Restricting a child's diet can be dangerous

In this excerpt from Parenting magazine, Ellyn Satter, a familytherapist and eating-disorder specialist in Madison, Wis., reports onthe debate raging over how best to feed kids.

Annie's parents were exhausted from fighting with their4-year-old daughter about food.

Acutely conscious of keeping her cholesterol level in check -which they believed could forestall any future development of heartdisease - they served her only broiled poultry and fish, vegetableswithout added fat, bread with a tiny dab of diet margarine andnon-fat milk.

Why, they asked me, was Annie only interested in eating at aneighbor's house?

I told these worried parents that in their zeal to eat healthyfoods, they were taking all the fun out of meals for their child.What's more, I said, they were lucky their youngster had found a wayof undermining their efforts: If Annie had stuck to her family'sfare, she might not have been getting enough food to grow properly.

Nutritionists agree it's nearly impossible for children, withtheir small stomachs and high energy needs, to eat a large enoughquantity of exclusively low-fat food to get the calories they need.That may come as surprising news to many parents who feel obligatedto see that their children eat very little cholesterol or fat.

Fueled by hysteria in the media, many mothers and fathers todayare making frantic - and drastic - efforts to change the family dietin the hope of staving off heart disease.

But there are voices out there that are not being heard.

The barrage of studies, press conferences, advertisements fromfood manufacturers and recommendations - highlighted, perhaps, by thesurgeon general's 1988 report linking diet to cardiovascular diseaseand cancer - has obscured a key point: There is substantialdisagreement among nutritionists, pediatricians, cardiologists andother experts over the extent to which parents should monitor theirkids' fat and cholesterol intake.

There are some points on which the experts agree.

They agree, for instance, that children younger than 2 shouldeat pretty much as they do now, with breast milk or formula for mostof the first year, progressing to a normal balanced diet with wholemilk by the beginning of the second year.

They also agree that overambitious intervention in a child'sdiet can be dangerous: Children of all ages can grow poorly when theamount of fat in their diet is too restricted; weight gain slows andchildren learn less well.

Most important, experts agree that heart disease is primarily agenetic condition inherited from parents.

A change in diet is just one of several ways to control how thatgenetic condition manifests itself.

Diet can improve blood cholesterol levels in some people, but itmay not in others.

In other words, no one can predict if a particular individualactually will benefit from a low-fat routine.

The question experts are debating is: Should all Americans,including children, be urged to change their eating habitsdrastically, knowing that such a change may prevent heart diseaseonly in some people?

A group of nutrition enthusiasts says yes.

Represented by such groups as the National Institutes of Health,the American Health Foundation, the American Dietetic Association andthe American Heart Association, these enthusiasts recommend thateveryone older than 2 limit his intake of cholesterol to 300milligrams or less per day and of fat to 30 percent or less of hisdaily calories, with no more than one-third of that amount comingfrom saturated fat and the rest coming from polyunsaturated andmonounsaturated fat (saturated fat comes from animal sources, whilepolyunsaturated and monounsaturated fats are derived from vegetablesand legumes).

To achieve this 30 percent level, many of the enthusiasts adviselimiting red meat and high-fat dairy products.

The reason for their recommendation? The low-fat andlow-cholesterol enthusiasts maintain that the problem of heartdisease is serious enough to warrant changes in everyone's diet.

Moreover, Dr. William Weidman of the Mayo Clinic in Rochester,Minn., a member of the American Heart Association's nutritioncommittee and the National Cholesterol Education panel of theNational Institutes of Heath, says reducing a child's total fatintake to 30 percent of the diet is not a risk so long as the childgets enough calories from protein and carbohydrates.

The heart association agrees, saying this type of restricteddiet will not interfere with growth and development as long as it isproperly followed.

According to a group of nutrition moderates, that is exactly thepoint: Children may not get enough to eat if parents attempt tofollow these recommendations on their own.

These moderates, including the American Academy of Pediatrics,the American Council on Science and Health and the Council forAgricultural Science and Technology, argue that encouraging parentsto put children on a rigid diet at this point is premature,especially since the available data on whether changes in dietdecrease the incidence of heart disease are inconclusive and sincemost of the research completed so far has been done with adults, notchildren.

What the moderates fear is that parents may eliminate healthfulfoods in attempting to achieve the specific low-fat goals of theenthusiasts.

For instance, if mothers and fathers reduce the amount of meatthey offer their children, they may be restricting the best source ofiron in their children's diet. And cutting back too far on dairyproducts means their kids will be deprived of essential calcium.

Only children with elevated cholesterol levels, the moderatessay, need to be strict in following the diet recommended by theenthusiasts. The rest of the population should simply stay within asafe range of fat intake.

Moreover, these moderates maintain that despite all the recentconcern, there is not a raging epidemic of cardiovascular disease, asthe media would have us believe.

More Americans today are simply living long enough to die fromsuch degenerative diseases as heart disease, stroke and cancer.

The lack of agreement among experts leaves many health-consciousparents confused about how to feed their children.

But what the enthusiasts forget is that one can't prescribediets for children, because they simply don't cooperate.

Children's eating habits are very different from adults'.Children do not eat a whole, carefully balanced meal - they usuallyeat one or two food items to the exclusion of everything else. Also,the total amount they eat fluctuates widely: They'll consume a greatdeal one day and hardly anything the next.

And, unlike adults, they won't eat food because it is good forthem - they'll only eat food that tastes good to them.

So parents can calculate fat percentages all they want, and putmeals on the table that have been planned with a dietitian'sprecision, but the fact is that they can't make children eat. Norshould they try.

By asking children to adhere to a rigid low-fat diet, explainsLeann Lipps Birch, a professor of human development and nutritionalsciences at the University of Illinois who has studied children andtheir eating habits for 15 years, parents wind up creatingunnecessary struggles over eating, which soon lead to negativeattitudes and behaviors toward food.

In my own nutritional counseling practice, I have found that ifthe mealtime structure and the good food are there, children will dowell with eating.

In their seemingly haphazard and often maddening way, childrendo wind up eating a balanced diet over the course of a week or two.

How can parents incorporate the recommendations of theenthusiasts as well as the moderates?

The diet recommended by the enthusiasts should be reservedsolely for the children who really need it - those who have beentested by their doctors and have been found to have an increased riskof heart disease.

Children who don't have a particular risk of heart diseaseshould not have to follow such a rigid diet.

Instead, parents should hedge their bets, following some of theprudent diet recommendations in case the research does pan out, butnot being so gung-ho that they make themselves miserable and impairtheir child's growth.

While parents can't control what goes into their children'smouths, they can control, for the most part, what is presented tothem at the table and from the refrigerator - and that represents anenormous amount of control.

If parents are relaxed and trusting about food, children won'teat large amounts of butter just to upset Mom and Dad. They will eatlarge amounts of butter - sometimes - because they need the calories,because they are hungry or perhaps because they're in the midst of agrowth spurt.

Annie's parents eventually learned to relax about food selectionin order to make mealtimes more interesting for their daughter - andfor themselves.

And they learned to be firm about the structure of meals andsnacks.

Along the way they rediscovered the simple fact that eating isone of life's great pleasures - one that is too important to spoilwith rigid diets and endless struggles over food.

Ellyn Satter is the author of Good Sense and How to Get Your Kidto Eat . . . But Not Too Much (Bull Publishing; 1987).