Food shaming is not a game

Posted by Sarah Dempster, Registered Nutritionist (Public Health)

“Our current learning focus is food. We are exploring what makes a food healthy / unhealthy” says the notice board in the entrance to my daughter’s nursery. I sigh. Is this a battle I want to pick? I already had some difficult words with the Head Teacher last year about food-based rewards, and I don’t really want to become known as that mum who complains about every food-related activity that happens in the school. Especially when people don’t seem to get what it is that I’m actually complaining about.

I’ve worked in and around public health nutrition for ten years. Over the past few years - probably since having children of my own - I’ve become increasingly concerned about the way we communicate to children about food. Take this “teacher tested” educational game for four to eight year olds as an example:

I wonder if, in our worthy quest to do everything we can to improve children’s eating patterns, some of the things we say and do are having unintended consequences. What might be the impact of teaching nursery-age children to polarise foods into “unhealthy” versus “healthy” categories? What are we saying when we imply that people who eat so-called “junk” foods like burgers or pizza are “greedy”? What happens in children’s minds when they’re presented with those same “unhealthy” or “junk” foods as a reward for good behaviour? Or when their parent’s food choices are so constrained that a hotdog is the only option for dinner?

Mixed messages

My biggest concern relates to the disconnect between nutrition education and children’s day-to-day experiences of food. One UK study involving 9-10-year olds showed that children have difficulty interpreting healthy eating messages. An example quote was:

“it’s not true that chocolate’s bad for you because I eat chocolate, and I’m not completely fat, am I?” (Fairbrother, Curtis, & Goyder, 2016, p. 481)

Overall, it is thought that what children believe and know from their own experiences about food has a greater influence on their eating behaviours than what they are taught (Schultz & Danford, 2016). This makes me wonder why we’re teaching children about “healthy eating” at a young age at all - shouldn’t we just be showing them through the experiences we facilitate and/or provide for them and their families? 

What do children understand from nutrition education?

Health is an abstract concept and we know that young children are concrete thinkers. While they may be able to categorise foods as “healthy” or “unhealthy” by rote in pre-school, they are unlikely to make sense of why each food is in each category. They can understand that food provides energy but it isn’t until they are much older that they can accurately explain physiological reasons for eating (Inagaki & Hatano, 2006; Nguyen, Gordon, & McCullough, 2011; Slaughter & Ting, 2010). They find the concept of “prevention” particularly difficult (Legare & Gelman, 2014).

There’s little research on the impact this may have. However, Pinhas et al. (2013) found some evidence that healthy eating lessons could trigger eating disorder development in susceptible children, who may become preoccupied with food after learning about nutrition. We know that children are under pressure to conform to the “thin ideal” body type from a young age. One Australian study found that 34% of 5-year old girls were already restricting food (Damiano et al., 2015). Meanwhile, children demonstrate anti-fat attitudes from as early as two years old (Di Pasquale & Celsi, 2017). Oversimplifying the relationship between food and size in a game like Greedy Gorilla will at best be ineffective and at worst, fuel the well-known negative consequences of weight stigma (World Health Organization, 2017).

What does the curriculum actually say?

Food and nutrition is a focus area in UK curriculum frameworks, with defined knowledge and skills outcomes at specific ages or stages. Food literacy is covered in a much broader way than just teaching kids what to eat for health. This provides the opportunity for rich, multi-sensory learning experiences… how food is grown, how people from different countries and cultures eat, what different foods look, smell and taste like, how to prepare foods… and as children get older, bringing in critical appraisal around what influences our food choices (e.g. social, health-related or financial factors, the food industry, diet culture). There are lots of examples of good practice around this and it can be done in very positive and inclusive ways.

Until recently, there was little evidence of moralistic language such as “junk food” or reference to “unhealthy eating” within the curriculum. However, the Department for Education (2019) now states that by the end of primary school, children should know: “the characteristics of a poor diet and risks associated with unhealthy eating (including, for example, obesity)”. This worries me, especially for young children who are dependent on adults for all the food they consume, and because we know that weight bias is prevalent in education settings (Nutter et al., 2019).

Food education is really important for young children, but I think we need to look at how public health and education professionals collaborate to get it right for all children. This means improving our understanding of the impact of the language we use, to ensure that we are not fuelling fear, shame or stigma around food or body size.


References:

1. Fairbrother, H., Curtis, P., & Goyder, E. (2016). Making health information meaningful: Children’s health literacy practices. SSM - Population Health, 2, 476–484. https://doi.org/10.1016/j.ssmph.2016.06.005 
2. Schultz, C. M., & Danford, C. M. (2016). Children’s knowledge of eating: An integrative review of the literature. Appetite. https://doi.org/10.1016/j.appet.2016.08.120 
3. Inagaki, K., & Hatano, G. (2006). Young Children’ s Conception of the Biological World. Current Directions in Psychological Science, 15(4), 177–181. https://doi.org/10.1111/j.1467-8721.2006.00431.x
4. Nguyen, S. P., Gordon, C. L., & McCullough, M. B. (2011). Not as easy as pie. Disentangling the theoretical and applied components of children’s health knowledge. Appetite, 56(2), 265–268. https://doi.org/10.1016/j.appet.2011.01.008 
5. Slaughter, V., & Ting, C. (2010). Development of ideas about food and nutrition from preschool to university. Appetite, 55(3), 556–564. https://doi.org/10.1016/j.appet.2010.09.004 
6. Legare, C. H., & Gelman, S. A. (2014). Examining Explanatory Biases in Young Children’s Biological Reasoning. Journal of Cognition & Development, 15(2), 287–303. https://doi.org/10.1080/15248372.2012.749480 
7. Pinhas, L., McVey, G., Walker, K. S., Norris, M., Katzman, D., & Collier, S. (2013). Trading Health for a Healthy Weight: The Uncharted Side of Healthy Weight Initiatives. Eating Disorders, 21(2), 109–116. https://doi.org/10.1080/10640266.2013.761082 
8. Damiano, S.R., Paxton, S.J., Wertheim, E.H., McLean, S.A. & Gregg, K.J. (2015) Dietary restraing of 5-year old girls: Associations with internalization of the thin ideal and maternal, media and peer influences. International Journal of Eating Disorders, 48: 1166-1169. https://doi.org/10.1002/eat.22432
9. Di Pasquale, R. & Celsi, L. (2017) Stigmatization of Overweight and Obese Peers among Children. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.00524 
10. World Health Organization (2017). Weight bias and obesity stigma: considerations for the WHO European Region. WHO: Geneva. http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/publications/2017/weight-bias-and-obesity-stigma-considerations-for-the-who-european-region-2017)
11. Department for Education (2019) Relationships Education, Relationships and Sex Education (RSE) and Health Education: Statutory guidance for governing bodies, proprietors, head teachers, principals, senior leadership teams, teachers. Department for Education: London. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/805781/Relationships_Education__Relationships_and_Sex_Education__RSE__and_Health_Education.pdf
12. Nutter, S., Ireland, A., Alberga, A.S., et al. (2019). Weight Bias in Educational Settings:a Systematic Review.Current Obesity Reports, 8, 185-200. https://link.springer.com/content/pdf/10.1007/s13679-019-00330-8.pdf#page32