Nutrition plays a vital role in growth, behavioral and cognitive development, reproductive health, and long-term health maintenance. Pediatric is arguably the most vulnerable population to the affect of food availability. In the early stages of childhood, appropriate nourishment can facilitate growth, cognitive and motor development. In school age children, it can facilitate or hinder academic success, and set up a foundation for a lifetime of healthy lifestyle or predispose a child to multiple chronic morbidities such as fatty liver disease, diabetes, and hypertension. In their teenage years, poor nutrition can lead to infertility, either through anovulation from malnourishment or PCOS from obesity.
Children are entirely dependent on their caretakers for appropriate nutrition in the most crucial stages of their lives. In America, 16 million children currently live in food-insecure households, and more than one third of children and adolescents are overweight or obese. While obesity touches all colors, genders, and social-economic backgrounds in America, African Americans, Hispanics, and children from households with lower education level are especially affected.
Obesity is usually thought of as a disease of excess, however, there’s a positive correlation between poverty and obesity. According to a study of over 28,000 low-income children in the Massachusetts WIC program, children in food-insecure households have 22 percent greater odds of childhood obesity compared to their food-secure counterparts. Though initially counterintuitive, several factors explain this relationship: lack of access to healthy food, greater exposure to obesity-promoting products, cycle of starvation and overeating, few opportunities for physical activities, high level of stress, depression, and anxiety, and limited access to healthcare.
Currently, several nutritional assistance programs such as WIC, Food Bank, and SNAP target low-income, food insecure populations. However, while these programs might address the issue of food insecurity and cycle of overeating and starvation, the types of food provided might contribute to obesity. For example, WIC provides 128 oz of fruit juice monthly to children ages 1-4, which is the maximum amount recommended by the AAP, food banks provide soda, juice, chips and other sugary snacks, and SNAP allows soft drinks, candy, cookies, ice cream, and cake to be purchased using monthly SNAP allowance. While the AAP’s policy statement in June 2017 does allow up to 3 oz of juice a day for 1-3 years old toddlers, it states that “fruit juice …has no essential role in healthy, balanced diets of children” and calls for pediatricians’ support to “reduce the consumption of fruit juice…by toddlers and young children already exposed to juice, including through…WIC.”
While we concentrate our efforts in providing assistance to food-insecure families, it is important to be mindful of the other phenomenon that tends to coexist with poverty and food insecurity: obesity. When families are provided with juice, soda, and other non-nutritious food as part of their food package, it can be confusing and difficult to choose to consume only nutritious food. It is crucial for healthcare providers and nutritionists to counsel patients on healthy food choices, especially in families with limited access to resources and education.
Several resources can help families learn more about healthy food choices:
https://www.choosemyplate.gov/
https://www.girlshealth.gov/nutrition/index.html
Phinga Do, MD
References:
https://ihcw.aap.org/Documents/COPC_Module1_RoleofHCProvider_FINAL.pdf
http://frac.org/wp-content/uploads/frac_brief_understanding_the_connections.pdf
http://pediatrics.aappublications.org/content/139/6/e20170967
https://fns-prod.azureedge.net/sites/default/files/wic/SNAPSHOT-of-WIC-Child-Women-Food-Pkgs.pdf
https://www.fns.usda.gov/snap/eligible-food-items
https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/ChildNutrition.aspx
Pediatric Advocacy 