Sunday, April 12, 2015

Good food, bad food and calorie counting? What kids really need to learn.

Nutrition education in schools worries me. My sentiments have been echoed
on the Academy for Eating Disorders list serve and among peers from SCAN--the Academy for Nutrition and Dietetics (AND) subgroup populated by progressive thinkers.
A very different path.

To change the direction of how kids are being taught, I've written this piece. Share this locally, in your schools, and virtually. Use it, and use it fully, including my name, please. Thanks for spreading the word and working for change.

Good food, bad food and calorie counting? What kids really need to learn.

By Lori Lieberman, RD, MPH, CDE, LDN

In an attempt to tackle the “obesity epidemic” kids, educators and parents often receive well-intentioned but potentially harmful messages to manage eating. (1)Calorie-counting apps and black and white messages about what’s healthy to eat can be problematic. Kids, parents and educators need practical, realistic strategies to add to their toolbox. Help kids learn to self-regulate their food intake utilizing current knowledge on eating behaviors and the food environment and know the damage of deprivation-based diet approaches.

One size does not fit all!

We are educating the masses—kids of all sizes and weights, including those who are sedentary and those with very high needs given their size, needs for growth and for sports—and kids with personality traits who tend to be very literal, anxious or perfectionistic. Consequentially, food messages should be presented to serve all without harm.

Good food/bad food

Nutrition messages need to shift from the ineffective ‘good’ versus ‘bad’ nutrients and foods, to factors that impact the ability to self-regulate intake. Directing individuals to restrict their fat intake can backfire. (2) Labeling sugar as ‘bad’ and setting calorie budgets fails to control weight in long term. (3) Evidence shows that perceiving a scarcity of food and deprivation from restrained eating creates greater problems (4) and contributes to eating disorder development. (5)

Calorie counting 

Calorie counting is ineffective in the long run and conflicts with utilizing hunger and fullness—essential for managing energy balance. It fails to teach kids about major obstacles to changing eating—eating behaviors and environment. Counting calories has little positive impact on improving eating habits and weight. (3,6,7)In one study kids who began dieting had a significantly higher likelihood of developing a serious eating disorder. (5)


Portions are also not one-size fits all. Current materials (1) refer to appropriate snack sizes but for underweight kids, competitive athletes, and those simply with higher needs, these may be inadequate. Many teens require more than the current campaign’s recommended single serving of most snacks and greater than the 100 calories encouraged as ‘moderate’.

Sit, structure, separate, sense

Let’s shift the focus to what works—a mindfulness approach addressing simple, achievable eating behaviors. (8,9)

Address these key behaviors to improve intake and portioning of food, applicable to all children and adults.
  • Sit in the kitchen or designated eating space, at a table or counter when eating.
  • Structure the day to include 3 balanced meals and snacks. Include an early breakfast and be prepared—keep snacks available and give kids a chance to eat when they need to. Encourage delaying not forbidding ‘seconds’, allowing time to sense fullness. Allow eating later when hunger is present.
  • Separate eating from distractions, like TV, phone, homework, computer; distracted eating increases intake. Separate food from sight; keep food off the counters to prevent triggering eating.
    • Separate food from its package! 
    • Plate it.
  • Use your senses
    • See, smell, feel, hear and taste your food—whether it’s a cookie or cantaloupe. You’ll be more satisfied when you really pay attention to and enjoy what you’re eating.

Encourage positive additions and messages to support a healthy diet.

  • Include 3 or more cups of milk, yogurt or milk alternative (such as soy milk) for protein, calcium and vitamin D.
  • Choose fruit frequently. 
    • Select from fresh, frozen, canned in juice. Don’t forget dried fruit—a convenient, satisfying, nutrient and fiber rich snack.
  • Vary the Vegetables: shred them, steam them, sauté them, dip them, puree them into soups or smoothies. 
    • Get them in all colors. Include more than a cup a day.
  • Get real! Choose more foods that are processed less, including nuts and seeds, beans, whole grains and fresh fish/meats.

Let’s spread a sensible, more sensitive message to promote health among school age kids of various sizes and needs. Advocate for diversity of foods to normalize intake for a diet rich in nutrients and adequate in calories. Let’s focus on learning to encourage portions that fit the individual’s needs by integrating both mindfulness and environmental strategies. And let’s accept that normal eating includes having foods at times simply because they taste good.


2. Wansink, Brian, and Pierre Chandon. Can “low-fat” nutrition labels lead to obesity? .Journal of marketing research 43.4 (2006): 605-617.
3. Lowe MR, Doshi SD, Katterman SN, Feig EH. Dieting and restrained eating as prospective predictors of weight gain. Frontiers in Psychology 2013;4:577.
4. Mullainathan, S, Shafir, E. Scarcity.New York::Times Books, 20135. Lowe, M. R., Thomas, J. G., Safer, D. L. and Butryn, M. L. (2007), The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa. Int. J. Eat. Disord., 40: 640–644. doi: 10.1002/eat.204056.
6. Downs, Julie S., et al. "Supplementing menu labeling with calorie recommendations to test for facilitation effects." American journal of public health 103.9 (2013): 1604-1609.
7. Ely, Alice V., et al. "Differential reward response to palatable food cues in past and current dieters: A fMRI study." Obesity 22.5 (2014): E38-E45.
8. Beshara, Monica, Amanda D.Hutchinson, and Carlene Wilson. "Does mindfulness matter? Everyday mindfulness, mindful eating and self-reported serving size of energy dense foods among a sample of South Australian adults." Appetite 67 (2013): 25-29
9.  Supporting Intuitive eating section, Linda Bacon


  1. I agree with almost everything you say, but one thought: I think talking about choosing fruits/veggies/"real" food you still send the message that those are the "good" foods and the others are therefore "Bad." I think that messages still can lead to the diet mentality. I think you can only do things like focus on "Real" food if you TRULY reject the diet mentality first. What do you think?

    1. Thanks for your insightful comment, Laura! Yes, there is this danger, and I did think long and hard about how to best nuance this. One can take any message to an extreme, or read between the lines. "Choose more foods that are less processed" certainly sends a message that less processed foods may be healthy additions--they generally are--but that is not to conclude that processed foods are to be avoided. Clearly it's about balance. A diet which is very high in fruits and vegetables but excludes more calorie dense foods would hardly be a healthy way of eating, for instance. I think we're on the same page, but my encouragement of individual food categories must be accepted simply as what it is--a means of including a range of nutrient rich foods that helps create a balanced diet.

    2. Totally agree. It's as if we need to first screen for temperament and personality style, group kids according to those results, and then deliver a temperament/personality-specific nutrition education class.

      I think if I had to design a one-size-fits-all curriculum for nutrition education, I'd stay away from any facts like choose fruit/veggie/"real" food more often than not, and I think I'd focus on learning to identify what you truly crave, taking care of emotional needs, honoring hunger, respecting fullness - intuitive eating stuff.

  2. Honestly, I do believe messages that promote physical health (including inclusion of nutrient rich foods to meet adequacy) also need to be included but in an appropriate manner. Especially given all the nutrition misinformation that's out there. But I absolutely see where you're coming from.

  3. It drives me INSANE that schools and other non-parental agencies are trying to control what kids are eating and drinking. It is the parents responsibility, not anyone elses. When I was in school, we all brought cupcakes on our birthdays, not anymore. Not allowed. I can understand the allergy aspect, but not the obesity one. I don't think it's so much about food intake, but more about activity level. I ate crap growing up. I brought cupcakes, chips, candy bars, etc to school to have as snacks with my lunch. My mom always prepared healthy/balanced dinners for us every night. I drank soda. Had to have milk with dinner. Was never told I couldn't have something because it was "bad" for me. If I showed up with that lunch today, it would probably be frowned upon. I did not have a weight issue. I was outside everyday after school, running around and playing. When I got to the age where I could play sports, I was doing that. I think it's all about activity. Kids these days aren't going outside and playing, they're playing with their electronics and gadgets. It drives me crazy that people blame food all of the time on obesity. I blame lack of activity. Sorry, that's my rant. It bugs me so much and I could go on forever.