fussytoddler It’s easy for parents to be concerned about their children’s eating habits, and tight family budgets alongside clever fast food advertising simply add to the pressure. In this feature from the March 2013 edition of JFHC (subscribe here), public health expert Alison Nelson offers a fascinating account of what children really eat and highlights the real areas for nutritional concern.

Our relationship with food is changing all the time and we are now much more informed about and demanding of the kinds of food that we eat.

Food has been absorbing an ever decreasing amount of the family budget, with average spending falling from 15% of disposable income to about 11%. However, it is always those on the lowest incomes that have to spend proportionately more of their disposable income on food.

With rising commodity prices of basic foodstuffs, including bread and eggs, this downward trend is reversing and is having the biggest impact on the types of food people on lower incomes can afford to eat.

Are children getting their 5-a-day?
Sadly, although we all know the 5-a-day fruit and vegetables message, the amount of fruit and vegetables that we are buying appears to be falling, especially in low income families. Fruit and vegetables are often considered to be “add-on” products because they don’t have a high calorie count and are not seen as essentials. 

This is not because people are ignorant; it is because they have to make choices about how they are spending their money, and they are buying high-calorie foods they know their family will eat.

However, this might not be the bad news it seems; it could be that people are wasting less fruit and vegetables than they did in the past, or that they are eating them “disguised” in other foods. The National Diet and Nutrition Survey now also measures the amount of fruit and vegetables in composite dishes (made up dishes), and it shows that fruit and vegetable intakes are rising. Young children are eating more fruit and older children are eating more vegetables than 10 years ago – but household spending on fruit and vegetables is certainly falling.

Spoilt for choice?
We also have a much more diverse and exotic choice of food available to us. We can now get almost all foods out of season and at any point during the year in a variety of forms. As a result, the average supermarket now has 40,000 products from which to choose, which, if you are trying to stick to a budget, is really difficult because you are constantly tempted by the wide range of products.

End of aisle placements also hugely influence what we buy, with a two to five times increase in purchases of products if they are found on the end of an aisle. There’s a whole science behind how supermarkets are laid out, which considers factors such as the direction and speed that you can walk down the aisles, the smells, and the height of the ceiling – all of this can make food shopping much more challenging for families trying to stick to a budget.

What are young children actually eating?
Part of the problem we have when looking at what young children are eating is that a lot of the data is quite old. We have the National Diet and Nutrition Survey, but the data for pre-school children is based on data collected in 1995. Food choices have changed since then.  We now have a rolling programme of the National Diet and Nutrition Survey, which collects data each year, so we are starting to build up a picture of food and nutrition patterns for families and children, althoughthis data should because of the small numbers involved.

Each year’s data is being combined to build an increasingly accurate picture of what we are eating and the nutritional consequences. The small but important changes we’re seeing include more children eating bread and cereals.

In the case of bread, it is mostly white bread that children are eating, and only a third of pre-school children are eating wholemeal bread. However, these children are eating wholegrain cereals, so we have got a shift in the types of breakfast cereals that people are eating.

About 85% of children eat biscuits, cakes, buns and pastries, but they are eating them less frequently and in smaller portions. Also, as children get older, the amount of full fat milk they are drinking falls off, but this is replaced with semi-skimmed milk, yoghurts and fromage frais.

Children’s iron intake is a concern. We know that children are eating less red meat, which is being replaced with chicken, turkey and coated poultry products. This is having an impact on iron intake, as white meats contain less iron than red meats.

The average amounts of fish being eaten by children is increasing – but this was starting from a very small base, so children still aren’t eating large amounts. There is a drop in the amount of confectionary being eaten by young children, but this increases as they get older – perhaps as parental control of food habits is challenged.

Does “healthy” food regulation really work?
Regulation aimed at improving children’s diet includes the Food and Drink Guidelines for Early Years Settings in England. However the fact that these are voluntary makes us question whether this is enough?

There are also standards that are mandatory for state schools, including:
 ● Healthy Start
 ● Nursery milk scheme
 ● School food standards.

Further regulations include:
 ● OFCOM restrictions on TV advertising
 ●  Responsibility Deal – the food industry working voluntarily to make changes
around fat, salt, fruit and veg intakes
 ●  Food labelling legislation – all the major UK supermarkets have agreed to be consistent and use a colour-coded front of pack labelling; the scheme will be voluntary and is expected to be used from 2013
 ● Change4Life/Start4Life

How concerned should we be about childhood obesity?
Unfortunately, many people do not recognise childhood obesity. Children are born with a reserve of fat, which is normal and the sign of a healthy thriving infant, but it quickly disappears if the infant is exclusively breastfed and develops appropriate weaning patterns and weight bearing activity.

However, 5% of children starting school are overweight or obese. By the time  children leave primary school, a third are obese or overweight. Crucially, only 5% of parents recognise if their child is overweight or obese, which makes it very difficult for health professionals to raise the issue with them. And then there’s a knock-on effect for children, as overweight children can become isolated, suffer from low self-esteem and suffer from bullying.

Why is obesity a growing problem?
We know from the Foresight report that obesity is “a passive, biological response to our changing physical environment”. Our environment has changed and we haven’t.

However, the UK is held up as a beacon of best practice because we are the only EU country to restrict the advertising of high fat, sugar and salt foods to children. We currently restrict the advertising of sugary fatty foods during programmes watched predominantly by children. But that doesn’t include programmes like Coronation Street or the other soaps that are watched by both adults and children. There is also an almost 100% recognition level for McDonalds’ golden arches for every child above the age of two.

As we have experienced the mass production of food, the wider availability of food and variety of choice, the relative fall in food prices, and sophisticated food marketing in the 1980s, so we have started to see a rise in obesity.

The government’s current approach to tackling obesity, although recognising the Foresight Tackling Obesities evidence, continues to expect the individual to take personal responsibility for changing their food choices. It calls for us “to be honest with ourselves about what we eat” – and this isn’t going to work. We can’t blame people; we can’t blame the individual without making other changes that make it easier to make the right choices.

The good news is that adults understand what constitutes a healthy diet and they certainly think it is important for children. Additionally, if you ask children what a healthy diet is, they will always mention fruit and vegetables.

Next steps

There is still some work we can do – for example, taking vitamin supplements was considered not at all or not very important for adults (68%) or children (67%). That’s worrying when we are trying to promote vitamins supplements like folic acid and vitamin D.

Finally, we need to shift our food culture. People need to understand food marketing, where their food comes from and how to cook it. More importantly, we, as health professionals, need to make sure that we are all saying the same thing. Messages are delivered by lots of different people and if a  new mother is hearing a different message from the worker in the children’s centre, their health visitor or their midwife, then they are going to ignore it and go elsewhere for their information.

Age appropriate, consistent messages are therefore something we really need to deliver.