Healthy Eating Guidelines through a Psychology Lens

New Healthy Eating Guidelines for 1-4 year olds have just been launched by the Government as part of their Healthy Ireland Campaign. While they provide detailed nutrition information, the psychology piece is somewhat lacking. As a specialist in the psychology of child feeding (researcher and consultant), I would like to share my response to these guidelines. The guidelines I refer to can be read here.

Yes - this has been totally hyped up by the media - which focused on the recommendation that young children should only be given half a biscuit or three crisps a week. I’ll get back to that in a moment. 

The Government Provided some Helpful Messages:

• The amount a child eats changes every day and at every meal - use your child’s appetite to decide how much to offer them. Toddler’s eating is unpredictable - they often don’t conform to portion sizes or recommended daily intakes.

• Have a regular daily routine. Children like predictability and structure - it helps them tune into feelings of hunger and fullness and eat the amount that is right for them.

• Sit down together for breakfast. I'm not sure why breakfast has special status. Eating together at any meal is an opportunity for socialising, role-modelling and exposing children to foods they might not have learned to like just yet. 

• Don’t use food as a reward for behaviour. Using food as a reward increases the value of “reward foods”. If food is linked to behaviour or parent approval, children can learn to eat for the wrong reasons rather than in response to what their bodies need.

But there are some Potential Pitfalls to These New Guidelines.

• These guidelines were designed to tackle obesity. They do not consider the range of feeding concerns parents face. These guidelines were developed for the general population, but with the aim to address one specific issue that is high on the government’s agenda. Treating the entire population with an obesity reduction approach fails to support the range of feeding concerns and challenges that are relevant to families. Many families face food refusal, fussy eating, and concerns about low weight, which are not adequately addressed by these guidelines.

• Recommendations make many parents feel guilty and anxious. Specific recommendations such as “3 crisps” or “half a biscuit” are unrealistic, difficult to implement, and contribute to parent guilt and a feeling of inadequacy. Parents do need some guidance on what a balanced and varied diet looks like, but too much focus on daily intakes and portion sizes raises anxiety when their toddlers don’t follow the plan. This can be particularly alarming for parents experiencing picky eating.

• Guilt and anxiety lead to unhelpful feeding strategies. When parents feel guilty or anxious about their child’s nutrition or weight, they try to control their child’s intake by pressuring them to eat more or restricting them from eating too much. Controlling feeding strategies override children’s ability to listen to their body and are associated with poorer outcomes for children’s diet quality, eating patterns, behaviour and weight. Although the government tells parents to adjust servings to suit their child’s appetite, my concern is that the overarching focus on portion size, recommended daily servings, and restriction will increase anxiety and lead to unhelpful feeding strategies. 

• Restricting foods (in the wrong way) is associated with obesity. The Government recommends restricting foods that are high in fat, salt and sugar to tiny servings (1 square of chocolate, half a plain biscuit, 3 crisps, or 3 soft sweets) once per week. They warn that these foods are associated with obesity. Research shows that overt restriction (that the child is aware of) is associated with poorer eating outcomes (diet quality, eating behaviours and weight status). Covert restriction (that the child is not aware of) is associated with better eating outcomes. I worry that the government guidelines will lead parents to restrict in the wrong way - contributing to the problems that they are trying to solve!  

• Nutrition is prioritised over the psychological and social side of healthy eating. So frequently, I see family relationships and mealtime harmony compromised for the sake of nutrition. When parents are too focused on nutrition, mealtimes become a battle of negotiations about how many peas have to be reluctantly eaten - which just makes eating worse. Parents I work with tell me that they dread mealtimes with their child, or that they used to enjoy cooking and eating but feeding their child has taken the joy out of mealtimes. Pleasure, community, culture, and relationships are important parts of healthy eating. Until equal importance is placed on nutrition and the psycho-social side of healthy eating, I strongly believe that nutrition will suffer. 

• The message that certain foods are “bad for you” is unhelpful. Foods high in fat, sugar and salt are placed on top of the food pyramid, coloured in bright red, and marked with warning symbols. This attracts extra attention to these foods, increases their value, and sends confusing messages to children and adults when these foods are so readily available and heavily marketed. This message is particularly dangerous for children with extreme picky eating, food anxiety, or children with feeding challenges for sensory, oral motor or medical reasons. Children think “they taste good, they are foods I can manage to eat, they’re everywhere, my parents give me some, but they’re bad!?...If I eat them, am I bad?” 

If Healthy Eating Guidelines were more Informed by Psychological Research...

• ...reassurance for parents that children with diverse diets and different eating behaviours can still be healthy 

• ...more reassurance for parents about the unpredictable - but normal - nature of toddlers’ eating

• ...information about what a balanced and varied diet looks like, without too much focus on portion sizes and recommended daily intakes

• ...“restricted foods” removed from their pedestal, coloured in a neutral colour, with no warning signs that induce fear and guilt, send confusing messages, and feed cravings

• ...information about managing children’s access to foods without being overly controlling and making eating worse

• ...and a balance of nutrition information alongside messages that promote food enjoyment, positive social interaction, and mealtime harmony. 

The Take Home Message?

Give your child some biscuits from time to time, in the context of a balanced and varied diet, and don’t feel guilty about it!

Selected References from the Research Evidence Informing this Article: 

Black, M. M., & Aboud, F. E. (2011). Responsive feeding is embedded in a theoretical framework of responsive parenting. The Journal of nutrition, 141(3), 490-494.

Daniels, L. A. (2019). Feeding practices and parenting: A pathway to child health and family happiness. Annals of Nutrition and Metabolism, 74(2), 29-42.

Hurley, K. M., Cross, M. B., & Hughes, S. O. (2011). A systematic review of responsive feeding and child obesity in high-income countries. The Journal of nutrition, 141(3), 495-501.

Mitchell, G. L., Farrow, C., Haycraft, E., & Meyer, C. (2013). Parental influences on children’s eating behaviour and characteristics of successful parent-focussed interventions. Appetite, 60, 85-94.

Rollins, B. Y., Savage, J. S., Fisher, J. O., & Birch, L. L. (2016). Alternatives to restrictive feeding practices to promote self‐regulation in childhood: a developmental perspective. Pediatric obesity, 11(5), 326-332.

Wolstenholme, H., Kelly, C., Hennessy, M., & Heary, C. (2020). Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-22.