Are We Failing the Next Generation?

By Frances McGrath, BNurs, BAppSc, DipNut

Goodfeeding.com

Reviewed by Catherine Forestell, PhD

With a death toll of over 200,000 Americans and rising from COVID-19, we are all feeling the effects of this cruel pandemic. What it has highlighted however, is that certain conditions appear to increase the severity of the symptoms and the risk of death; at the top of the list is obesity and the health complications associated with it.

As pointed out by Nancy Roman, President and CEO of Partnership for a Healthier America: “Of those suffering from underlying conditions — including diet-related diseases like diabetes, high blood pressure, or heart disease — 20 percent died after contracting COVID-19. Less than 2 percent of people without those conditions died.”

It is no secret that the United States has a staggering rate of obesity among adults and children. If current trends in childhood obesity continue, more than 57% of children in the U.S. will be obese at age 35, according to a new study from Harvard T.H. Chan School of Public Health.

“Our findings highlight the importance of prevention efforts for all children as they grow up, and of providing early interventions for children with obesity to minimize their risk of serious illness in the future.” Zachary Ward, programmer/analyst at The Center for Health Decision Science at the Harvard TH Chan School of Public Health (1).

With the healthcare system already under strain, it’s time to be proactive. We should no longer wait to be the ambulance at the bottom of the cliff, to pick up both the health and financial consequences of the obesity epidemic. Rather, it’s time to build the fences at the top of the cliff, by putting parents in the driver’s seat with the tools and resources to prevent obesity from the start. As the Dietary Guidelines for Americans committee works to provide population based recommendations for infants, toddlers and parents in a Birth to 24 month section, the evidence is building to show that exposure to a variety of flavors early in infancy may be the key to promoting the acceptance of foods that are characteristic of healthy diets, such as vegetables (2).

Experts point to the first 1000 days, those between the date of conception and a child’s second birthday, as a period of rapid growth and development. This is when parents have the opportunity to set their children on a path to health and wellbeing, solidify healthy food preferences and eating habits, and possibly minimize the risk of obesity. Starting with the foods mom eats while pregnant, and, where possible, breastfeeding, to the first foods baby eats on their transition to solid foods, these first sensory experiences are what flavor preferences are built on. By ensuring these are predominantly nutritious options, packed with vegetables, wholegrains and quality proteins, while minimizing the exposure to sugary and highly processed alternatives, we can start to build familiarity and acceptance.

Infant feeding behavior expert Leann Birch wrote in her contribution to the National Institute of Child Health and Human Development “B-24” project:

“Because feeding decisions during the dietary transition from milk to table foods shape what is familiar and preferred, they can have lasting effects on children’s developing intake and weight status. Early experiences with food can either limit or expand the boundaries of the familiar. If early experience includes exposure to a variety of foods and flavors, then a wider range of foods and flavors will be accepted. If not, the diets of young children will likely continue to be dominated by sweet or salty foods that are readily accepted without familiarization.” (2)

In this review, that has been used to drive the development of the new Birth to 24 months Dietary Guidelines for Americans, Dr Birch and colleagues provide a comprehensive literature review of the concept of familiarization and how it impacts learned likes and dislikes of flavors and food. One period in particular that appears to have the most significant impact is the 4-7 month window. This ‘flavor training’ window is a time when infants appear to be highly receptive to new flavors, requiring fewer exposures to become familiar thus increasing acceptance. (3) In fact, in one study, infants who were offered puréed foods, even in small amounts, even before weaning began, increased their intake of new fruit and vegetables after a single exposure and the effect of that exposure was extended to other similar foods. (6)

The flavor training journey can start from around 4-5 months. However, this should not be confused with complementary feeding because flavor training is not only about providing foods for nutrition. It is a taste only, a small dab on the lips with a clean finger or teaspoon of a ‘flavor’ other than that of sweet breastmilk or formula. (7) By offering a wide range of single vegetable purées, spanning the flavor spectrum, on multiple occasions, we can really start to build familiarity, which in turn will help to drive acceptance. Research shows that children are drawn to what’s familiar. If they’re exposed to a variety of flavors early and often, eventually those foods become familiar. Exposure does not mean eating a bowl full — a small taste along with looking, touching and playing with it can all help to build exposure and familiarity. (8)

It is no wonder the start of the feeding journey is filled with so much fear and anxiety. Parents know what baby ‘should’ be eating; nutrient dense, veggie forward meals. But it takes time to transition from a world of ‘sweet’ milk to the complex flavors of veggie forward solids. Studies suggest that just as a baby’s preference for sweet flavors can be strengthened by exposure, a preference for bitter, sour, and umami flavors-associated with more healthful foods–can increase with early and frequent exposures to these flavors of through foods.(9) Thus, capitalizing on the flavor training window before complementary feeding can help take the fear, stress and anxiety out of starting solids. Parents can give babies their first ‘tastes’ without the worry of providing nutrition. It’s a win win, mom relaxes, baby’s first experiences are free of anxiety, and by the time baby is ready to transition to solids, they are well on the track for accepting a wide variety of veggie forward healthy options, further solidifying preferences.

The flavor training ‘window of opportunity’ is therefore an exciting opportunity when parents can make a difference in setting lifelong health trajectories. In particular, it appears the period between 4-7 months as being the most impressionable time to make a difference. A key window of opportunity to ‘flavor train’ and set palates on a healthy path of acceptance and preference for a diet rich in nutrients and packed with fresh vegetables before cravings for chicken nuggets and french fries kick in. We owe it to our next generation to spread the word and give every child the start we all deserve.

1. Ward Z, Long M, Resch S, Giles C, Cradok A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood (2017). N Engl J Med, 377, 2145-2153. https://www.nejm.org/doi/full/10.1056/NEJMoa1703860#t=article
2. Birch L, Doub A. Learning to eat: birth to age 2 years (2014). Am J Clin Nut, 99(3), 723S-728S. https://doi.org/10.3945/ajcn.113.069047
3. Fildes A, Lopes C, Moreira P, et al. An exploratory trial of parental advice for increasing vegetable acceptance in infancy (2015) Br J Nutr, 114(2):328-336. https://www.ncbi.nlm.nih.gov/pubmed/26063588
4. Beauchamp G, Mennella J. Early flavor learning and its impact on later feeding behavior (2009). J Pediatr Gastroenterol Nutr, 48(suppl 1), S25–30.
5. Mennella J, Lukasewycz L, Castor S, Beauchamp G. The timing and duration of a sensitive period in human flavor learning: a randomized trial (2011). Am J Clin Nutr, 93, 1019–24.
6. Birch L, Gunder L, Grimm-Thomas K, Laing D. Infants’ consumption of a new food enhances acceptance of similar foods (1998). Appetite, 30:283–95.
7. Chambers L, Hetherington M, Cooke L, Coulthard H, Fewtrell M, Emmertt P. Reaching consensus on a ‘vegetables first’ approach to complementary feeding (2016). Nutrition Bulletin, 41(3). https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12220
8. Cernansky R. How to feed kids, without resorting to ‘kid’ food. The Washington Post. July 9, 2019. Accessed on Sept 8, 2020. https://www.washingtonpost.com/lifestyle/on-parenting/how-to-feed-kids-without-resorting-to-kid-food/2019/07/08/2da98516-9751-11e9-916d-9c61607d8190_story.html?noredirect=on
9. Forestell C. Flavor Perception and Preference Development in Human Infants (2017). Ann Nutr and Met, 70(3), 17-25.

Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only. Before starting any new foods or feeding practices, please consult your baby’s healthcare professional.