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.

Dutch Preadolescents' Food Consumption at School: Influence of Autonomy, Competence and Parenting Practices.

Eating habits appear to become less healthy once children move into adolescence. Adolescence is characterized by increasing independence and autonomy. Still, parents continue influencing adolescents' eating habits. This cross-sectional study used a Self-Determination Theory perspective to examine how parents can support preadolescents' food-related autonomy and competence and how these factors are associated with healthy eating motivation and food consumption at school. In addition, the effect of relative healthy food availability at home on preadolescents' food consumption at school was explored. In total, 142 Dutch preadolescents (mean age 12.18) and 81 parents completed questionnaires. The results showed that preadolescents perceived themselves as having higher food-related autonomy and lower competence to eat healthily as compared to their parents' perceptions. A path analysis was conducted to test the hypothesized model. Although parental support was positively associated with food-related autonomy, higher food-related autonomy was related to less healthy food intake at school. On the other hand, competence to eat healthily indirectly affected preadolescents' healthy intake ratio through their healthy eating motivation. Finally, the relative availability of healthy options at home was positively associated with preadolescents' healthy intake ratio outside the home. Findings from the study advance the understanding of individual and environmental factors that influence eating habits during the key life period of early adolescence. The results may inform interventions aiming to guide preadolescents to make healthy food choices on their own.

Promoting toddlers' vegetable consumption through interactive reading and puppetry.

Picture books with characters that promote healthy eating are increasingly being used to make this behavior more attractive. The first aim of this study was to investigate whether the effect of vegetable-promoting picture books on toddlers' vegetable consumption differed according to the reading style and the use of a hand puppet during reading. The second aim was to investigate whether these effects were mediated by toddlers' narrative involvement and character imitation. In a 2 (reading style: interactive vs. passive) x 2 (puppet use: with vs. without puppet) between-subjects design, 163 toddlers (2-3 years) were randomly assigned to one of the four reading conditions. The story was about a rabbit that loves to eat carrots. After the fourth reading day, the eating task was conducted in which children could eat freely from four different snacks, including carrots. The main finding was that interactive reading produced the greatest carrot consumption. The explanation for this effect was that interactive reading stimulated toddlers to imitate poses of the book characters, even more when interactive reading was supported by the use of a hand puppet. The findings underline that young children should be actively involved with health interventions in order for them to be effective.

Direct effects of food cues seen during TV viewing on energy intake in young women.

Few studies have examined direct effects of food cues presented within television (TV) programs on eating behavior in adults. This research experimentally determined whether exposure to food cues in TV programs affects energy intake during TV viewing among young women, independently from food cues presented in TV advertisements. The experiment involved a 2 (TV program with or without food cues) by 2 (TV advertisements with or without food cues) between-participants design. While watching TV, participants could freely eat peanut chocolate candies and crisps (potato chips). Participants were 121 young women (mean age = 19.6 years; mean BMI = 22.5). Participants who watched a TV program with food cues tended to have a lower total energy intake and ate significantly less peanut chocolate candies than participants who watched the same TV program without food cues. This effect was particularly pronounced among participants with a higher BMI. Food advertisements did not affect energy intake. Findings may indicate that subtle continuous food cues during TV programs could make young females more aware of their own eating and/or weight, leading to reduced intake of particularly sweet snack foods during TV viewing. Considering the non-significant trend for the effect of the TV program with food cues on total energy intake, findings should be replicated to provide possible tools for prevention campaigns using food cue reminders to watch one's intake.