Eat Your Vegetables!

One of my most vivid childhood memories is of being told I had to finish dinner before we could go to the state fair. On my plate were sliced orange disks which my mother said were carrots but, in fact, were sweet potatoes. I detested the mushy things and knew they were not carrots. I sat there for Hourrrrrssss, with tears streaming down my face, unable to handle the discrimination and oppression of the sweet potatoes. The unfairness! No merry-go-rounds for me! My mother was lying! The adults were in league to ruin my life! The trauma! The unfairness!

I’m kind of sad now that I never asked my long-dead mother whether this story actually happened, and why, in particular, she would lie and tell me that sweet potatoes were carrots. It seems kind of unlikely now. Also, ironically enough, I now love sweet potatoes and will eat them without marshmallows, butter, or any flavoring at all. (They’re really good stuffed with chili and jalapenos.)

Getting children to eat vegetables is always such trauma! What’s that about?

Was it the Plate? Or Just Day 2?

An article in the NY Times and elsewhere last week highlighted another study that focused on this age-old problem. Throughout recent history, all around the civilized world, children do not want to eat their veggies. In this particular study cited in the Journal of AMA Pediatrics, pre-schoolers were given plates with pictures of fruits and vegetables in segments and encouraged to put the food in the segments. The children did then consume 36% more vegetables compared to those using plain plates.

I couldn’t quickly get access to the full article in JAMA here (you can if you’re a physician), but it cited an earlier study where this had also been done with some success for older children. It also showed the data which were even more fascinating. If I’m reading this correctly (again, couldn’t see the whole study), children put a much larger portion of vegetables on their plate on the second day and, though they didn’t eat it all, ate more than on other days. Curiously, on the third day, they didn’t eat more.

This brings up so many unanswered questions. Is the result sustainable? Was it magic carrots on Day 2? Does this mean children really would eat more vegetables on these plates? Hard to know, and that’s one of the problems with these studies. Several parts of the research design suggest problems found in other studies. Prior research gave false positives because studies measured only whether children ate vegetables at all, without looking at a baseline, measured how much they put on their plate rather than how much they ate, or treated fruits and vegetables as interchangeable when, typically, children eat the fruits but not the vegetables.

Researcher Have Not Found a Surprisingly Simple Way to Get Kids to Eat More Vegetables

If you start down the rabbit hole to look at studies on this topic, one phrase pops up repeatedly: …researchers have found a surprisingly simple way to get children to eat vegetables… Yet, when some of the interventions are put into practice, they don’t yield results. It must not be tht simple. As an abstract in the January 2018 National Institute of Health puts it, studies don’t actually show children eat more vegetables.

…The evidence for how to increase children’s fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger.–Cochrane Database Systematic Review

Strangely enough, there are hundreds of articles every year with suggestions about how to increase childhood veggie consumption. Psychologists, physicians, nutritionists, and non-scientific parents have offered their ecommendations all over the place. Don’t force them. Do offer them. Create a garden. Put a salad bar in the cafeteria. Don’t give kids any veggies at all. Serve them to babies. Serve them to the pets. The salad bar studies did not show kids ate more. When they have a school garden, the kids seem to eat more from the garden, but not necessarily elsewhere. Serve them before the burger and fries. It does seem to work if the veggies are served before the entree. Also, neither french fries nor ketchup are vegetables.

There was even a bit of a scandal about the Smarter Lunchrooms Movement, where the USDA invested money into improved school nutrition, awarding grants to schools who adopt techniques to nudge students toward healthier choices. A recent critique of those Smarter Lunchrooms research methods suggested that findings described as “significant” only amounted to an extra bit of an apple per day and that other positive findings reflected what kids put on their plates not what they ate. Surprise! Giving out grant money leads people to fudge their results. Where has that ever happened before?

Do as I Say, Not as I Do…

So we’re back to anecdotal evidence and opinions. The only vegetables I liked growing up in the 1970s were tomatoes and corn. On the other hand, I grew up in the Midwest where every cook boiled the living sh*t out of veggies. They all tasted like slimy mush. I do eat quite a bit of vegetables now because of (a) high blood pressure and diabetes risk, (b) microwaves, and (c) California. Unfortunately, the future “health” argument doesn’t work well on kids, so (a) is out.

However, serving steamed fresh vegetables could work. We’ve eaten microwaved broccoli with our kids since they were small, and they do like it. I’ll never forget eating at a fancy restaurant with them in England where they were so excited to get broccoli. It turned out not cooked like mom’s–it was gray and limp, and my son looked at me with that same face I remember having at state fair time. How could you do this to me, mom? I thought you loved me. I thought the poor kid was going to gag right there.

Getting kids to eat veggies at home is heavily related to what parents eat at home. This made me curious about vegetable consumption data in general. There is an obesity epidemic in the U.S., even though there is also a rise in the number of vegetarians and in restaurants that serve vegetables and healthy food. Kids will follow the lead of their parents, so how are we doing with vegetable eating in general?

We Are Too Eating More Veggies!

Of course, the rabbit hole of data on the internet overtook my afternoon yesterday, when I found some nice fat data sets involving what people eat (rabbit hole for rabbit food, get it? ho ho). After refreshing my memory on how those magic pivot tables work, I determined, according to a UN Food and Agriculture shown at ourworldindata.org, that U.S. consumption of fruit and vegetables per person per day has increased. In the last fifty years, Americans are eating more veggies (and fruits). So there.

Or are we?

That seemed weird. If you look at vegetables as a portion of what we consume, it’s been dropping. This despite all those friends of yours who are now vegetarian. (Are they secretly crunching bacon in the dead of night?) Well, here’s your problem right here.

We’re eating more. A lot more. Almost 1000 calories more a day. Although it’s not obvious from that graph, it’s more sugar, more fat & oil, and more cereal & grains. Yeah, there’s more meat and dairy, but they increase about the same as the vegetables. This is the same data, but by food type.

It’s also worth noting that vegetables aren’t high in calories, so we can’t tell from this data whether people are actually eating a LOT MORE vegetables but not more vegetables in calories. Isn’t there anyone with data that will answer all my questions? Apparently not.

Italy & Greece? Must be the Tomatoes and the Olives

Of course, once I get playing around with pivot tables, the hours just fly by! There was a natural question I was dying to answer. If the U.S. doesn’t eat enough vegetables, who does? I self-selected a handful of countries, although the data set has them all, and here’s what I found.

The folks in the Mediterranean–Greeks, Italians, Israelis–eat a lot more fruits and vegetables than we do in the U.S. I’ve recently eaten Italian tomatoes so perhaps I know the secret! Also the Chinese have significantly increased their fruit and veggie eating.

I was curious that the Japanese, whose longevity is well known, don’t eat so much of the veggies. Of course, they don’t eat a lot of anything, and they don’t eat too much in general so maybe that is their secret? The U.S. increase in veggies wasn’t so impressive on this graph. But, hey, at least we beat the French, the Germans, and the British, in some years. We’re coming for you, Canada!

So I will sit here and eat my healthy spinach salad and feel morally superior to the French, who can make a terrine and gastrique but don’t eat veggies. And to the Brits who can make a proper cuppa tea but not a proper bowla broccoli!