Guidelines for healthy eating

More than 12.5 million children and adolescents (17.1%) in the United States are overweight, placing them at greater risk for conditions such as high blood pressure, high cholesterol, and type 2 diabetes mellitus as they grow older, according to the Office of the Surgeon General of the US Department of Heath and Human Services.¹ The number of overweight children has more than tripled over the past 30 years, appearing to reach a plateau between 1999 and 2006.² In response to the White House Task Force on Childhood Obesity's report "Solving the Problem of Childhood Obesity Within a Generation," public health organizations and legislators have come together to promote good nutrition in the community. The Senate's unanimous passage in August of the Healthy, Hunger-free Kids Act of 2010 not only reauthorizes existing federal child nutrition programs before they expire September 30 but also ensures healthier breakfasts and lunches in schools.

The White House Task Force on Childhood Obesity Report to the president calls for improvements in the quality of school meals; changes in other foods available at school to ensure that all food sold at school support healthful diets; modifications to curriculum, school program operations, and community policies and infrastructure to match changes in school funds; and revisions to policies and practices in juvenile justice and other institutional settings to ensure that all childhood and youth environments support healthy eating.³

Accordingly, the Healthy, Hunger-free Kids Act of 2010 authorizes the US Department of Agriculture (USDA) to establish national nutrition standards for all foods sold on school property throughout the school day.⁴ This includes vending machines and snack bar options. Under section 242 of the new law, the USDA is required to provide model product specifications and best practices to encourage food manufacturers to offer foods that support healthy diets and offer the taste and convenience needed to appeal to students (ie, provide healthy foods that children will want to eat).

To help schools comply with nutritional guidelines, the Healthy, Hunger-free Kids Act contains provisions to improve funding of school meals and incentives to upgrade cafeteria equipment to better prepare healthy foods from scratch whenever possible. The White House encourages schools to plant gardens to educate students about the importance of eating fresh fruits and vegetables.⁵ This goal is supported by the Senate, with the inclusion of $40 million in mandatory funding for grants to support farm-school-programs school gardens.³

Doctors at 3 medical centers in Massachusetts are meeting the challenge head on to promote farm-fresh eating among their patients. Not only are the doctors advising families to eat fruits and vegetables, they are writing prescriptions of sorts to ensure it. They will now give coupons amounting to $1 a day for each member of a patient's family to be used at local farmers' markets. The goal is to increase fresh fruit and vegetable consumption by 1 serving a day. The doctors will track their patients to determine its affects on eating patterns.⁶

INDIVIDUAL ENCOURAGEMENT

Education is key in encouraging healthy habits. Pediatricians are well positioned to take on a leadership role in promoting nutrition and healthy lifestyle choices to patients and their families. Education (80%) and detection (67%) are pediatricians' primary responsibilities in the battle against childhood obesity.⁷ Well-child visits present the ideal time to discuss levels of physical activity, nutrition, parenting, body mass index charts, and other risk factors for unhealthy weight.

In older children, 1-on-1 mentorship appears to help teens reach and develop healthy habits. A Baltimore, Maryland, study enrolled 235 low-income, urban black children, ages 11 to 16, and paired half of them with black college student mentors; 38% of the child participants were overweight or obese.⁸ Mentors and children met 1-on-1 for 12 sessions to make food together, shop for healthy choices, and participate in physical activities. Weight, height, body composition, physical activity, and diet were evaluated at baseline, 11 months, and 24 months.

After 2 years, overweight/obese status had declined 5% among the study group and increased 11% among the control group. Among overweight youth, the intervention reduced total percentage of body fat and fat mass and increased fat-free mass. Dietary changes were sustained. Researchers concluded, therefore, that behavior interventions can reduce obesity in adolescents.