New healthy eating guidelines for children aged 1-4 - transcript

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Aileen:  This is the safefood podcast.

Hello and welcome to the safefood Nutrition Podcast. I'm Dr. Aileen McGloin, Director of Marketing and Communications at safefood, the All Ireland agency promoting food safety and healthy eating. On this podcast, we talk about nutrition. Issues like obesity, food poverty, sustainability, and health in the media. Today, we're talking about the development of healthy eating guidelines for one- to four-year-olds in Ireland. We'll explore how scientific recommendations are translated into practical population healthy eating guidelines, and hear how they will be communicated. On Zoom, we're joined by Ursula O'Dwyer, Health Promotion Policy Advisor at the Department of Health. Ursula coordinated the development of the one to four year old healthy eating guidelines. Our second guest is Dr. Marian O'Reilly, Chief Specialist in Nutrition at safefood. Marian was also involved in the development of the guidelines. Welcome to you both.

Ursula:  Hi, Aileen.

Marian:  Hello, Aileen.

Aileen:  Ursula, I'm going to start with you, if you don't mind. We've had healthy eating guidelines for adults and children over five, for many, many years. Can you tell us why these guidelines for the under fives were developed now?

Ursula:  Yeah, sure, Aileen. When we launched the Obesity Policy and Action Plan in 2016, we made a plan to develop a range of health eating guidelines for different age groups, under the title of Healthy Food for Life. So in 2016, we launched revised food permit guidelines and revised healthy eating guidelines. And that was phase one. Phase two now, are the one to four year old healthy eating guidelines. And phase three will be older people. And what we've done is we've had the Food Safety Authority of Ireland develop scientific recommendations for us to underline this process for each of the age categories.

Aileen:  And could you give us an overview of the process of how these guidelines were developed?

Ursula:  Okay. When the Obesity Policy and Action Plan was launched, the department set up an oversight group called the Obesity Policy Oversight Implementation Group, and they had a subgroup on healthy eating, which I chaired, which I chair actually. And Marian also sits on that as a representative of safefood. And so it was through that subgroup that we developed the guidelines. On that subgroup, we have a number of other departments as well. We've got Children, we've got Education, we've got Social Welfare, and we've got Agriculture. So they were all sitting around the table as co-partners in this whole of government approach, that we take with Healthy Ireland. And then also we had a range of nutrition experts like Marian from safefood, Mary Flynn from FSAI, Margaret O'Neill from the HSE, and a number of pediatric dieticians from the Irish Nutrition and Dietetic Institute.

Aileen:  And were parents involved in the process themselves, Ursula? And if so, could you tell us a little bit about the insights you gained from parents?

Ursula:  Okay, well, to develop the guidelines, we set up a small expert group from the overall healthy eating subgroup, and they were the people, as I said, with separate nutrition expertise. So looking at mychild.ie and the safefood partnership around makeastart.ie, I put together an initial draft, and looking at resources in Northern Ireland as well, I put together an initial draft. And from there then we took that forward, I suppose, in an indirect way, parents were involved because we had three practicing dieticians who work with parents and their children on a regular basis. And then also, once we had pretty much the final draft, took the lead with Ipsos MRBI, we focus tested it with both urban parents and rural parents.

Aileen:  And what was the feedback from parents? Were there any particular challenges they found with it?

Ursula:  I suppose the main issue really was, the main thing we were concerned about was that they hadn't really got the message that small tummies need small meals. That they need three meals a day and two to three snacks, and that all of this food needs to be nourishing, because of the size of their small tummies. And therefore, that reflects on portion size as well. So we had actually gone through the food pyramid shelves first, and the servings on those, and then we put the plates, you know, we've got special, like examples of side plates for children, and then an adult dinner plate, and bowls, and cups, and glasses as well. So we moved that right up to the very beginning, because they felt that that message should come up very first. So that was the main thing. And then also they really wanted, specifically, meal plans, you know, daily meal plans. So we have one for a one-year-old and a three-year-old in the leaflet as well. And then we have other resources online for two-year olds, three-year-old vegetarian, and four-year-olds.

Aileen:  And Marian, can you tell us about safefood's role in the development of the guidelines?

Marian:  Well, we were obviously able to bring technical nutrition expertise to the table, but we were also able to bring insights into the challenges that parents face when feeding one to four year olds. We have insights from safefood funded research, and also from research we do around the development of our campaigns, such as the Start campaign. Some of the insights, to give you some examples, would be around limiting treat foods. And we know that from a nutritional perspective, they don't bring any nutritional value to the diets of children. But all the feedback we've had from our research, and particularly around research for campaigns, parents tell us that they've become normal in children's diets, and it just wouldn't work for them to not have any guidelines or recommendations around how to include these in small amounts in children's diets. So that's one example. Another example is around the amounts of foods. And we know from our research, parents' overriding concern, when it comes to quantity of food, is actually getting plenty of food into their children. They don't consider the consequences of overfeeding on one type of food, or generally overfeeding every type of food. So it was really important with the healthy eating guidelines that we're able to clearly communicate the right amounts of different types of foods to give this age group.

Aileen:  Ursula, the new guidelines take the form of the food pyramid, the same form as for older children and adults, but there are other formats used in other countries, like in the UK where they use the Eat Well Guide, for example. So why was the food pyramid chosen in Ireland?

Ursula:  Well, research has shown us that once people understand the shape of the food pyramid, and that the high fat, salt, and sugar foods are at the top of the food pyramid, or in the red triangle, as we call it now in the children's food pyramid. Once they understand that, then they understand that the base of their diet should come from the foods at the bottom, which are the fruit and vegetables, and cereals, bread and potato shelves. And safefood actually did some research for us, which found that people did understand that, once they understood the shape, whereas the circle, while it's very useful as well, people don't have a graphic image of the amounts as clearly as they do from the food pyramid. And so we've used it again this time. I think another important thing too, is that really, we're progressing children from one to four up towards the main food pyramid, from five years on. So if you look at the serving sizes, they're obviously much smaller for one year olds, it's getting more for two year olds, three year olds, and four year olds, and then gradually, they're up at the older children and adult food pyramid. So it was very important that we had consistency going through that and we will follow that consistency as well for future healthy eating guidelines.

Aileen:  Marian, I'm going to come back to you. The guidelines contain a number of key messages. You've mentioned some of them already. But would you mind just for our listeners telling us what the messages are, and a little bit about them?

Marian:  Okay, broadly speaking, I divide the core messages into three areas. The first one really is around children having small tummies, that Ursula talked about, parents didn't really get that message. So the need to eat small servings. They need to eat small amounts frequently, and having the three meals and two to three snacks a day is the key cornerstone to meal patterns. Limiting treat foods and not filling up on these ensures that children get the nourishing foods they need. And again, in and around portion size matters. So the amounts of foods, and the amounts of the different types of foods is very important. And there's a lot of emphasis on that, within the healthy eating guidelines. The second set of messages around the milk and dairy food shelf, milk and water are the main drinks this age group require. And milk is a really key food for this age group. Interestingly, and a lot of people don't realise this, milk and dairy foods, the amounts that children and adults need remains pretty consistent through life. And it's the other different foods that increase, and are at different proportions compared to the dairy food. So for one- to four-year-olds, dairy foods remain consistent right through to they're adults. But it's the other types of foods that you're trying to increase during that one- to four-year period. And the third set of messages around key nutrients. The first one is vitamin D, and the need to have a vitamin D supplement between Halloween and Saint Patrick's Day, and there's guidance on that. And the second message there is around getting enough of iron. So that maybe from meat and fish, and also iron fortified cereals play an important role for this age group as well.

Aileen:  You mentioned serving sizes, and the resources that are associated with the guidelines contain a lot of fantastic food photography. Could you tell us why this was such a particular emphasis?

Marian:  Well, as I mentioned before, when it comes to the amount of foods that parents are serving this age group, they're not really concerned about overfeeding children. So getting the right imagery, and using imagery to get across appropriate serving sizes to put in plates and bowls was really important. So safefood coordinated this piece of work, the food photography, to really get the food photography right. And what we wanted here was to get across amounts, number one, but also to make the food look appealing, but also realistic. And the type of meals we'd be serving this age group at home. Because the type of food photography we see in magazines, in our supermarket fliers, really is about making the food look as mouth-watering as possible, and not getting across amounts, or really reflect the type of foods we would cook at home ourselves. So this was a really important part of the healthy eating guidelines, and really has brought the guidelines to life. Because what we're able to do is demonstrate the amounts of foods to serve the different ages, from one, to two, to three, to four, and do it in a way that was true to what parents are doing at home. So we were able to do meal patterns, daily menu plans, and really bring the information to life.

Aileen:  And having seen it, it really does do that. The photography is absolutely fantastic. You mentioned it briefly before, treat foods were not recommended in the scientific recommendations, but they are included in the guidelines, in very small amounts, in the guidelines themselves. So can you tell us a little bit about how this sort of translation from scientific to real world takes place, and the kind of thinking behind that?

Aileen:  When you're developing practical healthy eating guidelines, you really need to look at where people are at the moment. And particularly through, we looked at the dietary surveys, we have a wealth of knowledge through our own safefood research, talking to parents, getting feedback from parents on the challenges. And this is the one area that they find really difficult. And the one thing they've always said to us consistently over recent years is, don't tell us not to have these foods, or give our children these foods, because it's part of our children's diets as it is, we need to reduce them, we know that, and how do we do that? So when you're developing healthy eating guidelines, you have to take those social norms, cultural habits into consideration. So in doing that, we focused on an amount that wasn't going to impact negatively on the nutritional intake of children, but allow a little bit of leeway, in terms of including these types of foods in children's diets. So a little amount, once a week, was the emphasis of these guidelines.

Aileen:  And Ursula, what were some of the main challenges faced by the working group in translating the scientific recommendations? Marian's just mentioned the treat foods there, but I'm sure there were many others.

Ursula:  Yes, well I suppose the first thing really was that working in the lockdown environment of COVID actually did make it more of a challenge, I think, but we were very fortunate in that we had signed off on the proposed design with the designer in February, at our last face to face meeting, of the Healthy Eating subgroup. But getting an agreement around what exactly should go in, and trying to keep it consistent with the mychild.ie and with makeastart.ie, as well as adding more to that. That was a key backwards and forwards process that we had to do. I think that in developing the next set of guidelines, I think probably, what we've learned is that it's probably a good idea to separate the translation of the scientific messages into healthy eating guidelines, and then the communications part of it as well. Because what has changed in the last four years is that all of the key people who were involved, like safefood, and the HSE, and ourselves, in the Department of Health, we all have communications teams now, who are well able to translate the message. So certainly in developing the next lot, that's one of the changes that I would make. And I would focus it much more towards remote working, because that's obviously what we're going to be doing, and having a number of sign-off meetings. Because we had changes coming in very close to the end last week, and that really isn't a satisfactory way to do things. But yeah, overall, really, once we got agreement from people, around wording and moved everything ahead, then the main challenges I think were covered. As Marian said, the treats, and the small tummies and small meals, and the portion sizes, those were important, but also I suppose the key message that we really do want to get out is this message around children having five micrograms of a vitamin D only supplement every day from Halloween until Saint Patrick's Day, because this is a brand new message. And we want to make sure that health professionals in particular pass this message onto parents.

Aileen:  And now that the guidelines have been developed, Ursula, the next step is obviously implementation. So could you tell me a little bit about how that's going to take place?

Ursula:  Yes, so the route that we decided to use around implementation was again, to put together the key people on our healthy eating subgroup. So we designed an implementation template, for want of a better word, for all the key government departments. Obviously, particularly the Department of Children and Youth Affairs. And also for the key partners, like safefood and HSE, to complete, so that we could develop an overall implementation plan for the whole campaign. This year, also, we had a social media campaign, which we haven't had before for healthy eating guidelines. And the children's food pyramid, and that's running at the moment. So I think that will help. And then also, apart from the general media presence, and I know that safefood are going to be doing some specific tools around portion sizes with food photography as well. And then the next stage also is that safefood and ourselves are working together on developing nutrition standards for the early learning and care centers, and preschools. So again, that's going to get the message out there, particularly it will be helpful to creche workers, and creche managers, and pre-school managers. And in fact, we focus tested the resources with them as well, and they thought that will be very useful, because parents often send in enough food in the lunch box to feed one of them for the day, let alone a child. So I think all of those people coming together, everybody getting it out on their own social media outlets, through their own networks, I think that will help get the message out there.

Aileen:  Ursula mentioned there, Marian, that some of the ways that the implementation will be carried out by safefood, will it impact on safefood's work in any other way?

Marian:  Absolutely, they're going to be great to have, because a lot of our work, especially around the Start campaign is communicating healthy eating messages to parents. And up until now, we haven't had the recommended serving sizes of different foods for one- to four-year-olds. And we know many families are made up of children of different ages, and we were able to give clear serving size and portion size guidance for over fives, fives and olders. Now we've the piece now for one- to four-year-olds. So we're going to spend a bit of time in terms of updating our information for parents on our website, hard copy resources where we have them. And Ursula mentioned there in terms of we'd be developing more resources for parents, and for pre-school workers around the serving size guidance. So there's plenty of work to be done over the coming months, but we're delighted to have these, because I think it's important for parents to have some clear guidance around, particularly the amounts and proportions of foods, which we didn't have until now for the one- to four-year-olds. So it's wonderful to have these resources to support parents with.

Aileen:  Absolutely, and in case I forget to ask this very important and practical question, Ursula where can people find the guidelines, if they're looking for them?

Ursula:  People can find the guidelines if they go to www.gov.ie/healthyireland/eatwell, all one word.

Aileen:  Brilliant. And just a couple of questions for both of you before we finish up, is there one notable thing that you've learned from being involved in the development of the guidelines yourselves? So maybe Marian, we'd start with you, and then if Ursula would come in.

Marian:  I think the big learning for me was the partnership approach. We had different partners around the table working in different areas of food and health. And for me, being more focused on the consumer and mass media end of things, learning from my colleagues who were working in the health services, and in the Irish Nutrition and Dietetic Institute, learning, I suppose, some of their challenges, and areas of communication, and learning from them. And the importance of that partnership approach, because it's important these healthy eating guidelines support all of us dieticians, and nutritionists, and communicators in the different sectors and different organisations.

Aileen:  And you, Ursula?

Ursula:  Yes, I certainly think that the partnership approach is very important, and that is a key signature of Healthy Ireland, bringing everybody together, and us all bringing out resources that are A, compatible, and that everybody can understand. And I think really, I suppose the other thing is that people are really confused. Parents are confused about what to give their children. And having the information in a very colourful, user-friendly format, from all the nutrition experts working in this area in the country, having messages that are agreed by them, and passed onto parents, so that they can help feed their children, and feed their families. I think that was a key learning as well.

Aileen:  And one final question for both of you, what do you think the key benefit of having these guidelines are, for everybody who will be using them?

Ursula: I think the key benefit is that early eating habits established at a young age do last a lifetime. And we will actually be reaping the benefits of these guidelines if they're implemented by parents and by preschools, and early learning and care centers, we'll be seeing the benefits from this in 50, 60, 70, 80 years ahead. So I think that is a really important thing.

Aileen:  Absolutely. And Marian?

Marian:  I think it's clarity for parents. Parents like information that they can use. And it's up to all of us now who have worked on these, and the different departments and agencies, to keep communicating the information that was developed as part of the healthy eating guidelines. And work with parents, learn, maybe some resources need to be adapted, but keep learning and evolving as we go forward. But I think it's provided clarity for parents, I think at the moment, those parents I've talked to who've seen the resources said they're brilliant, they're so visual, they're practical, I can work with that. So it's up to us now to get the information out there in as many formats as we can.

Aileen:  I couldn't agree more with you both. I think we will leave it there. I know the guidelines will be very much welcomed by health professionals working with young families, those working in early childcare and education, and with parents of small children themselves. Thank you so much to both of you, Marian and Ursula, for sharing your knowledge and experience of this really important process. And thanks to you, the listeners, for tuning in. Please do get in touch. Send your questions or thoughts to info@safefood.net and if you want to hear more from us, search safefood podcasts, wherever you get your podcasts. And please do sign up to the All Ireland Obesity Action Forum on safefood.net/professional. You can also join the conversation on Twitter, @safefoodnetwork, and follow us on LinkedIn. So until next time, thank you, and bye bye.

Aileen:  You've been listening to the safefood podcast.