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The Leading Voices in Food

E48: Maureen Black on Lasting Impact of Food Insecurity on Children

Hosted by: Kelly Brownell (Duke)
September 23, 2019

It is well known, and has been for many years, how prevalent food insecurity is in the U.S. and elsewhere. People are especially moved when they think of children who are malnourished. Our guest Dr Maureen Black is one of the world’s leading experts on nutrition and its impact on the health and development of children and on how to reduce health disparities by improving child nutrition.

Maureen Black, PhD is the John Scholl MD and Mary Louise Scholl MD Endowed Professor at the University of Maryland, School of Medicine and a Distinguished Fellow at RTI International. She is trained as a pediatric psychologist, with a PhD from Emory University and a fellowship in developmental disabilities at the Neuropsychiatric Institute at UCLA. Her expertise is in the intersection of nutrition and child development. Black conducts her work in low-income communities in the U.S. and in low- and middle-income countries throughout the world.

Interview Summary

Maureen, thanks so much for joining us. Would you mind helping paint a picture for us, if you would, of the developmental and health consequences of being in a food insecure household?

Thank you, Kelly. Yes, there are three areas that I can talk about. The first are the nutritional consequences. Typically, what happens in a food insecure family is that families reduce the quality of food by relying on inexpensive, low nutrient dense food so that children don’t feel hungry. That means that children are not getting the nutrients that they need to develop and grow. So, for example, iron or zinc deficiencies can occur. The second pathway is stress and anxiety that families experience when they are unable to feed their families. This can disrupt parenting and can have consequences on children’s behavior and development and overall health. So the third point is that food insecurity is often invisible because it does not necessarily result in children being either underweight or overweight. So if you don’t ask about food insecurity, you won’t know if a child is in a food insecure household.

So you and I were at a meeting together and somebody at the meeting, it might have been you, said that inadequate nutrition during key stages of development basically confers a life sentence on the child. So can you say what’s meant by this and do you agree, it’s pretty strong language.

It is strong language. And the strongest evidence from that comes from children being raised in low and middle income countries, whose the consequences of their early undernutrition is so severe that it stunts their linear growth. So in other words, their height is challenged. And that can remain with them really throughout life. So it can be a life sentence when it occurs very early in life. I’m talking about the first 1,000 days. That means from conception until a child turns two. That is a time of rapid brain development and not having adequate nutrients at that time can have long-term consequences.

So you mentioned particularly linear growth and a person’s height might be affected, but you also alluded to cognitive developmental changes. Are these things that could be damaged permanently with inadequate nutrition during those key stages?

Yes. Again, the strongest evidence that we have comes from low and middle income countries, where children have been very severely undernourished. There’s a difference between the level of malnutrition that we often see in low and middle income countries and what we see among food insecure children in the U.S. Are they at risk for developmental or behavioral problems? Yes, they certainly they can be.

So why do you think food insecurity is such an intractable problem? I know it’s still the case that the world produces enough food to feed people, but food insecurity just keeps happening and happening. Why do you think this is?

Food insecurity is often a subset of poverty. So one of the reasons is not having enough funds in order to purchase food. And a second reason is basically there have been increases in food prices. A third reason is that it’s often very confusing for families to know what are healthy foods, and we have had many opportunities for snack foods or availability of unhealthy foods that will help children feel full not hungry, but don’t contribute to a healthy nutrition. And the food assistance programs have not really kept pace with the level of child poverty that we unfortunately see in our country.

So if you’re thinking of preventing food insecurity in children in particular, what do you believe are the most important priorities? So is it enough just to get food to children or is it important to think of particular nutrients? Would we ever have the luxury to provide nutrients, for example, to a child’s particular stage of development?

You know, the WIC Program, the Women, Infants, and Children Program, does exactly that. It’s a supplemental program that is available for over 50% of the infants and young children in our country. And they provide nutritional counseling and they also provide food that is age specific. So it changes, for example, when children go from 12 months to the second year of life. But I think what would help up all of us is to focus on healthy habits among children. So it’s not just what food you eat, but it’s when you eat food. We’ve become a very snack dominant culture. So there’s a tremendous emphasis on snacks as opposed to on healthy meals. So helping families of young children develop healthy habits, I think would also help issues related to food insecurity.

Yeah, I know in the field there’s talk that goes beyond just what children might be eating optimally, but also around parent-child interactions around food and around feeding practices. Can you explain a little bit more about that?

Yes. Actually, I’ll tell you about a project that we’re doing in Maryland, which is called CHAMP. This is an NIH-funded project where we work in 54 childcare centers around Maryland. CHAMP stands for “creating healthy habits among Maryland preschools,” though it’s a project introduced into preschools that focus on diet and physical activity using superheroes. And there’s a parent component as well, so it focuses on not only what foods children eat, but it also focuses on providing the autonomy that children need to learn to feed themselves and make choices for themselves, so that it emphasizes not only food but also feeding behavior.

Let’s dive a little bit deeper into that. What exactly would parents be taught in order for children to have more autonomy?

Well, they would be taught as children are able to start to feed themselves, which happens during the second six months of life when they’re interested in touching things, then parents would learn to provide foods that are safe for children and that they’re able to touch and start to feed themselves. Parents also learn to what we call “listen” to their children by looking at their signs of hunger and signs of satiety. A third thing that parents are taught is that they are in charge of what food is offered, when it is offered, meaning the scheduling when it’s offered, and how it’s offered. But children are in charge of how much they eat, and if children choose not to eat, parents are taught not to pressure or force them, but to back off and wait for the next meal.

Oh that’s so interesting, because it’s so different than the way a lot of parents experience picky eating in their children or children not wanting to eat at certain times. So I can imagine this. So there must be research I’m assuming that shows that this is beneficial for the children and probably ultimately for the parents to feel better about interacting with their children.

Absolutely. And when you mentioned pickiness or Neophobia, that means hesitation about new foods, and this is very common in young children and it’s understandable that they would be hesitant about trying something that they haven’t eaten before. So parents learn that the best way to help a child eat a new food is for the parents to eat it, because children learn by watching what their parents do. So having a pleasant meal which is eaten together with parents eating the foods that they’re encouraging the children to eat can often be successful. Forcing children, pressuring them is rarely successful and often leads to distress on all sides.

Maureen, you mentioned the CHAMP study which sounds very exciting. Are there other things going on in your own work or in others’ work that you think is especially exciting and might help lead us into the future?

Yes. Thank you for the question, Kelly. We have a paper released in Pediatrics and in this paper I’m part of a group called Children’s Health Watch that monitors the health and development of young children who are raised in low income families. It takes place in five cities. So in the paper that we released we studied 28,000 children and we looked at them within specific ages. So under age one, one to two, two to three, and three to four. And what we found is that the children’s likelihood of obesity did not vary by whether they were in a food secure family or a food insecure family, but we saw increases in the rate of obesity throughout that time period.

So it tells us that children in low income families have certainly a higher risk of obesity as they, when we say get older, these are children who are age three. So it starts very early in life. We also found in that study that children in food insecure households were at risk for poor health and were at risk, developmental risk. So it reminds us that it’s not only the nutritional pathway but the stress pathway.

Well, that work is impressive in its importance, its scope, and also the size of the sample that you’re working with, so I’m happy you shared that with us. Let’s look into the future a little bit if we could. And in many ways that future is square in our face now, because we think about climate change, population increase projections around the world, political strife occurring constantly around the world and other factors, the challenge of decreasing food insecurity is pretty amazing. Is there any reason, do you think, to be hopeful?

Oh, of course, Kelly. There’s always a reason to be hopeful. I think one of the aspects of being hopeful is that there’s more attention on diet and physical activity. We see more attention on thinking about young children. I do think childcare is an opportunity. As we see more women in the workforce, we see more opportunities for child care. Much more to be done, but that provides a forum where we can help children and families develop the healthy habits that we know can stay with children throughout their lives.

I think we need more responsibility and attention in the food industry to help busy families have healthy options that are convenient, rather than unhealthy options. So I think that there is room for hope, but I think that it happens at multiple levels. So from an individual level through to childcares, up to policy levels to make healthy food available and affordable.

You know, Moreen, I appreciate your optimism and I share it. In addition to the things you mentioned, you can think about all the work that’s going on to address food waste with food rescue programs, for example, which can really help with these issues. So I’m glad that there’s reason to be optimistic, because, of course, these problems are so important. So thank you for joining us today and, of course, for being a leading voice in food. And I know our listeners will appreciate hearing from you, so thank you again.

Thank you, Kelly, thank you very much.


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