Eating tips for children (1) - babies

Babies grow quickly in the first year of life, so they need plenty of energy (kilojoules) and nutrients. A child’s growth isn’t always steady and even, which means that appetite and hunger can be unpredictable.

The amounts of foods eaten by your baby and their interest in food may be a little different from day to day. This is normal and shouldn’t cause any concerns if your baby is growing well.

Introduce solids at about six months of age

Breast milk is an important food for babies until at least 12 months of age, or longer if the mum and baby desire. Infant formula is important until 12 months. By about six months of age, a baby’s iron stores are low and extra foods will be needed to maintain healthy growth and prevent nutritional problems such as iron deficiency. Start to introduce solids around six months of age – when your baby starts showing interest in food.

Clues that your baby is ready for solids

When your baby starts to need the nutrients that solid food can provide, there will be obvious signs they are ready to try solid foods. These include:

• Good head control and able to sit up with support
• Watching and leaning forwards when food is around
• Reaching out to grab food or spoons to put in their mouth
• Opening their mouth when food is offered.

Physical readiness for solids

Your baby’s organs and body grow and develop certain physical traits between four and six months. This indicates that their body is ready physically for solids. This maturing process includes:

• Digestive system – digestive enzymes that help to digest food are developed.
• Immune system – immune gut defence mechanism is fully developed.
• Mouth and tongue – your baby is able to move food to the back of their mouth and swallow safely.
• Head and neck – your baby is able to hold their head up; head control helps them to sit up straight and swallow.
• Kidneys – your baby’s kidneys can now handle the increased load produced by solids.

Starting solids too early can cause problems

Hungry babies should be offered more breast or formula feeds until they are ready for solids. Some parents want to try solids early, believing this may help baby grow, sleep or settle better. Giving solids too early rarely helps these problems and may lead to other difficulties including:

• Poor growth, if the solid food replaces breast milk or formula
• Loose bowel actions or diarrhoea, if the baby cannot digest the food.

Don’t leave starting solids too late

It’s also important that starting solids is not left too late, as this may lead to problems including:

• Poor growth due to low energy intake
• Iron deficiency anaemia
• Feeding problems, particularly if not started before about seven to nine months of age.

Signs that your baby is not interested

Signs that your baby is not interested or is full may include closing the mouth tightly and turning the head away when offered food. They may cry when the food is offered or may push the spoon away. If this happens at your first attempts to feed your baby, relax and try again in a few days. While most babies naturally spit food out when first given solids, they soon learn to accept foods if you continue.

Getting to know when your baby is hungry or full is important to having happy, relaxed and enjoyable mealtimes.

Tips for introducing solids

• Be calm and relaxed when you start to feed your baby.
• Make sure your child is sitting comfortably and is not too hungry.
• Be patient. Your baby may only take a spoonful at first, but this will increase with time and practice.
• Be prepared – all babies will make a mess as they learn to eat.
• Stay with your child while eating to avoid accidents such as choking.
• Try again in a day or so if your baby refuses the first time.
• Wait several days before introducing a new food
• Offer foods on a small, infant-sized spoon.

Suggested first foods

First foods can be prepared easily and cheaply at home without salt, seasonings and sweeteners. The foods should at first be mashed and smooth, but you can quickly move on to coarsely mashed foods and coarser textures. General suggestions include:

• Start with a single food rather than a mixture.
• Offer infant cereal first as it is fortified with iron and makes an ideal first food. Mix with expressed breast milk or formula to a smooth texture.
• Otherwise, there is no particular order for foods:
• Give vegetables and fruits, introduce meats, or chicken, and ‘finger foods’ such as toast..
• Always sit with your baby while they are eating.
• Encourage drinking water from a cup.

Later feeding skills – from 8 to 9 months

While a baby’s first solids should be mashed and smooth, they soon need variety in the texture as well as the type of food. Other suggestions include:

• Give finger foods, such as pieces of cooked vegetables and crusts, to encourage chewing and self-feeding.
• Give baby a small spoon to encourage self-feeding, even while you continue to give most of the food.
• Progress from food that is pureed to food that is mashed then chopped into small pieces.

By the end of 12 months, your baby should be ready to eat a wide variety of family food.

• Offer more variety of fruit, vegetables, meats, chicken and well-cooked fish
• Introduce pasta, rice and bread
• Small amounts of cows milk on cereals, as custard, cheese and yoghurt. The main milk for babies less than 12 months should be breast milk or infant formula. However, it’s okay to introduce and use cows milk as part of custard, yoghurt and on cereal from seven to eight months of age.

Stay with your baby when they are eating. Let them sit with the family to watch and learn.

At around nine months your baby will develop other feeding skills. These include:

• Showing an interest in self-feeding
• Ability to chew lumps in food
• Independent eating with some assistance.

Always avoid small hard foods, such as nuts and hard uncooked vegetables, because babies might choke. Fruit juice is not suitable for babies.

Introducing cows milk

Suggestions include:

• Cows milk is a poor source of iron and is never a substitute for breast milk or formula for babies under 12 months. Continue breastfeeding or using infant formula until your baby is at least one year old.
• Cows milk contains higher levels of protein, salt, potassium and calcium than breast milk or formula. This can increase the load on the kidneys.
• Cows milk may be included from about eight months in small amounts as custard or yoghurt or on cereal.
• Milk should not be the main drink until after one year of age or until a range of food is eaten each day, including meat or meat alternatives.

Allergy and vegetarianism

There are issues to consider when you introduce solids to your baby, especially if your baby has shown signs of allergies or your family eats a vegetarian diet.

• Allergy – if there is a strong history of allergy in your family, seek advice from your doctor or maternal and child health nurse.
• Vegetarians – your baby may need extra nutrients if fed on a vegetarian diet. Seek advice from your doctor or maternal and child health nurse.

Unsuitable foods

Some foods are not suitable for babies under 12 months. These include:

• Honey – there is a potential risk of bacterial infection from honey.
• Tea – contains tannins that can restrict vitamin uptake.
• Whole nuts – should be avoided due to the risk of choking.
• Fruit juice – contains no nutritional benefit and can reduce the amount of milk consumed.
• Reduced fat milk – is not suitable for children under two.

Where to get help

• Your doctor
• An accredited practising dietitian, contact the Dietitians Association of Australia
• Maternal and child health nurse
• Maternal and Child Health Line (24 hours) Tel. 132 229
• Parentline (24 hours) Tel. 132 289
• Royal Children’s Hospital Nutrition Department Tel. (03) 9345 5663
• Australian Breastfeeding Association Tel: 1800 mum2mum (1800 686 2 686)

Things to remember

• Start to introduce solids at around six months of age.
• First solids should be finely mashed and smooth, then graded to coarsely mashed quickly. Your baby may only take a spoonful at first, but this will increase with time and practice.

Eating tips for children (2) - young toddlers

Toddlers can eat and enjoy a wide variety of foods and textures. This is the time to encourage your child to enjoy family meals and try a wide range of foods, tastes, flavours and textures.

Toddlers and young children have a natural ability to sense when they are hungry and when they are full. Children will learn to eat what the family eats if they are offered the same food and encouraged to try it. Low-fat or restricted diets are not recommended for toddlers as they may result in poor growth.

Common parental concerns

Picky eating can be common in toddlers. The world has become an exciting place and food may be less important when there are many other things to do. Some other reasons why toddlers’ eating patterns change include:

• Slower growth – growth slows down in a child’s second year. This means toddlers often have smaller appetites and need less food. The amount eaten from day to day can change dramatically. Although it sometimes worries parents, this change is normal and doesn’t mean your child is being difficult or is unwell.
• Grazing and snacking – toddlers rarely follow a traditional meal pattern. They tend to need small and regular snacks. This suits small tummy sizes and provides the energy to keep moving all day. The amount eaten at mealtimes, in particular the evening meal, may be smaller than parents would like. However, children can balance the amount of food eaten with exactly how much they need if they are given the opportunity to enjoy good foods, and are not forced to overeat or finish all the food on the plate. This means that healthy snacks are important to help provide the energy and nutrition your child needs during the day.
• Fussy eating – showing independence is part of normal toddler development and this often includes refusing to eat foods that you offer. Rejecting a food does not always mean the child doesn’t like it. If you offer it on another day, they may eat it!

Other common toddler feeding problems

Other common toddler eating behaviour may include:

• Meal-time tantrums and food refusal
• Delay in self-feeding
• Preference for pureed foods or difficulty with chewing
• Overeating
• Reduced intake of food or reliance on drinks.

Let your child decide

Your role as parent of a toddler is to decide what food and when to offer it, but the child decides whether or not to eat and how much they’ll eat. Remember that children eat when they’re hungry. Children have a natural ability to sense when they are hungry and when they are full. If you insist that your child eats more than they choose to, you are likely to be overriding this natural ability and may encourage future overeating.

Let your child decide whether they will eat and how much they will eat.

Mealtime suggestions for parents

Some suggestions include:

• Be a positive role model by eating a healthy, balanced and varied diet together as a family.
• Serve the same foods as the family eats.
• Remember that toddlers need small meals and regular snacks.
• Don’t worry too much – a toddler’s appetite and food intake can vary daily.
• Offer small serves and give more if needed.
• Let them tell you they’re full and don’t force a child to finish all food on their plate.

How to encourage new foods:

• Serve a new food with one your child likes.
• Be patient and keep offering new foods, even if they are rejected at first.
• Assume your child will like new foods.
• Offer new foods in a relaxed environment.
• Don’t use food as a reward, pacifier or punishment.

Make mealtimes a positive experience

Mealtimes should be relaxed and happy. Suggestions include:

• Let your child explore food by touching and expect some mess.
• Let children feed themselves and give help if needed.
• Enjoy family meals together at a table, so toddlers can watch and copy others, try the family foods and enjoy company while eating.
• Keep mealtimes relaxed. Don’t have too many distractions like the TV on.
• Offer encouragement, but don’t argue or force your child to eat.
• Talk pleasantly to your child at mealtimes, not just about food.
• Don’t ask your child to eat quickly.

Safety suggestions

To reduce the risk of choking, safety suggestions include:

• Always supervise young children when they are eating.
• Encourage your child to always eat sitting down to prevent falls and reduce the risk of choking.
• Avoid small hard foods such as nuts, raw carrot, hard lollies and popcorn. Offer lightly steamed vegetable sticks instead.

Drinks for toddlers

Offer all drinks to toddlers in a cup. Sometimes children fill up on
drinks, particularly sweet ones like juice, and this leaves less room for
foods. Suggestions include:

• Offer up to three cups of milk only each day, with water at other times for thirst. Full fat milk should be given up to two years of age and then reduced fat may be given.
• Juice and sweetened drinks are unnecessary.

Professional help may be needed

Many parents worry about their child’s eating at some stage, particularly in younger children when food intake and appetite appear to change daily. You should ask for professional help if:

• You have concerns about your child’s growth
• Your child is unwell, tired and not eating
• Mealtimes are causing lots of stress and anxiety.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• Maternal and child health nurse
• Maternal and Child Health Line (24 hours) Tel. 132 229
• Parentline (24 hours) Tel. 132 289

Things to remember

• Your role as a parent is to decide what and when to offer food, but the child will decide whether or not to eat and how much they’ll eat.
• Toddlers’ appetites and food intake can vary daily.
• New foods may be rejected at first, so be patient and keep offering them.

Eating tips for children (3) - older toddlers

After their second birthday, older toddlers continue to develop new eating skills and food habits. At times, older toddlers can be erratic eaters; they love food one day and dislike it the next. The meal they refused at home is eaten happily away from home. This can frustrate and baffle parents, but it’s a common eating pattern for a healthy and active older toddler. Very few children pass through these years without creating some worry and concern about eating.

Toddlers need a variety of foods daily from the following groups: fruit and vegetables, breads and cereals, meat, fish, chicken, eggs and legumes, and milk, cheese and yoghurt, for good health and growth. Reduced-fat dairy products can be included for toddlers two years or older, but avoid no-fat dairy products in this age group. Restricted diets are not recommended for toddlers, as they may limit the energy and nutrients needed for growth and development.

Appetite and hunger can vary considerably

Toddlers have changeable appetites. Growth spurts and changing activity levels during the day can result in a large appetite for a while, followed by small and picky eating soon after. The evening meal may cause the most concern, when children may be tired or not hungry.

Some other common reasons for irregular food intake include:

• Filling up on drinks – in particular, sweet drinks or milk
• Being either too tired to eat or not preferring the food served at that meal
• Frequent snacking – this can curb the appetite for main meals, although it generally isn’t a problem if the snacks are nutritious.

Food refusal

Most children are able to balance food intake with activity if they are encouraged, but not forced to eat. You can help by providing a variety of healthy and nourishing foods from which your child can choose. Offer children the same foods as the family, with a variety of textures and flavours for balanced nutrition.

If a food is refused, the child may not be objecting to the actual food, but may be testing to see the effect they have on people around them. By assuming the food is to blame, some parents can get caught up in a frustrating game. Some helpful tips to deal with food refusal include:

• Try to stay calm.
• Don’t force your child to eat.
• Allow your child some likes and dislikes.
• Offer new foods with familiar ones.
• Provide a small spoon or fork and a comfortable chair.
• Turn off the television – chat at mealtimes instead.
• Start with a small serve and give more if hungry.
• If a meal is refused, let your child sit quietly for a few minutes before leaving the table.
• Be a role model for your child. If you eat well, they may copy you.

Have fun with food

You can use food activities with older toddlers to help them learn about foods and nutrition. Letting children get involved in basic food preparation – like washing or peeling vegetables, making a sandwich or salad, or baking fruit or vegetable muffins – teaches them about healthy foods. Other learning opportunities include:

• Exploration of shapes, colours and how foods grow
• Development of skills like pouring, stirring and cutting
• Learning food hygiene, like washing hands before touching food or eating
• Sharing food with other people.

Healthy snacks

Snacks between meals are an important part of the day for young children, so keep these as healthy, nutritious and as interesting as possible. Suggestions include:

• Fresh and dried fruits
• Crackers with cheese or hummus
• Yoghurt (this can be frozen in hot weather in place of ice cream)
• Raisin bread, fruit loaf or toasted muffins
• Plain biscuits, scones or buns
• Dip and biscuits or vegetable sticks – remember that hard vegetables should be thinly sliced, grated or steamed for children under three years of age to reduce the risk of choking.

Always sit with and supervise children during meals and snacks, and enjoy meals together.

Healthy drinks

For some children who are busy playing and exploring, drinks may replace food or snacks. When appetites are small, this may reduce the amount or variety of foods eaten, or may affect the child’s growth. Milk and dairy foods are an important part of a child’s diet; about three small cups of milk each day provide a good amount of calcium for strong bones and teeth. . Water should be offered at other times. Sweet drinks such as juice and cordials aren’t needed.

Childcare and food

Childcare provides an environment for children to eat with others and experience new foods and tastes. Some parents may find that their toddler is tired at the end of the day and less interested in the evening meal. This will vary for each child.

Always ask about your child’s eating habits from childcare staff, as well as giving them important information about your concerns or problems at home. Working together with childcare staff can positively reinforce healthy food messages and eating for your child.

Tips for feeding older toddlers

Suggestions include:

• Offer a variety of foods daily from the main good groups.
• Enjoy eating together as a family.
• Don’t force your child to eat when tired or not hungry.
• Offer water to drink. Sweet drinks like juice or cordial are not needed.
• Offer healthy snacks between meals.
• Involve your child in simple meal preparation.
• Accept some food refusal without worry.
• Be a role model for your child and eat a healthy diet.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• Maternal and child health nurse
• Maternal and Child Health Line (24 hours) Tel. 132 229
• Parentline (24 hours) Tel. 132 289

Things to remember

• Most older toddlers are able to balance food intake with activity if they are not forced to eat.
• Children should be served the same foods as the rest of the family, with a variety of textures and flavours for balanced nutrition.
• Snacks between meals are an important part in the day for young children, so keep these as healthy, nutritious and as interesting as possible.
• Encourage active play and limit screen time.

Eating tips for children (4) - preschoolers

Once children start kindergarten or school, life takes on a new routine. A regular intake of food is needed throughout the day to keep children active and help their concentration while learning. Some children in this age group are still fussy, so offer a wide variety of foods and regular meals and snacks, and allow the child to eat according to their appetite without force or arguments.

Allow your child to eat according to their appetite

Children are able to decide how much food they need for activity and growth if allowed to eat according to their appetite. Forcing children to ‘clean the plate’ or giving sweets as rewards may lead to problems of overeating later in life.

Allow your child to decide how much food is enough. This shouldn’t cause problems for most children if a variety of healthy foods are consistently offered. Offer a small serve first and give your child more if they are hungry. Meal sizes will vary, as the amount of food a child needs depends on what else has been eaten during the day.

Meals for kindergarten

Children continue to learn new skills and ideas about food when eating outside the home. They can be involved in preparing their lunch box and helping their carers make healthy lunches. Preparing meals together is a great opportunity to give children positive messages about nutrition, such as ‘milk makes your bones strong’ or ‘bread gives you energy to play’. Suggestions for lunches include:

• Mixed sandwich, fresh fruit and a tub of yoghurt
• Lean meat and salad in pita bread, with dried fruit and a carton of plain milk
• Dairy foods and drinks can be frozen in hot weather and taken to kindergarten.

Healthy snack suggestions

Snacks are an important part of a child’s food intake for energy and nutrients. What children eat is more important than when they eat. Children who snack on lollies and chips may not get all the nutrients needed for good health. Healthy snack suggestions include:

• Fresh and dried fruits, or fruit packed in natural juice
• Yoghurt or cheese
• Fruit bread, bun or muffins
• Bread, rice cakes or crackers with spread
• Vegetable pieces and dip.

Treats are best kept for special occasions

By this age, children can eat independently and enjoy the social aspects of eating. Having friends means eating out of home more. There may be an occasional meal at a fast food restaurant. They may go to a party with lots of sugary and fatty snacks. These things will do no harm as long as good nutrition is continued on most days. Food is an important part of special occasions for everyone and should be enjoyed. However, high energy treats are best kept for special occasions and are not recommended for lunch boxes.

Strict diets aren’t recommended

Children grow at a steady rate during the kindergarten and early school years. Strict or low-fat diets are not recommended because children’s energy and nutrient needs are high. If you’re concerned about excessive weight gain, a good approach is to:

• Consult with your doctor.
• Develop healthy eating habits for the whole family.
• Encourage regular physical activities for everyone.
• Limit the time spent watching television.

Encourage physical activity

Children should be encouraged to be physically active from a young age. Physical activity helps children feel good and promotes a healthy appetite. For this age group, three hours per day of active play spread out over the day is recommended and only one hour or less of television or DVD watching. While formal sports aren’t necessary for fitness, children can benefit from your encouragement and guidance. Suggestions include:

• Watch less television.
• Play games in the back garden or a local park.
• Go for a walk to the park or playground.
• Teach your child to swim.
• Participate in kindergarten and school activities.
• Be involved in regular, fun activities with your children.

Healthy drinks

Active children need plenty of fluids. Around three glasses of milk a day provides enough calcium for bone development; water should be encouraged at other times. Sweet drinks such as juice, soft drink or cordial are unnecessary in a child’s diet. Low-fat milk can be combined with fresh fruits for a smoothie as a great afternoon snack.

Food tips for growing children

General suggestions include:

• Offer a variety of foods every day.
• Encourage healthy eating for everyone in the family.
• Let your child decide if they are full or hungry.
• Offer healthy snacks between meals.
• Involve children in meal preparation.
• Encourage water rather than sweet drinks.
• Enjoy family mealtimes and activities together.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• Maternal and child health nurse
• Maternal and Child Health Line (24 hours) Tel. 132 229
• Parentline (24 hours) Tel. 132 289

Things to remember

• Children are able to decide how much food they need for activity and growth if allowed to eat according to their appetite.
• Strict or low-fat diets are not recommended because children’s energy and nutrient needs are high.
• High energy treats are best kept for special occasions and are not recommended for lunch boxes.
• Reduce screen time and encourage active play.

Eating tips for children (5) - primary school

School age is the perfect time for children to learn about healthy food, bodies and activity. This is the time they start a busy social life, have pocket money and begin to help choose their own lifestyle. Children of this age learn quickly and are also influenced by their friends and popular trends.

Children need a wide variety of foods for a well-balanced diet. The amount of physical activity they have in a day will be an important part of how much they need to eat. When children are busy and active, snacking is important to keep energy levels high. A healthy morning snack at recess and one after school are usually needed each day.

Breakfast is important

It is important to encourage breakfast. A good night’s sleep followed by food in the morning helps your child to stay active and concentrate at school. It also means your child is less likely to be too hungry during the morning and it can help with performance at school. Be a role model and let your child see you eat breakfast too. A bowl of cereal with milk and fresh or stewed fruit is a great starter for the whole family.

School lunches

Many schools have a canteen that offers a range of food choices. Most schools follow government guidelines to encourage healthy food choices. The food your child chooses might be high in cost and energy, but low in nutrients sometimes. An alternative is a packed lunch from home, which is a great way for your child to learn about healthy food and to help with preparation.

Lunch box suggestions include:

• Sandwiches or pita bread with cheese, lean meat, hummus and salad
• Cheese slices, crackers with spread, and fresh or dried fruits
• Washed and cut up raw vegetables or fresh fruits
• Frozen water bottle or tetra pack of milk, particularly in hot weather.

School lunches – foods to limit

Highly processed, sugary, fatty and salty foods should only make up a very small part of your child’s diet. Foods to limit in everyday school lunches include:

• Processed meats such as salami, ham, pressed chicken and Strasbourg
• Chips, sweet biscuits, and muesli bars and breakfast bars
• Fruit bars and fruit straps
• Cordials, juices and soft drinks.

Treats and peer pressure

Peer pressure to eat particular ‘trendy’ foods at this age is strong. Let your child eat these kinds of foods occasionally, such as at parties, special events or when the rest of the family enjoys them. It’s best to limit the amount of money children are given to spend at school or on the way home.

The occasional lolly, bag of chips or takeaway food doesn’t do any harm. If they are eaten too often, however, you might find that:

• Not enough nourishing foods are eaten.
• Children become overweight or obese.
• You’re spending a lot of money – it’s much cheaper to provide homemade snacks and lunches.
• You’re missing a chance to teach your child about healthy eating.

After-school snacks

Children of this age may have swings in appetite depending on activity levels, so allow them to choose how much they need to eat while offering a wide variety of healthy foods. Some children only eat small amounts at the evening meal, so make sure that the afternoon snack is nutritious, not just high in energy.

Snack suggestions include:

• A sandwich with a glass of milk
• Cereal and fruit
• A bowl of soup and toast.

Family mealtimes

For schoolchildren, family mealtimes are a chance to share and talk about the day’s activities and events. The evening meal together is an important time to do this.

Family mealtime suggestions include:

• Allow talk and sharing of daytime activities.
• Avoid distractions such as the television, radio or the telephone.
• Let your child decide when they are full – don’t argue about food.
• Allow children to help with preparing meals and shopping.
• Teach some simple nutrition facts such as ‘milk keeps your bones strong’.

Drinks

Suggestions include:

• Children should be encouraged to drink plain water.
• Sweet drinks such as cordials or fruit juice are not needed for a healthy diet and aren’t recommended.
• A glass of milk (or a tub of yoghurt or slice of cheese) equals a serve of dairy food. Three serves are needed each day for calcium.

Exercise and activity

Physical activity is an important part of good health. Try to encourage your child to do something active each day, such as a hobby, play a game or be involved in sport. Some parents may also worry about their child’s weight.

For primary school children 60 minutes of activity is recommended each day, and no more than two hours of watching TV, DVDs or computer games.

To increase your child’s activity, try to:

• Limit the amount of time spent watching television for the whole family.
• Do something physical and active together.
• Go and watch your child play sports.
• Encourage daily activity, not just exercise.
• Use the car less – that means everyone!

Healthy tips for school-aged children

Suggestions include:

• Children need a variety of different foods each day.
• Snacks are an important part of a healthy diet for active children.
• Make snacks nutritious, not just high in energy.
• Plan to share meals as a family.
• Enjoy talking and sharing the day’s happenings at mealtimes.
• Let children tell you when they’re full.
• Give your child lunch to take from home.
• Let children help with food preparation and meal planning.
• Encourage physical activities for the whole family.
• Encourage children to drink plain water.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• School nurse
• Parentline (24 hours) Tel. 132 289

Things to remember

• Snacks are an important part of a healthy diet for active children, so offer nutritious as well as high energy snacks.
• Let children help with food preparation and meal planning.
• It is important to encourage breakfast, because a good night’s sleep followed by food in the morning helps your child stay active and concentrate at school.
• Limit screen time and aim for some physical activity every day.

Kilojoules and calories explained

We eat food to fuel our bodies for energy, growth and repair. Carbohydrates, proteins and fats are broken down by the digestive system into their simplest components: simple sugars, amino acids and fatty acids.

Carbohydrates are the body’s preferred fuel, although proteins and fats can also be converted into energy. Food energy is measured in kilojoules (kJ). The common term for this used to be ‘Calorie’, but ‘kilojoule’ is the term now accepted internationally. This unit of measurement allows us to talk about how much energy a food contains and how much energy is burned up during exercise.

Energy value

A kilojoule is a unit of measure of energy, in the same way that kilometres measure distance. Food energy can also be measured in terms of the nutritional or ‘large’ Calorie. One Calorie (Cal) has the same energy value as 4.186 kilojoules (kJ). This should not be confused with the ‘small’ or gram calorie, which is used by scientists to measure the amount of energy required to heat water. There are 1,000 (small) calories in one (large) Calorie, which is why it is also sometimes known as a ‘kilocalorie’. The terms ‘calorie’ and ‘Calorie’ are often used interchangeably, which can be confusing.

4.184 kilojoules = 4,184 joules = 1 Calorie = 1 kilocalorie = 1,000 calories

Kilojoules in food

The foods we eat provide energy, which is measured in kilojoules. Just how much energy depends on the amount of carbohydrate, protein and fat the food contains. Fats and alcohol are by far the most energy-dense foods. This is why they should only be consumed in moderation, particularly if you are overweight or obese.

The energy value per gram of various food components includes:

• Fat – 37kJ (9 Cal) – not all fatty acids may provide the same amount of energy
• Alcohol – 29kJ (7 Cal)
• Carbohydrates – 16kJ (4 Cal) – not all carbohydrates may provide the same amount of energy
• Protein – 17kJ (4 Cal)
• Dietary fibre – 13kJ (3 Cal) – if fermented by bacteria in the large intestine
• Water – 0kJ (0 Cal).

Research into energy values of food is ongoing

Research into fat and carbohydrate metabolism is changing our understanding about the energy values of different types of fats and carbohydrates. Research indicates that how the body metabolises (breaks down) different foods may be important. It appears that not all fats or carbohydrates have the same energy value as their chemical analysis in the test tube might indicate.

Some fats move on faster than others

Animal studies show that polyunsaturated, mono-unsaturated and saturated fatty acids are broken down differently in the body and may not be used in the same way. Some fats, like polyunsaturated fats (especially omega-3 fatty acids from fish oils), may be more easily used up from fat stores during exercise than fats from other animal sources.

This suggests that saturated fat may be more likely to go into and stay in fat cells than some forms of polyunsaturated fat and possibly mono-unsaturated fat.

Sugars and carbohydrates

Carbohydrates are broken down by the body into sugars or ‘glucose’. Some carbohydrate foods are metabolised faster than others; these are known as foods with a high glycaemic index (GI). Some research suggests that a diet dominated by carbohydrate foods with a high glycaemic index is associated with greater body fatness.

Our energy requirements are variable

Energy requirements differ from one person to the next because of genetic predisposition, build, gender, age, metabolism, environment and amount of regular physical activity. An individual’s energy requirements can also differ from one day to the next and as we grow older. For example:

• Young children and adolescents require high amounts of energy to fuel their growth and development.
• Women need more energy during certain stages of their reproductive lives, such as pregnancy and breastfeeding. It is thought that daily energy needs increase on average by about 1,800kJ for pregnant women and around 2,500kJ during breastfeeding.
• Muscle tissue has a big appetite for kilojoules. The more muscle mass you have, the more kilojoules you will burn.
• Men generally have higher energy requirements than women because they have more muscle tissue.
• As we age activity levels are often reduced, which causes a loss of muscle tissue, and so our energy requirements tend to decrease. Various other age-related changes to the metabolism also contribute to the reduced energy requirements. It’s not clear how much of the muscle lost during ageing is a result of the ageing process or due to reduced activity. Strength and resistance training in older adults (even the very old and frail) seems to help reduce or prevent the decline in muscle mass generally observed with ageing.

Too many kilojoules

When we regularly eat more energy than our body needs, the excess is stored inside fat cells. Just 1kg of body fat contains the equivalent of 37,000kJ. To lose 1kg of body fat in a week, you would need to burn an additional 37,000kJ, or around 5,000kJ a day.

How to lose excess weight

The best way to lose excess weight is to switch to a high fibre, low fat diet and, most importantly, to exercise regularly. Exercise not only uses up stored energy but also helps to stimulate muscle development. Remember, the more muscle tissue you have, the more kilojoules you can burn.

If you are over 40, have a pre-existing medical condition or you haven’t exercised for some time, see your doctor before starting a new fitness program.

Where to get help

• Your doctor
• An accredited practising dietitian, contact the Dietitians Association of Australia
• Nutrition Australia www.nutritionaustralia.org

Things to remember

• A kilojoule (or Calorie) is a unit of energy.
• The kilojoule content of foods depends on the amount of carbohydrates, fats and proteins present in the food.
• If we regularly eat more kilojoules than our body needs, the excess will be stored as body fat.

Obesity in children - management

Children can achieve healthy weight and growth with the help of their parents and family. The whole family will benefit from making healthy lifestyle choices. Choosing healthy foods, limiting takeaway and junk food, increasing physical activity and seeking professional advice can all help. Crash diets, appetite suppressants or humiliating and teasing an overweight child does not help.

Overweight and obesity often start during the primary school years. This is a major concern because many overweight children continue to be overweight as adults. The main influence on the diet and lifestyle of primary school children is their parents. Simple techniques in the home can have a dramatic effect.

How to assess if your child is overweight or obese

Body mass index (BMI) calculation is one of the tools used to assess whether a person is underweight, healthy weight or overweight. BMI is calculated by dividing your weight in kilograms by your height in metres squared (m²). There is a calculator on the Better Health Channel that will help you to work out BMI.

A child’s BMI changes according to their age and stage of physical development. BMI measures alone are not appropriate for children. BMI-for-age centile charts are designed specifically for children from two to 18 years of age. These are used in addition to the weight and height growth charts to give a more accurate picture of children’s development.

It is important that a child’s BMI is compared against his or her age and gender centile charts. The BMI centile range includes:

• Under 3^rd percentile – underweight
• 3^rd to 85^th percentile – healthy range
• 85^th to 95^th percentile – overweight
• 95^th percentile and above – obese.

Consult with your doctor

Growth charts and BMI for children should be used as a guide only. Your doctor can help assess whether or not your child’s weight is of concern. Consider making an appointment with your doctor to talk about your child’s weight.

Make changes to the whole family’s eating habits

Healthy food choices and being more active will benefit the whole family, so try to get everyone involved. Children who are overweight or obese will find it easier to achieve a healthy weight if the whole family makes healthy lifestyle changes.

Some suggestions include:

• Get good nutrition advice – Good nutrition advice may help to change the whole family’s eating habits. There are many fact sheets on the Better Health Channel that can guide you in making healthy choices.
• Shop carefully – stock your fridge and pantry with healthy snacks. Limit high fat or sugar treats. Switch to low fat versions of dairy foods, such as milk, cheese and yoghurt.
• Enjoy breakfast – make sure you all have a healthy breakfast every day. Choose low fat, low sugar, wholegrain breakfast cereal with low fat milk and some fruit.
• Provide healthy snacks – snacking is an important part of children’s eating habits and shouldn’t be discouraged – just make sure the snacks are mostly low in kilojoules. Fruits and vegetables make excellent snacks.
• Reduce unhealthy drinks – don’t buy sugary soft drinks. Encourage water and some low-fat milk.
• Eat more vegetables – if your child refuses to eat vegetables, try being creative with how you use vegetables; for example, finely grate carrot and zucchini into lasagne or spaghetti sauce.
• Offer smaller serves – some children will clear their plate at dinnertime, no matter how big the serving size, so give them a little less. Serving 10 or 20 per cent less over time can make a significant difference.
• Limit takeaway meals – try to have takeaway food less often. Takeaway food is often higher in salt and fat than home-cooked meals.
• Plan ahead – try cooking a dish the night before so that the meal is ready when you come home from work or cook large quantities and freeze meals for use later. If you can plan your meals, you’re less likely to opt for takeaway food, which can seem an easy option when you’re tired.
• Make mealtime a happy time – Enjoy mealtimes together whenever possible. Involve everyone in preparing healthy meals together.
• Ask the extended family to help too – encourage carers and grandparents not to give children unhealthy foods.

Become more active together

It’s much more fun to be active with others and everyone will benefit. Try to:

• Set a good example – children tend to follow their parents’ lead.
• Increase activity – children should be encouraged to be physically active. Encourage outdoor play.
• Become active as a family – go for walks together, play cricket, toss a frisbee in the backyard, go bike riding, take the dog for a walk or go swimming together. School-aged children need a minimum of 60 minutes of activity every day. Aim for everyone to be active outside school time or at least for 30 minutes each day. Encourage lots of opportunities for active play for pre-school children and toddlers.
• Reduce passive pastimes – reduce television viewing and computer games to a total of less than two hours per day for school-aged children and less than one hour per day for preschoolers and toddlers. .
• Find out as much as you can – seminars and educational activities run by teachers and community groups can help parents and children learn more about obesity and how to prevent it.
• Choose activities as rewards – instead of giving food ‘treats’ as a reward, suggest outings or a favourite game or story.

Tactics to avoid

Some weight-loss strategies are harmful or even dangerous. You should not use:

• Weight targets – don’t set specific weight targets. Instead, focus on healthy eating habits and increasing physical activity with praise for your child when they are successful in these areas.
• Crash dieting – a growing child needs a wide range of foods for healthy development. A crash diet that limits kilojoules too drastically or cuts out a food group (such as dairy foods) should be avoided. Reducing kilojoules by a small amount and doing that every day is the goal.
• Dramatic changes – family habits can’t be changed overnight. Children may resist dramatic changes to diet and lifestyle, so concentrate on changes that you can make part of your family life. Be guided by your health professional.
• Appetite suppressants – none of the current medications (pills) are safe for growing children.
• Ridicule – teasing a child for being overweight is harmful. Ridicule will only make the child feel self-conscious and upset and will not promote weight loss.

Tips for school

Suggestions include:

• Talk over your concerns with the school nurse.
• Ask your child’s teacher or principal for further information about any healthy lifestyle education offered at the school. Follow up at home to reinforce the messages.
• Don’t pack high-fat snacks (such as potato chips) in your child’s lunchbox.
• Encourage water as the main drink at school
• Educate your child about making healthier choices at the school canteen.
• Talk to the principal and other parents about the food choices available at the canteen. Suggest improvements if necessary.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• The Royal Children’s Hospital Tel. (03) 9345 5522

Things to remember

• Parents and carers can take an active role in helping their children to develop healthier habits.
• Children who are overweight or obese will find it easier to achieve a healthy weight if the whole family makes healthy lifestyle changes.
• Limit the amount of time children spend watching television or playing computer games, and encourage physical play.

Eating tips for teenagers

Good nutrition is essential for everyone, but it’s especially important for growing teenagers. Unfortunately many Australian teenagers have an unbalanced diet. One in four adolescents buys unhealthy takeaway food every day or even a few times a day. If you eat takeaway food regularly, you are more likely to put on weight than if you eat fast food only occasionally.

Don’t despair! It doesn’t take a lot of effort to change your eating habits. A few simple changes will make a huge difference. You’ll feel better, manage your weight, improve your skin and even save money!

Junk food is poor fuel for your body

About nine in 10 teenagers eat junk food every day. This might be fizzy drinks and high-kilojoule snacks like potato chips. However, your body can’t run properly on inferior fuel. Compared to home-cooked food, junk food (which includes fast food) is almost always:

• Higher in fat, particularly saturated fat
• Higher in salt
• Higher in sugar
• Lower in fibre
• Lower in nutrients such as vitamins and minerals
• Served in larger portions, which means more kilojoules.

While a mid-life heart attack might seem too far away to be real, it may surprise you to know that you could have health problems already. A poor diet can cause weight gain, high blood pressure, constipation, fatigue and concentration problems – even when you’re young.

How to improve your diet without even trying

Small changes can make a big impact. Try these tips:

• Cut back on fizzy sugary drinks. Go for sugar-free versions. Even better, drink water instead – try adding a slice of lemon, lime or orange.
• Keep a fruit bowl stocked at home for fast and low-kilojoule snacks.
• Eat breakfast every day so you’re less likely to snack on junk food at morning tea. A fortified breakfast cereal served with low fat milk can provide plenty of vitamins, mineral and fibre. Other fast and healthy options include yoghurt or wholemeal toast.
• Don’t skip lunch or dinner either.
• Help with the cooking and think up new ways to create healthy meals. Make those old family recipes lower in fat by changing the cooking method – for example, grill, stir-fry, bake, boil or microwave instead of deep frying.
• Reduce the size of your meals.
• Don’t add salt to your food.
• Don’t eat high fat foods every time you visit a fast food outlet with your friends. Many of the popular fast food chains now have healthier food choices on the menu.
• Change your meeting place. Rather than meeting up with your friends at the local takeaway shop, suggest a food outlet that serves healthier foods such as wholemeal rolls or sushi.

Change the way you think about food

There are lots of myths around about healthy food. Don’t make food choices based on false beliefs. Suggestions include:

• Compare the prices of junk foods against the price of healthier food options to see that ‘healthy’ doesn’t have to mean ‘expensive’.
• Experiment with different foods and recipes. You’ll soon discover that a meal cooked with fresh ingredients always leaves a limp burger or soggy chips for dead.
• Try different ‘fast’ options like wholewheat breakfast cereal, muesli, wholemeal bread, wholegrain muffins, fruit, yoghurt or noodles. ‘Fast food’ doesn’t have to mean ‘junk food’.
• Don’t think that your diet has to be ‘all or nothing’. Eating well doesn’t mean you must be a health food freak. A good diet allows for treats occasionally.

Change your environment

Suggestions include:

• Lobby your school canteen for healthier food choices.
• Ask your school canteen to include a range of low-price healthy food choices.
• Help with the grocery shopping and opt for fewer processed foods.
• Get involved in the kitchen at home. Browse the Better Health Channel recipe finder for inspiration – click on the ‘Quick and easy’ button if time is an issue for you and your family.

Where to get help

• Your doctor
• An accredited practising dietitian
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia

Things to remember

• A teenager who eats fast food regularly is more likely to put on weight than a teenager who eats fast food only occasionally.
• Many teenagers wrongly assume that healthy foods are expensive and tasteless.
• Eating well doesn’t mean you must be a health food freak – a good diet allows for your favourite junk foods occasionally.

Breakfast

Breakfast is considered an important meal because it breaks the overnight fasting period, replenishes your supply of glucose and provides other essential nutrients to keep your energy levels up throughout the day.

Glucose

Glucose is the body’s energy source. It is broken down and absorbed from the carbohydrates you eat. In the morning, after you have gone without food for as long as 12 hours, your glucose levels have dropped. Your body compensates by releasing the glucose that has been stored in your muscle tissue and liver, called glycogen.

Once all of the energy from the glycogen stores is used up, your body starts to break down fatty acids to produce the energy it needs. Without carbohydrate, fatty acids are only partially oxidised, which can cause reduced energy levels. So eating breakfast can boost your energy levels as well as your metabolism for the day.

Essential vitamins, minerals and nutrients

Breakfast provides a significant proportion of the day’s total nutrient intake and offers the opportunity to eat foods fortified with nutrients such as folate, iron, B vitamins and fibre. Essential vitamins, minerals and other nutrients can only be gained from food. So, even though your body can usually find enough energy to make it to the next meal, you still need to top up your vitamin and mineral levels to maintain health and vitality.

Skipping breakfast

Extensive research in Australia and overseas has found:

• Many children who skip breakfast are significantly heavier than those who eat breakfast.
• Skipping breakfast can diminish mental performance. Breakfast helps learning, as you are better able to pay attention and are more interested in learning.
• Eating high fibre breakfast cereals reduces fatigue.
• Children who eat an inadequate breakfast are more likely to make poor food choices for the rest of the day and in the long term.
• People who eat breakfast have more nutritious diets than people who skip breakfast. They also have better eating habits as they are less likely to be hungry for snacks during the day.

‘Going without’ becomes more common with advancing age – approximately 15 per cent of teenagers and one-third of adults don’t eat breakfast.

Why we skip breakfast

Some common reasons for skipping breakfast include:

• Not enough time
• Too tired to bother
• Wanting to spend the extra time dozing in bed
• No readily available breakfast foods in the house.

A healthy breakfast may reduce risk of illness

Compared to children who regularly eat breakfast, those who skip breakfast tend to consume fewer kilojoules overall and yet they experience the same rates of overweight and obesity.

There are a number of theories for this. There is some evidence that large meals are more likely to lead to weight gain than smaller, more frequent meals. This is because excess kilojoules eaten during one sitting are stored as body fat, once the glycogen storage areas are full. People who skip breakfast are usually ravenous by lunchtime and tend to eat more to compensate.

Snacking

People who skip breakfast tend to nibble on snacks during the mid-morning. This can be a problem if those snacks are low in fibre, vitamins and minerals but high in fat and salt. Without the extra energy that breakfast can offer, some breakfast skippers feel lethargic and turn to coffee to get them through the morning.

If you do skip breakfast, try a nutritious snack such as fresh fruit, yoghurt, a low fat muffin or a wholemeal sandwich to help you through that mid-morning hunger.

Cultural differences

Breakfast is not considered a staple meal in all parts of the world. People in some cultures consume only two meals each day instead of three, and breakfast isn’t traditionally always one of them. Other cultures may consume a different style of breakfast in the morning such as warmed leftovers or egg dishes with breads, rice or noodles. These types of breakfasts also provide a good nutritious start to the day.

Research is ongoing, but there doesn’t seem to be any harm in skipping breakfast if that has always been your preference. However, the nutritional content of your lunch and dinner must be sufficient to make up for the loss of breakfast.

Breakfast foods

Research has shown that schoolchildren are more likely to eat breakfast if easy-to-prepare breakfast foods are readily available at home. Some quick suggestions include:

• Whole-wheat or wholegrain breakfast cereals such as wheat biscuits, muesli or bran cereals
• Porridge – use quick oats
• Fresh fruits
• Wholemeal or multigrain bread to toast
• Muffins or crumpets
• Toast toppings, such as baked beans, eggs, cheese or spreads
• Fruit or plain yoghurts
• Fresh fruit juices
• Low fat milk.

Mid-morning snack time

Some people find that the thought of food first thing in the morning turns their stomach. If this is the case, switch your breakfast to morning tea or mid-morning snack time instead.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia

Things to remember

• A healthy breakfast has many health benefits.
• Children who skip breakfast may lack sufficient vitamins and minerals including iron, calcium, zinc and vitamin B2.
• Reasons for skipping breakfast include lack of time, lack of motivation and lack of available breakfast foods.

Cereals and healthy diet

Cereals and wholegrain foods can reduce the risk of developing certain diseases including coronary heart disease, colon cancer, diabetes and diverticular disease. Common cereal foods include bread, breakfast cereals and pasta.

Grains, whole grains and cereals

Grains include wheat, barley, oat, rye, corn, rice and triticale. Whole grains include wholemeal or wholegrain breads or crispbreads, dark ‘seedy’ breads, wholegrain breakfast cereals, wheatgerm, brown rice, puffed whole grains, bulgar, couscous, popcorn and oatmeal.

Refined cereals include cake, desserts, white bread, pasta, muffins, sweet or savoury biscuits, refined grain breakfast cereals, white rice, pancakes, waffles and pizza.

Nutritional content of wholegrain cereals

Grains consist of three major parts:

• Bran – the outer layer of the grain (fibre omega-3 fatty acids, vitamins and dietary minerals)
• Endosperm – the main part of the grain (mainly starch)
• Germ – the smallest part of the grain. (vitamin E, folate, thiamine, phosphorus, magnesium).

Whole grains contain all three layers of the grain.

Wholegrain cereals

Wholegrain cereals are a rich source of many essential vitamins, minerals and phytochemicals. The typical cereal food is:

• Low in saturated fat but is a source of polyunsatured fats, including omega-3 linolenic acid.
• Cholesterol free.
• High in both soluble and insoluble fibre and resistant starch.
• An excellent source of carbohydrates.
• A significant source of protein.
• A good source of B complex vitamins, including folate.
• A good source of many minerals, such as iron, magnesium, copper, phosphorus and zinc.
• A good source of antioxidants and phytochemicals that can help lower blood cholesterol levels.

A host of protective chemicals

Wholegrain cereals contain many different phytochemicals that have been linked to significant health benefits. These phytochemicals include:

• Lignans – can lower the risk of coronary heart disease, and regress or slow cancers in animals.
• Phytic acid – reduces the glycaemic index (GI) of food, which is important for people with diabetes, and helps protect against the development of cancer cells in the colon.
• Saponins, phytosterols, squalene, oryzanol and tocotrienols – have been found to lower blood cholesterol.
• Phenolic compounds – have antioxidant effects.

Refined cereals do not have the same benefits

When grains are refined (for example, to produce white flour), the bran and germ layers are generally removed, leaving only the endosperm. This process can cause 66 per cent loss of fibre, 92 per cent loss of selenium, 62 per cent loss of folate and up to 99.8 per cent of phytochemicals from the grains.

Some fibre, vitamins and minerals may be added back into refined cereal products (such as white bread), which compensates for losses, but it is impossible to add the mix of phytochemicals that is lost in the processing.

Sometimes, the fibre that is added back is from vegetable fibre. Some breads contain ‘Hi-maize’, which is a resistant starch from corn. It is unknown whether these breads have similar beneficial properties to breads high in cereal fibres. For example, ‘Hi-maize’ does not have the same laxative effect as wheat fibre.

Refined cereals generally have a higher GI than their wholegrain counterparts. This means that eating refined cereals causes a sharp rise in blood sugars, demanding a strong response from the pancreas (not good!).

Whole grains help protect you from heart disease

Cereal fibre or wholegrains offer protection against heart disease. A study of postmenopausal women found that eating at least one serve of wholegrains daily reduced the risk of heart and blood vessel disease by almost 30 per cent.

Heart disease is often caused by high blood cholesterol levels. Regularly eating cereals that are rich in soluble fibre, such as oats and psyllium, has been found to significantly reduce the amount of cholesterol in the bloodstream.

Diabetes type 2

A study by Harvard researchers in 2000 showed that eating one serve of wholegrain cereal every day can reduce the risk of developing type 2 diabetes by as much as 34 per cent. Cereal fibre is shown to be particularly protective against this condition. People with diabetes also benefit from eating wholegrain cereals.

Wholegrains and weight management

People who are obese tend to have energy-dense diets. High fibre foods, such as wholegrain breads and cereals, can be an effective part of any weight loss program. They take longer to digest and create a feeling of fullness, which discourages overeating. Whole grains are also naturally low in saturated fat and contain beneficial polyunsaturated fatty acids.

Bowel health

High fibre foods, such as wholegrain cereal products, increase movement of food through the digestive tract. The result is increased stool bulk, softer and larger stools and more frequent bowel action. This provides a good environment for beneficial bacteria, while decreasing levels of destructive bacteria and the build-up of carcinogenic compounds. Wheat fibre can bind certain toxins and remove them from the large bowel.

A high fibre diet, especially one high in insoluble fibre, has been associated with decreased risk of developing colon cancer and diverticular disease (a condition where ‘pouches’ form in the wall of the intestine).

Cancer

Whole grains can reduce the risk of some cancers, including colon, stomach and other digestive tract cancers, gallbladder, bladder, kidney and breast cancer. A consistent protective effect has been observed when whole grains are eaten three to four times a week. A Norwegian study found that people who ate the highest amount of whole grains reduced their risk of death from cancer and heart disease by almost 25 per cent. A study by the Mayo Clinic in 2001 found that those who ate the highest amount of cereal fibre were less likely to develop cancer at the juncture between the oesophagus and the stomach.

Wholegrain cereals recommended for health

Wholegrain cereals of various kinds are recommended as part of a healthy diet. Nutrition experts recommend that you eat at least 4–5 cereal serves daily. At least half of these serves should be whole grain.

Check food labels carefully

The new food standards code introduced in 2002 does not have composition standards for breads. This means manufacturers can make bread with whatever percentage of the relevant flour they want. In the past, ‘wholemeal bread’ had to have 90 per cent wholemeal flour and rye bread 30 per cent rye flour. This is no longer the case. However, you can look at the percentage labelling to find out how much wholemeal or rye flour is used.

Choosing bread

Tips when buying bread:

• When you buy wholegrain products, look for words like ‘wholegrain’ or ‘wholemeal’.
• Grainy and seedy breads are more nutritious and have a lower GI than more refined breads.
• Some ‘multigrain’ breads are made with white flour and various whole grains added.
• ‘Wholemeal wholegrain’ bread is made with wholemeal flour plus whole grains and has more fibre and nutrients and a lower GI than wholemeal, wholegrain or white breads.
• Sourdough breads have a lower GI, especially dark rye. These breads contain ‘wild’ yeast whereas other breads have specially cultured baker’s yeast.

Where to get help

• Your doctor
• An accredited practising dietitian, Dietitians Association of Australia

Things to remember

• Cereals and wholegrain foods can reduce the risk of developing diseases, such as coronary heart disease, cancer, diabetes and diverticular disease.
• A high intake of refined cereals has been linked to diabetes and some types of cancer.

healthy eating for kids

Healthy eating means eating a wide variety of nutritious foods from all of the food groups. These foods contain lots of vitamins, minerals and fibre. Eating a wide variety of foods from all food groups will help you grow.

Some foods contain too much sugar or fat and not many vitamins or minerals. These are foods we should only eat sometimes.

The foods you eat have been divided into three groups according to how nutritious they are. These make up what is often called the ‘food pyramid’. You can use these groups to help you decide which foods to eat more of and which to eat less often.

Group 1: Eat these foods most of the time

You should try to eat lots of:

• Fruits and vegetables
• Breads
• Grains such as rice and pasta
• Beans and lentils.

You can see that these are all foods that come from plants. These foods all contain vitamins, minerals and fibre. Try to eat a wide variety of these foods. Try not to choose just one of these foods (such as fruit) to eat all the time. Eating plenty of all foods from this group will help you stay healthy.

Plant foods contain thousands of nutrients (small parts), which can help to prevent serious diseases. This is why it is important to eat a variety of different types of plant foods.

Group 2: Eat these foods moderately

These foods are important for health, so you should eat them in medium amounts:

• Dairy products such as milk, cheeses and yoghurts (sometimes low fat ones should be chosen)
• Lean meat
• Chicken (without skin)
• Fish
• Nuts.

These foods are all good sources of protein. Protein helps build strong muscles and can repair our body when we hurt or injure ourselves. Some of these foods also contain some important minerals, such as the calcium found in dairy foods (for strong bones) and the iron found in lean meats (to give us energy).

Group 3: Eat these foods sometimes

These foods don’t give us very many nutrients and are really just ‘extras’. They may contain lots of sugar or fat (or both) but often don’t have many vitamins, minerals or fibre. It’s OK to have these ‘sometimes foods’ if you are healthy, active and not overweight. Most of the time they are better left for occasions like birthday parties.

An example of one serve of these foods includes:

• Sweet biscuits (2 small)
• Chocolate coated bars (1 bar)
• Potato chips (30g)
• Ice-cream (2 scoops)
• Lollies/chocolate (30g)
• Cake or muffin (1 medium piece).

The food pyramid

The three groups of foods you eat from are often shown as a food pyramid:

• The bottom of the pyramid is the biggest part of the pyramid. It contains the foods you should eat most of the time.
• The middle of the pyramid contains foods you should eat moderately (a medium amount). They are important for health but we don’t need too much of them.
• The top of the pyramid is the smallest part of the pyramid. It contains foods you should only eat sometimes.

Where to get help

• Your parents
• Your teacher

Things to remember

• Healthy foods we should eat most of the time contain lots of vitamins, minerals and fibre.
• Sometimes foods can contain lots of fat or sugar but not many vitamins and minerals.
• Try to eat a wide variety of nutritious foods from all food groups.
• Lollies, cakes and chips are OK to eat, but only every now and then (for example, at parties)

Food to have sometimes

Some foods should only be eaten occasionally. These ‘extra foods’ (sometimes called junk food) are foods like potato chips, chocolate, cakes, lollies, soft drinks and some takeaway food like hamburgers and hotdogs. These foods are usually low in nutrients and high in salt, sugar or fat. They are ‘extras’ to be enjoyed occasionally.

If these foods regularly replace more nutritious and healthy foods in your diet, you are likely to become overweight and may develop vitamin and mineral deficiencies and other health problems.

You can have ‘extra foods’ occasionally

We all enjoy a ‘treat’ now and then and it’s okay to have some of these foods now and then as an extra. How often you have them depends on your weight, age and how active you are. But you should keep to small amounts.

If you are overweight and want to lose weight, you should limit these ‘extra’ foods to no more than every second day – and then only if you have a nutritious and balanced diet and you are physically active.

If you are active and not overweight, you could probably have one or two ‘extra foods’ a day – as long as you’ve had your daily requirements of meat, dairy, fruits, vegetables and cereals.

Foods prepared outside the home

Australians spend around one-third of their weekly household food budget on foods prepared outside the home. These include restaurant meals, fast food and takeaway. These foods are often high in fat, salt and sugar. High consumption of these foods may contribute to obesity, heart disease and other disorders.

Fast food and takeaways are often high in saturated fats

The foods sold by popular fast food and takeaway outlets, including fried chicken, hamburgers and hot chips (fries), are often high in saturated fats. These types of fats can cause high cholesterol levels and may cause health problems.

These outlets prefer to use saturated fat because it is cheap and can withstand high cooking temperatures. One fast food or takeaway meal may have more than 50 per cent of your daily fat allowance and almost 100 per cent of your daily saturated fat allowance.

Saturated fats should make up less than 20g of the fat in your daily diet. However, Australians consume, on average, more than 40g of saturated fat per day. For example, each of the following takeaway meals contains about 20g saturated fat:

• Fish and chips
• Four slices of pizza supreme
• Hamburger with the lot and chips
• Fried chicken and chips.

Fat is high in kilojoules

Fat is energy dense; it contains twice the amount of kilojoules per gram (37kJ) as protein (17kJ) or carbohydrates (16kJ). Regularly eating more kilojoules than your body needs will lead to weight gain.

Several studies indicate that saturated fats can cause greater weight gain than polyunsaturated or monounsaturated fats, even when all varieties contain equivalent kilojoules. Saturated fats also contribute to the risk of heart disease by increasing blood cholesterol levels.

Salt

Convenience foods usually contain high amounts of salt. The body needs some salt. However, too much salt in the diet has been associated with an increased risk of high blood pressure, which is a known risk factor for heart disease and stroke.

A maximum salt intake of no more than 5g of salt per day is recommended for adults with normal blood pressure. Many Australians consume double this amount each day.

Less than 20 per cent of our salt intake comes from salt we add to our food. Cutting back on takeaway foods will help reduce your salt intake.

Sugar

Foods like soft drinks, cordials, biscuits, cakes and lollies have high sugar content. Although sugar has not been directly linked to developing heart disease or diabetes, there is evidence that a high sugar intake may contribute to the development of overweight and obesity.

In Australia, soft drinks have become among the most popular beverages. Their consumption has increased by 30 per cent in 10 years. The size of containers has also increased. Ten years ago soft drinks were available in 375ml cans. Now they are commonly sold in 600ml bottles, which provide at least 12–15 teaspoons of sugar.

Studies suggest an association between increasing consumption of sugar-sweetened drinks and the development of childhood obesity. That’s why eating foods and drinks with high sugar content should be limited.

Problems caused by too much sugar

High sugar intakes have been associated with:

• Tooth decay
• Decreased levels of good cholesterol
• Increased levels of blood fat associated with diabetes and heart disease
• Childhood obesity.

Additives

Food additives in junk foods are generally used to prolong shelf life or to enhance colour, flavour or texture. Some people are sensitive to food additives. Symptoms may include diarrhoea and skin rashes.

Healthier choices

Market surveys indicate that Australians would like healthier takeaway foods. Perhaps the easiest way to enjoy a fast food meal, without consuming too much fat, is not to have the hot chips or fries. A large serve of chips can contain around 50g of fat. Current dietary recommendations advise that adults trying to lose weight should restrict their daily fat intake to 40g or less. Active people can have up to 70g of fat.

Fast foods that have relatively low levels of fat and salt include:

• Pizzas with less cheese and meat
• Skinless chicken
• Grilled chicken
• Souvlaki
• Grilled, lean meat hamburgers
• Grilled fish burgers.

Moderation is the key

‘Extra foods’ may have higher levels of fat, salt and sugar, but they still contain nutrients and can be considered as a small part of a healthy diet. A general rule of thumb is to eat fresh, healthy foods about 90 per cent of the time, and indulge in the extra foods no more than 10 per cent of the time.

Suggested amounts of 'extra foods'

A healthy diet doesn't need extras, but if you want to include some extra foods in your daily diet, the Australian Guide to Healthy Eating recommends that people over four years of age, who are not overweight, could have up to 3 serves of extra foods each day, in addition to a nutritious diet. Examples of one serve include:

• 1 doughnut
• 4 plain sweet biscuits
• 1/2 small bar of chocolate
• 2 tablespoons of cream or mayonnaise
• 1 can of soft drink (375ml)
• 12 hot chips
• 1 1/2 scoops of icecream (50g scoop).

Alcohol is also an 'extra'

For adults who choose to consume alcohol the following amounts equal one serve

• 200ml wine (2 standard drinks)
• 60ml spirits (2 standard drinks)
• 600ml light beer (1 1/2; standard drinks)
• 400ml regular beer (1 1/2; standard drinks)

Where to get help

• Your doctor
• An accredited practising dietitian, contact the Dietitians Association of Australia

Things to remember

• Fast foods, takeaway, lollies and chips are typically high in fat, salt or sugar. They should be considered as extras to your usual diet.
• Australians are spending more money on extras. Spend your money wisely. Choose the healthy option when eating out or having snack foods.
• ‘Extra’ foods can be enjoyed occasionally as part of a healthy diet.

Fats and oils

Fat is important for many body processes. You need to eat some fat in your diet. Fat protects your organs, keeps you warm and helps your body absorb and move nutrients around. It also helps hormone production. However, some fats are better than others and having too much of any type is not a good idea.

Dietary fats are classified by their structure. Different types of fats react differently inside the body. Saturated fats (found mostly in animal products) increase blood cholesterol, which is a risk factor in coronary heart disease. Mono-unsaturated and polyunsaturated fats tend to lower blood cholesterol.

Dietary fats and blood cholesterol

There are two types of blood cholesterol: low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol. LDL is considered the ‘bad’ cholesterol because it contributes to the narrowing and silting up of the arteries, which can lead to heart disease and stroke. HDL cholesterol is considered to be the ‘good’ cholesterol because it actually carries cholesterol from the blood back to the liver, reducing the risk of cardiovascular disease.

Groups of fats

Each group of fats behaves differently inside the body. Dietary fat can be classified into four groups:

• Saturated
• Mono-unsaturated
• Polyunsaturated
• Trans fats.

Saturated, mono-unsaturated and polyunsaturated fats

Saturated fats contribute to the risk of heart disease by raising blood cholesterol levels. These fats are commonly found in many takeaway (‘fast’) foods, in commercial products such as biscuits and pastries, and in dairy products.

Mono-unsaturated and polyunsaturated fats both tend to lower blood cholesterol when they replace saturated fats in the diet. Polyunsaturated fatty acids have a slightly greater impact than mono-unsaturated fatty acids.

Replace saturated fats in your diet with either mono-unsaturated or polyunsaturated fats whenever possible. For example, replace butter in some cooked dishes with olive or canola oil.

Trans fatty acids

Trans fatty acids are rare in nature. They are only created in the rumen of cows and sheep, and are naturally found in small amounts in milk, cheese, beef and lamb. Trans fatty acids are also created during the manufacture of some table margarines and in solid spreads used in the food industry to make baked products such as pies, pastries, cakes, biscuits and buns.

Trans fatty acids are considered to behave like saturated fats in the body; they raise LDL levels and increase the risk of heart disease. Unlike saturated fats, they tend to lower HDL cholesterol, so are potentially even more damaging. It is the trans fats that are produced during food manufacturing that you should be most concerned about, not the trans fats present naturally in certain foods. Look for margarines that have less than one per cent trans fats on the label or choose foods with the Heart Foundation Tick. Limit how much takeaway food and packaged snack foods you eat.

Common fat-containing foods

Different foods contain different ratios of fatty acids:

• Saturated fats – sources include fatty cuts of meat, full fat milk, cheese, butter, cream, most commercially baked products such as biscuits and pastries, most deep-fried fast foods, coconut and palm oil.
• Mono-unsaturated fats – sources include margarine spreads such as canola or olive oil based choices, oils such as olive, canola and peanut oils, avocado, and nuts such as peanuts, hazelnuts, cashews and almonds.
• Polyunsaturated fats – sources include fish, seafood, polyunsaturated margarines, vegetable oils such as safflower, sunflower, corn or soy oils, nuts such as walnuts and brazil nuts, and seeds.

Sources of omega-6 and omega-3 fats

Polyunsaturated fats can be divided into two categories:

• Omega-3 fats are found in both plant and marine foods, although it is the omega-3 fats from marine sources that have the strongest evidence for health benefits (including reducing the risk of heart disease). Plant food sources include canola and soy oils, and canola-based margarines. Marine sources include fish, especially oily fish such as Atlantic salmon, mackerel, Southern blue fin tuna, trevally and sardines.
• Omega-6 fats are found primarily in nuts, seeds and plant oils such as corn, soy and safflower.

Benefits of omega-3 fats

Research is ongoing, but the benefits of omega-3 fats in the diet seem to include that they:

• Lower triglyceride levels, which are important risk factors in coronary heart disease
• Improve blood vessel elasticity
• Keep the heart rhythm beating normally
• Thin the blood, which makes it less sticky and less likely to clot
• Reduce inflammation and support the immune system
• Reduce blood pressure
• May play a role in preventing and treating depression
• Contribute to the normal development of the fetal brain.

Plant sterols

Plant sterols are present in all plants. Intakes of 2–3g of plant sterols per day have been shown to reduce blood cholesterol levels by an average of 10 per cent. This is because they block the body’s ability to absorb cholesterol, which leads to a reduced level of cholesterol in the blood. However, it is hard to eat this amount of plant sterols from natural sources, so there are now plant sterol-enriched margarines and dairy products on the market. Eating 1–1.5 tablespoons of sterol-enriched margarine each day can help to lower blood cholesterol levels.

Energy density

Dietary fat has more than double the amount of kilojoules per gram (37kJ/g) than carbohydrate or protein (17kJ/g), making it very ‘energy dense’. Foods high in fat are usually high in kilojoules. Some research suggests that saturated fats are more likely to contribute to weight gain (especially around the middle) than polyunsaturated fat and mono-unsaturated fats, even though they have the same kilojoule content.

Carrying too much body fat is a risk factor in many diseases, including coronary heart disease, type 2 diabetes and many cancers.

Cholesterol in food

People with high blood cholesterol or who are at risk of heart disease should also try to limit their intake of cholesterol-rich foods. However, while cholesterol in food can raise blood cholesterol levels, the effect is small compared to the effects of saturated fat.

Dietary cholesterol is only found in animal products such as:

• Full-fat dairy products
• Fatty meats
• Egg yolks
• Shellfish
• Offal – for example, liver, kidney and brains.

The Mediterranean diet

Researchers are investigating the possibility that a diet rich in mono-unsaturated fats, such as olive oil, may be protective against the development of coronary heart disease. People who have a high consumption of mono-unsaturated fats from olive oil (for example, in Greece and Italy) tend to have low rates of coronary heart disease, regardless of their body weight.

We must remember, though, that the Mediterranean diet contains much more than olive oil. It’s possible that the low rate of coronary heart disease in these countries relates to a high intake of vegetables, legumes, fruits and cereals, which are rich in antioxidants. The evidence so far is inconclusive.

Current recommendations on fats in your diet

Nutritionists recommend that we limit the amount of fats in the daily diet, particularly saturated and trans fats. Simple suggestions include:

• Use margarine spreads instead of butter or dairy blends.
• Use salad dressings and mayonnaise made from oils such as canola, sunflower, soy and olive oils.
• Use low or reduced fat milk and yoghurt or ‘added calcium’ soy drinks.
• Try to limit cheese and ice-cream to twice a week.
• Have fish (fresh or canned) at least twice a week – limit fish that is high in mercury to once a week. Very young children and women who are pregnant (or intending to become pregnant within the next six months) are advised to eat fish that is low in mercury (shellfish, salmon and canned tuna).
• Select lean meat (meat trimmed of fat and chicken without skin). Try to limit fatty meats, including sausages and delicatessen meats such as salami.
• Snack on plain, unsalted nuts and fresh fruit.
• Incorporate dried peas (for example, split peas), beans (for example, haricot beans, kidney beans, three bean mix) or lentils into two meals a week.
• Make vegetables and grain-based foods such as breakfast cereals, bread, pasta, noodles and rice the major part of each meal.
• Try to limit takeaway to once a week or less.
• Try to limit snack foods such as potato crisps and corn crisps to once a week or less.
• Try to limit cakes, pastries and chocolate or creamy biscuits to once a week or less.
• Try to limit cholesterol-rich foods such as egg yolks and offal like liver, kidney and brains.

Where to get help

• Your doctor
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• Nutrition Australia

Things to remember

• Dietary fat contains more than double the amount of kilojoules per gram than carbohydrate or protein.
• Animal products and some processed foods, especially fried fast food, are generally high in saturated fats, which have been linked to increased blood cholesterol levels.
• Replacing saturated fats with mono-unsaturated and polyunsaturated fats tends to improve blood cholesterol levels.

Food variety and a healthy diet

Food variety means eating a wide variety of foods from within and across each of the five food groups, in the amounts recommended. Eating many different foods helps maintain a healthy and interesting diet that provides adequate nutrition. Eating a variety of foods can help prevent diseases such as diabetes, cancer and cardiovascular disease.

Five major food groups

It is important that you eat a balanced diet with foods from each of the five major food groups. Choosing a variety of foods within and across food groups is also important. Each food group contains at least one nutrient (called the ‘characterising’ nutrient) for which it makes a particularly rich contribution to the total diet. For example, the milk group is known as a rich source of protein, calcium and riboflavin.

In each food group, different foods provide more of some nutrients than others. If you eat a variety of foods from each group, you will probably get all the nutrients provided by the foods in that group. For example, some vegetables contain vitamin C (capsicums), while others (asparagus and spinach) are high in folate. Most of the variety in your foods should come from plant foods (fruits, vegetables and grains).

Choosing a variety of foods within each group will also help to make your meals interesting, so you don’t get bored with your diet. The major food groups are:

• Fruit
• Vegetables, legumes
• Lean meat, fish, poultry, eggs, nuts, legumes
• Bread, cereals, rice, pasta, noodles
• Milk, yoghurt, cheese.

These food groups are laid out in the Australian Guide to Healthy Eating.

Ways to include the five food groups in your diet

It’s not hard to include foods from the major food groups into snacks and meals. Here are some suggestions:

• Fruit – this is easy to carry as a snack or it can be included as a part of most meals. For example, try a banana with your breakfast cereal, an apple for morning tea and an orange for an afternoon snack. Fresh whole fruit is recommended over fruit juices and drinks because fruit juices and drinks generally contain less fibre and are more concentrated sources of sugar and energy.
• Vegetables and legumes – raw or cooked vegetables can be used as a snack food or as a part of lunch and dinner. Salad vegetables can be used as a sandwich filling. Vegetable soup can make a healthy lunch. Stir-fries, vegetable patties and vegetable curries make nutritious evening meals. Try raw vegetables like carrot and celery sticks for a snack ‘on the run’.
• Lean meat, fish, poultry, eggs, nuts, legumes and tofu – these can all provide protein. It’s easy to include a mixture of protein into snacks and meals.
• Bread, cereals, rice, pasta and noodles – grains and cereals come from a wide variety of sources including breakfast cereals (oats, muesli and wholegrain flakes), wholemeal breads and biscuits, rice, barley, corn and varieties of pasta.
• Milk, yoghurt and cheese – eat a diverse range of dairy foods including milk, cottage cheese, yogurt and other types of cheese.

Sample serves from the five main food groups

Fruit
One serve equals:

• 1 medium piece (apple, banana, orange, pear)
• 2 small pieces (apricots, plums, kiwi fruit)
• 1 cup canned fruit
• 4 dried apricot halves
• 1½ tablespoons sultanas.

Vegetables and legumes
One serve equals:

• 75g (½ cup) cooked vegetables
• 75g (½ cup) cooked dried beans, peas or lentils
• 1 cup salad vegetables
• 1 potato.

Meat, poultry, fish and eggs
One serve equals:

• 65–100g cooked meat or chicken (½ cup lean mince, 2 small chops, 2 slices of roast meat)
• ½ cup cooked dried or canned beans, lentils, chick peas or split peas
• 80–100g fish fillet
• 2 small eggs
• 1/3 cup peanuts or almonds
• ¼ cup sunflower or sesame seeds.

Breads and cereals
One serve equals:

• 2 slices of bread
• 1 medium bread roll
• 1 cup cooked rice, pasta or noodles
• 1 cup porridge
• ½ cup muesli
• 1 1/3 cup breakfast cereal flakes.

Milk, yoghurt and cheese
One serve equals:

• 250ml (1 cup) fresh, long life or reconstituted dried milk
• ½ cup evaporated milk
• 40g (2 slices) cheese
• 200g (1 small carton) yoghurt.

Extra foods

‘Extra foods’ are those that do not contain significant amounts of nutrients and are considered not to be ‘core’ to the diet. They often contain high levels of fat, sugar and/or salt. Examples include margarine, butter and soft drinks.

How many serves children and adolescents need each day

Children and adolescents	Bread, Cereals, rice, pasta, noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts,legumes	Extra foods
Children 4-7 years	3-4	4	2	3	1/2 -1	1-2
Children 8-11 years	4-6	4-5	1-2	3	1-1 1/2	1-2
Adolescents 12-18 years	4-7	5-9	3-4	3-5	1-2	1-3

Sample serves from the Australian Guide to Healthy Eating.

How many serves women need each day

Women	Bread, cereals, rice, pasta, noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts,legumes	Extra foods
Women 19-60 years	4-6	4-7	2-3	2-3	1-1 1/2	0-21/2
Pregnant	4-6	5-6	4	2	1 1/2	0-21/2
Breastfeeding	5-7	7	5	2	2	0-21/2
60+ years	3-5	4-6	2-3	2-3	1-1 1/2	0-2

Sample serves from the Australian Guide to Healthy Eating.

How many serves men need each day

Men	Bread, cereals, rice, pasta, noodles	Vegetables, legumes	Fruit	Milk, yoghurt, cheese	Meat, fish, poultry, eggs, nuts,legumes	Extra foods
19-60 years	5-7	6-8	3-4	2-4	1 1/2-2	0-3
60+ years	4-6	4-7	2-3	2-3	1-1 1/2	0-2 1/2

Sample serves from the Australian Guide to Healthy Eating.

Why food variety is good for your health

Eating a wide variety of foods increases the likelihood that you will be exposed to sufficient quantities of all essential nutrients, which vary in amount and combination among different foods. This will help to improve your health and may help prevent diseases like:

• Diabetes
• Cardiovascular (heart and circulation) disease
• Cancer.

Good food variety means good nutrition

If you eat a variety of good food, your diet will provide you with adequate nutrition. However, you should remember that:

• The way in which foods are grown, stored and prepared can affect nutrient value.
• Food variety is not based on how much of each food you eat or how often you eat it.
• Providing energy (kilojoules) is not the only reason for food variety. It also helps ensure that important dietary components which provide no nutrition, such as fibre, are included in your diet.

Where to get help

• Your doctor
• A registered nutritionist or registered public health nutritionist
• An accredited practising dietitian, contact the Dietitians Association of Australia
• Community health centre
• Nutrition Australia Tel. (03) 9650 5165

Things to remember

• Eating a wide food variety of healthy foods (especially fruits and vegetables) helps to protect against diabetes, cancer and cardiovascular disease.
• Food variety means eating foods with different nutrients and from each of the five different food groups in the recommended amounts.