Writing in USA Today, Nanci Hellmich pens a piece that runs under the headline, ‘Eat Your Vegetables’: For Kids, it Means Fries. She makes a succinct point:
Kids aren’t eating enough fruits and vegetables, and when they do consume produce, they are more likely to eat french fries than nutrient-rich dark green or orange vegetables, a study shows…
The point is derived from a study conducted by researchers at Ohio State University and published in the Journal of the American Dietetic Associationunder the title “Correlates of Fruit and Vegetable Intakes in US Children.”
The issue of obesity in America and especially in children is a big one. We asked Pundit Investigator and Special Projects Editor Mira Slott to find out more:
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Hugo Melgar-Quinonez Ph.DAssistant Professor OSU Extension Specialist Department of Human Nutrition Ohio State University |
Q: Does your study in essence corroborate what we already know; that children are seriously deficient in consumption of fresh fruits and vegetables, and the problem exacerbates exponentially into the teenage years?
A: Our research is consistent with other data and findings and further demonstrates this stark reality. We know in general children are not consuming enough fruits and vegetables, basically reflected in government and industry campaigns and efforts to promote consumption. Our research focuses on samples of children representative of the U.S. population, which gives a broad perspective to the problem we know exists and has been presented in smaller samples and with specific population groups.
Q: What astonishes you most through your research?
A: In assessing the numbers, one finding that strikes me is that two- to five-year-old children are at lower risk of not meeting produce consumption recommendations than older kids, yet everything is still relative. Only half of two- to five-year-olds meet the daily recommendations for fruit, and 22 percent meet the vegetable intake. The start point is not great, so there is a real loss there. But more worrisome, the older the kids get, the higher their risk for not meeting fruit and vegetable intake.
Children are not doing what we’d like once they move into the real world. The chances they’ll get the necessary amount of produce in their diets drop exponentially each year; for fruit, consumption levels decline from 50 percent to 26 percent in the 6- to 11-year-old age group, then skid further to 20 percent for 12- to 18-year-olds.
In terms of vegetables that decrease in proportion of intake is not as dramatic because the start point is so low. Still it drops to 18 percent for 6- to 11-year-olds, then to a little over 10.5 percent for 12- to 18-year-olds. It’s a really dismal situation, the risks that our children are going to be facing as they become older and grow into adults. Chronic diseases related to obesity, nutritional deficiencies and other health issues associated with low intake of fruits and vegetables are tremendous.
Q: In your produce consumption numbers, do you segment out the proportion of fresh fruits and vegetables versus juices and other processed items? Besides the nutritional issues, do you take into account sugar, fat and calorie counts of these items? It seems these numbers are quite distorted without doing so.
A: What we face in these numbers is exactly the situation you describe. We must not forget that when we’re talking fruit consumption, at least 40 percent is coming from fruit juices, not whole fruit and product with very low fiber content. And with vegetables, an average of 28 percent of consumption comes from French fries.
Q: That information is quite disconcerting. For perspective, how do these food choices compare to past years? Are we trending upward, downward, or flat-lining? (Excuse the pun!)
A: We analyzed four years of data in a continuous survey. Right now eight years of data are available from 1999 to 2006. When we did the study, we only had data for four years. Our study covers 1999 through 2002.
Is this a problem that’s increasing or not and what’s the trend going forward? This is a matter of further research. I don’t have the evidence for how the conditions we’re talking about have varied in the last 10 years. Especially in the last year, a lot could have changed.
Q: Why is that?
A: Children in households that are wealthier have a higher consumption of both fruits and vegetables, but especially of fruits. Under the current economic conditions, those already having lower consumption might be facing more difficulties accessing types of fruits they need.
Q: So there’s a direct correlation between a family’s income level and produce consumption?
A: One of the things we’re not able to document in this research, but has been shown in other studies working with similar data, is the fact that families or households in lower income levels have higher risk for being overweight or obese. That’s been shown for children as well. This suggests people in lower income levels have less access to fresh fruits and vegetables. I think of the last year, and I’m afraid what we’ve seen in produce consumption numbers is not as dramatic as what we’re experiencing now. In a few years when new data is released, we will be able to analyze how the economic crisis both in the U.S. and globally has impacted produce consumption.
Q: You note that children’s access to fresh produce is at the very least a contributing factor to the problem. How affective do you think these government-backed free fruit and vegetable programs in school systems here and in the EU will be in alleviating the problem?
A: It is good news to see aggressive action on this front. I’m optimistic about new initiatives to increase children’s produce consumption. The U.S. government is stimulating changes at the school level by making fresh fruits and vegetables accessible in elementary and middle schools, accompanied by changes in school cafeteria lunch programs. By high school, behaviors have been engrained. We must make access to fresh fruits and vegetables easier for all the kids, starting with the head start programs and daycare centers receiving support from state and federal government.
Q: Isn’t availability just part of the predicament? What can be done to change entrenched eating patterns and cultural behaviors?
A: We are big advocates of nutritional education, teaching kids why it’s important to eat produce and what consequences they face when they don’t do so. Nutrition education represents a great vehicle. In the U.S., we have a strong capacity already built into the system to move into those environments and expand nutritional food choices, such as with WIC and the free fruit and vegetable program. We need a comprehensive approach to tap into different venues.
If kids understand the value of produce but don’t have access to it, what is the point?
We call it the food desert, because if families don’t have access to a grocery store with affordable produce, or fresh fruit and vegetables at school to consume, even the knowledge and desire won’t result in change.
We need to work with children, parents, and schools in the neighborhoods. Where parents have two jobs, there are additional obstacles. For people leaving homes early and coming home late at night, if they need to commute 30 to 40 minutes to get to a grocery store, just knowing the importance of eating produce won’t necessarily help. Low income kids are at higher risk of becoming overweight or obese and access to produce is the base barrier to overcome.
Q: Don’t certain ethnic groups incorporate more fresh fruits and vegetables into their diets? Does assimilation into American fast-food culture adversely affect this?
A: In one of our tables, you see that Mexican American kids consume more fruits than non-Hispanic white children, and African American children as well. The difference with vegetables is very small. There is some ethnic cultural role here. I am a Hispanic immigrant, originally from Guatemala, and I’ve seen the rapid growth of the Hispanic community in the U.S. It occurred to me the Hispanic community is getting bigger both in numbers and in the individual’s size! It’s a reality… the longer we are here the heavier we get.
My wife is a nutritionist and I work in the Department of Human Nutrition. We have one daughter who is a vegetarian, another with allergies, and a teenage boy who’s carnivorous. We think how privileged we are in being able to afford to select the right nutritious foods for our children, and realize how many families are challenged to do so.
Q: Have you examined the influence of how and when meals are eaten through the day, portion size, and other patterns on produce consumption? For example, dieticians promote eating a healthy breakfast to drive energy and brainpower, maximize one’s metabolism as well as to curb appetite of junk food as the day progresses.
A: We are already working on new studies that look at the dietary intake of these same children over time. Are there consumption differences in breakfast, lunch, supper, and snacks? Those without enough access to foods, or what we refer to as insecure households, have a higher proportion of kids missing breakfast and lunch. This is what we expect. The interesting finding is that it doesn’t apply to snacks. The insecure households have a greater snack intake.
The problem here is that the quality of snack is not one we want the kids to have. We found kids in insecure households are consuming snacks that are high in fat and sugar. If a larger proportion of poor kids are missing breakfast and eating fattening snacks, this is part of the equation for why they are at greater health risk.
The article in the Journal of the American Dietetic Association is brief, but the message is pretty strong.
It is an interesting study and many of its findings are not particularly shocking. Word that kids eat lots of french fries and drink a lot of juices is hardly going to cause shock and awe.
Still the study has its limitations. For example, it is not actually a study of what people ate. It is, instead, a study of what people remember they ate or claim they ate 24 hours later.
Still, there is something decidedly disturbing in data points such as this:
To identify the contribution of some groups of interest, vegetables consumed as french fries and fruit intakes from 100% fruit juice were generated for each analysis. Potato and fruit juice consumption have increased to contribute nearly one third of vegetable intakes and one quarter of fruit intakes, respectively, in the United States.
When you consider that most markets in the US are not 100% fruit juice markets, instead preferring cheaper blends, one realizes the situation is very bad and the opportunity to increase consumption is vast.
Where we start to have concerns is when the Professor starts drawing implications that are not supported by the research. For example:
One of the things we’re not able to document in this research, but has been shown in other studies working with similar data, is the fact that families or households in lower income levels have higher risk for being overweight or obese. That’s been shown for children as well. This suggests people in lower income levels have less access to fresh fruits and vegetables.
Actually the data suggests nothing of the sort. In fact the data cannot possibly suggest anything of the sort; this is just the professor’s personal bias suggesting that lack of access is the cause of the problem.
Lack of access may be a problem, but it could also be a cultural matter or, perhaps low income correlates with lower education or lower IQ scores and these things explain lower consumption of produce. There also is a chicken-and-the-egg matter: Is the problem lack of access or is there no access because the community won’t support those kind of offerings?
In other places in the interview, Professor Melgar-Quinonez seems to stop speaking as a scientist:
We are big advocates of nutritional education, teaching kids why it’s important to eat produce and what consequences they face when they don’t do so. Nutrition education represents a great vehicle.
Dare we suggest that nobody really cares if the good professor is a “big advocate” of nutritional education — what we want to know is if his study indicated that children exposed to nutrition education behaved differently from those that were not so exposed. And on that issue the study is silent.
We need to work with children, parents, and schools in the neighborhoods. Where parents have two jobs, there are additional obstacles. For people leaving homes early and coming home late at night, if they need to commute 30 to 40 minutes to get to a grocery store, just knowing the importance of eating produce won’t necessarily help. Low income kids are at higher risk of becoming overweight or obese and access to produce is the base barrier to overcome.
Precisely what percentage of the US population has to commute “30 to 40 minutes” to get to a grocery store? We worked in the south Bronx and that wasn’t the situation there.
In fact the data in the study does not support many of the professor’s suppositions. Right in the abstract, for example, this is explained:
…non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents.
This seems to imply that culture is predominant and that if you have a family that feeds you collard greens, you grow up eating more greens. If anything, this seems to imply that culture trumps economics.
In many cases there are internal contradictions in what is being claimed:
I am a Hispanic immigrant, originally from Guatemala, and I’ve seen the rapid growth of the Hispanic community in the U.S. It occurred to me the Hispanic community is getting bigger both in numbers and in the individual’s size! It’s a reality the longer we are here, the heavier we get.
Yet in the whole interview, the Professor claims that the big problem is financial barriers to access to fruits and vegetables. If this is the case, we would expect the immigrant communities to become thinner as they become more affluent. But the Professor says they are becoming more obese, which implies, once again, that the issue is not access but culture.
Even when he may be correct, the point doesn’t grow out of the research study and it is not obvious that there is a solution:
We think how privileged we are in being able to afford to select the right nutritious foods for our children, and realize how many families are challenged to do so.
You would think the Professor had done a controlled study giving half the respondents gift cards to local supermarkets so that money was no object and the other half had to struggle, and that there was some sound science at the end demonstrating that the families with access to money fed their children more healthily.
He hasn’t… the research report says nothing on this subject and it is at least as plausible to think that if you give people more money they will eat more and get heavier as to believe they will eat healthier.
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We value good research for the insight it provides into human behavior and the guidance it provides our industry institutions and individual businesses. We think, though, that researchers need to make crystal clear when they are reporting things that their research has evidenced as opposed to their own opinions or hunches.
We thank Professor Melgar-Quinonez for doing the research and attempting to explain it to the industry. We sincerely hope he will undertake research that might prove or provide evidence for his various positions. This research falls far from that ambition.
