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Changes in a Child’s Diet in the 20th Century
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Changes in a Child’s Diet in the 20th Century
Nada Al-Muhandis looks at changes in children’s diets in the UK during the 20th century, alongside some of the political and social influences on diet
During the 20th century, many changes occurred to the composition of our population in the UK. At the beginning of the century, only 4% of individuals were over 65. However, by the year 2000 over-65’s made up around 12% of the population. Earlier concerns about communicable diseases have been replaced by an emphasis on chronic diseases, which predominantly affect older people, including obesity, diabetes and heart disease. Diet has been widely implicated as a contributor to these diseases1. Since it can be too late to ‘cure’ many of these diseases, focus must instead be shifted to prevention. A key element to this is ensuring that children and young people have a good diet.
Historically, the government has tried several approaches to address the issue of poor nutrition in children. The first free school meals were introduced in 1879 in Manchester, to what were defined as ‘destitute and badly nourished children’2. A similar scheme was followed in Bradford, entitled the Bradford School Meals Project2. In 1906, the Education (Provision of School Meals) Act was introduced, allowing local authorities to provide school meals to those children who were ‘unable by reason of lack of food to take advantage of the education provided them’3. In other words, the government realised that hungry children were not able to learn. This act allowed, but did not require, local education authorities (LEAs) to provide school meals.
The Education Act was introduced in 1921, and this set out the conditions under which children were eligible for school meals2. In the first decade of the 20th century, the government emphasised that school meals should contain protein and fat as these are the principal promoters of growth, and because it was recognised that these were deficient in many children’s diets at home4. During the post-war period, food rationing had a surprisingly positive effect on the diets of children. More bread and milk was consumed, increasing calcium and fibre intakes, along with a larger amount of red meat in the diet, providing iron. There was less consumption of sugary foods, particularly soft drinks5.
Nutritionists realised that milk could provide a good source of protein and fat, essential for growing children. The voluntary Milk Club movement took off in 1927, where bottles of one-third of a pint would be provided for each child4. The Board of Education (in conjunction with the Ministry of Food) encouraged LEAs to achieve as close to 100% participation of children as possible, in what became known as the Milk in Schools Scheme, which became a legal requirement in 19444. In 1946 the provision of school milk became free. This continued for a further two decades. However, in 1971, the then education secretary, Margaret Thatcher, put forward plans to end free school milk to children over the age of 7, which aptly earned her the nickname ‘Thatcher, Thatcher, milk snatcher’. She consulted the Chief Medical Officer on the plans, who advised that ‘it was not possible to predict whether the withdrawal of free milk would harm children’s diets and overall health’6.
Pregnant women represent an especially vulnerable population group to poor nutrition. Pregnant women on low incomes are more likely to bear babies with low birth weight, and are less likely to breastfeed their infants. In a classic study, pregnant women who ate what was termed a ‘poor’ diet (low in protein, calcium, fruit and vegetables) had a higher risk of complications during pregnancy, including prenatal death, low birth weight, prematurity and birth defects, compared with pregnant women consuming ‘good’ diets. Crucially, when food supplements were given to women in the ‘poor’ diet group, their risk for these pregnancy complications became the same as for those women eating a good diet. Although the women may also have varied in regard to other lifestyle factors, this evidence suggests that the main factor influencing the development of the unborn child is diet7. In addition, diet during pregnancy affects not only the immediate health of the developing child, but can also have adverse health effects later in life. For example, there is strong evidence for an association between low birth weight and coronary heart disease later in life8.
The first 4-6 months of life is a period of rapid growth and development, which requires the nutrients and factors for the immune system which are found in breast milk. As well as providing essential nutrients for the baby, breastfeeding has been shown to protect against gut and ear infections and diabetes mellitus. However, despite national initiatives, the rate of breastfeeding in the UK has remained static since the 1980s9. Although the cheapest and most convenient baby feeding method, women on low incomes are less likely to breastfeed their infants. In fact 90% of women from social class I breastfeed, compared with only 50% of women from social class V9. There are a variety of reasons for this, but earlier and more effective health promotion should hopefully encourage all new mothers to consider breastfeeding.
Children at age 1 to 3 years require an increasing amount of energy, as well as most vitamins. Also required, but in lower amounts, are minerals such as calcium, phosphorous and iron. As the child reaches school age, there is a greater need for protein and vitamins (apart from vitamins C and D). Between 7 and 10 years, there is a marked increase in energy and protein requirements. The needs for thiamine, vitamins A and C remain the same, but there is an increased need for all other vitamins and minerals10. As both boys and girls reach adolescence at around 11-14 years, energy requirements increase by about 50%. Importantly, girls require a higher proportion of iron than boys at this age, especially as menstruation begins10.
It is irrefutable that the diet of the modern child is not what it used to be. The National Diet and Nutrition Survey conducted in 2000, on young people aged 4-18 years found that:
· Saturated fat intake was 30% higher in boys and girls than recommended
· The intake of sugar (measured as non-milk extrinsic sugar) was around 50% higher than recommended
· Up to a fifth of older girls and 12% of boys had vitamin A intakes below recommended levels
· Other vitamin intakes, including those of zinc, potassium, magnesium and calcium in boys and girls, and iron in girls, were below the reference nutrient intake (RNI). Some of these were significantly below the RNI.
· Sodium and chloride intakes (excluding additions during cooking and at table) were on average double the RNI11.
Considering the methods used in food advertising, these alarming figures are perhaps not surprising. In 2003, £522m was spent on advertising food, soft drinks and chain restaurants on television. This made up 72% of these industries’ total advertising budget12. British and American children are exposed to around 10 food adverts per hour of television13. Studies have also shown that the more television watched during a mealtime the less consumption there is of foods not typically advertised, such as fruit and vegetables13. Children and young people have been found to react differently to advertising, particularly on television. Children between 4 and 7 begin to be able to distinguish programmes from advertising, and although unengaged by subject matter, may be entertained by use of bright colours, music, cartoon characters and celebrity endorsements12. By the age of eight, most children have grasped the motivation of advertising to persuade12. Teenagers are more likely to pay attention to arguments put forward in advertising. Celebrities as role models continue to have an influence on this group, who are also likely to be influenced by witty taglines and stylish imagery12.
Knowledge about food, cooking, nutrition and health among children and parents clearly plays a part in determining what children and young people eat and the Department of Health (DoH) launched a national 5 a Day campaign in 2003, to encourage people to increase their intake of fruit and vegetables. In discussing the barriers which prevent people from eating more fruit and vegetables, the department website highlights ‘attitude and awareness’, along with access and availability14. The DoH has recently issued the 500th license for its 5 a Day logo, enabling brands to display the logo on the packaging of certain products, helping to publicise the 5 a Day message15; the scheme currently involves more than 700 brands. In addition, the government started the School Fruit Scheme in 2004, providing a free piece of fruit for all children between the ages of 4 and 6 years every school day16.
Food companies have claimed that there is no direct evidence linking food adverts with childhood obesity, and the British Retail Consortium has stated that ‘attacking food adverts misses the real cause of childhood obesity’17. It is difficult to underestimate the effect of advertising on children’s diets, but there are other factors that must be taken into account.
The actual amount of money spent on food, as found in household expenditure surveys, is related to income. The UK Family Expenditure Survey found that households in the lowest 10% income category spent the highest proportion of income on food than any group (23% of their income on food, compared to the top 10% who spend 14% on food). The actual amount spent is equally alarming, with £1 per week spent on fruit and vegetables in lowest income households, compared to £4.40 in highest income households14. For this reason, public education about the foods that are beneficial to our health should be encouraged and targeted to the whole population, as well as the especially vulnerable groups of our society, namely pregnant women, children, and young people, for whom changes in diet can make such an important difference to health.
References
1. Nichols, B.L., 2000. Nutriogenetics and child development in the 21st century. Nutrition 16:493
2. Gillard D., 2003. Food for thought: child nutrition, the school dinner and the food industry online article www.dg.dial.pipex.com/articles/educ25.shtml (accessed 10/08/07)
3. Vernon, J., 2005. The ethics of hunger and the assembly of society: the techno-politics of the school meal in
6. BBC news website: 1971 Councils defy Thatcher milk ban, http://news.bbc.co.uk/onthisday/hi/dates/stories/june/15/newsid_4486000/4486571.stm (accessed 9/8/07).
7. Hirschi, K. & Keen, C., 2000. Nutrition in embryonic and foetal development. Nutrition 16:495
8. Barker, D., 2007. The origins of the developmental origins theory. Journal of Internal Medicine 261:412-417
9. Fairbank, L., O’Meara, S., Sowden, A., Renfrew, M. & Woolridge, M., 2001. Promoting the initiation of breast feeding. Quality in Health Care
10:123 10. British Nutrition Foundation: nutrient requirements and recommendations website, www.nutrition.org.uk/home.asp?siteId=43§ionId=414&parentSection=320&which=1 (accessed 9/8/07)
11. Food Standards Agency NDNS website, www.food.gov.uk/news/pressreleases/2000/jun/nationaldiet (accessed 9/8/07)
12. Ofcom: Food advertising in context website, www.ofcom.org.uk/research/tv/reports/food_ads/#42 (accessed 07/8/07)
13. Ebbeling, C., Pawlak, D. & Ludwig, D., 2002. Childhood obesity: public-health crisis, common sense cure. The Lancet 10: 473-482
14. Dowler, E., 2003. Food and poverty: insights from the North. Development Policy Review 21:569
15. Department of Health: 5 A Day reaches 500th license milestone website, www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4117663 (accessed 07/8/07)
16. Department of Health. 2002. National School Fruit Scheme.
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