October 2013 Issue

Family Mealtime — It Doesn’t Just Create Warm Memories
By Larissa Gedney, MS, RD, LD
Today’s Dietitian
Vol. 15 No. 10 P. 30

Research shows children and adolescents who regularly eat with their families are more likely to develop healthful eating habits that last a lifetime.

As a child, family dinner was the norm at my house. By 5 pm every evening, my father strolled into the kitchen and sat at the table. My mother soon served platters of steaming food. My sisters and I promptly turned off the television and radio, and we took our seats around the table. My parents asked us about our day, and we answered them between bites of steamed vegetables and gulps of skim milk.

To this day, some of my favorite foods include the same fresh produce and whole grains that graced my family’s dinner table during those meals. Those foods influenced my decision to serve healthful foods to my own children.

While I fondly remember those family meals, numerous studies suggest that family mealtime offers not only warm memories but also an opportunity to instill good eating and nutrition habits in children. For example, an analysis of 17 studies of family meals (which were defined in several ways across the studies) suggests that sharing at least three family meals per week offers tangible nutritional health benefits to children and adolescents, including the following1:

• a 12% reduction in the risk of being overweight;

• a 20% decline in the consumption of unhealthful foods;

• a 35% decrease in disordered eating, such as bingeing, purging, using diet pills, fasting, and skipping meals; and

• a 24% increase in the consumption of healthful foods.

Unfortunately, societal changes have chipped away at this valuable practice, perhaps threatening the opportunity for children to develop healthful eating habits. Today, there are more families with two parents working full time, more single-parent households, and an increasing array of children’s extracurricular activities. Each of these can make it difficult for families to eat even one daily meal together, particularly dinner. The wide availability of convenience foods—many of which may not qualify as healthful—can make it even easier for family members to forego the traditional family dinnertime meal.

This article discusses the benefits and challenges of sharing regularly scheduled family meals. It also provides strategies RDs can use to promote family meals and healthful family eating habits.

Meal Consumption Trends
Meal patterns have changed over the past four decades. Findings from research conducted during that time vary widely regarding the percentage of meals families eat together and what even constitutes a family meal. So how often a family eats together at home remains unclear, loosely defined, and variable. For example, a study published in the Journal of the American Dietetic Association reported that the frequency of the evening meal eaten at home decreased from 89.2% in 1973-1974 to 75.9% in 1993-1994.2

A 2003 study analyzed meal questionnaires from 4,746 middle and high school students in Minnesota and found that 14% hadn’t participated in any family meals during the previous week, while 19.1% had participated in one or two family meals, 40.1% in three to six family meals, and 24.8% in seven or more such meals.3 The study looked at all meals—not just the evening meal—but 33.1% of the survey subjects had participated in fewer than three total family meals the previous week. In contrast, a CBS News poll in 2010 reported that 74% of viewers claimed they eat together as a family all the time, and 78% said they eat together most of the time on weekends.4

Research also varies on which daily meals are eaten together as a family and how that difference may affect any nutritional health benefits. Much of the research focuses on the evening meal, but breakfast and lunch can be valuable opportunities for parents to model healthful eating behaviors, too. These opportunities may be lost with the increased number of households with two parents working outside the home because more children may prepare breakfast for themselves or skip it altogether. According to a study published in The Journal of Adolescent Health, as adolescents got older, the frequency of breakfast consumption tended to decrease and fast-food consumption increased.5

Also, the expansion of government-funded school breakfast nutrition programs means more children eat their morning meals at school rather than at home with their family. While these school breakfast programs may help children meet their daily nutritional needs, they may make eating the evening meal as a family more important.

Although adolescents still consider family meals important to their family dynamics, children and preteens tend to consume meals with their parents more often than teenagers, who may report frequent scheduling conflicts or additional extracurricular activities.6 Perceptions also differ between adolescents and adults as to how many meals actually are eaten together as a family. According to a study published in the Journal of the American Dietetic Association, adolescents most frequently reported eating about three or four meals together per week, whereas their parents reported an average of seven meals.6

Parental Influence
While details remain unclear regarding when and how Americans share meals, evidence suggests that parents play a crucial role in their children’s weight status by feeding them healthful foods. Family meals give parents the opportunity to educate their children about good food choices. In addition, parents’ attitudes toward nutrition and healthful meals may play a role in children’s and adolescents’ weight and overall health.7

The frequency of family meals has been shown to have an inverse relationship to overweight and obesity in children and adolescents.8-11 Tracking middle school– and high school–aged children over the course of five years showed that those who ate with their families fewer than three days each week had a higher incidence of obesity, particularly young girls. As the children aged, the connection between family meals and overweight status weakened, suggesting that it’s important for younger children of a more impressionable age to eat with their families.8

Other longitudinal studies have suggested that an increase in the frequency of family dinners decreases the chance of being overweight as a child, becoming overweight as a teenager, or remaining overweight as an adult.9-11 This inverse correlation may result not only from the nutritional quality and control of the food served at home compared with that of restaurants but also from children’s interaction with their parents and their contributions to the children’s nutritional beliefs.

The traditions started during childhood continue into adulthood. People who remember frequent family meals and other meal traditions, regardless of how the family gathered and the types of foods consumed, continue to enjoy and prepare at-home sit-down meals into adulthood.12 During a time of transition, such as moving away from home for the first time to attend college, the routines and traditions established during childhood regarding meals remain relatively consistent.

Gender and age also seem to play a role in how significantly family meals affect children’s health status. In general, girls tend to be more influenced than boys by their parents’ nutritional behaviors at mealtime, with a significant increase in overweight prevalence for girls who reported never eating family dinners together or only a few days per week vs. every day.8,10 Also, the younger the children are when they begin experiencing family mealtimes, the less likely they are to be or to become overweight, with positive results seen in children as early as preschool age.8,11

The most variable results between obesity risk and family meals seem to come from differences in ethnicity, particularly in conjunction with socioeconomic status, perhaps suggesting the role of cultural food choices in weight status, regardless of whether the foods are eaten as a family or independently.13 A study published in the Journal of the Academy of Nutrition and Dietetics noted an increased risk of overweight for Hispanic boys with an increase in the frequency of family meals. This was seen most often in lower income households and with parents of lower education levels, as the nutritional quality of the foods served tended to be poor. Parents in these households reported buying more fast foods to serve as family meals than did parents of other ethnicities.13

Healthful Eating Habits Start Early
Exposure to healthful eating behaviors from an early age allows children to develop a sense of normalcy when it comes to making nutritious food choices. Older children benefit from family mealtime, although perhaps not as much as if they’d been exposed to it at a younger age. Family mealtime provides adolescents with tools to make their own healthful food choices when they eat meals away from home, go to college, or move away.

Family meals allow parents to model healthful attitudes and behaviors toward food and eating, including paying attention to both the quantities and types of foods eaten. When parents eat fresh fruits, vegetables, and whole grains with enthusiasm, children may mirror their parents’ enjoyment and eat these foods with an open mind.

In many instances, the parent who shops for and prepares the food makes the food choices for young children. This provides parents with the opportunity to instill healthful eating habits in children at a young age. In addition, it can set the example for meal routines and encourage socialization when eating together as a family at a set time on a regular basis instead of eating independently or on the run.

Families who eat dinner together are more likely to meet their daily recommended intake of fruits and vegetables.14 In addition, adolescents who ate more family meals showed a significant increase in making healthful food choices when they became young adults.14 This includes an increase in fruit, vegetable, calcium-rich food, and whole grain intake14 along with a decrease in soda intake.15

Family meals play another role in adolescent health. A study published in Pediatrics found that teenagers who ate at least five meals each week with their families were 35% less likely than other teens to engage in disordered eating, such as binging, purging, using diet pills, fasting, and skipping meals.1 The role of family meals in adolescent health may go even beyond the nutritional forum, with an inverse correlation between the frequency of family meals and poor school performance, and participation in high-risk behaviors, such as drug and alcohol use, and smoking.16 In addition, family mealtime gives parents the opportunity to recognize early warning signs of detrimental nutrition patterns, disordered eating, or other high-risk behaviors in their children so they can address the issues early.

Television’s Role
While extracurricular activities and employment schedules, which can’t always be controlled, may influence the feasibility of family mealtime, watching television is one variable that easily can be eliminated. The effects of watching television when eating include the following:

• Reduced frequency in family meals: Some studies have shown that watching television at mealtimes has been associated with a decreased frequency of family meals.6 Research also demonstrates that the perceived benefits of family mealtime may be diminished or canceled out when families eat together in front of the television.

• Diminished opportunity to reinforce healthful eating: Watching television during family mealtime, whether in the kitchen or living room, can eliminate opportunities for parents to talk with their children about the foods they eat.

• Distracted eating: Watching television during mealtime takes away from the attention on the types and quantities of foods consumed, which can lead to absentminded overeating.17 Studies have shown that individuals eat larger meals when they’re distracted while eating.18

• Decreased fruit and vegetable consumption: Not only does watching television detract from opportunities to engage in meaningful conversation and lead to overeating, it also may be related to a decline in the amount of fruits and vegetables served at a meal.19

These data may be influenced in part by the socioeconomic and education status of the families researched. In turn, this raises questions about whether these variables also affect the frequency of family meals, warranting further research. In addition, more research is needed to determine whether watching television causes a decrease in the number of family meals or whether people watch television when eating alone.

Strategies for Increasing Family Mealtime
Researchers trying to find a connection between overweight status and the frequency of family meals have come close to a consensus that there’s an inverse relationship between the two. Some relationships are significantly stronger than others, but certain factors stand out, such as the following20-23:

• Family meals play a role in food choices most significantly during early and middle childhood.

• Parental food choices and food attitudes at mealtimes influence their children’s food behaviors.

• Family mealtime provides opportunities to model healthful food choices and open discussions about good nutrition.

Meal patterns are changing, and with the rate of obesity growing among US youths, RDs must understand the possible factors that can influence these patterns and rates.

RDs can provide the following helpful tips to encourage eating together and make family mealtime easier and more convenient.

In the Kitchen
To help clients plan, prepare, and enjoy family meals, advise them to follow these guidelines21-24:

Keep meals simple. Being a gourmet chef isn’t a requirement to serve a family meal. Foods that are fast to make or that can be prepared ahead of time are smart choices for busy families. Also, using a slow cooker to start a meal in the morning is another option.

Some additional suggestions include prepping veggies as soon as you bring them home from the supermarket so they’re ready to use when needed; researching cookbooks and websites that offer recipes with few ingredients and that can be prepared in fewer than 30 minutes; planning your menu at the beginning of the week so you can avoid time-consuming, last-minute trips to the grocery store; and trying a vegetarian meal during the week. The ingredients may be less expensive to buy and faster to cook than some meats.

Make extra. The time it takes to grill one piece of chicken or steak is the same as cooking several at the same time, so RDs can encourage families to prepare extra to use as leftovers the next night or turn into another meal, such as cutting up chicken breasts and eating them on a salad.

Make freezer-friendly fare. When time allows, make a double batch of a particular food or several individual meals on the same day to freeze and enjoy at another time. Casseroles, lasagnas, and soups generally freeze well and easily can be prepared in large batches for future meals. Frozen vegetables are a quick, healthful option to add to meals and require little preparation.

Get everyone involved. Allowing children to complete age-appropriate tasks not only presents an opportunity to teach them about healthful eating, but it also can provide the encouragement needed to convince picky eaters to try new foods they helped prepare.

At the Dinner Table
Make the conversation light and fun. Family meals should be an opportunity to spend enjoyable time together rather than a chore.22,23

Be realistic. Parents should have realistic expectations about the amount of time spent at the dinner table and shouldn’t force children to sit for excessively long mealtimes, which may result in children dreading family meals.22,23

Turn off the television. Televisions, radios, cell phones, and other electronics can take away from the benefits of family mealtime.22,23

Enjoy weekend meals. Families should emphasize weekend meals together, such as Saturday evening dinner or a Sunday brunch, when schedules are too hectic to allow for family dinners during the week.22,23

Outside the Home
Shop together. Grocery shopping can provide a chance to discuss healthful food choices and involve children and adolescents in meal planning. This activity can be especially helpful for families who can’t eat at least three meals together each week.22,24

Be flexible with mealtimes and locations. Adjust dinnertime around extracurricular activities or bring a picnic dinner to the soccer field so you can eat as a family after a match.22,24

Avoid takeout meals. Although it’s a quick solution, hitting the local fast-food restaurant limits your options for healthful meals. But when it’s necessary to eat takeout, there are strategies to help you make better choices. Some fast-food restaurants post nutritional information next to each menu item to help consumers choose healthful options, while other chains have nutrition facts available on their websites. Look for items that are grilled or broiled rather than fried, and limit the add-ons, such as cheese, bacon, and creamy sauces. You also can supplement a takeout item such as a pizza with healthful sides, including carrot sticks, apple slices, and low-fat milk, to create a well-balanced meal.22,24

Pack meals and snacks together. Children can help their parents pack lunches, snacks, or other meals for the children to eat.22,24

In addition, RDs should encourage parents to make healthful food and meal choices because children are more likely to try foods and enjoy them when they see their parents happily eating them and will make similar food choices independently later in life.

When counseling children who are overweight, parental involvement is key for achieving a reasonable weight and good overall health. RDs should consider not only what foods clients eat but also where they’re eaten. Researchers have developed the Meals in Our Household questionnaire, available through the Academy of Nutrition and Dietetics, which RDs can use to evaluate objective and subjective components of family mealtimes.7 The questionnaire scores the family meal environment by assessing mealtime issues such as children’s behaviors, where the meal is eaten, and parental stress caused by children’s eating habits.

Health care providers may encounter challenges in encouraging families to increase the frequency of mealtimes spent together. For starters, not all family members will have an amicable relationship. During adolescence, teenagers may resist eating with their parents to exercise independence. In these instances, parents should look for other opportunities to promote healthful eating by personally choosing nutritious foods and keeping healthful snacks and meal items available in the house.

Future Research
RDs should remind parents that their own eating behaviors serve as the most important model for their children. In counseling clients, RDs should stress the importance of having family meals together whenever possible and emphasize the current research-based evidence suggesting that family mealtime can benefit children’s health. In doing so, RDs can instruct and motivate clients and their families to make time to choose healthful foods and eat them together.

While much evidence points to the conclusion that regular family meals positively influence children’s and adolescents’ nutrition habits, further research is needed to provide a clearer view of what impact socioeconomic status, education, and ethnicity have on the benefits of family meals. Studies also should examine the impact on nutrition choices of family meals eaten at home vs. those eaten at restaurants (sit-down or fast food).

While parents may more readily recognize other potentially dangerous behaviors when it comes to their children’s health and safety, such as riding a bike without a helmet or taking the wrong dose of medicine, they often overlook their children’s mealtime choices. It’s the RDs obligation to help parents become more aware of and influential over their children’s eating habits.

— Larissa Gedney, MS, RD, LD, is the clinical nutrition manager for acute care inpatients and outpatients at Conway Medical Center in South Carolina and a freelance nutrition writer.

1. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011;127(6):e1565-e1574.

2. Nicklas TA, Morales M, Linares A, et al. Children's meal patterns have changed over a 21-year period: the Bogalusa Heart Study. J Am Diet Assoc. 2004;104(5):753-761.

3. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103(3):317-322.

4. How Americans eat today. CBS News website. http://www.cbsnews.com/2100-500165_162-6086647.html. January 12, 2010. Accessed February 27, 2012.

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12. De Backer CJ. Family meal traditions. Comparing reported childhood food habits to current food habits among university students. Appetite. 2013;69C:64-70.

13. Rollins, BY, Belue RZ, Francis LA. The beneficial effect of family meals on obesity differs by race, sex, and household education: the national survey of children’s health, 2003-2004. J Am Diet Assoc. 2010;110(9):1335-1339.

14. Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood. J Am Diet Assoc. 2007;107(9):1502-1510.

15. Woodruff SJ, Hanning RM. Associations between family dinner frequency and specific food behaviors among grade six, seven, and eight students from Ontario and Nova Scotia. J Adolesc Health. 2009;44(5):431-436.

16. Skeer MR, Ballard EL. Are family meals as good for youth as we think they are? A review of the literature on family meals as they pertain to adolescent risk prevention. J Youth Adolesc. 2013;42(7):943-963.

17. Bellisle F, Dalix AM. Cognitive restraint can be offset by distraction, leading to increased meal intake in women. Am J Clin Nutr. 2001;74(2):197-200.

18. Oldham-Cooper RE, Hardman CA, Nicoll CE, Rogers PJ, Brunstrom JM. Playing a computer game during lunch affects fullness, memory for lunch, and later snack intake. Am J Clin Nutr. 2011;93(2):308-313.

19. Fitzpatrick E, Edmunds LS, Dennison BA. Positive effects of family dinner are undone by television viewing. J Am Diet Assoc. 2007;107(4):666-671.

20. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am. 2001;48(4):893-907.

21. Ansel K. Family meals: small investment, big payoff. Academy of Nutrition and Dietetics website. http://www.eatright.org/kids/article.aspx?id=6442468450. Accessed March 5, 2012.

22. Duyff R. The family table. Academy of Nutrition and Dietetics website. http://www.eatright.org/kids/article.aspx?id=6442460319. Accessed March 4, 2012.

23. Say ‘yes’ to family meals. Iowa State University Extension Nutrition website. Available at: http://www.extension.iastate.edu/publications/pm1842.pdf. October 2009. Accessed March 8, 2012.

24. Allbritton J. Family meal-planning strategies. Weston A. Price Foundation website. http://www.westonaprice.org/childrens-health/family-meal-planning-strategies. February 14, 2008. Accessed March 9, 2012.