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Eat Your Vegetables: Diet and Health in Childhood and Adolescence

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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An alarming trend has emerged over the past three decades in the United States: children and adolescents are falling victim to a wide array of health problems. According to studies released by the CDC, the Kaiser Foundation, and countless peer-reviewed academic journal publications, data indicate that obesity, asthma, and type 2 diabetes are all on the rise. Not only do these medical conditions degrade a child’s overall quality of life in the short-term, but over the long-term they result in a variety of serious problems. Treatment for these various health issues can result in a cumulative increase in the cost of health care over the span of a person’s life, but the negative effects of childhood and adolescent obesity in particular are even more concerning: chronic obesity can lead to cancer, coronary disease, osteoarthritis, liver and gall bladder disease, and lower life expectancy.

Experts identify two primary reasons behind this progression toward ill-health in our children and adolescents. First, they see an increasingly sedentary lifestyle brought on by the virtually ubiquitous prevalence and unlimited access to computers, smartphones, and television. Second, they see a marked and measurable decline in healthy eating habits.

Healthy Eating

Fortunately, one of the most effective ways of reversing this downward spiral is by changing the foods our children and teens eat most frequently. Research shows the foods that contribute the most to obesity and its related side effects are highly processed grains, sugary snacks, and sugary drinks. On the healthy side, the foods that prevent obesity and its side effects are vegetables, fruits, nuts, and whole grains. While this seems like common sense and common knowledge to most parents and child care professionals, one question remains. Once kids get used to eating the processed grains and sugary foods, what’s the best way to get them to eat the healthier foods, like fruits and vegetables?

About ten years ago, a group of children’s health scientists decided to explore this question in depth. Analyzing data collected in 2004-5 from over 700 preschool children and their parents, their findings have since served as a springboard for further research, and resulted in several novel and creative ways to improve the eating habits of children in the U.S. Published in 2010, “Parenting Practices are Associated with Fruit and Vegetable Consumption in Preschool Children” considered five tactics parents use to get children to eat fruits and vegetables, and rated their effectiveness.

Parenting Tactics: How do Different Parents Approach Vegetables?

The study analyzed the following five parenting approaches to getting children and teens to eat fruits and vegetables. While researchers analyzed the effect of these approaches on young children, they apply to picky teen eaters, too. As parents, it’s important to remember that the discipline strategies you use with preschoolers are almost identical to those you use with teens. What changes is the vocabulary you use, how you present the strategies – your parental marketing skills, as it were – and your overall attitude when you apply them.

Here are the five strategies researchers found most effective, with the specific tactics parents used within each strategy.

Top Five Strategies to Handle Picky Eaters

  • Teachable Moments. This approach involves:
    • Telling children eating fruits and vegetables will make them strong and healthy
    • Using mealtimes to teach about healthy eating habits
    • Involving children in food prep
    • Allowing children to eat partial servings
    • Educating children on the long-term effects of poor diet on health
  • Practical Methods. This approach involves:
    • Playing games to get kids to eat fruits and vegetables
    • Adding special sauce or spice to improve taste
    • Positive reinforcement for eating fruits and veggies
    • Rewards, such as dessert, for eating fruits and veggies
  • Firm Discipline. This approach involves:
    • Using guilt or shame when kids refused to eat fruits and vegetables
    • Insisting that kids finish all the food on their plate before leaving the table
    • Restricting subsequent free time if when kids refused to eat fruits and vegetables
    • Denying kids dessert when they refused to eat fruits and vegetables
  • Restriction of Junk Foods. This approach involves:
    • Limiting non-fruits and vegetable snacks between meals
    • Setting total limit on the amount sweet drinks kids consumed
    • Ensuring friends, spouses, and grandparents do not offer candy or sweets as snacks
    • Keeping junk food out of the house
    • Limiting fast-food intake
  • Enhanced Availability and Accessibility. This approach involves:
    • Scheduling meals that include fruits and vegetables
    • Showing kids you love fruits and vegetables buy eating them often
    • Placing fruits and vegetables within easy reach and making them available at all times
    • Offering fruits and vegetables with the option to refuse

While this study and the strategies and tactics listed focused on preschoolers, they also apply to teenagers. The underlying theory (strategy) remains the same, but the specifics (tactics) will need to change for teens.

The Results: What Worked?

Researchers concluded that of the five approaches analyzed, the “Teachable Moments” and the “Enhanced Availability and Accessibility” approaches proved the most effective in increasing fruit and vegetable consumption in children. On the other hand, the “Firm Discipline” and “Restriction of Junk Foods” approaches proved counterproductive. They did not result in increased fruit and vegetable consumption. Parents can extrapolate these results to picky teen eaters. The good news here, for parents of teens, is that the two approaches researchers found most effective also match the teen disposition.  Teens love to feel like they know things: enter the “Teachable Moments” strategy. Teens also love independence and agency: enter the “Enhanced Availability and Accessibility” strategy.

A Positive Step Forward

This research was conducted ten years ago, and it’s more relevant now than ever because rates of obesity for children, adolescents, and adults are still increasing with each passing year. That’s why national effort to reverse the trend in childhood, adolescent, and adult obesity is still in full swing. Solid scientific evidence about the various techniques and strategies to help kids eat healthy, balanced diets is important for parents and children’s health professionals. When combined with increased awareness of CDC health and exercise guidelines – 150 minutes of moderate physical activity or 75 minute of vigorous activity per week – we have a chance at giving our current generation of children and adolescents the tools they need to choose eating and exercise habits that give them the best chance of living long and healthy lives.

Our Behavioral Health Content Team

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