Nutritional Know-It-All: Feeding a Family

Mercedes Seidel
Abstract
In this review, I examined the relationship between nutrition and the family. I
explored barriers to healthy lifestyle choices, social factors to nutrition decisions such
as marketing, family influences such as eating together at the table, and the outcomes
of the children involved. I found significant relationships between social factors, family
influences, and barriers to eating and the diet of a family. I also found that there is no
easy answer when it comes to eating well in a family unit, and there are many factors
that influence decisions. It is not easy to separate each factor and prove sole causation
of behaviors and decisions. Though significant findings are available, there are
limitations to the current methods utilized in nutrition-related studies.
Introduction
Healthy eating has become a hot topic in todays society, and is often portrayed
as being obvious and oversimplified. As professionals in the field begin to speak up, it is
becoming better known that a balanced diet is not as easy to obtain as is commonly
thought, especially in families. Families vary greatly in many ways, including income,
education, work schedules, school schedules, ethnicity, location, age, activity level, and
peer groups, to list a few. This variance often leads to different dietary habits. Many of
these factors provide barriers to healthy eating within the home. Other outside forces
affect eating behaviors in the family. Marketing has been proven to have a large effect
on eating behaviors, and the rise of convenience foods provides alternatives that are

bound to be utilized. (Goris et al. 2010, Powell et al. 2007) These many factors can
affect the eating habits of families, which is shown to be an important aspect of a childs
dietary well-being. There are many outcome possibilities for children, and there are
many interrelated factors that have been shown to have significant effects on potential
health or nutrition related outcomes.
In this literature review, I will cover barriers to healthy lifestyle choices, along with
family and social influences like marketing on dietary or lifestyle decisions. I will also
analyze the role of family factors in behavior outcomes and decisions, before analyzing
the possible outcomes of the children in a family due to all of the aforementioned
factors. These topics were chosen in an effort to analyze the selection factors, or
reasons families make certain dietary decisions, before analyzing influences on
behavior and decisions, leading to certain outcomes. It is an effort to examine the
dietary choices of a family from start to finish.
Barriers
Ethnicity
There are many reasons a family might not be consuming a proper, balanced
diet. One possible barrier is race and ethnic food options. (Devine et al. 1999) One
study looked into the relationship between ethnic background and food choices. A large
determinant in this study was life course change, or major changes in a family or
individuals trajectory, which proved to have a significant impact on nutritional choices
across all groups. They found that many factors influence dietary choices, and ethnicity
is one of them. A recurring theme in this article is best illustrated by a quote; The

extensiveness of interactions between factors reveals that it is difficult to untangle the

influence of any one factor from another (Devine et al. 1999, p.88). This study came to
the conclusion that ethnicity is a factor in food choices, but assessing it by itself is not
appropriate for making concrete conclusions. Decisions were found to be highly
dependent on many outside factors such as location, time, class, etc. (Devine et al.
1999)
Socioeconomic Status
A study that was done to examine the effects of low-wage working parents work
life on the overall dietary habits found some interesting results. Coping mechanisms of
the busy, stressed parents were to supply the family with fast, premade meals and to
handle some of the stress in their lives with food. Along with these coping mechanisms
came a decrease in the value of family eating traditions. The conclusions of this study
have large implications in the understanding the barriers busy, low-income families have
to overcome to eat healthy. (Devine et al. 2007) Socioeconomic status was found to
have a strong relationship to dietary choices for many reasons, beyond lacking the
money to buy balanced ingredients. Many times foods are chosen not by preference,
but by the level of convenience or comfort it provides.
Familial Preferences
A factor that can provide a barrier to fruit and vegetable consumption in families
is the preferences of parents and food availability. A Gross et al. (2010) study found an
increase in fruit and vegetable consumption in children with parents who had a wider
variety of food preferences. Exposure to these factors and the perception that parents

want their children to consume more fruits and vegetables also played a role. Children
often have specific individual preferences that play a role in intake, and shopping for
those preferred foods with the parents showed an increase in consumption as well. An
interesting finding that may have implications for low-income and/or busy families is that
an increase in fruit and vegetable consumption was shown in children who ate school
lunches when compared to those that didnt. This study came to the conclusion that
Combining both nutrition science and family science should result in improving the
likelihood that elementary school students from limited-resource family and community
environments will increase their FV [Fruit and Vegetable] consumption and decrease
their risk of detrimental health outcomes. (Gross et al. 2007, p.240)
Social Factors
Deterrents of Healthy outcomes
Many times families with the best intentions run into difficulties in food choices
when marketing and location of convenience foods are considered. In a society that
values capitalism and is very responsive to marketing or advertising, it can be very
difficult for a family to make nutritional decisions that dont agree with advertised ideals.
In a comparison of children in six countries, the United States had the highest exposure
to TV food advertising at 199 minutes per day (Powell et al. 2007). Findings that a child
has potential to be exposed to over two and a half hours of TV food advertising each
day, has great potential to skew ideals. A strong relationship was found between obesity
and exposure to TV food advertising among children. Two scenarios were compared,
one based on literature and one on expert opinions. The literature based Bolton
scenario, found that 25% of obesity and overweight BMI findings for US boys and 26%

of obesity and overweight findings for US girls can be attributed to TV food advertising.
The expert opinion based scenario, labeled the Delphi scenario, estimated that 66% of
US childrens overweight and obesity could be attributed to TV food advertising. (Goris
et al. 2010, p.1009) These numbers were gathered with 95% confidence. (See Figure 1
for actual data.) Parents have their work cut out for them in regards to feeding their
families when the evidence shows that TV advertising has such a significant impact on
a familys nutritional status.
Figure 1

In order to combat the effects of marketing on children, and the family as a

whole, it is suggested that parents improve their critical thinking skills when it comes to

the media. This study found that parental critical thinking in regards to media is a
predictor of successful implementation of healthy dietary practices and behaviors, along
with information efficacy. This means that improvement is not only shown in regards to
diet, but also in the way that the parents find and process information. Information
efficacy also contributed independently to successful implementation of healthy dietary
practices. Another significant finding was that critical thinking in regards to media altered
family receptiveness, and this also predicted successful implementation of healthy
dietary practices. (Austin et al. 2015, p.1263) The relationships are shown below in
Figure 2.

Figure 2
Incentives for Healthy outcomes
Inasmuch as food advertising can be detrimental to family and childrens health,
it can also be a helpful tool in teaching children healthy behaviors if framed the right
way. It is an emerging research area, and its underdevelopment was shown through
programs such as 5-4-3-2-1 Go!. This program did not find statistically significant

relationships through promoting five servings of fruits and vegetables, four servings of
water, three servings of dairy, less than two hours of screen time, and at least one hour
of activity each day (Evans et al. 2007; Evans et al. 2011). The lack of significant
findings from this study can be inspected and used to improve upon techniques for
gaining interest in healthy lifestyle habits. An example of a program that did show
statistically significant results was the Child and Adolescent Trial for Cardiovascular
Health, or CATCH. Overall fat intake decreased, physical activity in PE class during the
trial increased, and daily energy intake from fat decreased, as reported by the students.
More daily vigorous activity was shown as a result of the trial as well (Leupker et al.
1996). These results were found after changes in the school food service, physical
education, and health curricula in the classroom were implemented. There was also an
added component of family education.
Family Influence on Eating Behaviors
Studies have shown that one of the biggest influences on childrens eating habits
are the choices and behaviors presented by the parents. This knowledge is important in
understanding how to assist children with making healthy decisions throughout their
lives. Exposing young children to good behaviors is known to be helpful. It is logical that
demonstrating proper interactions with food, in ways such as sitting down together as a
family for meals, would be important in the learning process. Teaching young ones the
values of portion control and balanced eating is something that could be taught from
family members and modeling the desired behavior on a consistent basis. This ties into
the previously mentioned effects of familial preferences. As mentioned above,
preference of parents can affect the behaviors of children. Consistent modeling of

healthy behaviors also affects choices and behavior. Seeing consistently positive
interactions with food and others in the presence of food is just as important as having
exposure to the right foods.
A study by Larson et al. (2013) found that some limitations in eating family meals
together were associated with gender, grade in school, race/ethnicity, family structure,
and socioeconomic status. After adjusting for these limits and physical activity, there
was a strong relationship found between dietary habits and eating meals together.
Participation in more frequent family breakfast meals was associated with several
markers of better diet quality and lower risk for overweight/obesity. (Larson et al. 2013,
p.1606) Results found that eating together as little as one to two times per week
showed statistical differences when compared to not eating together as a family at all.
Benefits were also shown for coming together for meals such as breakfast when dinner
together was not a possibility.
Different studies are interested in finding the relationship between family meals
and positive outcomes. Some studies are interested specifically in the childs health or
dietary habits, while some are interested in outcomes such as substance abuse, overall
well-being, violence, or a number of other possibilities. The overriding theme in these
studies is that eating family meals together provides positive outcomes across most
spectrums.
Outcomes
Children have the potential to follow many life course trajectories, which leaves
potential for many different outcomes. The ideal outcome is that children grow up to be

healthy mentally, physically, and emotionally. The focus of this paper is the nutritional
health of the children, and there are many different ideas on how to reach the proposed
outcomes. Many professionals in the field feel that a combination of techniques is the
preferred route.
Vos et al.s (2012) study measured body mass index outcomes of children
exposed to multidisciplinary cognitive behavioral treatment. Another measure was
quality of life. The childrens self-report after 12 months showed an increase in healthrelated, physical, and emotional quality of life. The parents report after 12 months
showed increases in health-related quality of life, and [independent] quality of life.
Though there were slight discrepancies between the childs and parents reported
quality of life, the general findings were that BMI, or body mass index, and health
related quality of life improved at the three and twelve month measurements (Vos et al.
2012).
Diet and emotional or mental health are interconnected. Stress or emotional
distress are causally associated with poor dietary habits, and the reciprocal causal
relationship is also important to understand. Implications of dietary disparities can be
very important to the understanding of familial relationships and satisfaction. It is
suggested that family therapists should thrive to have a basic knowledge of nutrition and
inquire into the dietary habits of their clients. Another possibility is that nutrition
professionals and therapists have open communication and utilize a team treatment
approach. The strong link between dietary quality and emotional or mental health is
something that should be explored and utilized in order to more effectively counsel a
family unit. An article by Todd Edwards (2002) states that along with the reasons listed

above, exploration of diet and nutrition could strengthen a therapists integrative

assessment that already includes questions about use of alcohol, prescription
medication, illicit drug use, cigarette use, and sleep. (Edwards 2002, p.248) There are
many possible outcomes for a family and the children that are a part of it, but this article
makes a logical argument that proper nutrition integrated conseling could be a strong
predictor of positive outcomes.
Study Improvement/Questions for Future Research
There were some limitations to the research in this field. One of the major
limitations is the data collection method of self-reporting. It is not an ideal method
initially, and the accuracy declines with the reports of children. The comparisons
between a child and parents reports also leaves some concern for the accuracy of the
research. Another limitation in these studies is the lack of international comparison.
Though some studies do incorporate this, it could be expanded upon to prove causation
based on nutrition factors instead of geographical factors. This transitions into another
major concern in this research. Are the effects of nutrition due to nutrient consumption
or social, emotional, or psychological factors? The last insufficiency I found while
researching is that there are very few long term longitudinal studies for children or
families. This is worrisome in that we know the results for the short term, but do they
apply later on in the childs life?
Conclusion
The goal of many nutrition professionals or those in related fields is to decrease
maladaptive behavior through education in order to convey that there is much more that

influences dietary behavior. There are many barriers that individuals must overcome,
and this is especially prevalent in families. Some of these barriers include race,
ethnicity, socioeconomic status, and the individual preferences to consume or not
consume certain foods. There are many barriers to healthy eating, but these are some
that are presented in this discussion. Another factor that greatly affects nutritional
choices is marketing. Nonideal foods are marketed at alarming rates, especially to
children. This can make decisions related to food very difficult in a family setting, due to
the influence of marketing. On the flip side, healthy foods can be marketed to children
and families, and may help with education and behavior change. There are healthy food
marketing programs that have been proven effective (Leupker et al. 1996), and some
that were less effective (Evans et al. 2011).
Another factor to healthy eating is how the family interacts with food. Children
often learn habits from their parents, so seeing good behavior modeled from a young
age can be helpful in creating healthy outcomes. Eating together as a family has shown
a positive relationship with healthy outcomes for children and families (Larson et al.
1996). Cognitive behavioral treatments have shown to have positive outcomes such as
reasonable body mass index findings and positive self-reported quality of life measures.
Similar results are proposed for nutrition integrated family therapy, an emerging concept
(Edwards 2002). Overall, the findings of this research are that nutrition is a very
complex process, and in order to improve the frequency of positive outcomes, many
things must be considered and integrated.

References

Austin, Erica W., Bruce E. Pinkleton, Marie Radanielina-Hita and Weina Ran. 2015.
"The Role of Parents Critical Thinking about Media in Shaping Expectancies,
Efficacy and Nutrition Behaviors for Families." Health Communication 30(12):12561268 (http://search.proquest.com/docview/1724445431?accountid=28148). doi:
http://dx.doi.org/10.1080/10410236.2014.930550.
Devine, C. M., Jastran, M., Jabs, J., Wethington, E., Farell, T. J., & Bisogni, C. A.
(2006). "A lot of sacrifices": Work-family spillover and the food choice coping
strategies of low-wage employed parents. Social Science & Medicine, 63(10), 25912603. doi:http://dx.doi.org/10.1016/j.socscimed.2006.06.029
Devine, Carol M., Jeffery Sobal, Carole A. Bisogni and Margaret Connors. 1999. "Food
Choices in Three Ethnic Groups: Interactions of Ideals, Identities, and
Roles." Journal of Nutrition Education 31(2):86-93
(http://search.proquest.com/docview/622092439?accountid=28148). doi:
http://dx.doi.org/10.1016/S0022-3182(99)70400-0.
Edwards, T. M. (2002). A place at the table: Integrating diet and nutrition into family
therapy practice. American Journal of Family Therapy, 30(3), 243-255.
doi:http://dx.doi.org/10.1080/019261802753577566
Evans, W. D., Katherine K. Christoffel, Jonathan Necheles, Adam B. Becker and Jeremy
Snider. 2011. "Outcomes of the 5-4-3-2-1 Go! Childhood Obesity Community
Trial." American Journal of Health Behavior 35(2):189-198
(http://search.proquest.com/docview/905212567?accountid=28148). doi:
http://dx.doi.org/10.5993/AJHB.35.2.6.

Evans, W. D., Necheles, J., Longjohn, M., & Christoffel, K. K. (2007). The 5-4-3-2-1 go!
intervention: Social marketing strategies for nutrition. Journal of Nutrition
Education and Behavior, 39(2), S55-S59.
doi:http://dx.doi.org/10.1016/j.jneb.2006.08.024
Goris, J. M., Petersen, S., Stamatakis, E., & Veerman, J. L. (2010). Television food
advertising and the prevalence of childhood overweight and obesity: A multicountry
comparison. Public Health Nutrition, 13, 10031012.
doi:10.1017/S1368980009992850
Gross, Susan M., Elizabeth D. Pollock and Bonnie Braun. 2010. "Family Influence: Key
to Fruit and Vegetable Consumption among Fourth- and Fifth-Grade
Students." Journal of Nutrition Education and Behavior42(4):235-241
(http://search.proquest.com/docview/754034909?accountid=28148). doi:
http://dx.doi.org/10.1016/j.jneb.2009.05.007.
Larson, Nicole et al. 2013. Eating Breakfast And Dinner Together as a Family:
Associations with Sociodemographic Characteristics and Implications for Diet
Quality and Weight Status. Journal of the Academy of Nutrition and Dietetics
113(12):16019. Retrieved April 18, 2016
(http://www.sciencedirect.com/science/article/pii/s221226721301335x).
Luepker, Rv et al. 1996. Outcomes Of a Field Trial to Improve Children's Dietary
Patterns and Physical Activity: the Child and Adolescent Trial for Cardiovascular
Health (CATCH). The Journal of Pediatrics 129(3):47273. Retrieved April 15,
2016 (http://ac.els-cdn.com/s0022347696700914/1-s2.0-s0022347696700914-

main.pdf?_tid=9dbdcc2a-0bce-11e6-91e000000aab0f26&acdnat=1461689451_21dfe43131a7d6297b2ec431623d4231).
Powell, Lisa M., Glen Szczypka, and Frank J. Chaloupka. 2007. Exposure To Food
Advertising on Television Among US Children. Arch Pediatr Adolesc Med
Archives of Pediatrics & Adolescent Medicine 161(6):553. Retrieved April 21,
2016 (http://archpedi.jamanetwork.com/article.aspx?articleid=570536).
Vos, R. C., Huisman, S. D., Houdijk, E. C. A. M., Pijl, H., & Wit, J. M. (2012). The effect
of family-based multidisciplinary cognitive behavioral treatment on health-related
quality of life in childhood obesity. Quality of Life Research: An International Journal
of Quality of Life Aspects of Treatment, Care & Rehabilitation, 21(9), 1587-1594.
doi:http://dx.doi.org/10.1007/s11136-011-0079-1

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