Feeding Our Children Nutritious Foods Should Be the Easiest of Decisions

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion. 

We are failing our children and future generations. In the United States in 2020, nearly 1 in 5 children and adolescents aged 2 to 19 years were affected by obesity. Worse still, childhood obesity rates rose during the pandemic, and they continue to increase. These statistics aren’t abstract epidemiologic concepts. They clearly reflect that our children are becoming sicker and at greater risk for lifelong problems, and they are entirely preventable. Obesity-related conditions include high blood pressure, high cholesterol, type 2 diabetes, joint problems, and breathing problems such as asthma and sleep apnea. We equate many of these conditions with adult chronic disease, but alarmingly they are becoming more prevalent in children due to obesity. Additionally, rates for obesity-related conditions in adults remain at markedly high levels and continue to trend upward. These trends will only worsen should the trajectory of childhood obesity rates not improve. All of this portends even worsening chronic disease across the lifespan and excessive premature deaths for Americans. 

What our children eat is at the heart of this epidemic. It doesn’t take a sophisticated exploration of the problem to understand many of the contributing factors and, arguably, ways to reverse the negative trends. Children are not eating enough fruits and vegetables, and they’re eating too many things — often impossible to call “food” — that have little or no nutritional value yet are high in calories. Data for the Healthy People 2030 objective to increase whole grain consumption by people aged 2 years and over show this dietary component is getting worse. And despite rather moderate targets for improvement in certain other dietary habits, we’re seeing little to no detectable change in Healthy People 2030 objectives to increase vegetable consumption by people aged 2 years and older, increase fruit consumption by people aged 2 years and older, and increase consumption of dark green vegetables, red and orange vegetables, and beans and peas by people aged 2 years and over. 

More specifically, data collected in 2021 reveal that nearly 1 in 3 children aged 1 to 5 years did not consume a daily fruit and nearly half didn’t consume a daily vegetable. Yet more than half of children in that same age category consumed a sugar-sweetened beverage such as soda, a sports drink, or flavored milk at least once in the preceding week. Many children consume beverages with added sugars routinely. That fact is also reflected in Healthy People data. The Healthy People 2030 objective to reduce consumption of added sugars by people aged 2 years and over — one of the highest-priority objectives, known as a Leading Health Indicator (LHI) — is showing little or no detectable change. LHIs are meant to draw attention to the most important underlying factors that impact major causes of premature death and disease in the United States. 

The news is bleak, and we don’t seem to be embracing the urgency of this issue. However, the problem is not insurmountable. But more elaboration of examples and depressing statistics won’t change the current condition. Only intentional action can, and that’s my plea today. 

While we can’t necessarily control our genetics, we can influence other factors that affect excess weight gain. ODPHP provides fact sheets for people across the lifespan, including children, to help them develop healthy eating routines. Suggestions include offering children a mix of healthy foods, avoiding drinks with added sugar (like chocolate milk and soda), modeling healthy eating for children, and encouraging/educating children of all ages to adopt healthy eating habits and make healthy food choices. Even simply adhering to the habit of moderation in what your children (and you) eat has significant benefits. Above all else, incorporating healthy eating into family routines and the culture of daily living — particularly when scheduling, budgeting, shopping for, and preparing meals — is essential. 

Apart from the food our children eat, we must also consider other influencing factors that lead to excess weight gain, particularly how much physical activity and sleep our children get each day. The Physical Activity Guidelines for Americans recommends that children aged 3 to 5 years be physically active throughout the day. Really, this simply means play and moving their bodies. Children aged 6 to 17 years need at least 60 minutes of moderate to vigorous physical activity every day. And as children age, the amount of sleep they need changes. For example, newborns need 14 to 17 hours of sleep per day while teens need 8 to 10 hours of sleep per day.

We especially need to account for social determinants of health (SDOH) when entertaining efforts to improve healthy lifestyles — be that in regard to diet, physical activity, or other behaviors we strive to improve. SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH greatly affect risks for chronic diseases, including childhood obesity. For instance, it’s more difficult to offer our children healthy food choices when social conditions don’t provide opportunity for access or affordability. Those societal conditions can include politics, profitability of goods and services, distance to the nearest vendor of fresh produce, cost of gas, marketing, affordable wages, and many, many other factors.

Affording healthy, nutritious foods is admittedly not always easy. But when one’s social conditions allow for some investment in time and an ability to do a little shopping around, it is feasible. One of the simplest cost-saving measures I’ve found is buying single-ingredient items like dried lentils and getting creative. Regrettably, not many Americans are afforded such opportunity. It’s in this inequity that the greatest challenges to leading healthy lifestyles lie. Societally, we must look to opportunities to address the inequities.

One obvious and far-reaching opportunity exists in our school nutrition programs. Schools and childcare facilities have a direct impact on eating patterns through the foods and drinks they offer children in literally billions of meals a year. At an absolute minimum, what we feed children through such federally subsidized and regulated — and far-reaching — programs ought to be the most nutritious. Why would we choose to provide children anything short of that, much less anything in these school meals that would negatively impact their health? As parents and grandparents — as well as health care professionals committed to advancing the health of the nation and its children — we should be demanding that school meals exemplify opportunities for healthy eating.

In the past 2 years, I’ve had the joy of watching my daughters become mothers. I’ve seen the earnest, almost desperate desire they have to nourish their daughters. They want to know what the best choices are for them to make and how to encourage and enable their daughters’ healthy habits as they grow, to ensure that nourishment is guaranteed.  Our society, our government, our schools, even industry — frankly, all of us — could take a lesson from their caring, from their sense of urgency, and their effort to do right by their children, my granddaughters.

Yours in health,
Paul 

Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion

In Officio Salutis