Developing Healthy Eating Behaviors: Why Is It so Difficult?

Abstract

In this era of obesity and excess energy density, much research attention is being devoted to effective strategies for weight loss, prevention of weight regain, and primary prevention of obesity altogether (1Collins C. Watson J. Burrows T. Measuring dietary intake in children and adolescence in the context of overweight and obesity.Int J Obes. 2010; 34: 1103-1115Google Scholar, 2Larson N. Neumark-Sztainer D. Story M. Weight control behaviors and dietary intake among adolescents and young adults: Longitudinal findings from project EAT.J Am Diet Assoc. 2009; 109: 1869-1877Google Scholar). The consequences of overweight and obesity are well documented (3Wang Y. Beydoun M. Liang L. Caballero B. Kumanyika S. Will all Americans become overweight of obese? Estimating the progression and cost of the US obesity epidemic.Obesity. 2008; 16: 2323-2330Google Scholar). Attempts to avoid these problems are certainly warranted, but are there vulnerable groups that require special attention? Neumark-Sztainer and colleagues (p 1004) provide disturbing insights regarding tracking of disordered eating behaviors from adolescence to adulthood with increasing reliance on diet pills and other unhealthy approaches. While it is not surprising and perhaps encouraging to document interest among young people to control their weight, it appears there may be especially vulnerable individuals who are attracted to drastic or potentially inadequate approaches who could benefit from timely and practical guidance. Health literacy and its variability across different segments of the country is a complicating factor. Essential to the investigation of this topic and its impact on public health is valid assessment methodology. Zoellner and colleagues (p 1012) report results from a cross-sectional study among highly disparate participants in the Lower Mississippi Delta region of Arkansas, Louisiana, and Mississippi. Based upon assessment with the Healthy Eating Index 2005 scores in comparison with the validated Newest Vital Sign health literacy scores, these authors documented a favorable association between the higher scores of each. With specific interest in sugar-sweetened beverage (SSB) intake, those with the lowest health literacy consumed more calories per day from SSB intake. Indeed, each additional point in health literacy score was significantly associated with fewer calories from SSBs, whereas income and education level, demographics previously considered important in such analyses, were not significantly associated. To determine whether enrollment in Head Start programs influences dietary intake of young children, Bucholz and colleagues (p 1021) compared data from the 1999-2004 National Health and Nutrition Examination Survey of low-income, 3- to 5-year-old children who attended Head Start vs those who did not attend. Using multivariate logistic regression analyses, authors assessed likelihood of not meeting recommended dietary allowances. While under-consumption of key nutrients was common among all low-income children, including folate, vitamin A, vitamin E, calcium, iron, and potassium, Head Start children were found to have lower mean protein intake as well as lower calcium, thiamin, riboflavin, and niacin, among other nutrients. Mothers play a significant role in the nutritional status of their offspring in utero and beyond, but less attention is paid to the potential influence of fathers on overall dietary intake and nutrient quality. Hall and colleagues (p 1039) report findings from a cross-sectional study comparing parent–child dyads in Australia. Overweight fathers and their children were assessed using validated food frequency questionnaires. Some associations appeared to be positive, such as fruit intake with both sons and daughters; no associations were reported for vegetables and only inconsistent association were reported among other less nutrient-dense foods such as sweets or snacks. While these results perhaps raise more questions than answers, the authors point out the need for further research to take the role of dads and their diet behavior into account. The importance of adult role models in shaping children's eating behaviors cannot be overstated. Latinos are the largest minority in the United States, with a quickly growing population and concomitant fiscal demands on the health care system. Evans and colleagues (p 1031) report results from a qualitative study among low-income, less-acculturated, Spanish-speaking Latino parents of preschool-aged children. The authors report that Latina mothers were motivated to improve healthy eating among their families but also reported barriers such as food costs, husband's preferences, and reliance on convenience foods as reasons for less-than-desired nutritional quality of the foods served. Level of acculturation influenced some of the food and nutrient intakes, and this factor needs better definition and assessment in future studies of this type. Community-based efforts aimed at teaching food purchasing and preparation skills were also recognized as potentially useful. Latina mothers are generally knowledgeable regarding food sources of healthy eating, but environmental conditions influence the type and amounts of foods purchased. We hope you will derive meaningful benefit from this issue. Best Regards.