Healthy eating behaviors in childhood may reduce the risk of adult obesity and heart disease
American Heart Association Scientific Statement:
DALLAS, May 11, 2020 — How children are fed may be just as important as what they are fed, according to a new scientific statement from the American Heart Association, “Caregiver Influences on Eating Behaviors in Young Children,” published today in the Journal of the American Heart Association. The statement is the first from the Association focused on providing evidence-based strategies for parents and caregivers to create a healthy food environment for young children that supports the development of positive eating behaviors and the maintenance of a healthy weight in childhood, thereby reducing the risks of overweight, obesity and cardiovascular disease later in life.
Although many children are born with an innate ability to stop eating when they are full, they are also influenced by the overall emotional atmosphere, including caregiver wishes and demands during mealtimes. If children feel under pressure to eat in response to caregiver wants, it may be harder for them to listen to their individual internal cues that tell them when they are full. Allowing children to choose what and especially how much to eat within an environment composed of healthy options encourages children to develop and eventually take ownership of their decisions about food and may help them develop eating patterns linked to a healthy weight for a lifetime, according to the statement authors. “Parents and caregivers should consider building a positive food environment centered on healthy eating habits, rather than focusing on rigid rules about what and how a child should eat,” said Alexis C. Wood, Ph.D., the writing group chair for the scientific statement and assistant professor at the U.S. Department of Agriculture/Agriculture Research Services Children’s Nutrition Research Center and the department of pediatrics (nutrition section) at Baylor College of Medicine in Houston.
The statement suggests that parents and caregivers should be positive role models by creating an environment that demonstrates and supports healthy food choices, rather than an environment focused on controlling children’s choices or highlighting body weight. Parents and caregivers should encourage children to eat healthy foods by:
Wood noted that some parents and caregivers may find it challenging to allow children to make their own food decisions, especially if the children become reluctant to try new foods and/or become picky eaters. These behaviors are common and considered normal in early childhood, ages 1 to 5 years, as children are learning about the tastes and textures of solid foods. Imposing rigid, authoritarian rules around eating and using tactics such as rewards or punishments may feel like successful tactics in the short term. However, research does not support this approach; rather, it may have long-term, negative consequences. An authoritarian eating environment does not allow a child to develop positive decision-making skills and can reduce their sense of control, which are important developmental processes for children.
In addition, the authoritarian approach has been linked to children being more likely to eat when they are not hungry and eating less healthy foods that are likely higher in calories, which increase the risk of overweight and obesity and/or conditions of disordered eating. On the other hand, an indulgent approach, where a child is allowed to eat whatever they want whenever they want, does not provide enough boundaries for children to develop healthy eating habits. Research has also linked this “laissez-faire” approach to a greater risk of children becoming overweight or having obesity.
Research does suggest that some strategies can increase children’s dietary variety during the early years if they are “picky” or “fussy” about foods. Repeatedly offering children a wide variety of healthy foods increases the likelihood they will accept them, particularly when served with foods they prefer. In addition, caregivers or parents who enthusiastically eat a food may also help a child accept this food. Modeling eating healthy foods – by caregivers, siblings and peers – is a good strategy for helping children to be open to a wider variety of food options. “Children’s eating behaviors are influenced by a lot of people in their lives, so ideally, we want the whole family to demonstrate healthy eating habits,” said Wood.
It is important to note that not all strategies work for all children, and parents and caregivers should not feel undue stress or blame for children’s eating behaviors. “It is very clear that each child is an individual and differs in their tendency to make healthy decisions about food as they grow. This is why it is important to focus on creating an environment that encourages decision-making skills and provides exposure to a variety of healthy, nutritious foods throughout childhood, and not place undue attention on the child’s individual decisions,” concluded Wood.
Caregivers can be a powerful force in helping children develop healthy eating habits, and yet their role is limited by other factors. The statement authors encourage policies that address barriers to implementing the statement’s recommendations within the wider socioeconomic context, including social determinants of health such as socio-economic status, food insecurity and others. While efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the lifespan, they note that they will be most effective as part of a multi-level, multi-component prevention strategy.
The statement was written on behalf of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health; Epidemiology and Prevention; and Cardiovascular Disease in the Young; the Council on Cardiovascular Stroke Nursing; and the Stroke Council. Co-authors are Emma Haycraft, Ph.D. (co-chair); Jacqueline Blissett, Ph.D.; Jeffrey M. Brunstrom, Ph.D.; Susan Carnell, Ph.D.; Myles S. Faith, Ph.D.; Jennifer O. Fisher, Ph.D.; Laura L. Hayman, Ph.D.; Amrik Singh Khalsa, M.D., M.Sc.; Sheryl O. Hughes, Ph.D.; Alison Miller, Ph.D.; Shabnam Momin, Ph.D.; Jean A. Welsh, Ph.D.; and Jessica G. Woo, Ph.D. Author disclosures are in the manuscript.
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
Your zip code can determine your health. What zip code do you live in? What zip code did you grow up in?
Living in segregated neighborhoods may double heart health risks for Black young adults. By Laura Williamson, American Heart Association News
Black people who spent their early adult years in racially segregated neighborhoods were twice as likely to develop coronary artery calcium – a predictor of heart disease – as those who lived in less segregated neighborhoods, new research shows.
The heart health benefits of living in a more integrated neighborhood persisted among Black adults as they aged, even if they later moved to more segregated neighborhoods in midlife, according to the study published Wednesday in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
The findings suggest "where you live from ages 18 to 30 has a stronger impact on cardiovascular health than where you live later in life," said senior study author Kiarri Kershaw, an epidemiologist and associate professor of preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago.
Residential segregation – the physical separation of people of different races into separate housing areas – was fueled by forms of structural racism such as discriminatory housing and lending practices. A growing body of research links structural racism and residential segregation to health disparities. One such disparity is that Black adults in the U.S. are 30% more likely to die from heart disease than their white counterparts, according to the federal Office of Minority Health.
Previous studies have linked neighborhood-level segregation to heart disease risk factors, such as high blood pressure, for Black adults. But most of that research measured segregation's impact at a single point in time. This study looked at how residential segregation affected heart disease risk for Black people from young adulthood through midlife. That risk was assessed using the CAC test, which measures levels of coronary artery calcium in the arteries leading to the heart. CAC scores are considered the strongest predictor of impending heart trouble. Higher scores signal more plaque in the arteries, a condition known as atherosclerosis, which happens as people age but also is influenced by factors such as high cholesterol levels, high blood pressure, cigarette smoking and diabetes.
Researchers analyzed health data for 1,125 Black adults in the Black Coronary Artery Risk Development in Young Adults (CARDIA) investigation, which recruited participants from Chicago; Birmingham, Alabama; Minneapolis; and Oakland, California. Participants were 18 to 30 years old and free of CAC when they enrolled. CAC scores were measured 15, 20 and 25 years following study enrollment. Segregation level was assessed by comparing the racial composition of the neighborhood where they lived to the larger area in which it was located. This was done at the time of enrollment and again 15 years later.
Kershaw and her team found those who lived in neighborhoods with medium to high levels of segregation during early adulthood were twice as likely to later develop CAC as their peers who started out in the least segregated neighborhoods. The researchers attributed the higher risk to an accumulation of heart health risk factors built up over time as a result of spending formative young adult years in neighborhoods with fewer resources for healthy living.
"These environments that are under-resourced shape your health in a variety of ways," Kershaw said. "Getting that early exposure sets you on this path that will build over your lifetime." Racially segregated neighborhoods often have less access to health care, fewer grocery stores providing healthy food options and less access to safe spaces for recreation. They can be more stressful places to live, driving unhealthy coping behaviors such as poor eating habits that in turn increase the risk for heart disease, she said.
Solutions have to address the root cause of the problem, said Dr. Fatima Rodriguez, a cardiologist and health disparities researcher at Stanford University School of Medicine in California. "The real risk factor here is structural racism," she said. "That's what is causing the higher cardiovascular disease risk." The next question for researchers is whether intervening in segregated neighborhoods can reduce heart health risks for the people who live there, said Rodriguez, who co-authored a 2020 advisory from the AHA that identified structural racism as a fundamental cause of the persistent health disparities found in the U.S. Interventions need to go further than "just treating cardiovascular risk factors" in young adults after they've already grown up in poorly resourced neighborhoods, she said. "We have to move much more upstream than that," Rodriguez said. "We need to invest in communities, invest in education, invest in children. These kids are living in neighborhoods with higher social vulnerability, and we need to fix that. We need to give them better access to things like green space and good nutrition so we can make healthy lifestyles the default."
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The Importance of Health Equity
Ever wonder how some of the most remarkable people find their purpose? At the Heart of It with CEO Nancy Brown gives you a look into their thought process and practices on how they manage their own well-being along the way. Dr. Regina Benjamin, the 18th Surgeon General of the United States and a public health expert, talks about the importance of quality healthcare for all and offers her advice and wisdom to help everyone live longer, healthier, happier lives.
At The Heart of It: The Importance of Health Equity
The Urgent Need for Health Equity
For years we’ve been striving to ensure everyone has an optimal, just opportunity to be healthy. But this is not the reality for many people of color and others whose health suffers because of social factors beyond their control. In fact, people in some under-resourced ZIP codes have shorter life expectancies than their neighbors just a few miles away. And people in often-remote rural areas face significantly higher death rates from heart disease and stroke.
COVID-19 has illuminated these unacceptable health disparities and worsened the problems. The pandemic and economic hardships have disproportionately harmed the health of Black, Latino and Native American people. That’s why our 2024 Impact Goal affirms our focus on identifying and removing barriers to health equity.
Read more about our work related to COVID-19 and health equity.
Structural racism is a driver of health disparities, report declares.
The nation's history of structural racism must be acknowledged as a driver of health problems and shortened lives for Black people and other racial and ethnic groups, says an American Heart Association report that seeks to spark action to fix the problem. "Structural racism has been and remains a fundamental cause of persistent health disparities in the United States," declares the presidential advisory published Tuesday in the AHA's journal Circulation. It offers a summary of the historical context of structural discrimination, connects it to current health disparities and looks for ways to dismantle or mitigate its continuing effects. Read more about the presidential advisory.
Reclaim Your Rhythm this Black History Month
This February, during Black History Month, the American Heart Association is encouraging Black women to Reclaim Your Rhythm and take control of their mental and physical well-being. Like taking a familiar song and adding, removing or changing pieces of it, Black women have been empowered with greater knowledge and determination to heal and protect their physical and mental health and wellbeing. In recognition of the physical and emotional toll the global pandemic and structural racism has taken on Black women, AHA will help empower Black women to bring to light their overall mental and physical well-being by using and uplifting their voices and sounds. Reclaim Your Rhythm will also use music to get their hearts pumping, or to rest or relax. Music means so many things to different people across the country. Your favorite playlist can change the trajectory of your day. In recognition of Black History Month, we have invited some of our favorite folks to share the songs by Black artists to get you moving alone or with others, or to help you rest and relax. We’ve also asked them to share their thoughts on the importance of taking care of their heart health and mental well-being.
Whose playlist inspires you? View our Reclaim Your Rhythm #BlackHistoryMonth initiative
The American Heart Association’s signature women’s initiative, Go Red for Women, is a comprehensive platform designed to increase women’s heart health awareness and serve as a catalyst for change to improve the lives of women globally.
It’s no longer just about wearing red; it’s no longer just about sharing heart health facts. It’s about all women making a commitment to stand together with Go Red and taking charge of their own heart health as well as the health of those they can’t bear to live without. Making a commitment to your health isn’t something you have to do alone either, so grab a friend or a family member and Go Red today.
Most heart disease and stroke deaths are preventable, cardiovascular diseases continue to be a woman’s greatest health threat.
Heart disease risk rises for everyone as they age, but for women symptoms can become more evident after the onset of menopause.
Menopause does not cause cardiovascular diseases. However, certain risk factors increase around the time of menopause and a high-fat diet, smoking or other unhealthy habits begun earlier in life can also take a toll, said Dr. Nieca Goldberg, a cardiologist and an American Heart Association volunteer. “Menopause isn’t a disease. It’s a natural phase of a woman’s life cycle,” Dr. Goldberg said. “It’s important for women, as they approach menopause, to really take stock of their health. ”On average, the onset of menopause, when menstrual periods permanently stop, occurs around age 54, said Dr. Goldberg, medical director of the Joan H. Tisch Center for Women’s Health at New York University Langone Medical Center. More than one in three female adults has some form of cardiovascular disease. An overall increase in heart attacks among women is seen about 10 years after menopause. Heart disease is the leading killer of women(link opens in new window).Learn how estrogen and hormone therapy and menopause..
Strive for Heart Health. If you’ve followed a healthy lifestyle and continue doing so at menopause, your risk for heart disease and stroke is lower. Family history also contributes to your risk. Women should take care of their heart through regular exercise and good nutrition and by eliminating unhealthy habits like smoking, which may contribute to early menopause, increase the risk of blood clots, decrease the flexibility of arteries and lower the levels of HDL cholesterol, Dr. Goldberg said.
To get the nutrients you need, the American Heart Association recommends eating a dietary pattern that emphasizes:
“You have to get over that,” she said, adding: “Do the activity that works for you.”
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.