Fostering healthy eating habits

Fostering healthy eating habits | Image Credit: © Lumos sp - © Lumos sp - stock.adobe.com.

All pediatric providers are educated on the importance of providing anticipatory guidance for nutrition beginning with the first newborn encounter and continuing throughout the adolescent/young adult years.

Despite this educational training and implementation in primary care practices, there are numerous problems with the translation of this guidance by parents of infants and young children and for school-age children and adolescents who have the freedom at school and other activities to make their own food choices.

The obesity epidemic, alone, is clear evidence of the major problem we face as pediatric providers for nutritional guidance. The January/February 2024 issue of Contemporary Pediatrics has three articles all related to nutrition including the now popular gluten free diet, Trendy gluten-free diets can lead to nutritional consequences¹; Assessing a national health program to prevent the onset of type 2 diabetes²; and What determines a healthy weight for a child?³

Strategies to prevent obesity

Providing healthy eating guidance for the growth and development of the pediatric populations begins during the prenatal period. Obstetricians and Midwives provide guidance on healthy weight gain and healthy foods and often practices have a nutritionist who discusses nutritional intake during at least on visit during the pregnancy.

As pediatric providers, a great opportunity to discuss newborn and infant nutrition is during pregnancy when new parents are meeting pediatric providers in their practice to select a provider for their infant. The next and very important opportunity is during the first newborn encounter in the hospital setting or in the pediatric office when the newborn is just a few days old. Discussions about exclusive breast feeding and/or formula feeding is an opportunity to also discuss overall maternal eating patterns and food selections.

The next step is to complete a detailed family history and genogram which then guides the individual health plans for the infant and as the infant continues to develop within the family unit. We must also ask about cultural and other significant influences on eating patterns and make recommendations to avoid habits that lead towards obesity.

One of the most important measurements during pediatric visits and throughout infancy and during the first 1000 days of life is the assessment of growth using the appropriate growth chart.³

The first three years of office visits represent the ideal opportunity to speak with parents about trends towards overweight in their infant and to make corrections at that immediate timepoint. Pediatric providers can also provide resources for the parents that guide their early food selections focusing on healthy choices.

Eating habits: Healthy or not?

The gluten free diet has become popular with parents for their children.¹ The diet is required for children and individuals who have a diagnosis of Celiac disease. However, as more foods are now labelled gluten free and available in supermarkets, individuals began ‘prescribing a gluten free diet for themselves and their children’ without seeking medical advice or understanding the consequences of eliminating essential foods that prevent iron and vitamin deficiencies.

Many restaurants are taking initiatives to keep individuals healthy who require special diets. For example, many restaurants have gluten free items listed on their menus. This is terrific for teens who must follow a gluten free diet as they can order a gluten free pizza with their friends and maintain their health requirements.

Meara² discusses a national initiative in England to prevent type 2 diabetes mellitus (DM).² The continuing increase in the number of individuals, including adolescents, who have a diagnosis of type 2 DM in the United States is a major concern. The amount of ‘hidden’ sugars in the foods consumed daily is most likely not known by most individuals.

Emphasis on reading labels and reducing unnecessary sugar intake is an initial strategy for prevention of type 2 DM. A quick way to know whether an adolescent or parent understands sugar content in foods is to give them a few labels to read in your office and then let them know which foods belong to each of the labels.

Adolescents and parents are often surprised when they learn that the foods and condiments, they often eat contain large amounts of added sugars. Immediate feedback is an easy and informative way to help educate children and adolescents to make good food choices at school and for parents’ ways to make good food choices while grocery shopping.

Nutritional guidance

There are so many foods that require considerable thought while eating out, (e.g., foods high in fat and sugar content), and food shopping, (e.g. snacks that offer no nutritional value and contain large amounts of sugar and fat) should be a focus of our nutritional anticipatory guidance. Discussing long term potential consequences of poor food choice, (e.g., type 2 DM, obesity, and inadequate nutritional intake) is also an essential component of every office visit. Designing ways to efficiently provide this information to children, adolescents, and their parents is an important goal to establish and evaluate in every pediatric office practice.

Click here to read more from the January/February issue of Contemporary Pediatrics.

References:

1. Fitch J. Trendy gluten-free diets can lead to nutritional consequences. Contemporary Pediatrics, 2024;40(1):15-16.

2. Meara K. Assessing a national health program to prevent the onset of type 2 diabetes. Contemporary Pediatrics, 2024;40(1):17.

3 Zimlich R. What determines a healthy weight for a child? Contemporary Pediatrics, 2024;(1):22-26.