Nutritional Pearls: Habitual Snacking

Christina is a 44-year-old mother of 2 small children. She is slightly overweight, and is beginning to notice an increase in both of her children’s weight as well.

She would like to know how to best manage her children’s weight and incorporate healthy habits into their everyday routine.

The children eat lunch and a snack at school, and have another snack before dinner after they arrive home from school.

How would you advise your patient?

What is the correct answer?
(Answer and discussion on next page)

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Answer: Habitual snacking between meal times leads to excessive body weight.

You're probably well aware of the high levels of childhood overweight and obesity in the United States and how difficult it can be for patients to lose excess weight. With that in mind, some researchers are focusing their efforts on understanding why children become overweight in the first place. 

Cognitive Scripts

We do know that children today eat far more frequently than they did 30 years ago—and that their overall snack consumption is easily equivalent to the number of calories they consume at breakfast or lunch.

Researchers are focusing on an area of study called cognitive scripts. These are best described as "expectations about the order as well as the occurrence of events."^{1
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For example, part of a cognitive script involving shopping for shoes at a store might go like this: Enter the store and find the shoe department. Choose a shoe. Ask a sales person to bring you the shoes to try on. Try on the shoes. Make a decision about purchasing the shoes.

These scripts are created by repetition of certain events in a particular situation, so the more common the event, the more likely they are to appear in an individual's cognitive script. As you might imagine, a person's cognitive script for a certain situation is influenced by past experience (visiting the shoe department every time one enters a department store) and can also predict future behavior (if one enters a department store, it's very likely that you'll visit the shoe department).

The Research

Researchers at Bowling Green State University in Ohio recruited 44 children between the ages of 4 to 6 from daycare centers and preschools in the area to participate in their study.¹ The children's height, weight, and age were recorded by interviewing the parent of each child, and the body mass index (BMI) was calculated before the study. The study authors theorized that those children whose cognitive scripts included food more frequently would have a higher BMI.

Each child was shown a simple line drawing illustrating the location of certain events that were familiar to the child and were asked "to tell a story about four activities that occur during that event."¹ These events—eg, a play date, a movie theater, and a sporting event—were chosen because food was likely to be available during these events but was not necessarily integral, as would be the case with say a birthday party or Thanksgiving. The researcher asked the child about food only if the child did not spontaneously mention food-related activities in their event scripts.

The Results

The researchers found that 54% of children mentioned food during the playdate event or the sporting event, but 74% of all children mentioned food when discussing a trip to a movie theater. Further, those children who mentioned food more frequently in their event scripts had a higher BMI than those who mentioned food less frequently.

What’s the “Take Home”?

More frequent mentions of food in a child's cognitive script that it not directly related to food suggests that they are likely to be eating (snacking) more frequently, and that easily leads to excess body weight.

This is applicable to both adults and children, so talk to your patients about their cognitive scripts: Are they setting themselves (or their children) up to expect frequent, excessive snacks?

Second, children's cognitive scripts are carried into adulthood: If you go to a movie, do you feel you have to have a tub of popcorn? Is it not a baseball game without a hot dog? Prompt your patients to be mindful of their cognitive scripts that include food, and help them make a conscious choice whether to eat or not.

Reference:

1. Musher-Eizenman DR, Marx JM, Taylor M. It's always snack time: An investigation of event scripts in young children. Appetite 2015;85(2):66-69.