Give them choice. Tell them to grab 2 snacks out of the tubs, they can have any two they like but they have to pick one from each.  This provides them with both choice but also a lesson in moderation. 

9. Prevent associating emotions with food ie. food-rewards,  food-bribes.  Create a reward system centred around tangible motivators i.e. screen time or a social event. Prevent . 'boredom eating' by setting clear and satisfying meal time, and activities and try and remove shame, guilt or prohibition from the table.

These are just some ways that we can be instrumental in aiding our children grow to become healthy individuals and prevent them walking down the path to obesity and the string of health issues that accompany. 

If you have any strategies you would like to share, feel free to comment below. 

References
Australian Bureau of Statistics. (2018). 4364.0.55.001 - National Health Survey: First Results, 2014-15. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/4364.0.55.001~2014-15~Main Features~Western Australia~10006

Australian Sports Commission. (2018). Find Your 30. Retrieved October 27, 2018, from https://www.sportaus.gov.au/findyour30

Bazerghi, C., McKay, F. H., & Dunn, M. (2016). The role of food banks in addressing food insecurity: a systematic review. Journal of Community Health, 41(4), 732–740.

Berman, M., & Lavizzo-Mourey, R. (2008). Obesity prevention in the information age: caloric information at the point of purchase. Jama, 300(4), 433–435.

Brown, R., & Ogden, J. (2004). Children’s eating attitudes and behaviour: a study of the modelling and control theories of parental influence. Health Education Research, 19(3), 261–271.

Carr, E. R. (2008). Rethinking poverty alleviation: a ‘poverties’ approach. Development in Practice, 18(6), 726–734.
Doak, C. (2002). Large-scale interventions and programmes addressing nutrition-related chronic diseases and obesity: examples from 14 countries. Public Health Nutrition, 5(1a). https://doi.org/10.1079/PHN2001304

Dobbins, M., & Tirilis, D. (2011). Social Determinants of Health: A Synthesis of Review of Evidence. Phirns. Hamilton, Ontario: Health Evidence, McMaster University.

Minkler, M., & Wallerstein, N. (2005). Improving health through community organization. Community Organizing and Community Building for Health, 26–51.

Ozer, E. J. (2007). The Effects of School Gardens on Students and Schools: Conceptualization and Considerations for Maximizing Healthy Development. Health Education & Behavior, 34(6), 846–863. https://doi.org/10.1177/1090198106289002

Pampel, F. C., Denney, J. T., & Krueger, P. M. (2012). Obesity, SES, and economic development: a test of the reversal hypothesis. Social Science & Medicine, 74(7), 1073–1081.

PHAIWA. (2016). Obesity. Retrieved October 27, 2018, from https://www.phaiwa.org.au/obesity/
Popkin, B. M., & Gordon-Larsen, P. (2004). The nutrition transition: worldwide obesity dynamics and their determinants. International Journal Of Obesity, 28, S2. Retrieved from http://dx.doi.org/10.1038/sj.ijo.080280
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Public Health Information Development Unit. (2005). Population health profile of the Rockingham Kwinana Region of General Practice.

Savage, J. S., Fisher, J. O., & Birch, L. L. (2007). Parental Influence on Eating Behavior: Conception to Adolescence. The Journal of Law, Medicine & Ethics, 35(1), 22–34. https://doi.org/10.1111/j.1748-720X.2007.00111.x

Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obesity Reviews, 17(2), 95–107. https://doi.org/10.1111/obr.12334

South Metropolitan Public Health Unit. (2013). City of Rockingham Health and Wellbeing Profile, (April). Retrieved from http://www.rockingham.wa.gov.au/getmedia/8c030502-9d63-4da8-900b-70aace78a794/PD-IS-Rockingham-Health-Profile-ONLINE.pdf.aspx

Wang, Z., Patterson, C. M., & Hills, A. P. (2002). Association between overweight or obesity and household income and parental body mass index in Australian youth: analysis of the Australian National Nutrition Survey, 1995. Asia Pacific Journal of Clinical Nutrition, 11(3), 200–205. https://doi.org/10.1046/j.1440-6047.2002.00291.x
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WAPHA WA primary Health Alliance. (2016). Population health needs assessment Perth Northern PHN,. Perth, Western Australia: WA Primary Health Alliance. Retrieved from http://www.wapha.org.au/wp-content/uploads/2016/08/WAPHA_Population-Health-Needs-Assessment_PHN-North.pdf