Even as childhood obesity continues to increase worldwide, with an estimated 390 million obese children and adolescents being heavier than expected for their age, temptations for children to eat a diet with poor quality are rife. Could this be counteracted by offering healthy food to children more frequently? A new research paper examines this hypothesis, showing the positive effects of increased meal frequency on childhood obesity.

Study: Association between Meal Frequency and Weight Status in Spanish Children: A Prospective Cohort Study. Image Credit: Sharomka / Shutterstock

Introduction

Today’s world encourages children to eat less fresh foods, including fruits and vegetables, with a high proportion of their diet coming from sweets and salty snacks. This is primarily due to parental behavior, including restricting access to certain foods. In fact, the latter practice has been shown to stimulate the desire for the forbidden food and encourage eating for taste rather than to satisfy hunger, causing excessive caloric intake.

However, regular healthy meals and snacks are conducive to regulating appetite and reducing frustration related to hunger in children in children above two years, at least. However, the evidence is scanty, indicating the need for more longitudinal prospective studies.

The current study, published in the journal Nutrients, included 1,400 children, the average age being ten years. All were followed up over a mean of 15 months. Their self-reported dietary frequency was recorded and compared with their body weight, height, and waist circumference. In addition, the standardized body mass index (zBMI) and waist-to-height ratio (WHR) were measured.

What did the study show?

The scientists did not find any correlation between meal frequency and sex or age. About 58% of children ate five meals daily, including breakfast, lunch, and dinner, with two snacks at mid-morning and mid-afternoon, respectively. About 12% had three or fewer meals, while 30% ate four times a day.

Overall, boys ate less frequently than girls. Those children who ate more frequent meals were more likely to follow the Mediterranean diet pattern. The group with higher meal frequency was associated with a lower zBMI and narrower waists.  

The results showed that abdominal obesity and excessive weight gain were less likely to occur when more regular mealtimes were observed, even after confounding for sex, age, school, physical activity, and diet quality, as well as for the mother’s educational level. Moreover, “higher meal frequencies were predictive for a favorable development of the weight status in Spanish children.”

What are the implications?

The current study shows that with a higher meal frequency, children were less likely to gain excessive weight, as measured by either the standardized BMI or the waist circumference compared to that of the hips. As a result, these children were less likely to be obese or overweight or to have visceral fat deposition.

This is among the earliest prospective studies on meal frequency associated with weight gain in children. A previous study on children with challenged hearing found the same pattern as in the current study but confined to those between 11 and 16 years old. Other researchers have confirmed this association.

One study showed the opposite association in children aged four years of age at the onset of the 9-year study period. This could be because younger children eat mostly on demand and according to their hunger. In the preadolescent period, beginning at about ten years of age, children respond to other cues than hunger, such as body image, peer pressure, or social expectations. This could explain why older children skip meals or otherwise limit their intake.

When families eat together, as is more likely when regular mealtimes are observed, children are more prone to be supervised and thus have healthier food patterns. The same is true of snack times when children tend to choose unhealthy snacks when unsupervised.

The present study shows that “promoting an adequate meal frequency of at least 3 meals (particularly from the age of 10), combined with a good-quality diet and adequate energy intake and expenditure, may be beneficial for the weight status of children.” Notably, earlier studies have largely ignored diet quality and energy intake, despite their evident impact on body weight.

The current study used the Mediterranean diet pattern as a proxy for healthy food choices. However, the researchers did not adjust for energy intake. The findings of this study should be validated by more extensive studies, considering the small number of results in all groups.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.