Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Efficacy of a smartphone application-based intervention for encouraging children's healthy eating in Denmark.

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

Do children favor snacks and dislike vegetables? Exploring children's food preferences using drawing as a projective technique. A cross-cultural study.

OBJECTIVE: To avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania. METHOD: In total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire. RESULTS: Fruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products. CONCLUSIONS: Children's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

Preadolescents' healthy eating behavior: peeping through the social norms approach.

BACKGROUND: The rising childhood obesity rate is a major public health challenge. The objective of this study is to examine key underlying mechanisms for peer-related social influence on preadolescents' healthy eating behavior by including factors closely linked with the quality of preadolescents' relationship with peers. METHODS: A cross-sectional study was conducted in a convenience sample of 278 Lithuanian preadolescents, recruited from a public school. A questionnaire containing sociodemographic questions, questions about food intake, peer-related social norms of healthy eating, social self-efficacy, vegetable preference, need for peer approval and feeling of belonging were applied. Data was analyzed using structural equation modeling. RESULTS: The results of the SEM showed that social self-efficacy predicts feeling of belonging to the peer group and need for peer approval. Feeling of belonging and need for peer approval predict actual intake of vegetables via injunctive norms of healthy eating. However, neither feeling of belonging nor need for peer approval predicted descriptive norms of healthy eating. Contrary to our expectations, descriptive norms were found to be unrelated with actual intake of vegetables, though vegetable preference predicted actual intake of vegetables. Vegetable preference was not predicted by injunctive or descriptive peers' social norms of healthy eating. CONCLUSIONS: The findings of this study offer insight for informing parents, teachers and for social norms marketing interventions by stressing the importance of social relations when the aim is to encourage healthy eating among preadolescents.

The influence of peers' and siblings' on children's and adolescents' healthy eating behavior. A systematic literature review.

OBJECTIVE: Peers and siblings are considered an important influence on children's and adolescents' food choice. However, there is a lack of studies examining how peer and sibling impact is related to children's and adolescents' eating behavior. The purpose of this study was to analyze peers' and siblings' impact on children's and adolescents' healthy eating behavior identified from a literature review, summarize the results, and discuss potential social factors that may predict these associations. METHOD: A systematic literature review. RESULTS: Findings of the systematic literature review show that peers, and to a lesser extent siblings' influence on children's and adolescents' healthy eating behavior more often is negative than positive, although in some studies, no significant effect was found. However, empirical research of which social factors related to relationships with siblings and peers may explain and predict peers' and siblings' influence on children's and adolescents' healthy eating behavior is limited. CONCLUSIONS: Peers' influence on children's and adolescents' healthy eating behavior is often found to be negative by the increase in consumption of energy-dense and low-nutrition value foods. However, in some cases, this influence can also be a positive one, and there is a need to find effective ways of how it could be used in encouraging healthy eating behavior of children and adolescents. Studies exploring siblings' impact on children's and adolescents' eating behavior are scarce. In addition, factors related to social interaction that may explain peers' and siblings' influence on children's and adolescents' healthy eating behavior are ambiguous. Therefore, more research in this area is needed.

Links of Adolescents Identity Development and Relationship with Peers: A Systematic Literature Review.

OBJECTIVE: According to Erik Erikson, the main task of adolescents is to solve the crisis of identity versus role confusion. Research has shown that a stable and strong sense of identity is associated with better mental health of adolescents. Good relationships with peers are also linked with better emotional and psychological well-being of adolescents. However, there is a lack of reviews of studies in the scientific literature examining the relationship between the adolescents' identity development and relationships with peers. The aims of this article were to analyze links between adolescent identity development and relationships with peers identified from a literature review, summarize the results, and discuss the theoretical factors that may predict these relationships. METHOD: A systematic literature review. RESULTS: Analysis of findings from the systematic literature review revealed that a good relationship with peers is positively related to adolescent identity development, but empirical research in this area is extremely limited. CONCLUSIONS: The links between adolescents' identity development and their relationship with peers are not completely clear. The possible intermediate factors that could determine the relationship between adolescent identity development and their relationships with peers are discussed. Further empirical researches is needed in this area.

OBJECTIF: Selon Erik Erikson, la principale tâche des adolescents consiste à résoudre la crise d'identité versus la confusion des rôles. La recherche a démontré qu'un sentiment d'identité fort et stable est associé à une meilleure santé mentale des adolescents. De bonnes relations avec les pairs sont également liées à un plus grand bien-être émotionnel et psychologique des adolescents. Toutefois, il y a un manque de revues d'études dans la littérature scientifique qui examine la relation entre le développement de l'identité des adolescents et les relations avec les pairs. Cet article visait à analyser les liens entre le développement de l'identité des adolescents et les relations avec les pairs identifiés dans une revue de la littérature, à résumer les résultats, et à discuter des facteurs théoriques qui peuvent prédire ces relations. MÉTHODE: Une revue systématique de la littérature. RÉSULTATS: L'analyse des résultats de la revue systématique de la littérature a révélé qu'une bonne relation avec les pairs est positivement reliée au développement de l'identité de l'adolescent, mais que la recherche empirique dans ce domaine est extrêmement limitée. CONCLUSIONS: Les liens entre le développement de l'identité des adolescents et leurs relations avec les pairs ne sont pas complètement définis. Les facteurs intermédiaires possibles qui pourraient déterminer la relation entre le développement de l'identité des adolescents et leurs relations avec les pairs sont présentés. Il faut plus de recherches empiriques dans ce domaine.