Dear DOCTOR Owen:

My daughter eats with the school lunch program and complains that there are not many vegetables to eat. She was told that most of the children would not eat vegetables, so the cafeteria does not prepare them any more. I try to present my family with balanced meals, but it seems that everywhere we go—including restaurants—we can’t find fruits or vegetables.

Vege Mom

Dear “Mom”:

According to comparisons with the Food Guide Pyramid adopted by the American Dietetic Association, the American diet is weighted toward fats and sugars, and falls far short of serving the recommendations for fruits, vegetables, and lean meats. Even the vegetables chosen are mostly starchy and often prepared with fat (e.g., French fries). Foods correlated with the most positive health benefits—dark-green leafy and deep-yellow vegetables, dry beans, peas, and lentils—are consumed much less, at 1.4 servings/day on average. Five servings, minimum, of fruits and vegetables are recommended daily.

A study published in Nutrition Week, Vol. 29, No. 3, 45, revealed that there has been a slight dietary increase of fruit intake since 1970. Much of the fruit intake, according to this study, was in the juice category, which is, of course, concentrated calories (compared to the natural fruit). The study showed that children are exposed less now to natural fruit products than in 1970, while there is a greater variety, more availability, and wider distribution of fruits than ever before. Shipping and preservatives now make fruit transportable around the globe. Most importantly to the obese, sugar consumption in this study was 2.5 times the 12 teaspoons/day recommended as the upper limit for the average diet. The typical American consumes 32 teaspoons of sugar/day, with its primary source in soft drinks (try dissolving 32 teaspoons of sugar in a glass of water!) followed by snack foods.

This Nutrition Week study showed that while the dietary intake of calcium is also deficient, the calcium is not found in vegetables, as recommended, but rather in milk and cheese. Furthermore, the milk is rarely skim or the cheese low fat, which increases the number of calories and dangerous fat.

If a patient says, “I swear I do not eat anything, but have gained all this weight,” the first question I ask is, “How much cola and how much milk do you drink?” The answer is usually, “Oh, I didn’t realize that beverages have calories.” (One 500-pound patient drank 3 gallons of milk a day, but said that he “doesn’t eat anything.”) Due to the affordability of cola in the United States, Pima Indians living in Arizona are fatter than their cousins who live 200 miles away in the Sierra Madres in Mexico. Virtually the whole group that lives in Arizona is developing diabetes while their relatives in Mexico are all thin and do not have diabetes because they eat large amounts of leafy vegetables and do not drink cola.

The environment determines the intake. If there were no fatty foods, no snack food machines, and plenty of fresh fruit and vegetables at your daughter’s school, the students (and faculty) would find a way to eat this kind of food anyway—or else not eat. Period. Either way, in my opinion, everyone is better off because I daresay that making changes in the school food environment would cause another health hazard— student/faculty protest riots!

You, as a parent, control the home, the take-to-school foods, the money for snacks, and other choice-friendly environments. Do you maximize that control? While this is tough to do so in the environments you describe, you must teach your daughter healthy eating habits. It’s scary to think that we may never get back to the “farm days” diet again or that we all may end up drinking perfectly balanced food supplements fed to us via a tube from the “trough.” Heck, we may end up doing away with cafeterias altogether!

Remember: 5—that’s FIVE—cups or servings of fruit and vegetables/day. As Martha Stewart would say, “It’s a good thing.”