The power of a family meal

{***Pause/Music***}
{***Noah***}

Coming up on Harvard Chan: This Week in Health…The power of a family meal.

{***Kathryn Walton Soundbite***}
(It’s really a time for family members to kind of slow down. I think in our busy lives it’s hard to find that time. So, if we’re able to just take some time out of our day, sit down with others, and connect, I think that can be really, really valuable.)

A growing body of evidence shows that when families sit down for meals together, children and adolescents eat healthier.

In this week’s podcast, we’ll explore new research on the impact of these meals—and ways to make it easier for families to dine together.

{***Pause/Music***}
{***Noah***}

Hello and welcome to Harvard Chan: This Week in Health, I’m Noah Leavitt.

For busy families, gathering together for a meal—whether it’s breakfast or dinner—can be difficult. But a growing body of research shows that these meals together can have an important influence on the quality of food that children and teens eat.

There’s been less research on effective ways to encourage families to eat together more often.

In this week’s episode we’re speaking with the author of a new study that could help public health professionals target interventions at busy families.

Kathryn Walton, is a research fellow at the Hospital for Sick Children in Toronto and a PhD student at the University of Guelph in Toronto. One of the co-authors of this study is Bryn Austin, who is a professor in the Department of Social and Behavioral Sciences here at the Harvard Chan School.

The researchers found that when families sit down together for dinner, adolescents and young adults eat more fruits and veggies and consume fewer fast-food and takeout items.

What’s unique about this study is that Walton and her colleagues looked at the families participating in the meal—assessing how they communicated, managed schedules, and even bonded with children—something called family functioning.

And they found that the benefits of family meals were seen regardless of how well—or poorly—a family functioned.
I spoke to Walton about the findings of her study—and how they could inform future initiatives to encourage families to eat together.

I began our conversation by asking her to explain what existing research has shown about the benefits of family meals.

{***Kathryn Walton Interview***}

KATHRYN WALTON: We know that family meals have many, many benefits for both children and adolescents. When we think about dietary intake we see higher intakes of fruits and vegetables, lower intakes of sugar sweetened beverages like sodas, less takeout, less fast food. But we also see higher well-being. We see lower rates of depression, substance abuse, and disordered eating.

So the benefits of family meals are very broad, but what my team was interested in was that perhaps these benefits only exist for certain families. And so it may not be the best message to be promoting family meals broadly for everybody when perhaps the benefits may look different for different families. So that’s kind of what brought us to this research, because nobody had really looked at the general family that actually participates in the family meal. So what do those interactions look like for different families when they sit down together?

So that’s really what inspired this research, is to understand, do high and low functioning families benefit the same way?

NOAH LEAVITT: And so you mentioned there that you were looking at something called family functioning. So can you explain a little bit about what that is, and then how you go about measuring that?

KATHRYN WALTON: Yeah, for sure. So family functioning is a measure of how well families problem solve, communicate, and connect emotionally. And so if we think about family meals, these are really important aspects of the meal. You’re sitting down with other people, there is going to be communication that goes on, but even in the planning of the meal itself. And so we sort of thought that perhaps for some families that experience lower levels of functioning, that they might have more difficulties planning the meal, making it happen, or perhaps the modeling that parents do during meal time, so modeling the foods they eat, modeling healthful food behaviors.

If parents and children don’t have a strong bond, perhaps that modeling isn’t as beneficial or as effective as families who have a stronger emotional bond. So that’s a little bit about that. So for example, one of the questions is when we make plans, we’re able to make things happen. And then another question is members in our family are accepted for who they are. So it’s fairly broad in terms of thinking about functioning.

NOAH LEAVITT: So as I was reading about that and hearing you talk about that, I would be interested to know, are there are any correlations between family functioning and other socioeconomic factors? Like are high functioning families likely to be higher income? Or low functioning families are likely be lower income? Do we know anything there about the factors that maybe drive higher levels of family functioning?

KATHRYN WALTON: For sure. So from our data, we don’t see that, because all of the participants were children of nurses from the Nurses’ Health Study. So in our study, everybody came from families with fairly similar income levels. So we do see at the same income level families from high end low functioning. Certainly there are correlates that can influence functioning, but across the board we do see families at all ends of the spectrum of socioeconomic status with both high and low functioning. So I wouldn’t say that income is a proxy for family functioning or anything like that.

NOAH LEAVITT: Mhm. Mhm. And then so in terms of would you actually found with the study, and as you kind of indicated you’re looking to see whether the benefits of these family meals hold up regardless of family functioning. So what did you find in terms of high functioning families, versus low functioning families, and the impact of these family meals on the nutrition of youth and adolescents?

KATHRYN WALTON: So we found that as you mentioned, above and beyond family functioning, that family meals do matter. So we first looked at does the association look different between high and low functioning families? So we looked at effect modification. And we found that the effect of family meals on youth dietary intake really looked very, very similar. There were no significant differences between those from high and low functioning families.

So then we thought, OK, let’s adjust for family functioning in our models. And again, we didn’t see any change in our associations when we adjusted for family functioning. So really it didn’t change our story. And so we see that for adolescents and young adults in both high and low functioning families, when we think about dietary intake, sitting down together really does make an impact.

NOAH LEAVITT: And so I know you looked at a few things, for example, vegetable consumption, sugar sweetened beverage consumption. Where did you see the family meals having the most impact? Was it increased vegetable consumption, decreased sugar sweetened beverages consumption, where was the most impact seen?

KATHRYN WALTON: Yeah, that’s a great question. And I think the fruit and vegetable intake was a big one. And that’s mostly because we typically see the amounts of fruits and vegetables eaten among this population really decline. And I think the other interesting thing is that we did look at fruit without juice servings. So we’re looking at whole fruits and vegetables, which is an important point. Because a lot of studies combine juice in that when we think about sugar intakes and that type of thing.

So it was the fruits and vegetables that we did see the most impact on, which is great. Amongst the youth in our study, we actually didn’t see a lot of sugar sweetened beverage select soda consumption, fast food or take out. So our effect sizes were fairly small there, but we did see some decline.

NOAH LEAVITT: And one of the other things I noticed is that there were some differences in terms of male and female participants in terms of kind of their dietary intake. So what were some of those differences, and do you have a sense of what might have driven those differences?

KATHRYN WALTON: Yeah. So I guess the biggest difference was that for male participants, frequent family dinners were significantly associated with fewer sugar sweetened beverages– so again, those sodas– but not for females. But again, the association actually looks fairly similar. It could be that they’re just consuming– we do see that males tend to drink more of those beverages than females. So that could be driving that association.

And we do see slightly higher rates of family meal participation among the females. So that could also be driving that a little bit as well.

NOAH LEAVITT: I thought it was interesting. There was a quote from one of your colleagues, Jess Haynes, who was talking about family meals don’t need to be complicated. It can be pulling something out of the freezer, putting a bag salad in a bowl, keeping it simple. So I think given that, what do you think it is about family meals that make them so influential in terms of improving dietary intake for kids in a family?

KATHRYN WALTON: It’s really a time for family members to kind of slow down. I think in our busy lives it’s hard to find that time. So if we’re able to just take some time out of our day, sit down with others, and connect, I think that can be really, really valuable. Putting down the screens, turning off the TV, and just sitting down face to face with others can be really beneficial.

And I think that we do need to remember that it doesn’t have to be a big full blown– I know American Thanksgiving just happened– it doesn’t have to be a Thanksgiving style meal every night. That’s just too much. And I think when we sort of let go of those expectations, and know that just sitting down together in itself makes a difference, I think that can help families.

Make what’s easy. Pull stuff out of the freezer as Jess said. Throw a bag salad on. Whether it comes from a bag or you chop it up yourself, you’re getting the same nutritional benefits.

NOAH LEAVITT: So I think one of the interesting points you make in the paper is that even though there is this kind of growing evidence of the benefits of family meals, there haven’t been many interventions designed to promote more family meals. So I guess given this growing body of evidence, what might an intervention look like aimed at getting families to sit down together and eat more often?

KATHRYN WALTON: Yeah, that’s a great question. And I think it is an interesting point that we have all this great research showing the benefits, but we really haven’t done a good job of helping families out. We just keep saying it’s great, it’s great, it’s great. But how do we actually sit down and make that time? So I think the big thing for interventions is that time piece, that families are very, very busy, and to sit down for even 20-30 minutes can be a challenge.

And so one of the things I like to think about is how do we make it easier to happen, and that I think includes getting the youth in the family involved, so that it’s not just one person night after night preparing everything while others sit and watch TV or whatever. So many hands do make light work. So if we can get the adolescents helping prepare the meal, not only does it get on the table faster, but it also helps teach really important food skills that will serve those adolescents into their adult years.

And we do with the family meal research, interestingly, see intergenerational associations. So youth that sit down for frequent family meals during their adolescence do so with their own children when they become parents. So it does have intergenerational implications.

NOAH LEAVITT: Is this something, I guess, where you could see potentially schools getting involved, I don’t know, doctors, hospitals, to kind of– because as you said, if making it start more with teenagers, if there are opportunities there to kind of provide more nutrition, kind of cooking training to teenagers, so when they go home they’re able to kind of jump in the kitchen and help out their families?

KATHRYN WALTON: Oh, for sure. I think that in the schools we could see more home economics type courses, nutrition courses to teach those really valuable food skills. We overall in North America have seen a decline in food skills. And so when we think about preparing healthful meals, that’s an important piece.

But thinking even more broadly, as a society we don’t make it easy, either. Like if we think about we want our kids to be physically active, which is great, and of course has many, many benefits for long term health. But extracurriculars are always during dinnertime. So it’s sort of which one do you do you pick? Do you sit down together, or do you put your child in the activity, and then you’re running through the drive-through? Right?

So it’s hard to make it all happen. And so I think as a society, thinking through the timing of when– it’s a bigger issue. But it’s something that our environment really doesn’t support.

NOAH LEAVITT: And I imagine that that time crunch is probably even harder for– if you’re a family where both the mother and father work, or maybe one of the parents is working two jobs. Is that, I guess, kind of a next step here? Like how do you find time for those family meals when people are maybe working multiple jobs just to make ends meet?

KATHRYN WALTON: Oh for sure. And I think that’s a really important piece, and something that’s a reality for many, many families. And I think a big point to that is to really highlight the research that shows that it doesn’t have to be dinner time. So in our study, we did measure family dinners, so the evening meal. But the research looking at other meals during the day show that the benefits from sitting down together any time of day still hold. So breakfast counts. If both parents are working in the evenings, and you can get even 15 minutes to sit down and check in before the start of the day with your children at breakfast time, that’s great.

And I think the other thing is that we need to be not so hard on ourselves. It’s very difficult, I think, for families to sit down together seven nights a week. A lot of the research does look at five meals a week for showing many benefits, but we do see that every meal counts. So even if you can sit down together one night a week, and as it gets easier, and as family members’ schedules change and make it, perhaps, easier to sit down more often, add more meals in.

But start where families are. I think we see it as an all or nothing thing, and the research doesn’t support that. Each meal you sit down together, the more benefits you get.

NOAH LEAVITT: You mentioned a few minutes ago this idea that the meals don’t have to be complicated. It can be a bag salad, it can be something frozen, it can be something simple. Kind of going back to that question about maybe like lower income families, or people working two jobs, what’s the role of– in the US we have Snap as a safety net nutritional program. Is there a role there for these kind of nutritional safety net programs to take any steps there that they can provide foods that are more conducive to a family quickly getting together for 30 minutes on a weeknight, or even a quick breakfast before school during the week?

KATHRYN WALTON: Yeah, for sure. I think it’s really a sort of broader public health question of how do we support families in making it easier? I do think that having for sure access to healthful foods does make the foods that you’re serving during the meals more beneficial. But when we think about family meals, just sitting down together is great. So whether you’re serving a pizza, or you’re serving some sort of gourmet salad, your children will reap many benefits from sitting down together.

So I think getting families to sit down together first, and then second, if we can start to add a salad in, make the side yourselves, slowly add some more homemade food in there as it allows, I think that that’s good. But just sitting down together is great too.

NOAH LEAVITT: Right. The idea of carve out the time first to get everyone to the table. And then from there you can think more critically about where you’re serving.

KATHRYN WALTON: I argue that the research really does support that that bonding time is really beneficial. And we do see research showing that for families with lower levels of functioning, so families that find it challenging to communicate, and may not have a strong emotional bond with each other, sitting down together or preparing a meal together can really help with that functioning and that communication. Because at very most, when you’re sitting down together you do have to ask for the ketchup to be passed. But preparing a meal together gives everyone a role in the family, as well, and can help with that bonding. So we do see that the more you sit down together, the higher your functioning can be.

NOAH LEAVITT: That was actually going to be something I was going to ask, was can these family dinners in some sense improve the functioning of these lower functioning families? Because it seems to be getting a lot of the things that they may struggle with, such as communication, or managing schedules, or those kinds of things.

KATHRYN WALTON: And I do think that it is important to note in the findings of our study that we see both high and low functioning families sitting down together frequently. So when we think about interventions, it’s not just low functioning families that we need to target there. We have lots of adolescents and young adults in our study that reported high levels of family functioning, but that they weren’t sitting down together. So I think we need to sort of look at why families sit down together in the first place, and target the interventions to the individual families.

NOAH LEAVITT: And so that leads well into my last question. I always like to ask people, what would the next steps be? So from your perspective, is it really making maybe digging more in, doing a larger, longer study to get at those factors that are driving why people might sit down for meals together, or why they just aren’t finding the time to do that?

KATHRYN WALTON: Yeah, for sure. I think that we have a really good body of research looking at the barriers for family meals. So we know that. We know why it’s hard to sit down for family meals– time, feeding picky eaters, that type of thing. But we really need to know despite these barriers, why are the families that are sitting down together doing that, and why are the families that aren’t, beyond other barriers, why aren’t they sitting down together? I think that’s an important piece to creating some interventions.

But then we really just need to dive in and start trying to support families, so testing interventions. What works, what doesn’t? And really partnering with families that we’re trying to support to make those interventions tailored, because I think every family experiences their own barriers. So whether we have a toolbox of items, whether we have healthful recipes, and we have items to help with conversation for families that are a bit nervous sitting down together for the first time, or whether we have tips on how to get the meal on the table faster, and then families can choose what benefits them most. Those are just some ideas, but really I think those are the next steps. We need to really understand why families do and don’t, beyond just time, and feeding picky eaters, and that type of thing.

{***Pause/Music***}

That was my conversation with Kathryn Walton about her research on family meals. If you want to read the full paper, we’ll have a link on our website, hsph.me/thisweekinhealth.

That’s all for this week’s episode. A reminder that you can always find us on iTunes, Soundcloud, Spotify, and Stitcher.