Clearly, many diets could benefit from changes. Health practitioners everywhere know the challenges patients face when adopting new, healthier behaviors. Change can be daunting, especially when it comes to a behavior as intimate as one's diet. The following tips can help you assist patients and their families to increase dietary fiber intake and reap its health benefits.
Explain to parents how fiber can improve overall health now as well as reduce the risk of chronic disease later on. Research tells us that those aware of the links between dietary fiber and disease tend to eat more fiber than those less informed.6 Increasing fiber-rich foods provides benefits beyond fiber—these foods also are packed with vitamins, minerals, and phytochemicals. Plus, nearly all fruits, vegetables, and dried beans are low in fat, sugar, and calories.
Support early introduction of fiber-rich foods. Teaching healthy eating should begin early—lifetime eating patterns are rooted in childhood. Gradually introducing infant cereals, pureed fruits and vegetables in the first year supplies the fiber that young children need. Reinforcing the importance of fruits, vegetables and whole grains between one and two years of age gets toddlers ready to enjoy a fiber-rich diet by age two. Preschoolers' dietary patterns track into the school years, then on to adolescence, into young adulthood, and finally to old age.7-10
Encourage parents to eat fiber-rich foods themselves. Modeling healthy eating and demonstrating enjoyment when eating healthy foods helps children accept and eat new foods.11-13 For example, children's intake of and preference for fiber-rich foods like fruits and vegetables are positively associated with parental consumption of these foods.14
Be sure parents know it is their responsibility to serve fiber-rich foods at every meal and snack and to continue offering them even if children initially refuse to eat them.15 Parents help children reach nutritional goals by making healthy foods available and accessible and giving children multiple opportunities to become familiar with the foods.14,16-18 It may take eight or more exposures to a new food before children will accept and prefer it.19
Help parents understand that children are responsible for deciding how much to eat.15 Researchers report that children prefer fruits and vegetables more when parents let them decide the amount to eat.14,20 In contrast, pressuring a child to eat a particular food, offering a reward for eating it, or restricting other foods may have the opposite effect than intended.20-22
Provide parents with suggestions for fiber-rich foods.
- Give developmentally appropriate suggestions. Young children may find some fiber-rich foods difficult to chew and swallow. Parents can minimize choking hazards by serving narrow strips of fruits and vegetables and holding off on nuts and seeds until children are at least four years of age.23
- Focus on whole fruits and vegetables. Americans of all ages eat too few fruit and vegetable servings.24-27 Fruits of all kinds and tender vegetables, like sugar peas and baby carrots, are popular with kids. Serving raw broccoli florets, sweet pepper strips, and other vegetables with a low-fat dip appeals to many children. Keep in mind that the amount of fiber in fruits and vegetables declines as processing increases. To get the most fiber, for example, choose orange segments over orange juice and unpeeled zucchini instead of peeled.
- Advocate that whole grains equal half of the grains eaten.28 The most commonly eaten grain-based foods are pasta, corn chips, white rice, and white bread.29 These foods are made with refined grains, which are much lower in fiber than foods made with whole grains. Whole-grain foods, such as wheat, rice, oats, or corn, can be identified by the word "whole" in ingredient lists on food packages. Mixing high-fiber grains with low-fiber ones can ease the introduction of whole grains. For example, make sandwiches with one slice of white bread and a slice of whole wheat.
- Promote label reading. Nutrition Facts labels are on virtually every food sold in the United States. These labels make it easy to find fiber-rich foods. The grams of fiber in the serving size of the food stated at the top of the label are clearly listed. Label readers need to remember that eating more or less than the stated serving size will affect the amount of fiber the food provides them.
Promote a slow, steady increase in dietary fiber until recommended levels are reached. A rapid switch from a low- to high-fiber diet can cause bloating, flatulence, and other intestinal distress. Achieve gradual increases by mixing high-fiber and low-fiber cereal, adding vegetables to soups and casseroles, and substituting an unpeeled whole apple for applesauce.
Remind parents to be sure that children get plenty of fluids. Normal hydration is vital for good health. Fluids are particularly important as fiber intake increases. Fortunately, many fiber-rich foods—like fruits, vegetables, and cooked brown rice and oatmeal—are naturally high in water. Other fiber-rich foods, like cereal, are often served with liquids.
Promote breakfast for everyone in the family. Breakfast eaters have higher fiber intakes than breakfast skippers.30 Favorite breakfast foods, like oatmeal, bran flakes, toast, and fruit, are rich in fiber.
Make parents aware of the value of regular, distraction-free family meals. The frequency of family meals is positively correlated with intake of fiber-rich foods.31-34Mealtime distractions, like having the television on, adversely affect dietary quality.31,35Families that routinely watch TV during mealtimes eat fewer fruits and vegetables and more pizzas, snack foods, and soft drinks than families that separate eating and TV viewing activities.36, 37
Suggest ways to get plenty of fiber when eating out. Americans are eating nearly 30% of their meals away from home.38 Restaurant foods are often low in fiber. Ordering salads, vegetable side dishes, vegetarian entrees, and whole grain breads can help boost fiber intake.
Let parents know that foods, not supplements, are the best source of fiber. Fiber supplements are not recommended for children. Whole-grain breads and cereals and fresh, frozen, and canned fruits and vegetables are the best choices for a nutritious, fiber-rich diet.
Endorse nutrition policies in daycare centers and schools that promote healthy meals and snacks. These policies often focus on fat, sugar, and calories. Promoting ample use of whole-grain breads and cereals, legumes, fruits, and vegetables also needs to be part of these policies.
Make yourself an example. Changes, even changes for the better, are hard for most people. Show your patients you live what you teach. Make your next—and every subsequent—meal, fiber-rich!
Carol Byrd-Bredbenner, Ph.D., R.D., FADA is Professor of Nutrition and Extension at Rutgers University, New Brunswick, NJ. Her research focuses on environmental influences on eating behaviors including advertising, television, nutrition labeling, and portion size. She has authored a number of nutrition texts, journal articles, and computer software packages.
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- Hampl J, Betts N, Benes B. The 'age +5' rule: Comparisons of dietary fiber intake among 4-to 10-year-old children. Journal of the American Dietetic Association.1998;98:1418-1423.
- Marlett J, McBurney M, Slavin J. Position of the American Dietetic Association: Health implications of dietary fiber. Journal of the American Dietetic Association.2002;102:993-1000.
- Blaylock J, Smallwood D, Variyam J. Dietary fiber: Is information the key? Food Review. 1996;19(1):24-30.
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- Kelder S, Perry C, Klepp K, Lytle L. Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. American Journal of Public Health.1994;84:1121-1126.
- Morales M, Nicklas T, Demory-Luce D, Zakeri I, Baranowski T. Are eating habits of children consistent with those later in life? (Abstract). FASEB Journal.2002;16:494.415.
- Singer M, Moore L, Garahie E, Ellison R. The tracking of nutrient intake in young children: The Framingham Children's Study. American Journal of Public Health. 1995;85:1673-1677.
- Gibson E, Wardle J, Watts C. Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children. Appetite. 1998;31:205-228.
- Gidding S, Dennison B, Birch L, et al. Dietary recommendations for children and adolescents: A guide for practitioners. Pediatrics. 2006;117:544-559.
- Brown R, Ogden J. Children's eating attitudes and behaviour: A study of the modeling and control theories of parental influence. Health Education Research. 2004;32:261-271.
- Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. Parental influences on young girls' fruit and vegetable, micronutrient, and fat intakes. Journal of the American Dietetic Association. 2002;102(1):58-64.
- Satter E. Child of Mine. Palo Alto, CA: Bull Publishing; 1986.
- Domel S, Braranowski T, Davis H, Leonard S, Riley P, Baranowski J. Measuring fruit and vegetable preferences among 4th- and 5th-grade students. Preventive Medicine. 1993;22(866-879).
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- Birch LL, Martin D. I don't like it; I never tried it: Effects of exposure on two-year old children's food preferences. Appetite. 1982;3:353-360.
- Fisher J, Birch L. Restricting access to palatable food affects children's behavioral response, food selection, and intake. American Journal of Clinical Nutrition.1999;69:1264-1272.
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- Birch L, Marlin D, Rotter J. Eating as the 'means' activity in a contingency: Effects on young children's food preference. Child Development. 1984;55:431-439.
- American Academy of Pediatrics. Choking: Common Dangers for Children. http://www.aap.org/pubed/zzz8qh03b7c.htm. Accessed June 1, 2006.
- Serdula M, Gillespie M, Kettel-Kahn L, Farris R, Seymour J, Denny C. Trends in fruit and vegetable consumption among adults in the United States: Behavioral risk factor surveillance system, 1994-2000. American Journal of Public Health. 2004;94(6):1014-1018.
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