Healthy Food & Healthy Living by Dr. Ayala

Are you in denial about overeating and your weight?

Denial is a powerful coping mechanism. When it comes to eating and weight issues many of us seem to be living in ignorant bliss. 

In much the same way many of us believe ourselves to be above average drivers, studies show that weight misperception is widespread. People don’t recognize overweight in themselves or in their loved ones, and even health professionals fail to identify overweight and obesity when just observing a patient. 

About 48 percent of overweight men and 23 percent overweight women considered themselves about the right weight in a study including about 16,000 people, and even among obese people only about 10 percent were aware of the extent of the extra weight they carried. About 8% of obese adults considered themselves to be "about the right weight” in another study.

We often don’t see the expanding weight on ourselves, and we don’t see it in our own kids: A meta analysis of more than 64,000 kids shows that 50 percent of parents did not identify that their kids were overweight or obese, and seriously underestimated their kids' weight status.

It may be that our eyes have acclimated to heavier bodies because so many of us are now overweight. Looking at mid 20th century footage of the movie-star-thin general public from that era surprises us, and contrasts clearly with our two-thirds-overweight/obese population. 

We’re unaware of how much we eat

We not only see ourselves as smaller than we actually are, we also underestimate how much we eat. Intake tends to be underreported by 10-40 percent according to a recent review of 59 studies, which compares people’s reports of intake to objective measures of the calories people need to eat to maintain weight (energy expenditure measured by doubly labeled water, which is the gold standard for assessing how many calories are spent).

Calorie undercounts are widespread, but studies show that overweight and obese people undercount to a greater extent.

Calories expenditure, however, is related to body mass – the larger you are the more calories you need, regardless of physical activity.

A new study including 221 people compared reported caloric intake with objective measures of energy expenditure using doubly labeled water, and also compared it to body size.

Overall, underreporting was very significant, and by as much as 1000 calories a day – had that been true people would be losing weight rather than staying the same weight or gaining some.

Obese people underreported caloric intake by as much as 42 percent. More active people also tended to underreport by almost as much: 41 percent. In comparison, thinner and more active people underreported – but by less.

But when you take into consideration body size and therefore resting energy expenditure, the absolute discrepancy between reported caloric intake and expenditure was equal: thinner people under-reported calorie intake less, but their caloric need is lower, therefore the absolute discrepancy between actual intake and caloric need was about the same.

Dietary patterns rather than calorie counts

Given the tediousness of counting calories, and the inaccuracy our self-assessed intakes, eating while counting perhaps isn’t serving us well. Regardless of the reasons why we tend to imagine we’re eating less and better than we actually are, our self deception allows us to gain weight over time.

The authors suggest that perhaps focusing on obesity-risky foods, such as high energy density foods, ultra-processed foods, foods with low fiber that cause little satiety, and sugary beverages, might better serve as dietary guidelines. Recommending a dietary pattern rather that focusing on specific foods and quantities can help curb overeating, especially since most of us are only partially aware of ourselves doing it.

Denial, again, is a natural coping mechanism, but it’s especially un-useful when interventions such as healthier eating and activity habits could have helped turn the tide.

Dr. Ayala

Artificial intelligence in the service of food brands

Do we really have free will when it comes to food choices? 

When we’re at the highest level of focus and control we may feel totally in charge, but as food choices and eating are everyday habits, and are made mostly without thought, much of what we ingest isn’t really because we applied judgment or even listened our hunger cues – much of our consumption is mindless.

That’s not necessarily bad. Automation of daily activities can free your mind to pursue other important tasks.

But when the tendency to follow cues and triggers is manipulated in favor of consuming unhealthy foods it can become a problem.

End caps and eye level placement

We already know that food manufacturers use efficient marketing tricks to promote sales. These nudges could have promoted the sales of any number of foods, but since highly processed foods are profit centers for big food manufacturers – who are the powerful players in the supermarket – these are the foods that enjoy strategic placement.

Supermarkets and food outlets are carefully designed to move you about, leading you to places you wouldn’t necessarily go. The necessities aren’t concentrated in one area, which forces shoppers to cover ground even if they’re in for just bread and bananas. The necessities are occasionally shuffled around to prevent us from getting into a speedy shopping rhythm. Since most customers tend to look to the right when entering a supermarket, special offers and promotions will be at the immediate right as you enter.

And then there’s the shelf: Most shoppers are right handed, so placement on the right makes for better sales. Eye level products sell better, that’s where you’ll find what makes more money for the store. Kids’ offerings will be lower, at kids’ eye level. Displays near checkouts and end-caps attract your eye while you’re waiting for the cashier driving impulse shopping.

None of this is by chance.

And now, artificial intelligence and machine learning can apparently upgrade these methods to the next level.

A new study in Public Health Nutrition looks at the way international food companies use artificial intelligence (AI) to nudge consumers to buy more of their products. Nudges are a strategy to affect people’s behavior, they can be employed in the service of improving health (when the kitchen counter displays cut carrots and apples regularly for instance), and they can also be used to promote consumption of less healthy foods. 

The researchers included 12 leading companies, including Danone, McDonalds, Pepsico, Coca-cola, Nestle, Yum Brands etc. They read through the companies’ reports for evidence of use of AI to influence customer behavior.

The use of AI is widespread, according to the study. It’s used for social listening: Comments on social media are analyzed for trends and hone in on what customers want. Ordering algorithms and data-driven demographics make sure products are precisely stocked for each location. Weather-related preferences are also digitally analyzed.

Position of the product on menu boards is just as important as its location in the supermarket. The researchers found that many companies use AI to manipulate the visibility and significance of offerings on their menu boards. McDonald’s for instance, describes using decision technology to adjust drive-through menu boards according to weather, time of day and trends. Yum Brands uses facial recognition and manipulates the position of products on the menu according estimated age, sex and mood.

Since much of food ordering is done on screens, companies use AI and other emerging tech to increase sales when customers are on their website or app. They deploy recommendation algorithms offering add-on suggestions, and use bots and voice assistants to augment sales.

Ads and products are targeted based on data that includes location and other information collected through cookies.

Realizing the promise of big data?

Is AI in the hands of food companies of concern?

The authors suggest that by altering the availability, position, functionality and presentation of their offerings companies ultimately increase consumption, and since what these companies sell is predominantly unhealthy food, an increase in consumption affects the population’s diet negatively. McDonalds gains are public health losses.

Using big data to create personalized options, and the ability to to test multiple versions of ads varying copy, images and placement, brings nudging to the next level, and resisting the lure of tempting food becomes even harder. The authors raise another concern: “data can be used to target unhealthy food and beverage marketing to certain populations, with the potential to exacerbate existing disparities in diets and health. Data related to engagement with unhealthy food marketing could also potentially be used to make inferences about long-term health risks, which could then be applied in insurance, financial services, differential pricing or other discriminatory applications.”

Big food often argues that they’re just giving people what they want. Data driven products indeed give the food industry the ability to appeal to our craving for sugar, fat, salt, convenience, availability, and low price. What most people are tempted to do is munch junk food sitting on a couch in front of a screen. 

Employing ever more sophisticated ways to make us do what’s easy and tempting is hardly what big data promised to add to mankind.

Dr. Ayala

Does playing with fruit get kids excited to eat them?

Unhealthy foods are marketed to kids wherever kids can be found, and since kids spend a lot of time on screens, marketing messages permeate their online destinations, including games, shows and social media. This creates a virtual food environment of tempting processed foods full of sugar, fat and salt, that fuels real world unhealthy eating and obesity. 

Eating habits established at a young age tend to stick, that’s why it’s so important to build good ones. That – and kids’ susceptibility to entertaining advertisements and games’ hidden messaging – is why marketers target young audiences. There are many studies that show that advergames that promote unhealthy foods make kids fond of the brands behind the games, and lead to consumption and appetite for sweet and salty junk foods.

For that reason, public health advocates call for stricter regulation of marketing of junk foods.  

Can we also fight fire with fire? Can the same marketing techniques be used to make kids reach for apples and carrots?

Digitally marketing fruit 

A new study in the journal Appetite examines whether playing a fruit advergame affects fruit intake. 123 kids played games that featured either fruit (whole fruit, fruit drinks or cups of fruit), toys, or no game at all. The games integrated advertising features such as sounds, timers, and brand logo visuals. After playing, the kids were seated at a table with bowls of pieces of fruit, and the same logos as in the advergame they played.

The researchers expected fruit intake to rise after playing the fruit game, but that did not happen – the electronic fruit game did not lead kids to eat more fruit.

Not all studies show this disappointing result. Another study in the Archives of Pediatric and Adolescent Medicine that had kids playing a Pacman-style advergame with healthy or a less healthy snack showed that the healthy advergame promoted the healthy snack much the same as it “sold” the junk food.

But if the same methods that promote junk food don’t apply to healthy ones what would explain that?

The authors suggest that our brain is much more sensitive to highly palatable and energy dense foods – they’re evolutionarily conditioned to push the buttons that move us to consume calories in preparation for the next famine. Low-calorie foods just don’t have as much of an effect. Unhealthy calorie-rich food that’s designed to taste good has an unfair advantage. 

The other factor, they suggest, is that the cumulative effect of years of priming and branding of unhealthy foods stimulates junk-food intake in a way that a short term game doesn’t. Food companies spend about $14 billion a year on ads, with more than 80 percent of that marketing budget promoting fast foods, sugary drinks and unhealthy processed foods. 

Another worry is that there’s evidence that exposure to advergames promoting unhealthy foods leads to a generalized increase in appetite and caloric intake, regardless of what’s promoted. Seeing so much food in our digital worlds is enough to cause craving and overeating.

Playing with fruit in real life

Playing with food virtually may not lead to better eating habits, but handling real food may very well do the trick.

Involving kids in food preparation not only teaches them valuable life skills, it’s also proven to increase their intake of fruits and vegetables. Involving kids in growing and preparing vegetables — through garden-based programs improves veggie consumption. The more kids handle a food the more likely they’ll grow fond of it.

And what works even better, according to the scientific literature, is setting an example. Eat nutritious food, show genuine excitement for healthy and delicious fruits and healthy dishes, and kids will likely adopt your habits eventually.

Dr. Ayala

Why taking time to eat can help control your weight

When I survey my eating habits, which I tend to do especially around the new year, I make note that I should improve my eating speed. How you eat is not as important as what you eat, but it does matter. I notice that when I eat a leisurely meal with company, or when it’s a multi-course one, I feel full halfway through the meal. They say it takes 20 minutes for our brain to register satiety and I certainly experience that.

Yet my natural instinct when I’m eating alone is to wolf things down, which is a pity, as there's no reason to rush through something as pleasurable as eating. 

If you want to eat more intuitively, and regulate your needs based on hunger, slowing down can really help.

Slow down to eat less

A review article in the American Journal of Clinical Nutrition includes 22 studies in which volunteers manipulated eating rate while measuring food intake, hunger, or both. Slower eating was associated with fewer consumed calories no matter how the slower eating was achieved.

Another review and meta-analysis in the International Journal of Obesity compiles 23 studies, and concludes that eating quickly is associated with excess body weight.

A study in the British Medical Journal (BMJ) finds that the odds of being overweight are three times higher in people who report eating quickly and until full. A study in the American Journal of Clinical Nutrition shows that when volunteers took large bites, rather than smaller ones, they ate about 100 calories more of a chocolate custard.

There are many such studies demonstrating that slow eating is a habit associated with moderation in intake and lower rates of overweight and obesity.

But slow eating may not just make you feel full sooner, it may also actually increase your energy spend.

Slow down to burn more?

Eating slowly and chewing thoroughly can increase food related energy spending, also called diet-induced thermogenesis. When our body is engaged in dealing with food – its digestion, absorption, breakdown and storage – it spends energy on it. Is the energy spent when you eat slowly significantly greater?

A study with 11 healthy volunteers had them eating food quickly, swallowing the food as fast as possible, and compared it to eating slowly: chewing the food until there were no lumps in it and only then swallowing it. The metabolic rate was assessed using oxygen uptake. The researchers also measured the blood flow to the abdominal organs. They found that slow meals increased the energy spend – diet-induced thermogenesis – and the blood flow to the gut. The changes were significant, although they may not impress you in caloric count: for a 100 calorie little meal eating slowly spent 6 calories more, and for a 300 calorie eating event the volunteers used 10 extra calories. 

Which doesn’t sound like much, however, multiply the results of the 300 calorie meal trial by 3 daily meals, practice this over a month, and now we’re talking 1000 extra calories burnt just for eating slowly.

Is it chewing that’s burning these calories, is it the prolonged sensory stimulation in the mouth that’s causing increased activity in the gut which takes up more energy, or is it both?

To address this the researchers recently published a follow up in Scientific Reports in which volunteers consumed liquid food that doesn’t need chewing in three different settings: in the control they swallowed 20 ml of a cocoa drink every 30 seconds without it lingering in the mouth, in the second setting the volunteers kept the fluid in their mouths for 30 seconds and then swallowed it, and in the third trial they kept it in the mouth and fake chewed it for 30 seconds before swallowing it.

And the results: the duration of tasting the food, and the duration of chewing both increased energy needs as measured by oxygen uptake. The blood flow to the gut also increased in both test groups.

Chewing liquid food, which obviously doesn’t need to be broken down at all, uses fewer calories. The 200 calorie beverage in this trial burns an additional 2 calories when it lingers in the mouth, and 4 more if it’s also chewed. Chewing drinks is not something people do in polite society. Chewing chunky food is what makes a small but cumulative difference.

The authors conclude: “slow eating, which involves chewing food slowly and thoroughly, increases DIT (diet-induced thermogenesis) and may be an effective strategy for preventing overweight and obesity.”

Add the energy burning bonus to the effects on appetite and satiety and eating slowly makes more and more sense.

Tips for slowing down

• Share meals: We’re on our best, most polite behavior when in company, and family meals are important in so many ways. 
• Sit at a table: Eating on the go, in front of a screen or over the sink makes you gobble food real fast. 
• Solid calories are better: Food that doesn't need chewing goes down fast. Minimize liquid calories (sweetened drinks) and highly processed foods that dissolve in your mouth. The more fiber in your food, the more chewing it demands. 
• Try small courses: Not to suggest that you need to prepare several courses, tasting menu style – you can serve yourself a small amount of one course, take a short break, and then consider seconds.
• Chew: I don't suggest counting to the 32 suggested by The Great Masticator, or counting at all, but keeping food in your mouth a tad longer and not swallowing it whole is helpful.
• Let go between between bites: Put down your fork; same goes for letting go of hand-held foods such as pizza or apples between bites.
• Drink in between: Sipping water with your meal slows you down, and at the same time distends your stomach, sending satiety signals to your brain.

Changing eating behavior isn’t easy, and if small, slow bites aren’t in your nature, think about what triggers your own fast eating – is it screen distraction, eating by a computer, hunger? Address that trigger and repeat the behavior again and again to make the new habit stick.

Dr. Ayala

Can fruits and veggies relieve anxiety?

If you mention that grey skies make you sad you won’t get much pushback – many believe that rainy days bring about miserable moods and know at least one person who’s predictably affected – yet there’s genuine skepticism about food’s effect on our mental wellbeing.

Nutritional psychiatry is still an emerging field.

There’s growing evidence, however, that certain foods bring about better moods, and that other foods can bring you down.

Several studies have shown that a healthy diet, rich in fruits and vegetables, may impact mental health and is associated with lower rates of depression. Besides numerous studies that show a link between eating fruits and veggies and psychological benefits, there are also studies that actually put it to the test: a study of 171 young adults who usually don’t eat their 5-a-day were assigned to either start doing so or continue as usual. After 14 days the participants on the fruit and vegetable boosted diet reported greater psychological wellbeing.

De-stress with salad?

A new study in the journal Clinical Nutrition examines the connection between eating fruits and vegetables, and perceived stress levels. The researchers looked at a large population of more than 8600 25-91 year olds from the Australian Diabetes, Obesity and Lifestyle cohort. Diet and perceived stress were assessed by validated questionnaires. The stress questions were things like: “you feel rested”,“you feel that too many demands are made on you”, and “you are irritable or grouchy” on a sliding scale. 

And the results: Those eating the most fruits and vegetables (more than 470 grams a day, about 16 ounces, which is close to the recommended minimum of 5 servings a day) felt less stressed than those who ate the lower end of fruits and veggies (less than 240 grams or 8 ounces a day). These findings held after adjusting for confounding factors such as exercise, smoking and caloric intake. 

An inverse relationship between plant-based foods and stress has been shown in other studies. A recent systematic review of studies in the journal Nutrients, which included 61 studies, and looked at fruit and vegetable intake and a whole array of psychological symptoms, from depression to general mental wellbeing, quality of sleep, stress, nervousness and happiness, concludes that eating 5-a-day “seems to have a positive influence on mental health, as stated in the vast majority of the included studies.”

The inflammatory connection

This association doesn’t prove causality. The connection is plausible, though, and could be explained by the fact that fruits and vegetables contain antioxidant phytochemicals that reduce inflammation and cellular oxidative stress.

The connection between inflammatory foods and mood disorders was examined in a recent meta-analysis in Public Health Nutrition, which included four studies and about 50,000 people, looking to see if the inflammatory profile of their diet is linked with developing depression.

The diet was scored using the Dietary Inflammatory Index, an index based on thousands of scientific articles, which enabled scoring most foods and nutrients.

The study found that a pro-inflammatory diet (a diet low on fruits and veggies, high on highly processed food, meat, refined grain, desserts and sugar) was associated with a higher incidence of depression, and that people eating diets with the highest inflammatory score had a 23 percent higher risk of becoming depressed.

As mentioned above, mental nutrition research is relatively new. The 5-a-day fruit and vegetable recommendation is already exhaustingly verified and established as a way to support health and wellbeing. The mental-health benefits, if they pan out, are just another added bonus.

Dr. Ayala

The best foods for love

Every day’s a good day to celebrate love, and a holiday that prompts us to pay attention to our loved ones and to the magic they bring to our lives is very welcome indeed, every year and this one especially.

A favorite way to say I love you is through food, now why’s that?

Food is love

Love is as yet impossible to completely define. The physiologic manifestations of falling in love and the early days of infatuation have been characterized as a kind of obsessive madness; other types of love are hard to explain biochemically and emotionally. 

Food, like undefinable love, elicits complex emotions. Consuming food elicits pleasure, and sometimes longing, and unease. Offering food, gifting food and sharing it lead to closeness between people. “The people who give you their food give you their heart,” wrote Cezar Chaves.

Food is the language of affection. Food may feel like love because it releases similar neurotransmitters, such as dopamine and norepinephrine. 

Food also brings us back to our original love, our earliest feelings of contentment and safety – our parents giving us sustenance and relieving the discomfort of hunger with sweet milk and gradually varied foods while holding us close. 

No wonder food, comfort and love are so entangled.

Aphrodisiac offerings

Are there foods that elicit love and desire better than others? 

“Eat oysters love longer” goes the saying. Aphrodite, the goddess of love, is the root of the term aphrodisiac, and the search for substances that enhance desire, pleasure and performance is as old as human history. Many of the traditional aphrodisiacs are herbs and foods, among them are maca root, ginseng, nutmeg, saffron, and cacao.

Do they work? There is some supporting evidence for their use. A double blind placebo-controlled study in men found that maca (a root plant from the South American Andes, not to be confused with matcha green tea) enhances perceived desire. Saffron, the golden hued spice made of the stigma of crocus flowers, has demonstrated aphrodisiac properties in male rats. Results in a pilot study of 20 men were promising, but a later study in 346 men failed to show improved sexual desire. Red ginseng was found to increase arousal in a double blind placebo controlled study of 32 menopausal women, and other studies have shown benefits in men.

Chocolate, regarded as an aphrodisiac since ancient times, is reported to release phenylethylamine and serotonin, lifting mood and desire, and it's no doubt delicious. A study of 153 Italian women reports significantly higher sexual desire in chocolate eaters, but no differences were found in arousal or satisfaction, and the effect disappeared when adjusted for age.

The evidential support for these aphrodisiacs is indeed scant, and the FDA doesn’t recognize any of over-the-counter ingredients as safe or effective love potions. 

Salad as love gesture

Nothing’s as critical for setting the mood for love as plain overall good health. To that end, a healthy diet, physical fitness and getting enough rest are the most effective aphrodisiacs. 

So chopping a big bowl of salad and letting your loved one sleep in could work, and a basket of colorful fruit is an excellent love offering – it’s not just chocolate in a heart-shaped box that says I love you.

And any food that’s shared is romantic.

Valentine’s Day food gifts aside, cooking and presenting healthy foods communicates love every day of the year, warmth that we can sense in our bones. 

Dr. Ayala

Who should remind kids to eat their fruit?

Most kids don’t eat enough fruits and vegetables. On the other hand, they’re all too happy to eat junk food, candy and sweetened drinks. The allure of sweet foods is understandable. We humans have an innate preference for sweet flavor and high-calorie foods – a fondness that served us well a long long time ago when food was scarce and we had to hunt and gather it. It’s biological.

But it’s not just the inborn preference that’s leading kids to the cookie jar. Kids also see lots of unhealthy food in media content directed at them, and marketers present these unhealthy foods in a way that’s cleverly persuasive. Food products are placed in entertainment directed to kids, in ads online, on billboards, in games and practically everywhere their eyes go.

So on one hand, parents might be modeling healthy eating behavior and placing fresh produce on the counter, yet on the other, kids see celebrities, athletes and cartoon heroes drinking soda and eating candy bars. Do parents and the people who care about kids’ health even have a chance against cute animals pushing the opposite message?

Whose behavior do kids most emulate?

Kids imitate behaviors encountered in real life, as well at what they see on screens and in fictitious characters. 

A new study in the journal Appetite tests three social endorsers making an argument for fruit. Based on previous studies, endorsers are categorized as either experts (such as a dietician or medical doctor), celebrities (famous or admired people) or peers (a child-like character).

The study recruited 340 6-11 year olds through schools. Kids were shown a cartoon promoting grapes and mandarins, in which the presenter was either an expert (physician), a celebrity (actress or football player) or a child. The arguments for eating fruit were the same in all conditions, and were things like: “it is important to eat a lot of fruits because they help you stay fit,” and “to stay healthy, it is important to eat a lot of healthy foods, such as grapes.” A control group saw no videos.

After viewing the cartoon (or no cartoon in the control group), the kids could select just one of four types of snacks: grapes, mandarins (both appearing in the video), fruit gummies and fruit chews. These snacks were chosen because they are similar in size, shape and color to the fruit.

And the results: The kids in the expert condition – those who saw a doctor making an argument for eating fruit – selected fruit over candy significantly more than in the celebrity, peer and control groups.

The authors conclude that the effectiveness of a health-related message depends on the source who’s presenting the information, and experts perform better than other social endorsers. 

Ads sell. That’s why companies spend so much money on them, and most of the marketing efforts targeted at our kids promote junk foods and sugary drinks.

But persuasion and reasoning work, too. Kids do care about their health, weight and fitness. And this is where input from experts, as well as the parties interested in kids' health – parents, family and friends – come in. Kids are in front of screens like never before, due to Covid-19, so inserting reasoned nutrition public service announcements can help. 

And what works best, in my experience, as well as according to the scientific literature, is setting an example. Eat your fruits and vegetables, show genuine excitement for these truly delicious foods, and kids will – eventually – follow.

Dr. Ayala

 

A closer look at grains – good or bad for you?

Quarantine brought on a spring-cleaning frenzy like no other, and the closets of our habits deserve a similar process – plenty of old trash there ready to be tossed. There’s never been a better time to take inventory of our diet.

Most of us know that we should be eating more fruits and veggies, but grains are shrouded with dietary confusion.

Yes, highly processed grains are fast absorbed, cause blood sugar spikes, and are linked with bad outcomes, but whole grains are good for you. Eating whole grains is associated with lower risk of heart disease, type 2 diabetes and colon cancer. Whole grains are associated with digestive health and lower rates of obesity. A recent study in the Lancet suggests that low intake of whole grains is the leading dietary risk factor for death and disease in the USA, and that 3 million yearly deaths globally can be attributed to low consumption of whole grains.

Why aren’t people eating wholesome grains? Why is it that despite repeated recommendations to eat at least half of total grains (and at least 3 ounces) as whole grains fewer than 10 percent of Americans do so?

According to a new paper in Appetite people don’t even know what whole grain means. And that’s not the only gap in knowledge that stands in their way.

Whole grain confusion

Through a series of focus groups the researchers explored the knowledge, perceptions and attitude of Australian consumers.

The participants were asked 12 questions that were discussed in detail, such as: Do you know what the term whole grain means? How is it different to refined grain? Can you name some whole grain foods? How would you identify whole grain foods at the supermarket? Can you name any health benefits of whole grains?

A few patterns emerged:

• Although people think whole grains are healthier than refined grains they struggle with naming any long-term benefit, and could name no specific reason for the recommendations.

• People don’t know how to identify whole grain foods. The main tool to identify bread as whole grain was that “Whole Grain” is printed on the label.

• Another obstacle to consuming whole grain was suspicion of all carbohydrate-based foods – all grain foods, whole grain foods included, are indeed rich in carbs.

Similar findings were reported among UK teens, in Finland, Italy, the US and elsewhere.

It’s no wonder people are confused. Carbs have been vilified for decades. Then came the gluten-free fad (gluten is a problem only for people with celiac, or a gluten sensitivity). Although people love bread, only a few of them believe that whole grain breads are a healthy food.

Somehow, we became so nutritionally confused that we don’t recognize whole grains as the foundation of human diet from the beginning of time.

Taste, price, and availability

Whole grain products usually cost more than highly refined ones, and not all of them taste great. Access to a good, healthy, affordable loaf of whole grain bread is far from universal, and that’s another major barrier stopping people from adopting whole-grain foods. As you’ll see below, though, some whole grains are super cheap, and you don’t need to be a master baker with a sourdough starter you’ve been feeding and carresing over the years to make a bowl of oatmeal, farro or kamut.

How to eat more whole grain

A primer to whole grain

Here’s a quick guide on whole grain.

What: Whole grains contain the three parts of the grain kernel, the bran, germ and endosperm. Refined grains are stripped of the bran, which contains fiber, B vitamins and minerals, and the germ, which is packed with phytochemicals, healthy fats and vitamins.

Why: Quality carbohydrates, including whole grains, are associated with good digestive health and lower risk of diseases, including heart disease, type 2 diabetes and colon cancer. Please ignore the media onslaught on gluten – If you’re healthy and not sensitive to it, gluten will do you no harm.

How: Choosing a whole grain product should be easier, I know, and unfortunately, “Whole Grain” on the package isn’t a guarantee the product is healthy. I hope that labeling laws will improve and make selection more straightforward, but in the meantime you have to read the ingredient list. Look for “Whole Grain” as the first ingredient on the ingredient list. I also suggest that you take a look at “added sugar” – many breads and grain products add sugar a-plenty which is something you should eat less of.

Bear in mind that one of the best ways to eat whole grains is to make them yourself, and while I’m not suggesting you start baking your daily loaf from wheat grown in your back yard, cooking  brown rice, oatmeal (oatmeal is always whole grain), quinoa, farro, and wheat berries is practical, inexpensive and 100 percent whole grain!

Dr. Ayala

These crazy times call for bread therapy

We’ve lately switched from watching people competitively bake on TV to doing it ourselves.

Baker's yeast is more elusive than toilet paper. Rare sightings are urgently reported, it’s there for a moment, then gone again. It’s the most sought after item in my NextDoor messaging boards. Baking supplies are flying off the shelves. Procuring flour – especially the rare white whole-wheat type ­– is another small triumph in the Covid-19 era.

Bread as therapy

Stay-at-home orders make food preparation a necessity. But it seems like what we’re longing for is more than a satiating meal. We want to bake bread. 

Why do we derive such pleasure from kneading dough, seeing it rise and tearing its crackly crust?

Any creative activity that you engage in gives you a small mental boost. Checking off a to-do list is somewhat satisfying, but a creative task is more therapeutic than tidying your bed. And while most of us can’t write a poem, play the cello or come up with a creative solution to a work problem on any given day, we can create a dish. A study of 465 college students found that the most common do-it-yourself or “maker” activities were domestic arts: baking, cooking and gardening, and that these activities improved mood and kept participants in the present.

Cooking and baking are widely used as an occupational therapy modality. Making food is found to boost self esteem, reduce anxiety and improve mood.

And it looks like we all need some occupational therapy these days.

Bread baking incorporates another beneficial healing modality – art therapy – right into it. Dough, much like clay, paint and wood, is incredibly tactile, we can’t stop petting that baby (and that baby, unlike buttery pastry dough, appreciates as much caressing as we’ll give it); bread making is sensual, primal, and takes mastery. 

Eat more bread?

Bread, the most widely consumed food in the world, a staple of the human diet for thousands of years, has become something many people are trying to avoid.

How come the food that almost defines human cooperation and civilization got such a bad rap? It came in three superpositioned waves. 

First came refined grain and industrial white soft bread.

Bread used to be a four-ingredient food—milled grain, water, salt and a leaven, usually yeast. The mastery of bread making wasn’t about clever ingredients but rather about technique, patience and heat.

The vast bread section in supermarkets displays a different kind of bread, a bread made with refined flour, vitamins and iron added into the mix—refined flour is enriched according to FDA regulations to compensate for what the refining process takes away, as removal of the germ and bran from the wheat grain takes away much of its micronutrients and fiber. Many brands of bread also contain a long list of softeners, additives, conditioners, preservatives and other unpronounceable chemicals.

Yes, that soft white bread is not very good to eat, in Michael Pollan speak, it should be called an edible bread-like substance.

Then came the carbs-are-bad perennial myth.

The focus on macronutrients has been terribly misguided. Yes, refined sugars are associated with bad outcomes, but it’s not because they’re carbs. Fruits and veggies are also mostly carbs. Whole grains are actually associated with lower risk of diseases such as heart disease, type 2 diabetes and colon cancer. Whole grains are associated with digestive health and with lower rates of obesity. A recent study in the Lancet suggests that 3 million yearly deaths in 195 countries can be attributed to low consumption of whole grains.

On top of that came the gluten-is-bad era.

Gluten, however, is a problem only for people with celiac, or a gluten sensitivity. Gluten-free for the rest of us is neither healthier nor more pure. Gluten-free should be read like allergen information, not like a mark of distinction, and gluten-free foods can also be pure junk.

Of the three layers of undoing bread’s good name only the first has merit.

Bread, we owe you an apology

Bread made with whole grain is good to eat, it’s delicious, and it has deep cultural roots. I can’t imagine going without it for long. Perhaps its delightfulness makes moderation a bit of a challenge, but we don’t shun spring’s splendor because it distracts us too much. If I had to pick only three foods to survive on bread would be one of them. 

Jews who observe Passover go without bread for a week. The holiday is a reminder of hard times, of slavery and of redemption but for many, going without bread renews the appreciation for this humble yet genius wonder. It doesn’t take a week for bread craving to take hold. 

In these fearful times we long for the comforting aroma of freshly made bread. The bakeries in Paris are open, their work deemed essential, grateful clients form long lines that snake around the block. You can ask French people to stay home, but you can’t take away their fresh bread.

Will we continue to bake bread once life goes back to normal? Maybe not, but anyone who bakes bread with simple healthful ingredients learns to appreciate the baker, and a good loaf of real bread. 

Let’s hope bread forgives us for shunning it, for confusing it with its fake look-alikes, for calling it evil. 

Bread, and its makers, are indispensable.

Dr. Ayala

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Don’t have time or patience for a sourdough loaf just yet? Start with whole wheat pita bread, simple bread therapy at its best, especially when you see that pita pocket forming.

Size matters: A simple trick for overcoming large portion distortion

Bigger portions make people overeat, that’s already well established.

Portions can grow in two ways, however: A portion can grow in size, or by increasing the number of units in the serving.

So here’s a question for you: What would induce more eating, a super-sized sandwich, or 3 normal sized sandwiches that weigh the same as that super sized one? A mega 8-ounce chocolate bar or a package of the same weight with 8 pieces of 1-ounce chocolate treats? In other words, does increasing the volume of the food have the same effect as increasing the number of units?

To answer this question researchers from Belgium and Australia, led by Jolien Vandenbroele, conducted a series of experiments. Their findings appear in a new paper in the journal Appetite.

What’s just enough 

In the first experiment 186 participants watched a video during which they could snack on chocolate brownies. The brownies were presented in different sizes: (8, 16 and 32 grams), and different numbers of pieces (1, 2, 3 and 8 pieces). That enabled 12 different brownie plates, in which the total weight of brownies served varied from 8 grams all the way to 256 grams. The different plate presentations also play with brownie size vs. number: people who got 64 grams of brownies (about 2 ounces), for instance, could be presented with 8 small pieces, 4 medium pieces, or 2 large pieces. The participants were unaware that their consumption was being monitored.

And the result: When presented with more food people ate more overall, but the way the treat was presented mattered too.

For the example of the 64 grams of brownies above, when these were comprised of 8 pieces, only 18 percent of people ate the full portion, while 40 percent consumed the entire plate when the brownies were presented as 4 medium pieces, and 60 percent ate the full 64 grams when the brownies were cut into 2 large pieces; the larger the size of the brownie, the more of it the volunteers ate.

So, the bigger the portion the more people eat, but larger slices rather than a greater number of smaller ones produced more overeating.

The second study, involving 193 participants, tested the perception of amounts as it relates to food’s piece size and the number of pieces. People were shown photos of chocolate in 4 different sizes (12.5g, 25g, 37.5g, 50g) and four different unit-numbers (1, 2, 3, 4 pieces), so that the photo could depict total portions from 12.5 grams to 200 grams.

In this study, portions made up of more units were perceived as containing more than portions made up of larger chocolate pieces, for instance, a total of 100 grams of chocolate made up of 4 pieces was perceived as having 114 grams, while 100 grams presented in just 2 pieces were perceived as 83 grams – less than their actual size.

Judging by the results so far, it seems like our mind perceives greater number of items as greater quantity, and that might be why multiple pieces adding up to a large portion don’t lead to as much overconsumption as one big oversized piece of food.  

Which leads us to study number 3. In this study 189 people were made to concentrate on either size increase or number increase before they were presented with food. This was done through showing them pictures of gradual increase in quantity of garbage bags, machine oil or water. They were shown either growth of unit, i.e., the water bottle starting at 16 ounce and growing gradually to 32 ounce, and eventually to 1.3 gallons, or growth in number, i.e., one 16 ounce bottle growing gradually to 10 bottles of 16-ounce each.

After this exercise, the volunteers watched a short movie, during which they were given a snack: brownies, much like in the first study. They were all given 100 grams of brownies (about 3 ounces) – the total portion weight remained the same – but half of the people got these as 2 large pieces, and the other half got them as 6 small pieces. The researchers calculated how much of the brownies the volunteers ate, and participants were also asked to estimate the weight of the brownies on the plate they got.

And the results: Participants who focused of changes in size seemed to estimate the 2 larger brownies plate as weighing more than the 6 smaller brownie plate. They also ate less when their plate had 2 large cakes. Those who focused on number of units perceived that the plate with 6 brownies weighed more than the 2-brownie plate, and tended to eat less when the brownies were small.

Larger or more, there’s a difference

These 3 studies suggest that we subconsciously quantify food on the plate, and that a larger number of pieces impress us more than a large piece of the same weight.

Ask young kids what’s more valuable, 4 quarters or 10 dimes, and their intuitive answer is invariably 10 dimes. We see the number of items much more clearly that we see size or monetary value, at least when we’re young and uninitiated.

Multiples of smaller food units can register as more food, may lead to greater satiety, and may also suggest to us that each small unit is a “normal” or suggested serving size.

Try this

Divide foods you want to eat less of into many small pieces: cut cakes into littler portions and shape cookies smaller. When presented with a very large portion, consider cutting it to several pieces.

For fruits and veggies, try the opposite and supersize them.

And although family sized highly processed snacks and drinks are sold for lower prices per weight, beware of those. Larger bottles of soda, bigger packages of snacks and supersized meals require much self-control, and make overconsumption the default.

Dr. Ayala

Quick tip for picky eaters: Serve a veggie by itself

Feeding kids thier veggies is a common struggle for many parents and the scientific community is on it with new research. Whether your kid’s a picky eater or an adventurous one, some methods are proven to increase the chances that he’ll grow fond of veggies and fruit.

Repeated exposure

The most important piece of advice for parents who want to get their kids eating more fruits and veggies is to serve them again and again. Repeated exposure works for many things in life – anything you’ve done several times becomes easier to do, turning eventually into a mindless routine, and familiarity itself can breed fondness. We do what we’ve already done, and we’re all creatures of habit.

But it works especially well with food.

Fear of unfamiliar food might be a natural evolutionary tendency that kept us humans safe from ingesting poisonous plants – eating only what we already knew to be risk-free worked well for us as gatherers.

But what’s the best way to repeat food exposure? Should parents prepare the vegetable in several different ways? Serve a variety of vegetables? Variety is something that is known to increase food intake in adults; does it also work for young kids?

Solo or together?

Researchers from the UK recruited preschoolers aged 2-5 years in five nurseries. Their new study appears in the journal Appetite (online ahead of press).

The tested veggies were served as a single snack, with repeated exposure, or mixed with other vegetables: The kids were served about 3 ounces of either baby sweet corn, celery or red peppers alone 5-6 times, or combined with the other target veggies plus radishes and green peppers.

Exposing kids to single vegetables repeatedly worked its wonders – confirming many previous studies. The effect was seen as early as the third exposure.

To the researcher’s surprise, however, serving the vegetable alone worked much better than offering variety. Serving the variety didn’t increase veggie intake, and surprisingly still, kids who were exposed to a single vegetable and increased its intake after several exposures didn’t eat more of it when it was served mixed with other veggies. In other words, getting these young kids to accept and eat more red peppers when served as a snack didn’t lead them to eat more red peppers when they were in a bowl with other veggies.

The paper discusses the “contamination effect” – kids will reject a food they like if it’s touching or mixed in with something they don’t like.

It very well might be that young people prefer new foods served as stand-alones.

Similarly, another new study shows that giving young kids (age 2-6 years) a choice of vegetables didn’t increase their intake and even decreased it when comparing to just giving them the veggie, with no choice at all.

The take home message: 

Young kids who object to new foods might react better to new veggies presented separately and of course repeatedly. Kind of good news, as this is also the easiest way to do it.

This is a relevant strategy for the caregivers of children averse to new flavors and textures.

Not all kids present these challenges. For the rest, I’ve always been a proponent of streamlining food prep, and for serving kids the family meal as soon as they are able to eat it; by the age of 2 years most kids can eat anything adults eats, don’t need any special meals, and smaller portions of good food that parents enjoy are just fine.

Many young kids will love salad.

Just serve the veggies time and time again, in a positive, calm, no pressured way – a real clear takeaway from research: pressuring kids to eat is counterproductive and it certainly isn’t fun – and fear not, kids outgrow this phase.

Dr. Ayala

Eating for two and losing control

The cool, fashionable, fit mom image took over in the last few decades.

Just like 40 is the new 30, and 50 is the new 40, parenthood no longer implies a negative change in physique.

And while celebrity moms such as Beyoncé, Scarlett Johansson, Jessica Alba and Gwyneth Paltrow seemed to bounce back from pregnancy and delivery as if it were a beauty nap, the reality is that many women fear the body changes and weight gain associated with pregnancy.

And for good reason. Celeb post-partum photos tell a story that doesn’t relate to what women see in their own corner. Nearly half of the women in the US gain more weight than the Institute of Medicine recommends during pregnancy, and that excessive weight is hard to lose – studies show those extra pounds are often retained for a very long time. Women’s hunch is that pregnancy is a time of high risk for weight gain, because the usual patterns of eating are disrupted, appetite might increase, and the external cues that help regulate eating – such as clothes that used to fit – are no longer relevant.

Eating in moderation is hard at any stage of life, and at times of great change women are afraid to lose their balance.

Losing control

A new study in the American Journal of Clinical Nutrition followed a cohort of more than 11,000 pregnant women in Avon, England. This study is a long-term prospective study of parents and their children. Expectant moms filled questionnaires when they were pregnant, way back in 1991-1992. Weight gain during pregnancy was derived from medical records. The babies’ weights at birth and as 15 year olds were also studied.

The study found that more than a third of pregnant women reported loss of control over eating during pregnancy.

Loss of control was associated with higher caloric intake, especially from carbs. Loss of control led to more snacks and dessert foods, more added sugar from candy, cake and chocolate, and lower vitamin B6, C and A intake.

Women who reported loss of control over eating gained on average 8 pounds more than those who didn’t report losing it.

What’s even more interesting is that loss of control during pregnancy resulted in heavier babies, and a two-fold increased chance of being overweight or obese at age 15.5 years.

The authors, led by Nadia Micali, suggest that the outcomes in the kids might be much more than environmental influences of perhaps living in a home with more snacks.

“It has been suggested that metabolic and appetitive fetal programming might also be affected by imbalanced maternal intake in pregnancy. In rodents, high-sugar diets in pregnancy have been shown to lead to altered metabolic and inflammatory pathways and higher oxidative stress in the offspring.” 

For two, not double

We’re not supposed to look at other people’s plates, but I confess to being guilty of peeking from early on. I had a somewhat sad and unfailing realization: It’s the rare woman or man that remains thin beyond their 40s who isn’t watching what she or he eats.

In our time of abundance, the main nutrition message centers on how to moderate eating, how to not overdo what’s naturally tempting and fun to do.

“You’re eating for two” is often interpreted as “eat twice as much” which is, admittedly, more catchy and convenient than “you should eat well, gain some weight but not too much (and not too little)”.

What mom eats affects the developing fetus, and the message is apt regarding the importance of healthy, clean nutrition – almost everything mom puts in her body, including alcohol and medications, crosses the placenta. The extra calories needed for the pregnancy are, however, modest, and never even close to double of everyday caloric needs. (Generally, there are no extra caloric needs in the first trimester, and you need only about 350 calories extra in the second trimester, and 450 extra in the third.)

An expectant Mom’s diet and excessive weight gain may have a lasting effect on her child’s weight and health.

On the other hand, because pregnancy and becoming a parent are a time of enormous change, they hold the potential for positive, healthy transformation, too. It’s in these times of inevitable alteration that the possibility for lasting habit change can occur, and many parents adjust their behaviors, attitudes, speech and customs when they become aware that they’re becoming role models, and when they see that their actions might shape those they care about the most.

In that sense, every parent eats for two, or three, or five or however many are in their circle or influence for many years to come.

Dr. Ayala

How to beat college weight gain without even trying

The college year is coming to an end, and many first-year students will be dismayed to find that their clothes have gotten a bit tight – while the freshman 15 might be a bit of an outlier, students gain an average of 7.5 pounds in the first year of college. It’s hardly surprising that when students have tempting food options and all-you-can-eat situations under the college meal plan, they may overeat and gain weight.

Students are therefore encouraged to be wise and careful in the college cafeteria, to weigh their options and portions, so that the extra weight won’t creep up on them.

Which is quite hard to do, especially since there are so many other changes and challenges in college.

An alternative to guiding every single student toward better choices – ones they’ll have to make repeatedly – is to make the better choice the natural, easy one to make. This doesn’t eliminate choice; it just nudges towards the healthier option and makes it the default.

Strategies from behavioral economics

Making the healthy meal the default relies on some powerful behavioral tendencies. People choose defaults because they are the path of least resistance, because the default seems like the ‘normal’, recommended or popular choice, because it lets them avoid decision making and investigation, and because they may not even notice there are other options. Applying default options has proven to get more people to save for retirement and to take a flu shot.

So why not try it in the cafeteria?

A new study published in Public Health Nutrition tests this idea.

In an experiment involving 129 first-year students in two campuses, the students dined in 3 different lunch settings. In one, the default was optimal nutritionally, emphasizing energy dense foods and lower fat and energy items; in the second the default was suboptimal – it had more fat and saturated fat, and in the third the students had complete free choice with no defaults. In both optimal and sub-optimal settings the default was described in larger fonts, and was available immediately. Alternatives were in smaller fonts and entailed a 15-minute wait.

The defaults affected students’ choice a great deal.

In the optimal default setting 94 percent of students made what the nutritionist considered optimal choices. With the sub-optimal default none of the students made optimal choices. Without defaults, when the menu was wide open to any choice, 47 percent of students made the optimal choice. Likewise, caloric intake was greatest in the suboptimal default, followed by the free array menu, and lowest with the optimal default.

This proof-of-concept study suggests that defaults could steer undergrads to make lower-calorie, healthier choices.

Ways to stay fit at college

This is just one of many tools that can be tried in order to curb weight gain. And until school cafeterias make it easier to chose wisely, here are a few great tips:

Seek good options

Former Miss Massachusetts and 2016 college graduate Alissa Musto was training to compete at Miss Massachusetts and eventually Miss America and knows just how hard it can be to stay on track with healthy eating while in college. “One rule that I like to stick with in dining halls or buffets is dedicating 75% of my plate to foods where I can visually identify all of the ingredients: raw vegetables, hard boiled eggs, plain rice, garbanzo beans, fruits, etc.  Added salt and sugar can easily sneak up on you in the more processed and prepared foods, as well as sauces and dressings.”

Kelly Morgan, professor of health and certified health coach suggests to look up your school’s dining website. “Most schools provide nutrition information, and some even provide healthy eating tips tailored to the options on campus.” In between meals, with the rush of the day, plan ahead: “Prepare snacks or small meals that you can carry with you for long days on campus. Finding time to eat between classes is critical for keeping your energy up as well as maintaining focus. The snacks will also keep you from binging on the less healthy options in the dining hall or quick stop food places around campus.”

Get creative, suggests Rachel Graham, who while in college started an Instagram account devoted to eating healthier on campus. “Don’t be afraid to ask the employee serving you lunch at the diner if you can have today’s lunch on a bed of greens instead of bread. Can’t go to the diner? Have a back-up recipe that you can make in your dorm.”

“Invest the time in some free cooking lessons,” recommends Registered Dietitian and Nutritionist Chris Shuff. “There are few things more attractive than finding out your date can cook delicious and healthy food. Develop cooking skills to gain a competitive edge in the dating world through physical and culinary seduction.” Another piece of advice from Chris: “Don’t practice your new freedom of choice by intentionally eating junk. There are plenty of ways to enjoy the independence without intentionally overeating on junk foods,”

“Avoid keeping junk food snacks in your dorm room to limit temptation,” advises Registered Dietitian Juliana Shalek. “Keep nutritious snacks on-hand such as Greek yogurts, nuts, whole grain crackers, low-fat cheese to eat between meals; your body often craves sweets during times of stress (aka studying for a big exam), so try not to keep sweets around to avoid munching on them.”

Watch what you drink

Yoga teacher Lilia Karimi gained the classic freshman 15 when studying abroad her freshman year. “As soon as I returned home and cut down drinking, I lost ten pounds. When you are drinking, your sleep patterns are off and you're typically also eating later at night- not helping out your metabolism.”

“Liquids are the biggest culprit of hidden calories, so stay away from excess juice, soda, and alcoholic beverages,” Says Academic Life Coach Nikki Bruno. “Carry a water bottle with you at all times. Get used to drinking your coffee black. Definitely avoid artificial sweeteners as they can actually cause you to crave more sugar and snack more!” 

Keep active

College campuses offer endless opportunities to work your body, and involvement in physical activities often also leads to better eating habits.

As the girl who gained (and lost) her Freshman 15, exercise physiologist and personal trainer Kathryn Alexander encourages every student to get involved as soon as possible: “There are so many active things you can do! You can join rec sports, play pick up basketball, jog around pretty neighborhoods, or even do more extreme sports like mountain biking. Check out your rec center – they probably have things you’ve never even heard of. You’ll be working on your health and fitness while meeting new active friends with similar hobbies.”

Get enough sleep

Set a sleep schedule, urges Registered Dietitian Julie Upton. “Sleep is involved in appetite regulation so when you skimp on sleep or stay up late (and likely snack), it's a double-whammy on achieving or maintaining a healthy weight. Most college students need at least 7 hours a night but many likely need more. When you are sleep-deprived, you are hungrier but the other issue is that the lack of sleep affects your willpower and resolve, so you'll eat unhealthy foods that you normally wouldn't touch."

Seek balance

“Start a meditation practice - even five minutes a day can help you gain more body awareness,” advises Lilia Karimi. “Finding this awareness helps you get more in touch with your body, your emotions, and having a better relationship overall so that your focus is on health - and not just losing weight.”  

“Remember, you get to live your life the way you want. You don’t have to plan and carry every meal with you – and you also don’t have to throw caution to the wind and live with wild abandon either,” concludes Kathryn Alexander. “You can go drink and have fun without having 10 beers.”

 

I’ll drink (some water) to that!

Dr. Ayala

How to fight unhealthy snacking – and save your sanity

Over-snacking may be one of the major drivers of the obesity epidemic.

Kids now snack, on average, three times a day, and while frequent snacking wouldn’t be a problem if the snacks were healthy and nutritious – carrots and apples for instance – the typical snack is energy-dense, and capitalizes on sugar, fat and salt.

Snacking opportunities are everywhere, and snacks are sold and promoted wherever kids go. So what should a parent do? Urge his child to eat just half the pack? Forbid these sweets and sugary drinks altogether?

Parents can try to influence kids’ eating directly, through restrictions and urging, or covertly, by designing their environment – keeping certain foods out of the house, and avoiding places that serve mainly unhealthy foods.

The first method sounds like a good idea, but studies have shown that parents who try to restrict food achieve the opposite results: The more they restrict a food the greater the child’s desire for it, and when that same food becomes freely available kids overeat it. Most studies find a link between parental restriction and kids’ overweight and over-snacking. These results, however, can be bidirectional: It might be that parents of kids who’re overweight and already indulge on junk food tend to urge and pressure their kids to stop, as a response to the situation.

To actually prove causality and to help disentangle the connection between parents’ feeding actions and kids habits it’s better to follow families over time.

Which is what a new study conducted in Australia and recently published in the journal Appetite does. The study included 252 moms and their 3-11 year-old kids from diverse socioeconomic backgrounds.

Parents first reported on their strategy for “Managing Kids’ Food”.

To assess parents’ restrictions and control on eating the questionnaire included questions like “I have to be sure that my child does not eat too many high-fat foods” and “If I did not guide or regulate my child’s eating s/he would eat too many junk foods.” Parents responded to these on a sliding scale.

To assess parents veiled methods of controlling snacking the questionnaire asked them to scale themselves on questions like: “How often do you avoid taking your child to places that sell unhealthy food”, and “How often do you avoid buying sweets, crisps [chips], biscuits and cakes and bringing them into the home.”

Kids intake of all snacks, healthy and unhealthy, was evaluated at two time points, separated by 3 years.

The study found that parents who used more restrictive methods had kids who increased their unhealthy snacks 3 years later.

Parents who used more covert methods – such as not keeping high-calorie, nutrition-poor snacks at home – managed to decrease their kids unhealthy snacking over time.

These results held true even after adjusting for parents’ and kids’ weight, parental education and socioeconomic status.

This study joins others in showing that over time, well-meaning parents’ attempts to curb unhealthy snacking by restricting them backfires and achieves the opposite results. On the other hand, if parents remove unhealthy foods and replace them with healthy foods, without comment of fuss, kids eat better after 3 years.

Moreover, this study showed that snack intake in the first point of data collection did not predict parents’ strategy – on the other hand, the strategy parents used predicted snacking after 3 years. In other words, parents in this study weren’t responding to kids bad habits by restricting snacks; kids’ snacking, however was shaped by parents restriction and pressure, and in a totally counterproductive way.

Tips for healthier snacking

Snacking has become a way of life, and many parents are scrambling for ways to get kids to eat better ­– and to do so without unpleasantness and friction.

Here are a few favorite nuggets of wisdom and helpful tips from nutrition advocates and health experts who deal with this problem constantly:

Avoid pressure, struggle, restriction, guilt and deprivation

Because you’ll never win a power-struggle with your kid! Especially not in the long run.

Exerting control can lead to a feeling of deprivation, and “deprivation often leads to rebound eating and sneaking foods,” says Karen Koenig a psychotherapist specializing in the psychology of eating. “Sadly, parents often create the behavior they’re trying to prevent by being too rigid with food rules to begin with.”

“Don’t make snacking into a moral issue.” Karen adds. “Calling foods “good/bad” makes children (and adults) transfer the morality of food choice onto themselves, causing them to feel, say, virtuous eating broccoli and naughty eating a donut. Language matters a great deal, so it’s important to explain to children that foods go from less to more nutritious and that they aren’t good or bad children because they choose one food or another.”

Let your kids choose

“Bring your kids to the grocery store, and focus on the fruit and vegetable aisle. By allowing them to participate in choosing food you will increase the likelihood that they will eat the food later,” suggests internist and pediatrician Dr. Olatokunbo Famakinwa.

Registered dietitian Courtney Meidenbauer also emphasized giving kids the autonomy to select their food: “When it comes to snack options for children, the key is to offer many choices, but ideally all those are healthy options. When options A, B and C are all considered "healthy" snacks, there's no poor choice.”

Set an example

Kids are keen observers, and what you do matters more than what you say.

“Kids often want what YOU have, so make your own choices good ones. It'll be in both of your best interests,” advises health coach and personal trainer Robyn Lanci of Well Rooted Kitchen.

Provide a safe haven

Just like the study mentioned above suggests, removing junky snacks is a useful method parents should utilize. 

Pediatrician Heather Finlay-Morreale says: “One thing parents can do is simply not buy processed food for snacks. Provide healthy snacks low in simple carbs and high in protein. Options include yoghurt, fruit, carrots with hummus dip, nut butter on whole grain crackers, and cheese sticks. Sugary drinks should simply be eliminated. Other options are water or milk. Ultra-pasturized milk boxes do not need refrigeration and are a great portable option.”

“If it doesn’t make it into your shopping cart, it won’t make it into your pantry and subsequently into your kiddo’s mouths,” advises Registered Dietician Trish Brimhall. But make sure you keep your guidelines moderate and balanced so your kids won’t raid their friends’ pantries. “It is important that you don’t go overboard with extreme nutrition such as limiting all favorite snack foods, forbidding chips or sweets,” Trish concludes.

Choose your battles

You really can’t win them all, and many situations are beyond reasonable parental control.

“We eat very healthy at home, so if the kids are at a birthday party or when we’re on vacation, we can be a little more lax at those times,” Says Therapist Heidi McBain.

Therapist Rachel Gersten, likewise, doesn’t impose the house rules out of home: “I suggest parents try to let go of what their kid eats outside of the home. It's important to do as much as you can (like sending healthy lunches and snacks to school or activities), but also accept that they're kids and will eat the occasional sugary treat or maybe drink a soda when they're away from home. I think the lessons on nutrition and continuously emphasizing the importance of healthy eating is crucial to making sure they grow up knowing the importance of nutritious foods, even if they eat junk food as kids sometimes."

Although it may seem like too many outside forces are acting against our kids healthy eating choices, we parents still have tremendous influence over kids’ food habits, and good habits can protect our kids for life.

Dr. Ayala

Want kids to eat their veggies? Try herbs and spices

Vegetables shouldn’t be such a hard sell. They’re colorful, pretty, crunchy, and in my personal opinion, quite delicious even in their raw, unadorned state.

But despite lots of urging from every health authority and mom, people don’t eat enough of them. Eating veggies has never been as important: Veggies, with their abundance of fiber, phytonutrients, antioxidants, vitamins and minerals, not only reduce the risk of several chronic diseases – such as heart disease and diabetes – eating them can replace other foods, and there is no other food group with fewer calories and more filling capacity. They’re the food that societies facing rising rates of obesity should turn to and delight in – a carrot, after all, is much tastier than the “stick” of food avoidance.

Shockingly, only about 2 percent of American teens eat the recommended amount of vegetables daily.

Multiple strategies have been employed to change this sorry statistic – education campaigns have been quite successful in making people aware of the benefits of 5-a-day, but they have not moved the needle enough – and one of the promising ones is adding flavor and interest to vegetables.

A pinch of flavor

A new study, published in Food Quality and Preference tests how the addition of herbs and spices may affect teens’ fondness of vegetable dishes.

The study was conducted in a rural Pennsylvania school, among teens aged 14-18. Surveys taken before the study showed that about 75 percent of students reported that the main reason they don’t eat more veggies at school is their taste. The kids also had very little familiarity with herbs and spices.

Nevertheless, when vegetables such as carrots, green beans, cauliflower and broccoli were prepared with herbs and spices, students liked and selected them more, and preferred them over the plain versions. The kids favored the seasoned dishes even when the spices and herbs were unfamiliar to them – dill-seasoned broccoli and cauliflower with coriander got better ratings than plain broccoli and cauliflower, even though dill and coriander were unfamiliar to the kids.

And since meals – both at school and at home – strive to reduce added salt and oil, recipes with healthy spices and herbs could make vegetables more desirable.

Another recent study in Appetite tested vegetable consumption in a university cafeteria, comparing the selection of seasoned vegetables to steamed ones. The researchers tested several different vegetables – carrots, broccoli, and green beans – steaming and seasoning them with things like garlic, parsley, dill, cinnamon and black pepper, as well as some oil and salt, as opposed to just steaming them with vegetable oil and salt. Given the choice, students preferred the seasoned vegetable, and even people who otherwise wouldn’t have selected a vegetable side were 1.6 times more likely to pick one if it was seasoned.

Dare to flavor

Processed food is very high in flavor – much of it comes from sugar and salt, with other flavorings, not all of them natural, added to the mix. Regardless, the profile of most of these craveable foods is the polar opposite of bland.

Yet when parents and cafeterias prepare vegetables they often add very little flavor to them. Serving veggies raw and plain can work if they’re at the height of ripeness, freshness and flavor, and if people already love that particular veggie.

For other vegetables, especially those with a hint of bitterness, seasoning could make a huge difference, and a little effort and attention could elevate veggies' desirability and consumption among kids.

“I like to start off with something they are familiar with, like Italian seasoning,” says registered dietitian and chef Julie Harrington. “Most children are familiar with the Italian seasoning that is on their pizza or in their pasta sauce.”

Kids’ cooking teacher Katie Kimball likes to combine the novel with the familiar: “When I use a spice like turmeric, for example, I like to call the veggies "mustard veggies" because all my kids adore mustard. That explains the yellow color and reduces their skepticism. We add smoked paprika to veggies in a breakfast hash, a very strong flavor that many might think is too much for kids - but along with oregano, it helps veggies taste a little like pizza. And of course, pumpkin pie spice makes numerous recipes including squash or sweet potatoes go right down the hatch!”

Registered dietitian Jennifer Glockner offers these tips:

Spices and herbs may have a powerful flavor so just a tiny amount may go a long way. Pureed or finely chopped herbs work well for kids.

Cinnamon or nutmeg can pair well with sweet vegetables such as sweet potatoes and carrots.

Dill or chive works well with cruciferous vegetables like cabbage or cauliflower.

Mint and/or citrus (juice, zest, slices) adds brightness to salads (tomatoes, cucumber, bell peppers).

Paprika is a fun spice that adds smokiness and color to vegetables.

Jennifer also reminds us that we should “try, try, try again. It can take up to 12 tries to like a new food including vegetables and seasonings.”

Let’s celebrate the last days of National Nutrition Month and “Go Further With Food” by breathing new flavors with spices and herbs. These wonderful natural, healthy flavorings from nature unlock veggies’ potential and can make them exciting to both kids and adults.

Dr. Ayala