Over the past 30 years the prevalence of overweight preschoolers (2-5 years old) has more than doubled to its current — and alarming — 13.9 %, and has more than tripled in 6-19 year olds to its current 16.5%. It is known that overweight parents more often have overweight children, suggesting that the nutritional habits and foods at home are related to children's eating habits.

The healthiness of children's food choices in the store appeared to be influenced by those of their parents.

Educating children and adults has been a major focus in the ongoing struggle to control the unhealthy eating habits of American adults and children. It is clearly better to educate children before they become overweight. But just how early can this be done? When, where and how can children be influenced?

Lessons in the Back of a Grocery Cart
A recent study published in the November, 2008 issue of Archives of Pediatrics and Adolescent Medicine suggests that children are learning about food choices vicariously, even if not intentionally, at a very young age. It also suggests that some early interventions may be more effective than anyone imagined. One of the best ways to teach the lessons of a healthy diet may be while they are in the cart at the grocery store.

This study included 120 children, ages 2-6 years old who were asked to pretend they were adults shopping in a grocery store stocked with play food items. The foods were classified as "least healthy," "somewhat healthy" and "most healthy" choices, based on standard criteria. The children's purchasing behaviors were analyzed.

Parents of children in the study were also questioned about their choices of food and beverage products and were also asked to make choices from among the same products available to their children in the play store. In addition, they supplied information about family demographics, children's exposure to TV, how often the child accompanied parents to the grocery store, and how much the child helped with food choices.

Parents' generally self reported purchasing healthier products than did children. Children chose a mixture of healthy and less healthy food. No significant age or sex differences were noted in their choices.

Children who made the least healthy choices also purchased about the same number of healthy products. Children who chose the healthiest products chose more than four times as many healthy products vs. less healthy.

The researchers concluded that children's food choices between healthy and non-healthy were not random and that children were able to regulate their food and beverage choices. They found a significant association between the healthfulness of what parents chose in the store and the healthfulness of their children's play purchases. The healthiness of children's food choices in the store appeared to be influenced by those of their parents.

The data was analyzed looking for influences on children by TV exposure, shopping with parents, and parental preferences. The only significant predictor of the healthfulness of the children's purchases was parental reports of their own food and beverage purchase choices. The authors concluded that children copy and integrate their parents shopping behaviors even when they are too young to understand the nutritional implications of their decisions. This highlights shopping in the grocery store as a potential locus of educational interventions with very young children.

This study needs to be expanded to determine the influence ethnicity, socioeconomic status, parental educational level, and availability of other expanded choices of types of play food before large-scale conclusions can be drawn. However, the notion that very young children are potentially influenced by "point of purchase" education is an important addition to the arsenal of weapons in the fight against childhood obesity.

The Takeaway for Parents
Although the study did not specifically address this, grocery shopping, like many necessary chores, can be made more enjoyable when a little effort is put into making it a bonding and teaching experience for parents and children. Consider putting away your cell phone and your child's hand held computer game and relating directly to each other during the outing. Talking about colors, shapes, and sizes of food items, counting out loud as you load your cart, thinking up rhyming words for foods, allowing your toddler to place the item in the shopping cart or a small one of his/her or her own can transform a chore into a time of laughter and learning.

Be sure that your child isn't overtired, or hungry, and consider bringing along a snack and a drink so being surrounded by "inaccessible" food and drink doesn't overwhelm your toddler. And have fun yourself as you discover your toddler's sense of humor and sense of delight in the colorful and stimulating environment of what you think of as "just a grocery store."