Friday, February 21, 2014

Will Eating More Fruit Reduce Childhood Obesity?

sharma-obesity-fruitDon’t get me wrong – I am all about fruit. I have no problem eating 5-10 servings of fruit and veggies each day and could probably eat more.

So, if we could only get all kids to eat more fruit, I say, “Go for it” – even if it does absolutely nothing for their weight.

In fact, I believe that fruit and veggies are so good for us, that even if our kids ended up gaining a few extra pounds from all the good stuff, they’d still be better off than before.

Unfortunately, apart from there not being a shred of evidence from any intervention study that I know of, showing that getting kids to eat more fruit and veggies will do much in terms of reducing their likelihood of packing on the pounds, I am not even sure we have a proven strategy that will actually get them eating more fruit in the first place (anecdotal stories aside).

Thus, I was not all that surprised by the findings of Michael Bourke and colleagues from the University of Manchester’s Institute of Public Health, published in the Journal of Epidemiology and Public Health, showing that getting kids to eat more fruit is far more difficult than one might think.

Their systematic review of literature of interventions to increase fruit and/or vegetable consumption in overweight or obese children and adolescents revealed a total of five studies describing seven interventions all of which used family-focused approaches to increase daily fruit and vegetable consumption.

Only one intervention reported a lasting statistically significant increased consumption of fruit and vegetables – the key word here being “statistically” – whether or not this change was “clinically” relevant remains debatable.

Given these rather sobering findings, the authors wisely conclude that,

“Successful public health interventions tackling childhood obesity will need to take a holistic approach and target behaviour change in multiple aspects of children’s lifestyles and their surroundings, including nutritional education, parental support and physical activity.”

That said, I would question the wisdom of why anyone would consider targeting fruits and veggies as a way to reduce childhood obesity in the first place.

If fruits and veggies are good for you, then all kids should be eating more of them – I am certainly not aware of any data suggesting that overweight and obese kids are specifically “undereating” fruits and veggies. If I am informed correctly, skinny kids are also largely failing to meet the recommended number of servings.

I am also not aware of any studies that conclusively show that lack of fruit and veggies is a major cause of childhood obesity.

Finally, I have yet to see any evidence that getting overweight kids to eat more fruit and veggies will actually do anything for their weight. In fact, given that we now know how difficult it is to get kids to eat more fruit and veggies, I doubt if we’ll ever see a study proving this point one way or another.

But if we agree that more fruit and veggies are good for kids, I see no reason to focus this question on overweight and obese kids in the first place.

In fact, by doing so, we are implying that there is something specifically wrong with the amount of fruit and veggies eaten by overweight kids – compared to normal weight kids.

This kind of framing is what puts the “blame” squarely on the overweight kids (or more likely on their parents) – thus propagating the “lifestyle choice” notion of obesity causation.

Thus, while I understand that it is far easier to get research funding and perhaps papers accepted in journals when the issue can be framed in the context of “obesity” than in more general terms, we should not forget that the more general terms are the actual problem.

Eating too few fruit and veggies is not an obesity problem or an issue in any way specific to obese kids. Framing research on fruit and veggies as a potential solution to this problem is both misleading and stigmatizing.

Are our kids eating enough fruit and veggies? Probably not.

Is there an easy way to change this? If yes, we have yet to find it.

Has any of this anything to do with reducing childhood obesity? I sincerely doubt it.

@DrSharma
Edmonton, AB

ResearchBlogging.orgBourke M, Whittaker PJ, & Verma A (2014). Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review. Journal of epidemiology and community health PMID: 24436339

 

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7 Responses to “Will Eating More Fruit Reduce Childhood Obesity?”

  1. Erik Hemmingsson says:

    Hi Arya
    Well said about when science increases obesity stereotypes. When researchers talk about diet and exercise as the core solutions to the epidemic, they are in fact adding further woe to the obese by indirectly suggesting that they are lazy and self-indulgent. This needs to stop.

    Sincerely,

    Erik Hemmingsson
    Karolinska Institutet, Stockholm

  2. Casey says:

    I find it surprising considering the work of Dr. Rolls and energy density: http://ajcn.nutrition.org/content/91/5/1237.full

  3. C says:

    Excellent post. I hope lots of researchers read and take to heart your excellent explanation of the harms associated with targeting these interventions based on weight. Thank you so much for this.

  4. Gabriella Kadar says:

    If the kids need intervention, then possibly the parents aren’t eating fruit and veg either. When kids are given no alternative but fruit as snacks, then that’s what they eat. Or they eat nothing. That’s what I did with my kids. They certainly did not starve to death because the only thing available between meals was fruit.

    Fruit costs more than junkfood on a calorie by calorie basis. That’s probably the biggest problem.

    This all sounds like getting kids to read when parents don’t read. Why would kids read if there are no books or magazines or newspapers in the house and the parents never read? Why would kids bother to get information or entertainment from the written word if the parents don’t?

  5. Louisa says:

    Our family rule was that fruit had to be eaten before any “treat.” My husband and I have always been challenged by ongoing weight issues but, happily, this has not been an issue for our three (now adult) children. Interestingly, our children have all adopted the same strategy with our grandchildren. Even those with the sweetest of “sweet tooths” have avoided weight issues.

  6. Janet Karasz says:

    Root cause analysis!

    For a delightful way to tempt the fussy eater, http://instagram.com/leesamantha

  7. RG says:

    I can’t tell how seriously you mean this. I agree that a serving of raw apple does not equal a slice of apple pie, weight wise, much less a bowl of lentils vs a bag of potato chips. Nonetheless, in my personal experience, I do better at weight maintenance/ loss when I buy my favorite fruits and veg, prep and eat them. ditto with exercising and keeping a simple food log. Obviously its possible to write a food log and ignore the trend, and I have done it. still, its a useful tool. Is it really true that there is no correlation between obesity and food choice?

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