The authors respond:

We clearly agree that there are a number of irnpor- tant unresolved issues that relate to the health and nutrition of children. Dr. Walker highlights the par- adox of obesity in children-increasing rates of obesity concomitant with stable or declining energy intake in children. A part of the explanation is the declining level of physical activity in children, as reviewed in our paper.’ Food intake has to be ex- amined in concert with activity levels. To that end, the 1995 report of the Dietary Guidelines Advisory Committee* addresses for the first time the need to balance the food a person eats with physical activ- ity. Energy intake cannot be examined without also looking at physical activity.

The United States Department of Agriculture (USDA) is moving ahead to ensure that meals served in 92000 schools to approximately 25 mil- lion children throughout the United States are con- sistent with the Dietary Guidelines. Dr. Walker questions how children will react to changes in the nutrient content of school meals. Evidence suggests that meals that are healthful, tasty, and attractively served will stimulate increased participation in school lunch.3

While we agree that more research needs to be conducted on ascertaining behaviors of individuals who are habitually well, we have also learned much from health communications research on how to ef- fectively change behaviors! A recent review of the nutrition education literature5 showed that child nu- trition programs that were behaviorally based and that involved self-assessments, decision making, and behavior change strategies were most effective in improving nutrition andor dietary patterns. Of 23 behaviorally-based child nutrition program eval- uations, 18 achieved behavior change directed to- ward a healthier diet. This was in comparison to 8

out of 17 traditional “nutrition education” pro- grams.

What we’ve learned from health communica- tions research is that a new paradigm must be, used in order to effectively change behavior. This is be- ing done in schools throughout the United States under USDA’s Team Nutrition. Team Nutrition of- fers a science-based, multifaceted approach that uses media, in-school curricula, and community ac- tivities to improve the diets of American children.

Finally, we disagree with Dr. Walker that the outlook for changing children’s diets is depressing. On the contrary-as our paper suggests, knowledge of children’s consumption patterns is extensive. Re- search on effective interventions, including the use of social marketing, provides us with models that can be used to improve the health and nutrition of children.

Eileen Kennedy, D.Sc., R.D. Jeanne Goldberg, Ph.D., R.D.

1. Kennedy E, Goldberg J. What are American children eating? Implications for public policy. Nutr Rev

2. Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995. United States Department of Agriculture, Agricultural Re- search Service, Washington, DC.

3. State of Alabama, Department of Education. Let’s do lunch at school promotion, NET Program, 1993, per- sonal communication.

4. Sutton SM, Balch GI, Lefebvre RC. Strategic ques- tions for consumer-based health communications. Public Health Reports 1995, NovembedDecember.

5. Contento IR. The effectiveness of nutrition education and implications for nutrition education policy, pro- grams, and research. J of Nutr Educ 1995, in press.

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