Pizza: Good, Bad or Just Right for Your Child?

From the Show: Healthy Children
Summary: Most kids love pizza, but should it be part of their diet?
Air Date: 1/21/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Lisa Powell, PhD
Powell-Lisa Head ShotLisa Powell, Ph.D. is a Professor in the Division Health Policy and Administration in the School of Public Health, the Director of the Illinois Prevention Research Center, and the Associate Director of the Health Policy Center in the Institute for Health Research at the University of Illinois at Chicago. Dr. Powell has extensive experience as an applied micro-economist in the empirical analysis of the effects of public policy on a series of behavioral outcomes. Much of her current research is on assessing the importance of economic and environmental factors (such as food prices, sugar-sweetened beverage [SSB] and soda taxes; access to food stores, fast-food restaurants, other eating places, and facilities for physical activity; and television food advertising exposure) on food consumption and physical activity behaviors and as determinants of body mass index and the prevalence of obesity, including related disparities. Her work has contributed to the policy debates on SSB taxes and child-directed marketing in the U.S. Dr. Powell’s research has been funded by the National Institutes of Health, the Centers for Disease Control and Prevention, the U.S. Department of Agriculture, and the Robert Wood Johnson Foundation. Dr. Powell is the recipient of the 2013 University of Illinois at Chicago Researcher of the Year Award in the Social Sciences.
Pizza: Good, Bad or Just Right for Your Child?
Kids love pizza and seem to eat a lot of it.

But, pizza contributes to more calories, saturated fat and sodium in children’s and teens’ diets.

Since dietary counseling is more effective if focused on specific foods, rather than overall nutrients, and pizza plays a prominent role in children’s overall diet, it's suggested that pizza be directly addressed in nutrition counseling.

Lisa Powell, PhD, is here to discuss how pizza can still be a part of your child's diet.

RadioMD Presents:Healthy Children | Original Air Date: Wednesday, January 21, 2015
Host: Melanie Cole, MS
Guest: Lisa Powell, PhD

Melanie: Pizza. Kids love it. Adults love it. It contributes to a higher calorie, saturated fat, and sodium intake in children’s and teen’s diets. It’s the second largest contributor to caloric and nutrient intake in children’s diets and its impact on maintaining healthy weight is very important. My guest today is Dr. Lisa Powell. She is a professor in the Division of Health Policy and Administration in the school of Public Health at the University of Illinois at Chicago. Dr. Powell, welcome to the show. So pizza is like the most popular food for kids, teens, and even adults. Tell us a little bit about this study and what it means for kids that are eating pizza a couple of times a week. Are we supposed to stop them from doing that, or can we make pizza a healthier way to do things?

Lisa: Absolutely. What we wanted to look at here was, we already knew that pizza was a high contributor to calories and that it was eaten quite often, but we wanted to see if these trends were persisting. We looked at some of the more recent data and what we found was that children ages 2-11, on any given day, 20% percent of them are consuming pizza and 23% of adolescents are consuming pizza. When they do so, they are taking in a lot of calories. What we found, what we want to look at, we used data on multiple 24 hour dietary recall, so for the same kids, on a day they eat pizza compared to a day that they don’t. The question is: “Do we care that they’re eating so much of it? Does it add extra calories or nutrients that we want to think about limiting?” What we found is that, yes, it does. For children aged 2-11 we found that on a day they eat pizza they’re taking in an extra 84 calories, 2.8 grams of saturated fat, and 134 extra milligrams of sodium. For adolescents, we found larger adverse affects. We found that they were taking in an extra 230 calories, 5.4 grams of saturated fat, and almost 500 milligrams of sodium. So there is quite a lot of additional intake of calories and nutrients that these kids are over-consuming and we want to think about limiting.

Melanie: Yikes! Do the quality of the nutrients matter, because pizza from California Pizza Kitchen is different than pizza from unknown (2:31). Is the type of cheese, if we’re using a good, all-natural mozzarella versus the stuff out of a bag that has tons of sodium in it, do any of these things make a difference?

Lisa: Absolutely. In this study we looked at averages. We are looking across the days that you eat pizza. We knew where the source of the pizza was, so the nutrients that were taken in to consideration in the study are impacted by the source. The study was not able to look at, for example, if we knew that an individual was getting pizza from fast food we would be using the US nutrient database and there would be an average for, say, a pepperoni pizza or a cheese pizza, whatever it might be, but of course there is variation within those. Some of the implications of this: If on average, across all the types of either store bought pizza, or fast food, or restaurant pizza that people are eating, if youths, for example, are taking in these additional calories or saturated fats or sodium, really the policy implications, or the implications for parents, that you really want to be looking for those types of pizzas that might be, as you say, lower in some of these nutrients that we want to limit, have more natural products. We need to get away from a lot of the processed foods that we’re eating. One of the things we’re looking for is, for parents, putting your pizza dollars into pizzas that are healthier.

I think we could look to some of the food manufacturers and some of the restaurants and say: “Look. On average we know that we’re getting these extra calories, saturated fats, and sodium. Could you look towards reducing some of these nutrients in the pizzas that you’re making?” Bringing down the saturated fat, bring down the sodium. We’ve seen that in bread. Bread companies have been bringing down sodium slowly in bread so that people aren’t even noticing. No one is complaining. Ideally, we are not at all saying don’t eat pizza. We are saying; perhaps, eat a little less of it, less often. Eating it 20% of the time, that’s a high number. When you do eat it, instead of eating 4 or 5 slices, maybe eat 1 or 2 slices and pair it with a salad. Don’t make it your entire meal.

The third thing is saying: “Let’s change the nutrient content.” It’s a prevalent consumption item. Even if it comes down a bit, it will remain a pretty prevalent item. So let’s think about changing the nutrient content. If we do that, we could really have some broad population reach in terms of changing the diets of kids.

Melanie: Rock on. Hear! Hear! I know frozen pizzas are the worst, the ones you buy at the store. They are so processed that you can’t even read the ingredients. The preservatives, it’s crazy. Frozen pizzas we know, Dr. Powell, out the window. What if we’re going to have pizza from a fast food place, delivery place, or even a good restaurant? If we’re adding things like spinach or making the kids have a salad along with the pizza, so they won’t eat as much of the pizza, adding things like spinach and making sure there are tomatoes, keeping away from the sausage and pepperoni, all of these things are going to help. Kids don’t necessarily notice. They think they don’t want it on there but they really don’t care as long as it’s pizza.

Lisa: That’s right, if it’s healthy from the get-go. Kids start eating pizza at a young age. It’s tasty and they like it. If they start eating it and there are more natural products on it, less processed items, less meat or leaner cuts of meat, so that it’s healthy. Small changes on the margins even, if those are made now, kids are going to grow up eating healthier. If the only pizza they knew had whole grain in it, they probably wouldn’t be complaining. I think that making some of these changes, so that you don’t really notice a difference, too much of a difference at least. Also encouraging and making pizza that has a few more vegetables on it the norm. Kids would be used to that.

Melanie: Absolutely. The sauce itself, unless we’re talking about the frozen pizza, is really not such a bad product. It’s a tomato sauce, there’s lycopene. It’s kind of good for you, maybe gets the taste buds going a little. I actually, Dr. Powell, have kids whom, when I order a pizza and get spinach and mushrooms and onions and peppers, some of my kid’s friends will actually pick the stuff off the pizza. I’m like: “If you just ate it, you wouldn’t even know the difference.” Picking spinach off the pizza? There’s nothing left but bread and cheese.

Lisa: Maybe start off with a small number of vegetables on it and sort of moving over time. Kids can be pickier when they are younger. I really think, given that we know that the pizza, on average, which is being eaten across the US on a daily basis by so many kids, we know now that that current type of pizza really just has too much saturated fat and sodium in it. If we can move away from some of that and bring that down a bit, it would make a large difference. I think that adding additional vegetables to it would only be a bonus on top of that. If we can’t have more vegetables on it, have some vegetables on the side. So instead of eating 3-4 pieces, the kids are eating 2 pieces and they’re having, even if they’re just plain-Jane kids and they just want some raw carrot sticks on the side, whatever it might be, just put them on the side.

Melanie: I’m lucky, Dr. Powell. My kids will eat anything and they eat very, very healthy. But then my son gets pizza at school. We have to get the schools to hear what you’re saying. Are you sending this study, and how much pizza is contributing to childhood obesity, around to the school systems? We don’t have a lot of time, but how would you suggest that we as parents get this study to the schools so that they can look at the pizza they’re serving every single day, that if the kids can choose, they will choose every single day, and make that more healthy?

Lisa: I think one of the things with the schools, the schools are governed by, and they do have nutritional regulations. The USDA just came out with new regs for competitive foods that are sold in schools. So hopefully there will be some changes over time. But I think the study certainly does suggest that if pizza is offered fairly frequently at schools this really shows. I think that there can be an impact and schools have a role to play. One of the things that I should note about our study, I didn’t mean to say that the pizza at our schools is necessarily more unhealthy. We didn’t find that big of an impact of some pizza at schools, it might be that other items at schools are not as healthy. Really, over all, we need to make pizza from all sources a problem. We want to make some comprehensive changes. We should just encourage everyone. Even small changes with such a problem activity, any change can help make a difference.

Melanie: Great information. Parents start your kids young. When they’re going to eat pizza, and they are going to do it anyway, load it up with as much healthy stuff as you can. That will guide them in to eating a healthier pizza when they’re older. This is Melanie Cole and you’re listening to Healthy Children. Stay well.
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