Instalación de programas y configuración del sistema

Several investigators have attempted to answer questions around food choice and children. The following research investigated different aspects of food choice to show that providing choice within the context of a healthy food environment is central to creating good habits. The research presented investigates the consequences of restricting or controlling food offered to children, allowing self-selection, providing free access to unhealthy options, involving children in food decisions and the effect of the environment on food choice.

One of the earliest theories located about children and food choice was the ‘wisdom of the body’(143). Although the theory has been introduced previously, it is worthy of looking into in more detail. The theory is based on children being encouraged to self-select what and how much foods they eat which results in a high-quality diet and habits. While the original report of Davis (42) could not be accessed, Strauss (143) provides a peer-reviewed account of Davis’ well-known experiment. Her rudimentary experiment included 15 infants whom she cared for in an orphanage and she tracked their food intake, bowel motions and other growth measures. Her claim was let “children do for themselves” (143). Davis provided the food and the children decided if they ate and how much. Her research showed that children were healthy and had good eating habits when given no restrictions on the intake of the food provided (143). One important factor acknowledged by Davis was the food she provided was healthy and the theory would not necessarily translate if several unhealthy options were available (143).

In 1999, Fisher and Birch (29) investigated the relationship between maternal restriction of certain foods and the children’s intake of such foods when given unrestricted access. A multi- component approach (including questionnaires, interviews, observations, body composition measures and food measures) was used to establish that openly restricting access to particular foods does not appear to translate into a moderate intake when given free access (29). Being able to moderate one’s intake is part of creating a habit and placing a constant restriction on certain foods does not appear to support the formation of a healthy habit. This concept has similar findings to several papers that explored the restraint theory in adults (64, 149-151). The restraint theory describes that the ‘self-imposed restriction of foods’ in adults can predispose an individual to over-consumption (29, 64, 149-151). Overall, Fisher and colleagues (29) used a comprehensive and robust approach to exemplify the idea that restriction of certain foods does not translate to self-regulation and a moderate consumption of such foods if they are offered freely. The negative effect on a person’s relationship with food and eating caused by disproportionate control, restriction and pressure placed on what to eat has been acknowledged by several other researchers in the field including, Scaglioni

Scaglioni and associates (32) completed a review of how different parenting approaches affect children’s nutritional behaviour. They looked at two aspects of control in a systematic review of the literature (32). The first was restriction of and control over the intake of

unhealthy food. The second was parental pressure towards children to eat healthy foods, often with a reward of unhealthy food (32). The evidence indicated that extreme restriction or pressure over food intake might be a causal factor in children’s poor eating habits and diet quality (32). In a second review, Scaglioni and colleagues appraised a range of evidence to conclude that excessive parental control over children’s food choice has a negative effect on children’s food acceptance (31).

Satter (65, 125, 142) has published extensively about children’s eating and feeding behaviours; in particular exploring the negative effects of excessive parental control over food choice. Her research led to the development of a the DOR (65, 142).The work considers the negative effects on children where there is parental control over food choice, which can reduce nutrition quality, reduce the ability to self-regulate and results in a diet of reduced quality (125). The paper claims that if children have been raised with restrictions over food choice then these negative effects on choice is likely to be carried through to adulthood (125). Her research also supports that, in the context of a healthy food environment, children should be able to decide if and how much they eat to support the creation of healthy eating habits. Satter’s work supports other research conducted in the home and school setting which highlight; having choice within a range of healthy opportunities, whether it is food or physical activity is important (152); parental restriction may reduce the ability to self-regulate (153); parental control over a child’s eating can reduce the child’s ability to use their own hunger and satiety cues (65); and restriction of ‘palatable foods’ may actually promote that food (29).

It is important to note that this research is not insinuating that providing free access to predominantly unhealthy food is a recommendation either. Beets and colleagues (132) observed that when given healthy and unhealthy options together, most primary school children opted for the unhealthy choices. The setting was out-of-school in a vacation care situation, with observations each morning and afternoon tea over 10 days. Snacks were offered in three different combinations (healthy, unhealthy and a mix of healthy and

unhealthy). When given the third choice of either healthy or unhealthy options, children opted for the unhealthy option. Choosing unhealthy food when available has been shown in other studies also (27, 28, 100, 154). In context, it appears that children need choice, but from an environment of largely healthy foods.

Thus far, it appears that choice is imperative to develop healthy eating habits. However, free access to all foods is not conducive to support healthy food behaviours. The amount of food choice given to children is a complex question as it depends on many factors. Hanks and colleagues (133) stated that the removal of food choice will evoke a negative response amongst children. They used a concept called libertarian paternalism to influence a positive response to choice amongst high school students (133). Libertarian paternalism does not seek to infringe on people’s liberties, rather, this concept leads students to choose healthier foods even when faced with less healthy choices by providing a supportive and encouraging environment (133).

Hanks’s research used environmental cues - such as changing the lunchroom to increase the convenience of purchasing fruit and vegetables, providing an express lane for healthy options, promoting healthy foods only and verbal encouragement at the counter - to

encourage students to make healthier choices (133). The research showed the likelihood to choose fruit increased by 13 per cent and vegetables increased by 23 per cent (133). In addition, after the intervention there was an increase in consumption of the whole food serve of fruit by 18 per cent and vegetables by 25 per cent (133). Therefore, environmental cues at the point of purchase could be helpful supports for children to make a healthier choice even

The investigation of libertarian paternalism was tested in a lunchroom that mimics a sit-down meal (as opposed to a canteen situation) amongst high school students (as opposed to primary school children), which is different to the context of this study. As discussed previously, high school-aged children are at a different stage of cognitive development and thus outcomes from studies cannot be generalised to primary schools. Nevertheless, the concept does portray the potential of retaining choice, while still improving which foods are chosen. In contrast to research previously discussed (29, 132), Hanks et al. (133) have shown the positive effect of food choice, in a supportive environment, on the purchase and consumption of vegetables and fruit in the presence of unhealthy options. Overall, many studies support that importance of having choices with many healthy options available in a supportive environment to encourage children to partake in healthy eating behaviours (65, 155-157).