Feature

Parents often try to stave off picky eating habits in their children by prompting them to clear their plates before leaving the table, or to try "just two more" bites of chicken before dessert. But according to childhood obesity expert Debra Haire-Joshu, PhD, that type of encouragement may inadvertently teach children to overeat and put them at risk for obesity.

"Parents notoriously overfeed their children," says Haire-Joshu, a professor of behavioral science and health education at the Saint Louis University (SLU) School of Public Health with more than 20 years of clinical and research expertise on obesity. It's not uncommon, for example, for parents to serve up three times the portion size appropriate for their child, she says. "Children know when they are full-a lot of the picky eating going on is natural and biological. They are going to eat when they are hungry."

Parents' misunderstanding of what qualifies as normal childhood eating, along with the media's push of sugary and fatty foods to children and many U.S. schools' poor nutrition policies are among the reasons that 9 million U.S. children today are overweight, says Haire-Joshu.

She is taking a two-pronged approach to reduce those numbers. For one, she is spearheading a national parent education program that teaches parents how to battle the bulge in their children. In addition, as a 2003-2004 Robert Wood Johnson health policy fellow with Sen. Edward M. Kennedy (D-Mass.), Haire-Joshu worked on legislation on childhood obesity that seeks to remove junk food from schools and boost schools' physical education (PE) programs, among other things. Ironically, while research shows that physical activity promotes learning, says Haire-Joshu, schools tend to cut PE to free time for more academics.

Such advocacy is critical, says SLU psychologist and epidemiologist Ross Brownson, PhD.

"Childhood obesity is by any standard an epidemic and one that will have huge implications in the future," he notes.

Haire-Joshu's program and policy work are particularly salient, Brownson adds, because of their national reach.

Beyond baby fat

As a master's-level clinical nurse specialist who worked with diabetic patients in the late 70s and early 80s, Haire-Joshu saw firsthand how controlling weight and controlling diabetes were inextricably linked. And because many of her patients were already overweight by age 40, she saw a need for more behavioral research on preventing obesity early in life.

To that end, she earned her doctorate in educational psychology at SLU. "I love research, so I wanted to learn how to design and test innovative and effective behavioral interventions."

As she switched gears, Haire-Joshu pursued a range of NIH-funded health research on such topics as smoking cessation and weight gain, diabetes and weight control, and began educating parents and children about healthful eating through established community groups such as Big Brothers/Big Sisters. Her most recent project is an obesity prevention component called "High-5 Kids" that she designed in partnership with the national community-based organization Parents as Teachers. The program trains parent educators to teach young parents of preschoolers what to expect in terms of their children's overall development. Through High 5-which refers to the recommended five daily servings of fruit and vegetables-parents learn the ins and outs of healthful childhood eating, such as appropriate preschooler portion sizes, how regular mealtimes prevent pleas for candy and the importance of having healthy snacks within their children's reach. So far, the High-5 programs, and a companion program on obesity prevention in teen mothers, have reached more than 3,000 young parents.

Parent educators also stress the need for patience when introducing new foods to children: Research shows that on average it takes children seven to nine times of trying a new food before they will add it to their repertoire, says Haire-Joshu. Most parents give up long before that, she notes. In addition, the program emphasizes that budget eating doesn't have to mean fast food: Parents learn about boosting nutrition with seasonal fresh fruits and vegetables as well as with inexpensive frozen and canned vegetables. Educators also remind parents that their children are watching what they eat.

"Parents who say they hate carrots or mutter "Yuck," at the sight of vegetables in front of their kids just aren't modeling good eating behavior," she says.

With funding from the National Cancer Institute, Haire-Joshu is analyzing data she's gathered on High 5's effectiveness and will funnel her findings directly back into the program.

Junk food-free schools

Haire-Joshu's policy work has the potential to help even more children and parents keep childhood obesity at bay. During her fellowship with Sen. Kennedy last year, Haire-Joshu provided Kennedy with background on the Institute of Medicine report, "Prevention of Childhood Obesity: Health in the Balance." Impressed with its findings and suggestions for changes at the state, federal and community levels, Kennedy gave Haire-Joshu the green light to begin work on a draft of a bill on the report's recommendations. Kennedy introduced the bill, titled the Prevention of Childhood Obesity Act, in January 2005. This bill will not only ban vending and soda machines from schools, it will fund the development of more community walking trails and parks and help school gymnasiums to stay open for afterschool programs.

The bill also mandates the creation of a forum of experts on children's health, advertising and marketing to examine healthier ways to market food to children; it also calls for government entities such as the U.S. Department of Agriculture to evaluate its healthful eating practices and programming to "make sure what the government is doing reflects science," says Haire-Joshu.

While she says she was tempted to stay on Capitol Hill to influence public health, Haire-Joshu returned to her beloved research and community programs at SLU because she didn't want to abandon her ongoing research projects. But she's keeping her policy connections alive by serving as an adviser to staff of Sen. Barack Obama (D-Ill.) on obesity and chronic disease issues and monitoring the progress of Kennedy's childhood obesity bill. She says her Capitol Hill experience taught her that psychologists need to move to the forefront in communicating their science to policy-makers, who she says are "willing and eager" to hear about and support work that promotes health.

"We do great programs and have good data that show changes, but many of those changes are not as large as they should be," she says. "So much of what we know is not yet helping the population at large."