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Kids can be taught to put down the fries and choose more healthful foods, a recent study concludes.
According to the Dietary Intervention Study in Children (DISC), nutrition education programs for children can enhance health outcomes.1
The multicenter, randomized, controlled trial, sponsored by the National Heart, Lung, and Blood Institute, assigned 663 8- to 10-year-old children with elevated LDL cholesterol either to a nutrition education program that taught about eating foods low in saturated fat and cholesterol or to a "usual-care" group that taught general nutrition information.
The DISC dietary recommendations were similar to the National Cholestrol Education Program Step II diet.2 The children in the intervention group were taught to distinguish among "go," "slow," and "whoa" foods. Go foods are the lowest in fat and added sugar and relatively low in calories. Slow foods are higher in fat and calories than go foods, and whoa foods are the highest in fat and added sugars and high in calories.
After 3 years, children in the nutrition education program consumed >67% of their calories from go foods, while children in the usual-care group consumed 57% of their calories from these foods. The intervention group ate more heart-healthy foods and achieved modest reductions in LDL cholesterol while maintaining adequate growth, iron stores, adequate nutrition, and psychological well-being during the critical growth period of adolescence.
The DISC findings have several implications for the primary care setting. First, possessing practical information and behavioral skills enables children to make preferred choices. Parental support and guidance boost this ability. Second, long-term adherence requires frequent reinforcement (DISC study participants received regular interventions and individual follow-up sessions). And third, motivational interviews and assessments of stage of change help subjects set and stick to goals.3
This doesn't have to be time consuming, as brief interviews could be easily incorporated into primary care settings and delivered by pediatricians, nurses, nutritionists, or health educators, the investigators suggest.3
EDUCATING IN THE PRIMARY CARE SETTING
Part of the process involves assessing patients' and families' behaviors and attitudes toward eating, explains American Dietetic Association (ADietA) spokesperson Sue Moores, RD, a nutrition consultant in St. Paul, Minn. She suggests starting with straightforward questions about nutrition habits, such as, "What do you drink with your meals?" If the answer is soda, care providers can discuss alternatives that offer less sugar and more nutritional content, such as reduced-fat milk.
"Snacks, desserts, and pizza contribute about a third of daily calories for adolescents," says DISC lead author Linda Van Horn, PhD, RD, professor of preventive medicine at Northwestern University in Chicago. "Find out how much of these foods is typically consumed and whether more nutritious alternatives could be arranged."
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PROGRAMS IN THE COMMUNITY
"Over the last 3 or so years, it seems like people have been trying to do things more relevant for kids," says Beth Thayer, RD, ADietA spokes-person and coordinator for the Health Alliance Plan in Detroit.
To find community programs, Thayer suggests calling local hospitals, dietetic associations, public health departments, cooperative extension services, nutrition departments of universities, and YMCAs.
Eyeing long-term cost reductions that could result from a healthier pediatric population, some health insurers also have made nutrition programs a priority.
"Many programs today consist of community outreach that works directly with school districts; others work specifically through physicians' offices," says Mohit Ghose, spokesperson for America's Health Insurance Plans.
Incorporating nutritional counseling into pediatric practices makes sense, experts say.
"It's so much easier to build on success, rather than manage
damage," Moores says. "It's never too early to
start."
Ingredients for Successful Nutrition Education Programs
Don't steer your patients to just any nutrition education program. Consider the following expert advice.
Footnotes
We Can! (Ways to Enhance Children's Activity and Nutrition) is a national resource for parents and caregivers interested in practical tools to help children 8–13 years old stay at a healthy weight. More information is available online at www.nhlbi.nih.gov/health/public/heart/obesity/wecan/.
New dietary guidelines for infants, children, and adolescents, recently published by the American Heart Association and endorsed by the American Academy of Pediatrics, summarize current available information on cardiovascular nutrition in children.1
The Department of Agriculture has developed new dietary and exercise advice designed specifically for children aged 6–11, available online at http://mypyramid.gov/kids/index.html.
References
2. American Academy of Pediatrics: National Cholesterol Education
Program: Report of the Expert Panel on Blood Cholesterol Levels in Children
and Adolescents. Pediatrics 89:525–584, 1992.
3. Van Horn L, Obarzanek E, Barton BA, et al.: A summary of results of the Dietary Intervention Study in Children (DISC): Lessons learned. Prog Cardiovasc Nurs 18:28–41, 2003.[Medline]
1. Gidding SS, Dennison BA, Birch LL, et al.: Dietary recommendations
for children and adolescents: A guide for practitioners: Consensus statement
from the American Heart Association. Circulation 112: 2061–2075, 2005.
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