Childhood overweight and obesity have increased globally over the past two decades1. Such increases have been linked to the consumption of unhealthy diets, physical inactivity or sedentary lifestyles2. Environmental conditions characterising neighbourhoods, homes and institutions like schools can moderate such behavioural factors2.
During the school term, children spend a considerable amount of time (approximately seven hours per day, Monday to Friday) in and around their school environment. Accordingly, this environment can influence their nutrition literacy, food preferences, purchasing behaviours, and ultimately, their dietary intake3. Some of the foods they consume from these environments are high in refined carbohydrates, sodium, and saturated or trans fats. Therefore, some studies examining the healthiness of school food environment have described it as obesogenic, meaning the environments have the potential to promote obesity among individuals or populations4-6. Some local data support this. For example, a recent study by Fernandes and colleagues7 examined the school food environment and dietary behaviour of Ghanaian children and adolescents and reported that independent vendors within school premises sold unhealthy foods, particularly confectionaries and sugar-sweetened beverages. Our study on commercial food advertising on Ghana’s largest university campus in the capital city, Accra, revealed a preponderance of unhealthy food advertising within the school compound8. Although the university environment is mostly occupied by young adults, the unhealthy food advertising within this environment can influence children and adolescents who may live nearby or visit the university community. As a result of community partnerships, there are residential facilities for faculty, staff, and their families as well as a basic school for children within the University compound. The children associated with this site may still be exposed to the food marketing intended for university students.
Childhood obesity can affect many aspects of children’s lives, including their physical health, social and emotional well-being, and self-esteem2. Obese children are at increased risk of developing chronic non-communicable diseases such as heart disease, stroke, cancer, diabetes and chronic lung disease in adulthood9This presents health and economic impacts on affected countries, particularly in resource-constrained countries such as Ghana. In these settings, healthcare systems are often insufficiently equipped to meet the health needs of the population.
Preventative measures are therefore encouraged. Of several measures against childhood obesity, encouraging physical activity and healthy dietary habits are popular10. In this blog, we aim to draw attention to food parenting – a parenting practice that may influence children’s dietary habits.
Parenting goes beyond just the biological relationship but encompasses a vast array of practices that should, in theory, support the physical, emotional, and intellectual development of a child from birth to adulthood. Parenting practices are context-specific behaviours and feeding comprises a fairly large component. Parents play a prominent role in food provision and eating experiences of children, particularly during the early stages of life. Healthy dietary practices initiated in children by parents through food-related parenting practices can inspire healthy dietary habits and consumption both within and outside the home. These healthy dietary habits have the potential to persist well into adulthood. Food-related parenting practices or food parenting are considered as part of parent-child interactions in the context of food intake11.
The efforts of governments to limit the spread of the novel coronavirus (COVID-19) through stay-at-home mandates and lockdowns – could mean many parents and children spend a higher amount of their time together at home. This presents an opportunity for parents and caregivers to start the journey of modifying any unhealthy dietary practices in their children. Moving forward, the food provided at home and food choices that parents will engage in at home can be vital in establishing healthy dietary behaviours in their children.
Following, we highlight some dietary practices that parents and caregivers could engage in with their children to influence healthy eating and build healthy dietary habits among children.
- Limiting access to and availability of energy-dense nutrient-poor foods such as those that are highly processed while simultaneously incentivizing healthier food alternatives. It is understandable that during uncertain times like this current pandemic, families may stock up on more processed or non-perishable foods, many of which have a longer shelf-life, and require minimal preparation. However, families should consider stocking their homes with healthier options that contain lower levels of saturated fats, salt and added sugars. This can be accomplished by careful consideration of the nutrition labels (if it is provided for the product) to know what the product contains.
Currently, the closure of schools as part of government efforts to mitigate the spread of COVID-19 would suggest that children are spending more time at home. Thus, children and adults are both at high risk of frequent snacking while idling at home12. Healthy snacking, therefore, should be encouraged by parents. Instead of allowing children to snack on foods high in added sugars, sodium, or saturated fats, healthier snack options like whole fresh fruits, vegetable salads, nuts and seeds, low-fat yoghurts, and fat-free milk can be offered to children as snacks. In place of sugary drinks, children should be encouraged to drink more water and if possible, fruits or vegetables like slices of cucumber or lemon can be added to give it a more appealing taste or flavour. Studies have shown that home availability and accessibility of fruits and vegetables are positively associated with children’s fruit and vegetable intake13. Even though consumption of fresh fruits and vegetables is almost always the best option, they can be preserved by freezing and canning where possible with minimal nutrient loss depending on the commodity and can still serve as healthy food alternatives14 These changes can build preference and consumption of healthy snacking options among children. By reducing the availability of unhealthy or ultra-processed foods high in saturated fats, salt and added sugars in the home, parents have the ability to influence the food choices of their children.
- Parents and caregivers role model eating a wide variety of healthy foods while staying at home. It is widely understood that children watch and imitate peers, family members and other adults they observe in their lives. The dietary practices of caregivers can therefore influence their dietary behaviour. What parents will eat can set as an example for what their children will also eat. For example, there is evidence from a systematic review conducted by Pearson and colleagues (2009) showing that parental consumption of soft drinks, fruits and vegetables has a significant and direct relationship with children’s intake of similar foods13. Caregivers can, therefore, serve as role models for children’s dietary behaviour by eating healthier food options such as vegetables, fruits, whole grain products, low-fat dairy products, lean meats, legumes, eggs and fish while in the presence of children. When children observe these behaviours in their parents and other primary caregivers, they are more likely to want to make similar choices and may eventually adopt these habits which can ultimately shape their dietary behaviour. Foods that are high in calories, fat, sugar and salt should also be eaten less often. When parents themselves limit the intake of such foods, children will be less likely to eat them as well. Such practices will send the right message concerning healthy eating habits to the children. Parents, therefore, should demonstrate healthy food habits by eating healthy.
- Involving children in home meal preparation to encourage less frequent food consumption outside the home. This provides a meaningful opportunity for the family to work together. This should be done with consideration for the age-appropriateness for each activity so that children can play a part without getting injured or feeling overwhelmed. Children can be involved in less endangering activities such as washing of vegetables, salad preparation (which does not require actual cooking but just assembling different vegetables together) and perhaps setting up the dining table. Their participation in these activities can provide them with a sense of involvement in what they eat as well as accomplishment. During meal preparation, nutrition- literate parents can easily introduce healthy foods and explain the health benefits. Existing evidence points to the fact that food intervention programs like engaging children in meal preparation can also be an effective way to influence children’s food preferences and to try new foods that they may have not tried before. In a study conducted by Van der Horst and colleagues15, children who were involved in meal preparation at home were found to choose and consume more vegetables than those who were not. The frequency of helping with food preparation in the home was also found to be associated with higher fruit and vegetable preferences and higher self-efficacy for selecting and eating healthy foods in Canadian children16. Therefore, involving children in food preparation could potentially help them to develop healthy eating habits.
- Scheduling meal times to enable eating together as a family. Family dinners may not happen for many reasons including long work, busy schedules and complicated lives. Staying home provides an opportunity for the family to have meals together. This doesn’t necessarily have to be home-prepared meals even though typically, homemade meals include more protein, vitamins and fibre, and less saturated fat, added sugars and sodium than restaurant or take-out food17. Aside from density of positive nutrients18, eating while sitting at the table has been associated with increased fruit and vegetable consumption as well as healthier portion sizes in children19. During family mealtimes, parents can also teach their children some food safety practices like proper hand washing, proper food handling (including washing of produce), and appropriate table manners. These practices can inculcate healthy eating behaviours into children, and thus emphasize the need for families to eat meals together whenever possible. Such an opportunity of being together at a table can also allow time for family bonding and may even improve mental well-being.
From the foregoing, parent-child interactions in relation to food can contribute to the development of healthy dietary habits in children. Further development of these interactions/healthy habits during the current pandemic can promote healthy lives now and post COVID-19. These habits could potentially be carried on beyond the pandemic and have potential long-term health-benefits such as reduced risk of obesity and diet-related illnesses.
Written by: Gideon Senyo Amevinya, Krystal Rampalli, Wilhemina Quarpong, Akua Tandoh, & Amos Laar
Gideon is an Early Career Researcher on the MEALS4NCDs Project
School of Public Health, University of Ghana
Krystal is a Ph.D. Candidate in the Department of Health Promotion, Education, and Behavior at the University of South Carolina – Arnold School of Public Health. She is currently based in Accra, Ghana, working with the MEALS4NCDs project.
Wilhemina is an Early Career Researcher on the MEALS4NCDs Project
School of Public Health, University of Ghana
Akua is a Ph.D Student of the School of Public Health, University of Ghana, and an Early Career Researcher on the MEALS4NCDs Project
Amos Laar is a lecturer at the School of Public Health, University of Ghana, and Principal Investigator of the MEALS4NCDs Project.
- Lobstein T, Jackson-Leach R, Moodie ML, et al. Child and adolescent obesity: part of a bigger picture. The Lancet 2015; 385(9986): 2510-20.
- Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. Journal of family medicine and primary care 2015; 4(2): 187.
- Brug J, Kremers SP, Van Lenthe F, Ball K, Crawford D. Environmental determinants of healthy eating: in need of theory and evidence: symposium on ‘Behavioural nutrition and energy balance in the young’. Proceedings of the Nutrition Society 2008; 67(3): 307-16.
- Barquera S, Hernández-Barrera L, Rothenberg SJ, Cifuentes E. The obesogenic environment around elementary schools: food and beverage marketing to children in two Mexican cities. BMC public health 2018; 18(1): 461.
- Swinburn B, Egger G. Preventive strategies against weight gain and obesity. Obesity reviews 2002; 3(4): 289-301.
- Timmermans J, Dijkstra C, Kamphuis C, Huitink M, Van der Zee E, Poelman M. ‘Obesogenic’School Food Environments? An Urban Case Study in The Netherlands. International journal of environmental research and public health 2018; 15(4): 619.
- Fernandes M, Folson G, Aurino E, Gelli A. A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana. Food Security 2017; 9(5): 1073-90.
- Amevinya GS, Laar A. Commercial Food Advertising at the University of Ghana, Legon Campus. World Public Health Nutrition Congress 2020; 31 March to 2 April 2020; Brisbane Convention and Exhibition Centre, Australia. 2020.
- Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity reviews 2008; 9(5): 474-88.
- WHO. Obesity and overweight. 2020. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed April 20, 2020.
- Vaughn AE, Ward DS, Fisher JO, et al. Fundamental constructs in food parenting practices: a content map to guide future research. Nutrition reviews 2016; 74(2): 98-117.
- Pearson N, Biddle SJ. Sedentary behavior and dietary intake in children, adolescents, and adults: a systematic review. American journal of preventive medicine 2011; 41(2): 178-88.
- Pearson N, Biddle SJ, Gorely T. Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public health nutrition 2009; 12(2): 267-83.
- Rickman JC, Bruhn CM, Barrett DM. Nutritional comparison of fresh, frozen, and canned fruits and vegetables II. Vitamin A and carotenoids, vitamin E, minerals and fiber. Journal of the Science of Food and Agriculture 2007; 87(7): 1185-96.
- Van der Horst K, Ferrage A, Rytz A. Involving children in meal preparation. Effects on food intake. Appetite 2014; 79: 18-24.
- Chu YL, Farmer A, Fung C, Kuhle S, Storey KE, Veugelers PJ. Involvement in home meal preparation is associated with food preference and self-efficacy among Canadian children. Public health nutrition 2013; 16(1): 108-12.
- Fertig AR, Loth KA, Trofholz AC, et al. Compared to Pre-prepared Meals, Fully and Partly Home-Cooked Meals in Diverse Families with Young Children Are More Likely to Include Nutritious Ingredients. Journal of the Academy of Nutrition and Dietetics 2019; 119(5): 818-30.
- Mills S, Brown H, Wrieden W, White M, Adams J. Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study. International Journal of Behavioral Nutrition and Physical Activity 2017; 14(1): 109.
- Litterbach E-kV, Campbell KJ, Spence AC. Family meals with young children: an online study of family mealtime characteristics, among Australian families with children aged six months to six years. BMC public health 2017; 17(1): 111.
I think this is a very good thing for many people to consider. Obesity is a serious thing in Africa since we tend to eat a lot of heavy foods. We did a lot of manual works like farming and others so we were ok but now that most people work in offices, there’s a need to start conversations like what you people have. Thanks for drawing our attention to it.
The rate of child obesity in Ghana is on the rise and this information relays the necessary direction for parents and caregivers concerning the dietary habits in children.