Why nutrition education is a critical element in raising a healthy generation
MALAYSIA may be a food paradise, but its children aren’t getting enough nutrients – at least not of the right kind.

In November last year, Deputy Health Minister Lukanisman Awang Sauni said in Parliament that some 29.7% of kids between zero and four years old had, or are currently suffering, from stunting, citing Health Ministry’s data in the last five years.

Kelantan and Putrajaya, he said, had among the highest ratio of children suffering from it, and the issue isn’t limited to the lower income group.

“Those with lower incomes tend to go for cheaper and less nutritional food due to their limited financial resources...whereas many with higher incomes are more career-focused, which leaves them little time to cook at home,” he had said.

Stunting is defined by World Health Organisation (WHO) as low height-for-age, and is the result of chronic or recurrent undernutrition. While to a layman, the issue might sound solely about height, from a medical perspective, the condition is much more sinister.

Stunting, the WHO says, prevents children from reaching their physical and cognitive potential. The condition is “largely irreversible” because “a child cannot recover height the same way that they can regain weight.”

Children who are stunted fall sick more frequently, miss learning opportunities, do less well in school and grow up to be economically disadvantaged. They are also more likely to suffer from chronic diseases.

On the other end of the spectrum, another 30% of Malaysian kids are either overweight or obese.

In 2022, the Southeast Asian Nutrition Surveys (Seanuts II), which studied the nutritional status, dietary intake and lifestyle behaviours of some 14,000 children between six months to 12 years old in Indonesia, Malaysia, Thailand and Vietnam, found that one-third of Malaysian children aged between seven and 12 are overweight or obese.

At the core of these two problems is the lack of nutrition education; including teaching parents what to feed their children and empowering children to make healthy choices as they grow up.

Taylor’s University School of Food Sciences and Gastronomy senior lecturer Dr Salini Devi Rajendran says the lack of nutrition education is a serious issue with long-term negative repercussions.

“We live in an age of abundant information. Parents know what they need to feed their children, but many lack the will or perseverance to educate themselves and their children about how important it is to feed the body right,” she says.

While she understands that the lower income group may find it hard to put healthy food on the table due to rising prices, she says this doesn’t mean that families with better income eat better, even when they are financially able to do so.

“Some well-to-do families consider easy access to food as a luxury so they eat what they like. The awareness (about a healthy diet) is there but there’s still the question of whether families are practising it. Many of us know about the “quarter-quarter-half” Malaysian Healthy Plate, but how many of us really do that?” she asks.

Seah says if parents themselves don't make great food choices, it's unfair to expect their children to do so. — Dr SHIRLEY SEAH

Influential agent

Parents, Salini says, are children’s first “influential socialisation agent” who play a very important role in providing children with food environment and experience. “Family-based nutrition education is important in shaping eating behaviours. Home is where kids first learn about food.”

Sunway Medical Centre dietitian Dr Shirley Seah says the fundamental foundation parents need to teach their children is a healthy relationship with food. Modelling good eating behaviour is one of the most effective ways to do this.

“As often as possible, eat together as a family. This is a great way to model positive food behaviour in children. Eating together allows for opportunities to try new foods, eating slowly at the table and enjoying a meal. Studies have also suggested that families who eat together during mealtimes tend to have diets that are of higher quality, with more fruits and vegetables and less fast food and sugary beverages,” Seah says.

She adds that families should also keep all conversations around food positive, including not making negative comments about a child’s or anyone else’s appearance or eating patterns.

“This can help strengthen your child’s relationship with food. Positive conversations should also centre on ‘eating real food’, as much as you can, including having lots of fruits and vegetables and listening to your body’s cues for hunger and fullness. There should be no ‘forbidden foods’,” Seah says.

“Avoid labelling foods as ‘good’ or ‘bad’ or use words that imply that certain foods are better or worse than others. Kids may internalise these negative remarks and in turn, lead to food shaming or developing unhealthy eating habits or disordered eating,” she says.

Salini says parents should also inculcate in their kids the “belief in eating” or the reason why we eat what we eat. “Eating is inextricably linked to emotions and knowing why we eat fosters a healthy relationship with food. We eat rendang to celebrate Hari Raya, for example, or a birthday cake to celebrate birthdays,” she says.

“Most days, we should eat well to keep our body healthy, but that doesn’t mean we can’t – from time to time, and in controlled portions – eat food that makes us happy,” she says.

Salini says parents play a very important role in providing children with food environment and experience. — Dr SALINI DEVI RAJENDRAN

Dangers of food as love language

Asian mothers (also grandmothers and aunts) are known to express their love through food, often asking kids if they have eaten and cooking up a storm for the family, especially for special occasions.

Seah says this traditional mindset around food among Asian parents may lead to overeating in children. “It is common for Asian parents to always ask whether their child has eaten, or being concerned whether their child has eaten enough. It’s not unusual to see parents putting pressure on their child to finish a certain portion of food to prevent food wastage,”

“While encouragement is good, parents also need to look at the amount of food they give; is it sufficient or is it too much?,” she says.

Salini says if mothers cook, it is up to them to make judicious decisions on what they should feed their children. “If you prepare their meals, the onus is on you to help – not force – them to eat better,”

“As children grow older, they should be able to decide what and how much they can eat something, but this training should start from when they are small, with parents trusting their children’s hunger and satiety cues instead of just asking their kids to finish their food,” she says.

Salini also says parents should emphasise physical exercise in their children. “Eating and exercise go hand in hand. Physical activities help kids get healthier and balance their diet,” she says.

Seah adds that modern technologies including smart phones, video games and television have also influenced current lifestyle, leading to a decline in physical activity and children being sedentary.

Parents should also avoid food-based rewards, she says. “It can be very tempting to use sweets or treats as a motivator to reward good behaviour, but this can set the stage for unhealthy relationship with food, where children then begin to associate unhealthy food with positive feelings,” she says.

“Instead, parents should model positive food behaviour by finding non-food rewards such as extra time at the playground or going on a special outing to a place of their kid’s choice.”

This will help children understand that there are many ways to be rewarded and motivated other than food. “Also, parents should bear in mind that screen time reward should also be limited as this might contribute to sedentary behaviour,”

Including toddlers and children in the family's decision-making process about food is also an important aspect of nutrition education.

Inclusivity is important

Salini says including toddlers and children in the family’s decision-making process about food is also an important aspect of nutrition education.

“From meal planning and grocery shopping to meal prepping and cooking, including them goes a long way in helping build a healthy and solid foundation about food,” she says.

These activities encourage discussion and communication and give parents a priceless window to discuss about why we eat certain foods, she adds.

“If you prepare their lunchboxes, let them decide what they want, but tell them that certain foods like protein, fruits and vegetables, need to be included.”

Seah also emphasises the importance of communication. “Talk to your children about the health benefits of certain foods, but don’t nag,”

“Use age-appropriate terms to explain to kids of different ages. Explaining why it is important to have carrots in your diet can sound very different to a two-year-old and a 12-year-old. A toddler doesn’t care that carrots are packed with beta-carotene which is a precursor to vitamin A and helps support healthy eyesight. A 12-year-old might think that this information is cool and loves the new knowledge,” she says.

“Talk to them about the different types of food, such as fresh produce versus commercial products. Most grocery stories have mapped out sections of fresh produce and processed foods and this is a perfect place to teach your child to navigate. Go through the fresh produce areas first as essential foods – which should be eaten daily – while leaving the commercial products as optional, to be enjoyed sparingly,” she says.

Parents should talk to their kids about the different types of food, like fresh produce versus commercial products. — Freepik

Leading by example

Kids learn by watching what their parents do. Parents are their kids’ role models, so Seah says if parents don’t make great food choices, then it is unfair to expect their children to do so.

“Always offer healthy options at home. If you want your kids to stop drinking soft drinks and eat ultra-processed snacks, don’t have them in the house. Instead, always have wholesome snacks like eggs or fruits. They are allowed to get the occasional treat when they’re outside, but it should be known to your child that those foods aren’t going to help them grow strong, hence, they don’t make it into the house,” she says.

Salini agrees. “If parents don’t provide healthy food at home, how can kids familiarise themselves with them?”

Seah also suggests to add foods to the family menu instead of cutting out certain items. “This is a simple and effective strategy to emphasise variety which promotes the addition of foods into a diet, instead of restricting or taking certain food out. A child can then have a cookie and some orange slices – it doesn’t have to be one or the other,” she says.

The good news it, wherever parents and their children are in their nutrition education journey, it’s never too late for anyone to develop a good, new habit.

“Even as adults, we are constantly developing new habits, like trying out a new hobby or embarking on a lifestyle change. So I believe the same goes for children,” Seah says.

“As children grow, they tend to establish their own thinking and have their own food preferences. However, don’t despair and continue to have a variety of vegetables on the dinner table. It’s important not to force your kids to have veggies – this will only create negative associations with food,” she adds.

Salini says when parents don’t cook at home, it’s not easy to get kids to be familiar with nutritious food. “Part of why they don’t like certain vegetables, for instance, is because they are not familiar with the taste and texture of those vegetables,”

Like other habits, eating vegetables is something that needs to be cultivated. “Forming a habit takes time; it’s not done over a few meals. Just don’t give up and continue taking small steps to help children eat better,” Salini says.

“You may be surprised that one day when your child, now a teenager or even a young adult, might take the initiative to try that once-hated vegetable! Changes take time, and miracles do happen,” Seah concludes.
StarExtra
While parents know what they need to feed their children, many lack the will or perseverance to educate themselves and their children about how important it is to feed the body right.