Study Shows Programs Can Teach Kids to Eat Healthier

A study of preadolescent Kids found that those who attended a behaviorally oriented nutrition education program and were taught to follow a diet low in saturated fat and dietary cholesterol adopted significantly better dietary habits over several years, compared with their peers who received only general nutritional information.

The government-sponsored study showed that after three years, kids in the intervention group consumed more than 67 percent of their total calories on average from heart-healthy foods, compared with less than 57 percent for kids in the usual care group.

"We need to act now to prevent obesity in our kids," says Elias Zerhouni, M.D., director of the National Institutes of Health. "Obesity is a high priority at NIH. This year, we will spend about $440 million on a range of research on this important problem."

The results, published in the June 2005 issue of Pediatrics, are from a new ancillary study of the Dietary Intervention Study in kids (DISC). Scientists reviewed dietary recalls from 595 kids who were ages 8 to 10 and who had high blood cholesterol levels at the start of the study. The researchers analyzed dietary information by food groups and measured adherence to recommended food patterns and changes over time.

"These new findings offer valuable lessons for finding effective ways to help kids develop healthier eating habits--a critical need in light of the rising rates of obesity and related conditions among kids," says Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), which sponsored the study.

The study provides glimpses of real-world eating behavior and reveals the challenges of trying to eat a healthy diet in a fast-paced world. For example, the study documents a long-suspected phenomenon of modern society: About one-third of the total daily calories consumed by the kids in both groups came from snack foods, desserts, and pizza.

The main DISC trial is the first long-term clinical trial of the effects of a fat-reduced dietary intervention on growing kids. Over the seven years of the original study, kids who adopted a low-fat, low-cholesterol diet decreased their intake of total fat, saturated fat, and cholesterol within the first year of the study and maintained lower levels for several more years. Those selected for the intervention group participated in a nutrition education program that included a behavioral component to promote healthier eating. Parents of the kids in the intervention group participated in a similar program.

Researchers previously reported that the dietary changes made by kids in the intervention group did not adversely affect the children's nutritional status, growth, or development.

For the new findings, researchers analyzed the dietary recalls collected over three days at the beginning of the study and again after three years. They found that the dairy food group and the desserts/snacks/pizza group had the greatest impact on the children's body mass index (BMI) and their levels of LDL, or "bad," cholesterol. Girls and boys who consumed more dairy products were more likely to have a lower BMI. Boys who consumed more desserts, snacks, and pizza were more likely to have higher BMI and LDL levels.

Specific foods within each food group were also classified based on the ingredients or preparation methods as either "Whoa" foods--those that were high in saturated fat and dietary cholesterol--or heart-healthy "Go" foods--those that were low in saturated fat and dietary cholesterol.

Compared to baseline, after three years, kids in the intervention group consumed more of the "Go" food choices in all the food groups except fruit, and they consumed fewer of the "Whoa" food choices with one exception: pizza. They also consumed on average slightly fewer snacks and desserts after three years compared with the usual care group. In addition, kids in the intervention group chose more "Go" versions of desserts, such as low-fat frozen yogurt, gelatin, or angel food cake, and more "Go" versions of pizza, such as those made with low-fat cheese, compared with those in the usual care group. The authors note, however, that kids in both groups ate fewer than recommended servings of fruits and vegetables.

The intervention group's greater consumption of total daily calories from "Go" foods shows that kids and their families can be taught to improve children's diets, according to Linda Van Horn, Ph.D., R.D., professor of preventive medicine at Northwestern University and lead author of the study.

"You can raise a child to enjoy healthy eating and to be selective about food choices. Habits developed in childhood will hopefully last throughout their lives," says Van Horn. "With the right guidance and nutrition education, kids learn to prefer healthy foods such as carrots and raisins or cereal as snacks, for example."

Eva Obarzanek, Ph.D., R.D., NHLBI nutritionist and DISC project officer, agrees that most kids could benefit from healthier eating patterns like those followed by DISC participants. "DISC has shown that following a diet low in saturated fat and cholesterol is safe for kids in this age group--and a heart-healthy diet can lower blood cholesterol levels," she says.

Other studies have shown that atherosclerosis, or hardening of the arteries, begins in childhood. The National Cholesterol Education Program recommends that kids over the age of about 2 years, as well as all adults, adopt a heart-healthy eating pattern to reduce their risk of developing heart disease as adults. kids and adults can also lower their risk by maintaining a healthy weight and by being physically active.

To help families adopt healthier lifestyles, the NIH has launched a national public education program targeting parents and caregivers of children ages 8 to 13. Developed by the NHLBI and promoted in collaboration with several other NIH institutes, national health and youth organizations, and community-based groups, We Can! Ways to Enhance Children's Activity & Nutrition provides resources to encourage healthy eating, increase physical activity, and reduce sedentary time.

The science-based We Can! Program helps parents teach their kids to:

• Eat a sufficient amount of a variety of fruits and vegetables each day

• Choose small portions at home and at restaurants

Eat fewer high-fat foods and energy-dense foods that are low in nutrient value such as french fries, bacon, and doughnuts

• Substitute water or fat-free or lowfat milk for sweetened beverages such as sodas

• Engage in at least 60 minutes of moderate physical activity on most, preferably all, days of the week

• Reduce recreational screen time (such as television, computers, and games) to no more than two hours daily.