Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Wednesday, April 23, 2008

Kids in the Kitchen: There is morKids in the Kitchen: There is more to Obesity than Eating Righte to Obesity than Eating Right- Andrea Walkonen

The Problem: One out of every three children in the United States is considered obese by today’s standards. The occurrence of childhood obesity has more than doubled since the early 1970’s. There have been many initiatives to put a stop to childhood obesity, but few have succeeded. Kids in the Kitchen, an initiative of the Association of Junior Leagues International, was launched in 2006 to address the growing problem of childhood obesity. The program was launched in over 225 communities worldwide, including Canada, Mexico, the United Kingdom and the United States. It grew to 255 communities in less than a year. The objective of Kid’s in the Kitchen is to educate the public on solutions to the children’s obesity epidemic.
According to the Junior League, the key impact of the Kid’s in the Kitchen program is educating families through their website. The website includes fitness and nutrition tips from supporting organizations and partnering campaigns such as the United States Department of Agriculture, the American Dietetic Association, Women’s National Basketball Association, Cartoon Network and many others. It also includes a virtual recipe collection consisting of recipes from celebrity chefs, local restaurateurs, celebrity moms and nutrition experts. These nutrition and fitness tips and recipes are designed to teach children and parents about healthy eating habits starting at a young age. Kid’s in the Kitchen has approached this initiative with live events and demonstrations that involve the kids and their parents in hands-on activities. The activities are designed to teach families about healthy habits. Events range from local chefs giving cooking demonstrations in schools and community centers to grocery-store tours that educate kids and their parents on selecting nutritious and affordable recipe ingredients.
Different leagues use different events based on location and resources. For example, at the Junior League of Brooklyn, a petition was addressed to the Board of Education which resulted in the school providing free lunches in city schools. It also created a model for school lunches everywhere. The Junior League claims that education is the first and most important step to prevent further problems with obesity in children. While the Junior League’s program has made an impact, it has yet to improve the nation’s childhood obesity epidemic. Kid’s in the Kitchen carries reminiscences of the modeling theory. It assumes that the best way to prevent childhood obesity is to get the children to model their parents eating behaviors.
Kids in the Kitchen fails to decrease the incidence of childhood obesity because it fails to consider socioeconomic factors influencing food choice and activity level, it places little emphasis on the importance of physical activity as well as proper nutrition in preventing childhood obesity, and it fails to address the importance of the role of parents in encouraging healthy behaviors. The program places too much emphasis on individual factors affecting behavioral decisions and fails to address the equally important social contexts in which individuals base their behavioral decisions.
Social Learning Theory: Kids in the Kitchen exemplifies the modeling theory of behavior also known as the social learning theory (13) The program resonates aspects of the social learning by teaching children to model the behaviors of their parents when it comes to meal preparation and activity choices to adopt healthier behaviors. While the program has the right idea in educating families on the importance of preparing meals together, it fails to identify the lifestyles and different environments in which the children are raised.
The social learning theory is a very simple theory. The basic design of the theory is that an individual observes a behavior, that individual then imitates the behavior and the result of the behavior is a consequence (13). In this model individuals learn by vicarious learning. The Kids in the Kitchen program reflects characteristics of the social learning theory by attempting to have children observe their parents dietary behaviors through active participation in family meal preparation. The goal is to have children adopt their parents’ dietary behaviors by observation and interaction. The problem with Kids in the Kitchen is that it fails to consider the influences on parents’ behavior that result in poor behavior in children. The dietary behaviors of parents are affected by their socioeconomic status as well as their knowledge of what healthy behaviors they should be practicing. The social learning theory might be beneficial if the correct behaviors were being modeled. Not only is Kids in the Kitchen failing to recognize environmental and social influences on dietary behaviors, they are also not fully emphasizing the importance of physical activity. The social learning theory might also be beneficial in this circumstance if parents were to model healthy physical activities, which are also influenced by environmental and social factors. The limitations of the social learning theory are that it does not consider the idea of choices; it assumes that what an individual sees is what an individual does. It also is a very time consuming model that greatly depends on the ability to change prior generation’s behaviors in order to influence future generations. If Kids in the Kitchen wants to continue to use this model, there are several factors that must be considered in order to have an impact on the increasing rates of childhood obesity.
Socioeconomic Status influences Obesity: The socioeconomic status of the family is a key factor influencing food choices. Parents are forced to spend longer hours working to support the family and therefore have litte, if any, time to prepare healthy meals and spend time with their families. Studies have shown that individuals of low-income areas have higher rates of obesity as a result of availability and quality of food (2). Due to the lack of resources in poorer communities there are less supermarkets available and smaller independent grocery stores that provide low cost high-energy foods. Those healthier options that are available are unaffordable and often very poor quality (2). As a result parents choose to buy cheap convenient meals and snacks that require little to no preparation and offer little nutritional value.
Fast food has also become an affordable option for both low-income and wealthier families. The fast food trend is continually increasing as parents and children are spending less time at home and more time with friends, at work, at school, etc. Our society has placed an emphasis on the unlimited supply of convenient, relatively inexpensive, energy dense foods (4). In the 1970’s, only 17% of children consumed their meals away from home of which 2% of energy intake was from fast foods. Today children and families consume more than 30% of the meals away from home of which 10% of energy intake is from fast foods (3). The increase in fast food consumption is a result in the change of family oriented lifestyles.
Parents either choose or are forced to work long hours resulting in no time to prepared nutritious home cooked meals. Family meals have been replaced by take-out and fast food meals. Instead of focusing on how to get kids to want to help prepare family meals, Kids in the Kitchen must first focus on how to get families back into the habit of eating meals together. Their program is unsuccessful because it fails to recognize that some families lack both the time and resources to prepare home cooked meals together. Kids in the Kitchen advertises the importance of getting kids involved in their own health but needs to fails to recognize that the availability of healthy ingredients and food options varies within socioeconomic areas. If the parents do not have the resources to provide healthy food options they cannot teach their children how to make healthier choices when they themselves do not have the means to purchase healthier food options. The program is unsuccessful because it does not implement educational tools to help lower income families find healthier affordable options.
Few families recognize that there are programs available that will help provide healthy food options. One of the largest programs involved with low-income families is WIC. WIC provides food, nutritional counseling, and access to health services for women, infants and children of low-income families (6). Another large food initiative for low-income families is the Food Stamp Program. In this program, the families receive a card, similar to a credit card, with which they can purchase healthier foods for better health (7). Kids in the Kitchen would benefit from partnering with associations such as WIC and Food Stamps to help increase awareness of programs such as these offered to low-income families. Many families don’t know about these programs or are ashamed to participate. Kids in the Kitchen has failed to recognize the opportunities available for underserved individuals. Higher levels of obesity have been reported in low-income families (2). By failing to address the issue of socioeconomic status, Kids in the Kitchen has overlooked an important part of the obese population. The WIC program and the Food Stamp program are both available for lower income individuals. The decision of who receives help from either program is based on several factors that are established during a pre-screening process. Those who receive food stamps or help from the WIC program are allotted a certain amount of money to purchase food items necessary for proper nutrition. The Food Stamp program allows for the purchase of breads, cereals, fruits, vegetables, meats, fish, poultry, and dairy products (15). Similarly, the WIC program allows the purchase of iron-fortified cereals, juice, eggs, dairy products, nuts and seeds, fish, iron fortified infant formula, fruits and vegetables (14). Both programs have strict guidelines about which foods are acceptable for purchase. Their guidelines are Federally regulated by the Food and Drug Administration (14). Kids in the Kitchen does not have partnership with programs such as WIC and Food Stamp and is therefore weak in the fight against childhood obesity. Food Stamp served over 25 million individuals in 2005 giving over $28.6 billion for the year (15). This shows how beneficial these types of programs can be in providing nutritious foods for families of lower socioeconomic status.
The financial issues of proper nutrition have also spread to school districts. School districts that do not have efficient funding establish pouring rights contracts with soft drink companies, which allow the schools to place vending machines on school property and sell beverages at school (3). This has helped schools to make money while also helping to promote sugary, high calorie beverage consumption further complicating the obesity issue. In an effort to save money, schools have subcontracted lunch programs to corporate food services, which encourage the sale of low quality foods including fast foods (3). The same budgetary constraints have led to a decrease in physical education programs and classes (3). Physical activity is one of the most controllable factors influencing obesity that needs to be addressed along with socioeconomic status.
Physical Activity: Physical activity is one of the most controllable factors in preventing obesity. Changes in physical activity are a result of changes in environment including safe areas for children to play and walk, vehicle use, and decreasing school physical education programs. Children who are from ethnic minorities, children living in neighborhoods where physical activity is limited, children with disabilities, and children living in apartments or public housing are at higher risk of obesity (5). These children do not have access to safe play areas and are often times forced to play inside where television and video games have replaced physical activity (5). A nationally representative survey in 2002 found that 53 percent of parents drove their children to school while 38 percent had their children take the bus, 17 percent of their children walked, and only 5 percent rode their bikes (8). Parents whose children did not walk or bike were asked why their children were not allowed to walk or bike. The most common responses were that the school was too far away, there was too much traffic with no safe walking route, parents fear their children being abducted, its not convenient for the child to walk to school, there is high crime in the neighborhood, and their children simply do not want to walk to school (8). Not only are children missing out on opportunities for physical activity in getting to school, they are being deprived of physical activity in the schools as well. The lack of funding in schools had led to a cut in the physical education programs in schools in and effort to save money and increase emphasis on academic achievements.
The National Association of Early Childhood Specialists in State Departments of Education recently reported that 40 percent of elementary schools have reduced, deleted or are beginning to consider deleting recess since 1989 (8). There has been a 25 percent drop in play and a 50 percent drop in structured physical activities said to be a result of an increase in homework from the early 1980s to the late 1990s (8). Kids in the Kitchen recognizes the need for an increase in physical activity. They have partnered with Cartoon Network’s Get Animated program to increase kids motivation to be physically active (1). However, they place more emphasis on the nutritional aspect of childhood obesity and fail to equally emphasize the importance physical activity in fighting the obesity epidemic. Using a television programs seems contradictory to promoting physical activity. It requires that children watch television in order to learn about the benefits of physical activity. Children today spend more time in front of the television than ever. They are viewing the message about the importance of being physically active yet they are not becoming more physically active. According to the American Academy of Pediatrics, kids are watching more then four hours of television a day, over twice the amount recommended (10). The guidelines state that children older than two should watch no more than one to two hours of quality television each day while children under two should not be watching television at all (10). Studies show that ‘screen time’ may result in obesity as a result of replacing times for physical activity (3). A study on the reasons as to why children participate in physical activities found that there are three main reasons for participation in physical activity including the development of physical competence, gaining social acceptance and support from peers, family, coaches, etc., and simply for the fun derived from participating in such activities (9). In order to enhance children’s perceptions of their physical competence there needs to be an environment that will focus on helping children to learn these skills through support of educators and families (9). Kids in the Kitchen provides hand on cooking demonstrations that have been effective in the past. They could therefore benefit from providing hands on fitness demonstrations where fitness instructors and educators are available to interact with children and families to show them that physical activity can be fun and rewarding. Current physical activity promotion campaigns focus highly on the health benefits of physical activity however children and even adults are not interested in how the activity affects their health if it is not an activity that they enjoy doing. This is why personal interaction with the families would be more useful. It would show families that physical activities don’t have to be difficult and can be adjusted to fit their level of perceived ability. It is important to target the entire family as the parents are role models for their children and greatly influence their children’s behaviors. Kids in the Kitchen also overlooks the importance of the parents role in changing children’s behaviors.
Parental Influence: Parents play a critical role in the development of children. They are responsible for the dietary patterns, the exercise and physical activities, and overall behavioral patterns of their children. Therefore the parents’ awareness of promoting healthy behaviors to prevent childhood and adult obesity is equally, if not more important than the children’s awareness (5). The parents raise their children according to their own beliefs and experiences. If their beliefs and experiences result in unhealthy behaviors then the children are going to grow up believing what their parents have taught them is acceptable. If more emphasis is placed on parents to make lifestyle changes then the children will adopt similar behaviors. There are two main factors affecting children’s obesity that can be controlled by parents. The factors include physical activity levels and dietary behaviors. Based on several studies, both of these factors are highly influenced by the media, which can also be controlled by the parents. A seven-year study on the affects of parent-only based interventions compared to child-only based interventions found that a family-based, health-centered approach targeting parents only induced greater weight loss in obese children upon termination of the study (11). The parents of the study were taught how to influence their children through their own behaviors by modeling self-regulation skills as opposed to making decisions for them. The study also revealed that there was a lower rate of resistance in the parent-focused group’s children. This was believed to be a result of the children in the child focused group being actively responsible for their own behaviors and feeling forced to change. Upon termination of the study 60 percent of the children from the parent focused group changed from obese to normal weight status while only 31 percent of the child-focused group changed weight status (11). These studies reveal the importance of parental influence on changing children’s behaviors. Kids in the Kitchen focuses on directly changing children’s behaviors while failing to consider how influencial parents can be on their children.
Improvements in Public Health: Kids in the Kitchen has the right idea in using the social learning theory as a model for behavior modification, however they are focusing on the wrong models. The parents are one of the most influential models to children and should therefore be targeted for obesity prevention. One of the biggest issues that parents need to become aware of is the effect of the media on their children’s behaviors.
As previously discussed, children are watching twice as much television today compared to previous years (10). Several changes need to happen to reduce the media’s influence on children. One of the most important is the amount of time spent in front of the television. The time children spend watching television displaces time they could spend doing physical activities (12). Parents need to limit the amount of time their children watch television and replace that time with family activities that incorporate physical activity. Another problem with television is the effect of advertisements. One study found that in the early 70’s children were exposed to approximately 20,000 TV commercials a year which increased to 30,000 commercials a year in the late 80’s (12). The most recent estimates of commercial exposure are 40,000 per year (12). The majority of commercial advertisements targeting children are for food. Candy compromises 32 percent of all commercial ads with cereal compromising 31 percent and fast food compromising 9 percent (12). Studies show that television was a significant predictor of how often and what type of food products the children requested at the grocery store and at home with three out of four requests being products seen in television ads (12). There have also been experiments proving that the type of advertisement seen affects the children’s food choices. One experiment involved the manipulation of the type of advertisement shown to 5 through 8 year olds at a summer camp. One group of children was exposed to ads for candy and other sugary snacks while a second group was exposed to ads for fruits and juices. Results of the study revealed that the children who saw the fruits and juices ads requested these types of products, as did the other group with the unhealthy food ads (12).
Kids in the Kitchen would be more successful if they focused more of their attention on educating parents about healthy behaviors including diet and physical activity with an emphasis on reducing the amount of time spend watching television. The program should make an effort to change the type of advertisements shown on TV by replacing sugary snack and junk food commercials with commercials that make healthy food options more attractive to children. The unhealthy food commercials make the products very desirable to kids by convincing them that its ‘cool’ to eat those types of food and that life is easier with those types of foods. Programs like Kids in the Kitchen should create advertisements that make healthy food options seem ‘cool’ and desirable to both kids and parents. Parents have the final decision in what types of foods are available and what types of activities their kids are involved in and should therefore be the main target for preventing obesity.
With childhood obesity on the rise, people need to step back and really examine what is making our children obese and where changes can be made to prevent the obesity epidemic from spreading. Programs such as Kids in the Kitchen are on the right path to obesity prevention, however, they are not focusing their attention on the correct areas of intervention.
Kids in the Kitchen focuses on individual behaviors that influence obesity but the real problem with obesity stems from social and environmental factors influencing our children’s dietary and physical activity behaviors. The socioeconomic status is highly overlooked as a key area of obesity prevention. With lower socioeconomic groups having less access to quality foods, one area of change for intervention should be how to make healthy food options available for an affordable price. Kids in the Kitchen should encourage programs like WIC and Food Stamps as an acceptable option for low-income families. Not only should dietary interventions be improved, but physical activity programs must be strengthened.
In order to change physical activity levels in children, they need to have resources available to support safe and fun physical activity. Physical education programs must be reintroduced back into schools. Parents must learn to make better decisions regarding their own health in order to influence their children to make similar decisions. While parents should be heavily targeted to influence behavior change, so too should the media. More advertisements should be advertised encouraging healthier food options as opposed to junk food options. Children will base their decisions on how appealing a product appears on television therefore targeting the media to change the types of advertisements would change children’s opinions of how healthy foods are more appealing than unhealthy foods. The major change that characterizes all of the previously mentioned changes is the alteration of focus from individual factors that influence behavior to social and environmental factors that influence behavior. Should Kids in the Kitchen shift their focus and address the social and environmental factors, they would be more successful in reducing childhood obesity.


1. Junior Leagues’Kids in the Kitchen Initiative Continues in 2007-2008. The
Association of Junior Leagues International. 2005.
2. Cummins, Steven & Sally Macintyre. Food Environments and Obesity –
Neighborhood or Nation? International Journal of Epidemiology, 2006. 35(1): 100-104
3. Ebbeling, Carra B PhD; Ludwig, David S MD & Pawlak, Dorota PhD. Childhood
Obesity: Public-health Crisis, Common Sense Cure. The Lancet, August 2002. 360(9331): 473-482.
4. Hill, James O. & Peters, John C. Environmental Contributions to the Obesity
Epidemic. Science, May 1998. 280(5368): 1371-1374.
5. Council on Sports Medicine and Fitness & Council on School Health. Active
Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. Pediatrics, May 2006. 117(5): 1834-1842.
6. United States Department of Agriculture. WIC Program: About WIC. Food and
Nutrition Service. Last Updated 09/12/2003.
7. United States Department of Agriculture. Food Stamp Program. Food and Nutrition
Service. Last updated 03/04/2008.
8. Anderson, Patricia M. & Butcher, Kristin F. Childhood Obesity: Trends and
Potential Causes. The Future of Children, 2006. 16(1): 19-45.
9. Weiss, Maureen R. PhD. Motivating Kids in Physical Activity. President’s Council
on Physical Fitness and Sports Research Digest, September 2000. 11(3).
10. Dowshen, Steve MD. How TV Affects Your Child. Nemours Foundation found at Last Updated February 2005.
11. Crow, Scott & Golan, Moria. Targeting Parents Exclusively in the Treatment of
Childhood Obesity: Long-Term Results. Obesity Research, 2004. 12: 357-361.
12. The Henry J. Kaiser Family Foundation. The Role of Media in Childhood Obesity. February 2004.
13. Edberg, Mark. Essentials of Health Behavior: Social and Behavioral Theory in
Public Health. Jones and Bartlett Publishers. Sudbury, Massachusetts, 2007.
14. United States Department of Agriculture. WIC Food Package. Food and Nutrition
Service. Last updated 12/06/2007.
15. United States Department of Agriculture. Food Stamp Program. Food and Nutrition
Service. Last updated 03/04/2008.

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