Back to school: For kids' eating habits, a return to routine and nutrition
As elementary schools move closer to reopening in Los Angeles County, pediatricians and dietitians are rejoicing in the potential for a return to consistency and routine in healthy eating behaviors among children and their families.
Prior to the pandemic, Los Angeles Unified School District reported that 80% of children qualified to receive free or reduced-price meals. Across the U.S., campus closures have led to a rise in food insecurity and inconsistent eating habits, particularly among low-income children who received the majority of their meals at school, studies show.
Without the stability of the school environment, Erin Morse, chief clinical dietitian in the Department of Nutrition at UCLA Health, says she’s seeing the effects of inactivity, less routine in meal times, less motivation and increased difficulty resisting ultra-processed snack food.
“All of these things compounded together have a profound negative effect on their health,” Morse says of children and their families.
Cambria Garell, MD, physician medical director of the UCLA Fit for Healthy Weight Program, and general pediatrician at Venice Family Clinic's Simms-Mann Health and Wellness Center, says the pandemic has led to an “alarming” increase in childhood obesity.
“I’ve seen many children that have gained 15, 20 and up to 30 pounds over the past 12 months,” she says. “The weight itself is not necessarily the problem here — it’s the behavior that may have led to the weight gain, like frequent snacking, sugar-sweetened beverage intake and sedentary behaviors.”
Additionally, Yasi Ansari, dietitian at the Inpatient Eating Disorders Program at UCLA Santa Monica Medical Center, says social isolation from the pandemic has caused challenges for children and adolescents that are prone to eating disorders and disordered eating, such as frequent dieting, meal skipping, over exercising, preoccupation with food, and weight and body image issues.
Ansari has seen student athletes develop their own ideas of what “diets” are best for them to follow. “I can’t stress to them enough that getting all the nutrients they need – including carbs – are essential to their growth potential and development,” she says.
“The brain alone needs carbs to function, but also to sustain the regular processes of the body,” she says. “And if students have athletics on top of that, they need a variety of food groups to feed their performance and growth.”
Dr. Garell says the reopening of schools will provide the necessary food variety some children have lacked over the past year.
“School nutrition programs have guidelines that they need to follow, like the appropriate amount and balance of whole grains, fruits and vegetables. For low-income families that may not have as much access to healthy food in the home or in their surrounding neighborhoods, the healthiest meal that they get is actually at school.”
Stability and routine
In addition to nourishment, the school meal setting can be a source of routine, socialization and education. Research shows that children thrive when their environments are stable, consistent and predictable.
Luisa Sabogal, a dietitian at the UCLA Fit for Healthy Weight Program, says the more consistent families are in their eating behaviors – such as not skipping meals – the more likely they are to have control over their portions. Feeling satiated makes them less likely to seek out excess calories.
Dr. Garell says a great way for families to mimic this at home – whether or not children have returned to school – is to have meals together and at the same times, as much as possible.
“While there's a lot of things that we can't control in this pandemic, we can control what types of foods are brought into the home, the time we go to bed and how much screen time we have that's outside of school,” she says.
Here are some ways families can foster a healthy food environment in the home:
Emphasize variety and shift away from the mindset that foods are either good or bad.
Ansari says she’s seen some patients resist some of their culturally traditional foods because of the stigma on fats and foods that contain carbohydrates. “I come from a Persian-American background, and I can’t tell you how many times I heard how bad rice is for you. We don’t want patients to fear their cultural foods, we want them to emphasize variety in their meals,” she says. “You can have the salad AND the pizza. All nutrients are key to development for kids.”
Morse recommends that parents create a warm, inclusive, judgement-free environment for their children. "Encourage open dialogue to talk about health," she says. "Use compassion. Shame, blame and anger could set a family up for failure."
Demystify what healthy means by using language children understand.
Instead of saying, “eating broccoli is healthy for you,” Morse suggests using phrases such as, “eating this will make you run faster, make your muscles stronger, help you see better or make you think better.
If it’s difficult to access fresh fruits and vegetables, use frozen alternatives.
“There are also affordable household staples that have a long shelf life, like legumes and lentils, nuts, and peanut butter,” Morse says.
"Cook together. Find a new vegetable that you do not usually cook, and look up tasty ways to prepare it."
Get children to participate in the meal planning and food preparation process.
“It's much more affordable and healthier to cook at home,” Morse says. She suggests having each family member select a different recipe for each day of the week and encouraging the kids to participate in the kitchen.
In addition to the suggestions above, experts emphasize flexibility, balance and a little bit of grace.
"The topic of childhood obesity can be a difficult subject to tackle," Morse says. "However, it’s okay to speak up and ask for help."
She recommends parents ask for an appointment with a registered pediatric dietitian.
“There’s so much we can focus on that’s health promoting other than talking about weight gain,” Dr. Garell says. “It’s important for us to realize how hard this (period) has been for parents and we have to identify the barriers to help them move forward.”
To learn more about the nutritional, physical and health needs of children and adolescents with obesity, visit the UCLA Fit for Healthy Weight Program and for information on the relationship to body image, food and exercise, consider contacting a registered dietitian.