CHILD DEVELOPMENT PERSPECTIVES
Learning to Eat in an Obesogenic Environment:
A Developmental Systems Perspective on
Childhood Obesity
Leann L. Birch and Stephanie L. Anzman
The Pennsylvania State University
ABSTRACT—Currently,
children are developing in an
obesity-promoting, or obesogenic, environment, which has
emerged within the past 3 decades. This rapid change provides a rare opportunity to investigate the phenotypic outcomes that result from the expression of human genetic
predispositions in a new environment. Unfortunately, the
environmental changes that have occurred are associated
with epidemic obesity rates in all age groups. Using a
developmental perspective, this article argues that this
probabilistic outcome is not predetermined, however. The
article also provides examples of learning paradigms—familiarization and associative and observational
learning—that present opportunities for parents and caregivers to restructure children’s environments in early life,
increasing the likelihood of healthy weight-status outcomes
in the context of the current obesogenic environment.
KEYWORDS—childhood obesity; obesogenic environment;
learning; early experience; food preferences; eating behaviors; developmental systems theories
Obesity in the United States has increased dramatically since
1980, doubling among adults and tripling among children
(Ogden et al., 2006). Young children are included in this
The authors thank Mastaneh Sharafi and Brandi Rollins for their
assistance in preparing this manuscript.
Submitted for publication January 19, 2009; revision received
March 18, 2009; accepted March 29, 2009.
Correspondence concerning this article should be addressed to
Leann L. Birch, The Center for Childhood Obesity Research, The
Pennsylvania State University, 129 Noll Laboratory, University
Park, PA 16802; e-mail: [email protected].
ª 2010, Copyright the Author(s)
Journal Compilation ª 2010, Society for Research in Child Development
population, with nearly 25% of 2- to 5-year-olds being overweight (Ogden et al., 2006). Childhood obesity has also reached
epidemic proportions worldwide, in developed and developing
countries (Lobstein, Baur, & Uauy, 2004). The psychosocial and
metabolic comorbidities of childhood obesity begin early, persist
into adulthood, and include Type 2 diabetes, hypertension, cardiovascular disease, disordered eating, and social stigmatization
(American Academy of Pediatrics [AAP], 2003). Current U.S.
health-care costs associated with obesity are estimated at $250
billion per year (Finkelstein, Ruhm, & Kosa, 2005). Given the
scope of the problem, preventing childhood obesity has become
a priority (Institute of Medicine, 2005). Most prevention efforts
have had limited success, focusing almost exclusively on promoting healthy eating and increasing physical activity among
school-age children and adolescents (Institute of Medicine,
2007). We argue that waiting until children are school-age
misses the best opportunities for prevention. Our argument is
focused on the development of children’s food preferences and
eating behavior, although we acknowledge the importance of
physical activity. Using a developmental systems perspective, we
describe how early eating experiences shape behavioral phenotypes and suggest alternative approaches for early obesity
prevention.
Developmental systems theories (DSTs) posit that phenotypic
outcomes are probabilistic; co-actions at multiple levels (e.g.,
genetic, cellular, physiological, psychological, social, cultural)
determine outcomes. Individual trajectories can be altered if any
levels of the developing system change enough to trigger a systemic reorganization (Gottlieb, 2002, 2007). Because species
tend to stay in broadly stable environments, development can
appear to be predetermined. However, experimental evidence,
much of which comes from animal models (Harshaw, 2008),
demonstrates that a range of seemingly predictable phenotypes
(such as species-specific bird calls) can be altered if the speciestypical environment changes. The change from environments
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Learning to Eat
of scarcity to the obesogenic environment in many societies
worldwide provides a rare opportunity to study the effects of
dramatic environmental change on human development. For the
majority of human history, genetic predispositions to prefer or
reject basic tastes and to learn about food and eating evolved
and were expressed in environments characterized by food
scarcity. In recent years, the food environment has changed
markedly in much of the world. The current Western diet is
characterized not by food scarcity but by the availability of too
much inexpensive, palatable, high-calorie food (Nestle, 2002;
Pollan, 2008). During this period of rapid environmental change,
we have also seen the emergence of the obesity epidemic, congruent with the developmental systems perspective’s prediction
that phenotypic outcomes will be altered by changes in the
species-typical environment (Harshaw, 2008).
Although these co-occurring changes show that obesity is a
more probable outcome in current obesogenic environments than
in the environments that historically preceded them, DSTs also
tell us that in any environment, individual level outcomes are
not predetermined by any one level of the developing system.
Development is plastic, and as noted, even in the case of probabilistic outcomes in a given environment, individuals’ developmental trajectories may be shifted toward more adaptive
outcomes if a change in one or more levels of the developing system is sufficient to trigger systemic reorganization (Gottlieb,
2002, 2007). Understanding how children’s genetic predispositions affect developing patterns of food preference and intake
may reveal opportunities for early obesity prevention, even in
‘‘obesogenic’’ environments. Although changes in the political
and economic conditions that have created an obesogenic environment are essential to reversing population trends in obesity
(Brownell & Horgen, 2004), the time scale for macroenvironmental change will require decades. Clearly, the obesity epidemic
needs to be addressed now.
Early interventions to prevent obesity show particular promise,
given evidence that alterations in early dietary experience affect
developing neural, metabolic, behavioral, and psychosocial systems, resulting in metabolic and behavioral programming
(Harshaw, 2008; Levin, 2006; Waterland, 2006). Research
shows that prenatal factors, such as maternal obesity and maternal diet, ‘‘program’’ postnatal neural and metabolic systems that
affect eating behavior and obesity risk (Levin, 2006; Lucas,
Fewtrell, & Cole, 1999). Additionally, there is experimental
evidence that mothers’ diets during pregnancy influence their
children’s food preferences later in life (Mennella, Jagnow, &
Beauchamp, 2001). Another important developmental period is
the transition from the exclusive milk diet of infancy to an
omnivorous diet that includes a variety of foods. This transition
is rapid and dramatic: Milk provides more than 80% of an
American 4-month-old’s total daily calories, but by 18 months of
age, 80% of the child’s total calories comes from ‘‘table foods’’
(Fox, Reidy, Novak, & Ziegler, 2006). DSTs propose that periods
of rapid transition or instability, like the prenatal period and the
139
postnatal dietary transition just described, are ideal points in
development for systemic reorganization. Thus, we argue that
these are optimal times for preventive interventions and for early
learning about food.
CONTEXTUAL INFLUENCES ON CHILD FEEDING
A focus on early feeding must consider the various contexts that
influence the food environments of infants and young children.
Most U.S. families have one or two overweight parents, dramatically increasing children’s obesity risk (Whitaker, Wright, Pepe,
Seidel, & Dietz, 1997). This increased risk is related to both
genetic and environmental factors (i.e., main effects of genetics
and environments, and gene–environment interactions and correlations). In early childhood, parents shape children’s eating patterns by determining which foods are available in what amounts,
as well as the timing and frequency of feeding. Parents also
make choices about whether to breastfeed or use formula and
when to introduce solid foods. In addition, they serve as models
for children’s eating. Child-feeding practices are also affected by
child characteristics and by perceived environmental threats to
healthy development (LeVine, 1988). Traditional child-feeding
practices evolved across human history in response to food scarcity. Chief among them was intake beyond satiation. However, in
the current obesogenic environment, this practice can be maladaptive, promoting overeating and overweight and creating a
major threat to children’s health.
Feeding practices are influenced by additional macroenvironmental features, such as the cost and availability of food
and cultural customs. Likely as a result of complex combinations of these and other influences, certain demographic
groups are at higher risk of obesity, including African Americans, Hispanics, and Native Americans, and families with
obese parents and lower levels of income and education. Paradoxically, these groups have the greatest need for early preventive interventions but also experience barriers to their
effectiveness, as children in these groups tend to have less
exposure to healthy lifestyles and thus fewer opportunities to
practice what they may learn via an intervention. Future
research must therefore investigate ways to address these barriers in order to facilitate use of the learning paradigms
presented herein. Although most of the research we review is
from U.S. populations, globalization has resulted in the Westernization of many countries’ food supplies and dietary
patterns, with accompanying increases in obesity. Thus, this
research could be applied in many contexts, with culturally
appropriate alterations to feeding interactions.
EARLY EXPERIENCE: LEARNING ABOUT FOOD
AND EATING
The child brings a set of predispositions to early feeding interactions—a preference for sweet and salty tastes, a tendency to
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Leann L. Birch and Stephanie L. Anzman
reject bitter and sour tastes, and a neophobic rejection of novel
foods and flavors. In addition, during prenatal and postnatal
development, infants are biologically prepared to learn to eat
what is available in the environment (Rozin & Vollmecke, 1986)
and to learn food and flavor preferences, initially through familiarization, and later through familiarization and associative and
observational learning (Birch, 1999). The current Western diet is
obesogenic because it is attuned to these predispositions: Foods
and beverages high in sugar and foods with added salt are readily available. Because children learn to prefer and eat what is
available, accessible, and being eaten by others, it is not surprising that children’s diets are too high in added sugars, fat, and
salt, although their consumption of complex carbohydrates,
fruits, and vegetables is well below recommended levels (Kranz,
Findeis, & Shrestha, 2008). Whether or not children learn to like
and eat their vegetables will depend on the prenatal and postnatal food environments that caregivers create for the expression of
children’s predispositions.
THREE LEARNING PARADIGMS THAT INFLUENCE
CHILDREN’S EATING
Familiarization Learning
Rheingold (1985) described development in terms of becoming
familiar with the world. In familiarization learning, the evaluation of a stimulus increases following an individual’s repeated
exposure to it. Aspects of the environment are reflected in phenotypic outcomes, as individuals come to prefer and select those
foods that they have repeatedly experienced in their environment. Initially, all foods are unfamiliar, but infants can distinguish among flavors at birth (Mennella & Beauchamp, 1996;
Mennella, Nicklaus, Jagolino, & Yourshaw, 2008) and develop
flavor preferences quickly. Familiarization learning begins during the prenatal period, when flavors from the maternal diet are
present in mothers’ amniotic fluid, and continues postnatally,
when these flavors are present in breast milk. Such learning was
demonstrated in a study in which infants whose mothers drank
carrot juice during either pregnancy or lactation showed greater
acceptance of carrot-flavored cereal compared with infants who
did not experience either type of familiarization (Mennella et al.,
2001). Thus, one potential advantage of breastfeeding is early
familiarization with a variety of flavors from the maternal diet
(Forestell & Mennella, 2007). Additionally, repeated exposure to
a variety of solid foods in infancy enhances the acceptance of
fruits and vegetables in childhood (Mennella et al., 2008), and
familiarization generalizes to other, similar foods in early life
(Birch, Gunder, Grimm-Thomas, & Laing, 1998; Pepino &
Mennella, 2005).
Repeated exposure continues to affect acceptance and preference for flavors in childhood. When 2-year-old children were
exposed to novel fruits and cheeses, preference increased with
increased exposure (Birch & Marlin, 1982). Preschoolers who
were repeatedly fed tofu prepared one of three ways (sweet,
salty, or plain) learned to prefer the familiar version over others
(Sullivan & Birch, 1990). Furthermore, repeated exposure to a
novel vegetable (red bell pepper) increased school-age children’s consumption, whereas rewarding children for consuming
the food did not (Wardle, Herrera, Cooke, & Gibson, 2003).
Birch, McPhee, Shoba, Pirok, and Steinberg (1987) also showed
that increased preference was contingent on repeated experience with the taste of the food; looking at novel fruits did not
affect preference. Familiarization may occur more quickly as
additional foods are added to a child’s repertoire and neophobia
decreases with further development (Williams, Paul, Pizzo, &
Riegel, 2008). Consistent with broader developmental theories
related to familiarization learning (Rheingold, 1985) and with
the epigenetic framework, individuals learn to like what
becomes familiar, highlighting the critical role of food availability. If children have frequent experience with healthy foods in
early life, it is possible to promote acceptance of healthier
choices, even amidst an abundance of energy-dense foods,
changing individual ontogeny toward healthier eating and
weight outcomes.
Associative Learning
In associative learning, an initially neutral stimulus (conditioned
stimulus [CS]) begins to elicit responses after repeated pairings
with a meaningful stimulus (unconditioned stimulus [UCS]). For
example, if a novel food (CS) is followed temporally by nausea
and vomiting (UCS), the negative valence of the sickness
becomes paired with the novel, previously neutral food, even if
the food did not cause the sickness (e.g., Garcia, Kimeldorf,
& Koelling, 1955). The food then serves as a cue for the consequences of its ingestion and is subsequently avoided. In a similar
fashion, associative learning can also shape children’s food preferences.
Conditioned preferences are more common than conditioned
aversions and require more CS–UCS pairings. When this type
of learning occurs, food cues come to predict the positive
postingestive consequences of satiety that result from the
ingestion of needed nutrients (Sclafani, 1999, 2001). Most evidence of this was obtained in research with rats (Myers, Ferris,
& Sclafani, 2005; Sclafani, 1999, 2001), but young children
also learn to prefer foods paired with positive postingestive
consequences. When 3- and 4-year-old children had repeated
exposure to high- and low-calorie versions of two novel drinks
paired with different flavors, their preference increased for the
drink flavor paired with the high-calorie version but not for
the flavor paired with the low-calorie version (Birch, McPhee,
Steinberg, & Sullivan, 1990; Johnson, McPhee, & Birch, 1991;
Kern, McPhee, Fisher, Johnson, & Birch, 1993). As noted,
learned preferences for energy-dense foods would be adaptive
in environments where food is scarce and insufficient energy
intake threatens children’s health, but in an obesogenic environment, such preferences can be maladaptive by promoting
excessive intake.
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Children also learn food preferences by associating foods with
the social contexts in which they are eaten. Depending on the
emotional valence of the context, foods eaten may become more
or less preferred. When children were pressured to eat a food
(e.g., ‘‘Finish your soup’’) or were offered rewards for eating
a food (e.g., ‘‘If you finish your peas, you can watch TV’’), preference and intake of the food decreased (Birch, Birch, Marlin,
& Kramer, 1982; Galloway, Fiorito, Francis, & Birch, 2006).
Evidence suggests that the use of coercion to promote children’s
intake of healthy foods is particularly likely to be counterproductive, producing dislikes. In one retrospective study, young adults
reported that the foods they had been coerced to eat as young
children were the ones they came to dislike the most (Batsell,
Brown, Ansfield, & Paschall, 2002).
In contrast, positive social contexts can promote the development of food preferences. In one study, for example, providing
food rewards paired with praise and positive attention increased
preschool children’s preferences for the foods (initially neutral
sweet and nonsweet snacks) used as rewards (Birch, Zimmerman,
& Hind, 1980). Positive social contexts can also lead to counterproductive associative learning, however. For example, cultural
traditions often dictate the serving of special, highly palatable
foods at celebrations. In the United States, this means that cake
and ice cream, not peas and carrots, are traditional fare at
birthday parties. Such learned associations may also potentiate
liking for palatable, energy-dense foods that should be consumed
in moderation.
Observational Learning
Because children usually eat in social contexts, there are many
opportunities for children to be influenced by the eating behaviors of others. Observational learning may have positive or negative effects, depending on what models are eating. If adult and
peer models are consuming fast foods and sweetened beverages
rather than healthier options, they are promoting children’s
intake of those foods, with negative effects on diet quality. For
example, in one study, French fries, the most frequently consumed vegetable among adults (Block, 2004), were also the most
frequently consumed vegetable among 15-month-olds (Fox, Pac,
Devaney, & Jankowski, 2004). Models can also have positive
effects: For example, a comparative study of mother–daughter
beverage choices found that daughters whose mothers drank
more milk drank more milk themselves, were more likely to meet
dietary recommendations for dairy-related nutrients, and had
higher bone density (Fisher, Mitchell, Smiciklas-Wright,
Mannino, & Birch, 2004). Adult models can also be effective at
increasing children’s willingness to try novel foods (Addessi,
Galloway, Visalberghi, & Birch, 2005; Harper & Sanders, 1975;
Hendy & Raudenbush, 2000; Highberger & Carothers, 1977).
Peers are also effective models (Dunker, 1938; Hendy, 2002;
Marinho, 1942); indeed, they can be more effective than adults
(Hendy, 2002), as suggested by the social cognitive view that
children are most likely to change their behaviors when observ-
141
ing models similar to themselves (Bandura, 1986). In quasiexperimental research, Birch (1980) demonstrated that peer
models were effective at altering preschoolers’ vegetable preferences and intake at lunch. After 4 days of observing the peer
models choosing and eating vegetables that the observers disliked, observers’ preference for, and intake of, those vegetables
increased significantly.
Although the use of multiple learning modalities might be
particularly effective in changing children’s food preferences,
little research has tested this hypothesis. In a rare multimodal
study, Jansen and Tenney (2001) examined how children’s
preference for a sweetened drink was affected by pairing flavornutrient conditioning with teacher attention and parental modeling.
Preference increased only when flavor-nutrient conditioning,
teacher attention, and parental modeling were used in combination. Food marketing to children, which employs all three
learning modes, provides a powerful demonstration of the potential impact of early learning and experience on children’s food
preferences and intake patterns. Children spend 3–5 hr per day
watching television, exposing themselves to more than 40,000
television commercials annually, the majority of which feature
confectionary, presweetened cereals, and snacks (Vandewater,
2008). Children are repeatedly exposed to the same advertisements (familiarization), in which they witness foods paired with
positive social settings and music (associative conditioning) and
enjoyed by exuberant and attractive peer models (observational
learning). Television advertisements are successful in changing
children’s food preferences, requests, and consumption (see
McGinnis, Gootman, & Kraak, 2006). Because 90% of food
commercials advertise foods high in fat, sugar, and sodium and
low in other nutrients (Batada, Seitz, Wootan, & Story, 2008),
these findings are particularly problematic with respect to promoting healthier diets to prevent obesity. It is clear that these
three learning paradigms could easily lead to preferences for
unhealthy foods in the current environment. However, these
learning paradigms could also present the potential to shift
developmental trajectories, pending conscious efforts to shape
children’s environments, so that healthy preferences may be
learned when many foods are still unfamiliar.
CONCLUSIONS
The centrality of early learning and experience in the acquisition
of food preferences and eating behaviors points to the pivotal role
of children’s eating environments in shaping children’s obesity
risk. Research is needed to identify key environmental features
that affect early obesity risk by persistently influencing children’s early learning and experience with food and eating.
Increasing the availability and accessibility of healthy nutrientdense foods early in life is one promising avenue to altering phenotypic outcomes by means of the learning paradigms reviewed
herein. The emergence of new phenotypes is particularly likely
during developmental transitions, including the prenatal period
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Leann L. Birch and Stephanie L. Anzman
and the rapid and dramatic dietary transition that occurs in
infancy and early childhood. The potential plasticity of food preferences and intake patterns during the first years of life provides
relatively unexplored opportunities for influencing development
during a transition when phenotypic patterns of preferences and
intake can be ‘‘built into our bodies’’ (Hougan, 2008; Shonkoff &
Phillips, 2000), affecting subsequent neural, behavioral, and
metabolic outcomes, and potentially leading to overall systemic
reorganization as developing children continue to choose and
consume healthier food options within an overall obesogenic
context.
Systemic reorganization toward healthier phenotypic outcomes
can be facilitated by targeting multiple levels of the developing
system simultaneously. Parents’ decisions about what to feed
their children are affected by food marketing, availability, cultural traditions and preferences, and the relatively higher costs of
fruits and vegetables compared with those of energy-dense foods
(Caprio et al., 2008), all of which are potential macrolevel barriers to parents’ exposing their children to healthy foods early in
life. Likely as a result of complex combinations of these and other
influences, certain demographic groups are at higher risk for
obesity, including African Americans, Hispanics, and Native
Americans, as well as families with obese parents and lower levels of income and education. These groups seem particularly
likely to not only experience the various barriers just described
but also to lack opportunities for the modeling necessary to promote the early liking of healthy foods. Additional research is
needed to explore ways to influence these barriers and to promote
healthy developmental trajectories by altering factors that, in the
present obesogenic environment, predict obesity risk. Effective
early preventive interventions are urgently needed to address the
obesity epidemic among all segments of the population, but especially among groups at highest risk of childhood obesity.
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