The entire crowd at the middle school basketball game cheered, and my heart sank. They were in fact cheering for me, but this was the most embarrassing moment I can remember. I was 8, and I wasn’t a part of the basketball game.
No, I was just hanging out with my friends, Noah and Brandon. For 8 year old Chris, basketball games were about asking my parents for money and then employing advanced mathematical modeling to optimize the amount of candy I could purchase at the concession stand with my limited fiscal resources.
Airheads. The answer was always Airheads. In case you don’t remember, Airheads are a taffy like substance shaped like a small shoehorn. The most popular flavor was white mystery, which tasted like a combination of cherry, strawberry, and self-loathing. They were 10 cents. While my dollar could buy 1.33 candy bars or two bags of popcorn, it could buy 10 airheads.
Why does this matter? Well, eating healthy isn’t simple, even as a kid. In this story, food served as entertainment for me, respite for my parents, structure for social activities, and was influenced by intensive marketing campaigns toward children. Don’t believe me? Go to the Airheads website – Holy Crap!
A study of 4,987 children found that child behavior around food had already begun to lead to high rates of both underweight and overweight kids by age four.
Why are we talking about diet anyway? This is a site about emotional and behavioral health, not weight loss. Well it turns out healthy eating is pretty important for your mental health. A systematic review of 12 epidemiologic studies, completed by O’Neil and colleagues, revealed a strong relationship between diet and mental health. Collectively, these studies included 82,779 participants and showed unhealthy dietary patterns were consistently associated with poor mental health outcomes, and high quality diets were associated with better mental health.
Of those twelve studies, Dr. Jacka and colleagues published one of the strongest. Unlike most of the other studies in the review that only looked backward at the association between diet and mental health, this one looked forward. They measured the diets and mental health of 3,040 adolescents and then measured those same things again a year later. The study found that diet quality was associated with mental health in a dose-dependent manner, meaning a diet that is more healthy is better than one that is just a little healthy, and a little bad is better than really bad. Kids whose diet improved from time A to time B had improved mood. The reverse was also true. Another important result from this study is that mental health at time A didn’t predict diet at time B. This is important because it refutes the idea that people eat healthier because they are less depressed. It also supports the idea that they are less depressed because they eat healthier. Still, it would be nice to have a study that showed that changing one’s diet improves symptoms.
While there hasn’t been a randomized controlled trial like that in children, Dr. Jacka did this in adults. The study was just published in January, and it was the first of its kind. The investigators randomly assigned depressed patients to 7 weeks of nutritional counseling or social support. The people getting nutritional counseling showed significantly greater symptom improvements and higher rates of remission at 12 weeks compared to those receiving social support.
I see no obvious reasons to think that children would have less success with such an intervention. If anything, the shorter lifetime to develop bad habits around food and the role of parents in shaping the food environment seem to me to make such interventions even more likely to have a large effect.
While these studies looked mostly at internalizing disorders (anxiety, depression, etc.), diet has been found to effect younger children with externalizing symptoms (ADHD) as well.
What does this have to do with my most embarrassing moment?
Aside from accumulating empty calories, basketball games were a time for mischief. This story took place at an unfamiliar school with big wooden bleachers. Naturally, we were drawn to explore what was underneath them. Noah and Brandon, slid through the foot board and the back panel, and I followed them confidently, which in hindsight was poor judgment.
I soon found myself stuck, my rib cage wedged between two wooden panels. I couldn’t get out. My predicament came to the attention of all of the adults around me. Most of them strangers. A crowd encircled me after the initial efforts to pull me out failed. As it turns out, people would rather do anything than watch B-team grade school basketball. When the small group of heroic individuals plied the boards and freed this unfortunate animal, the crowd cheered. Indeed, this would be the most excitement at a B-team basketball game until four years later, when Jason would confidently score a basket in the wrong hoop winning the game for the other team in a classic 13 to 12 point shootout.
I am a fat kid. Now, I am an adult man, but deep down I am a fat kid. This is a hard subject for me to write about because it is something I have struggled with my whole life. I want to lay that out there in this first nutrition article for It Takes A Blog. When I write about this stuff, some of it will be about things I am doing right now to try and change. Some of it will be about things we are doing to help my kids avoid the path that I took.
The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.
5 Real steps to improve your family’s diet today
1) Take stock
Answer the following questions about your child. These are taken directly from the first study by Jacka and colleagues (except the study is Australian, so I changed the terminology – biscuits to cookies, takeaways to fast food, etc.) I really value drawing directly from the research to provide you practical next steps. I find it frustrating to read articles that cite studies, only to make vague or personal recommendations that had nothing to do with the actual science they reference.
Here is their healthy eating checklist:
(Assign 1 point for each item.)
__ Eating breakfast at home on school days
__ Eating lunch brought from home
__ Two or more fruit servings per day
__ Four or more vegetable servings per day
__ Fruit and/or sandwiches as after school snacks
__ Generally avoiding cookies, potato chips, pies, fried foods, chocolate, sweets, ice-creams as after school snacks
__ Consuming healthy after school snacks and avoiding unhealthy after school snacks
Add up total points. Less than 2 is low (bad), 3-4 medium, more than 5 is high (good).
And their unhealthy eating checklist:
__Cookies, chips, pies, fast food, fried foods, French fries, chocolates, lollies, sweets or ice-creams after school?
(almost every day = 4; most days = 3; some days = 2; hardly ever or never = 1)
__In the last 5 school days, how many days did you have non-diet soft drinks?
(# of days +1)
__On the last school day, how many glasses or cans of soft drink did you have?
(None = 1 to more than 2 liters = 8; roughly # of glasses +1, but they didn’t specify)
__In the last five school days, how many days did you have fruit drinks?
(# of days +1)
__On the last school day, how many glasses of fruit drinks did you have?
(# of drinks +1, up to 10)
__How often do you usually eat fast-food?
(Once a month or less = 1 to Most days = 5)
__In the last five school days, how many days did you buy snack food from a convenience store or fast food restaurant after school?
(# of days +1)
The goal here is a low score, but the cutoffs for good, okay, and bad weren’t listed in the paper. I have emailed the author to try determine these and to clarify the scoring of parts of the checklist that I had to guess on or that still seem vague. Also, I’m still confused as to what pies refers to in Australian culture – Meat pies? Some other dessert? Or does Australia have much greater childhood pie availability than the US?
2) Set goals
In the randomized controlled trial of a nutrition intervention (the one for adults), the dietitians were counseling patients to reach the following goals:
- whole grains (5–8 servings per day)
- vegetables (6 per day)
- fruit (3 per day)
- legumes (3–4 per week)
- low-fat and unsweetened dairy foods (2–3 per day)
- raw and unsalted nuts (1 per day)
- fish (at least 2 per week)
- lean red meats (3–4 per week)
- chicken (2–3 per week)
- eggs (up to 6 per week)
- olive oil (3 tablespoons per day)
- reducing intake of extra foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week)
They also coached them toward mindful eating, which entire blogs and books are dedicated to. Here is a mindful eating awareness checklist from psychologist Susan Albers.
3) Help your child: eating well is harder for kids with behavioral problems
That last part about mindful eating is important, because a 2013 study of 3-6 year old kids showed that those with lower executive function and lower capacity for emotional regulation were more likely to eat in the absence of hunger, i.e., not mindfully.
They observed children completing tasks and used parent and teacher reports to quantify children’s executive function and emotion regulation. You may remember from the recent article on music and attention that executive function is associated with development of the prefrontal cortex. This is the part of your brain that helps control impulses and override more emotional parts of the brain.
Kids were asked if they were full. If they weren’t, they were fed until they said they were full. Then they sat the kids down at a table with crayons and a coloring book as well as pretzels, animal crackers, etc. The kids with lower executive function and trouble regulating emotions ate more.
This means that your child with attention problems and emotional dysregulation needs extra help to break the cycle of poor diet → worsened executive function → poor food choices.
4) Eat healthy together
As you will frequently hear from me, this should be a family affair. It models the behavior you want for your child. It helps your mental health (see trial in adults described above). And your mental health helps your kids mental health. Frequent family meals are associated with increased fruit and vegetable consumption as well as fewer depressive symptoms and better emotional well-being in children.
5) Stay tuned
We are in the midst of a couple experiments at our home right now and will be writing about them in the coming weeks:
- evaluating an app and coaching service for kid’s nutrition
- trying out an online meal planning service for families with young kids
Also, in the future you can expect more in depth discussion of specific diets and supplementation as they relate to specific problems (depression, ADHD, etc.)
Eat, Drink, and Be Merry!
P.S. Have you noticed that diet has an effect on your mental health or your children’s mental health? Please tell us about it in the comments!