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Tips for Healthy Eating

If you’re eating a nightly family meal at home, you already have a leg up on healthy eating. When we eat at home rather than in a restaurant, food portions tend to be more reasonably sized, and fruits and vegetables are more reliably offered. Sodas and high-fat foods, like French fries, are also less likely to show up at home than if the meal is eaten at a restaurant. It’s not just that eating family dinner gives kids a health boost, but what they learn about food at dinner translates to their other meals.

Many people find it difficult to figure out how to make a healthy meal, but it’s not as hard as you might think it is. Parents are often confused and overwhelmed by all the food choices at the supermarket—about 45,000 items on offer, with about 20,000 new products introduced each year.¹ And there is too much food grown each year in America—almost 3,900 calories per day for every man, woman, and child, even though the average adult needs only about 2,200 calories and children require even fewer. Food companies deal with this overabundance by advertising snack foods, offering larger portions, and getting families to eat more by making food more convenient and cheaper. Another way they increase food consumption is by offering more options. In a study where adults were offered unlimited access to M&M’s, people ate more of these candies when there were a greater variety of colors presented.²

It’s not just that we are being marketed lots of unhealthy foods but we are also exposed to a shifting, confusing landscape of diets and food fads. Should I get low fat or low carbs for my family? Is butter a better fat than margarine, or is it vice-versa? How often do I need to feed my family broccoli to get the anti-cancer properties I’ve read about? Is coffee going to increase my risk of pancreatic cancer or decrease my risk of Alzheimer’s?

As Ellen Goodman, a former Boston Globe columnist, wryly noted, “There seems to be some sort of planned obsolescence now to medical news. Today’s cure is tomorrow’s poison pellet. Fresh research has a sell-by date that is shorter than the one on the cereal box.”³

Indeed, information about nutrition should be taken with a grain of salt, sugar, and fat. For starters, nutritional science is a relatively young field that doesn’t yet explain what happens inside our bodies when we eat different foods. But the newness of proven scientific findings doesn’t prevent “news” about nutrition from being reported quite vigorously and quickly, in ways that, let’s say, news about astrophysics or molecular biology isn’t. Nutrition news, when it’s based only on a single study involving mice, or with the participation of only a very small group of people, makes for catchy headlines. Take these, plucked recently from Science Daily, an online website:

• “High salt consumption appears to be bad for your bones.”

• “Adolescents’ high fat diet impairs memory and learning.”

• “A few cups of hot cocoa may help fight obesity-related inflammation.”

• “Vegetarian diets associated with lower risk of death.”⁴

Some of these findings may well stand up when the studies are repeated over time. Some, however, have been done on animals only and don’t necessarily apply to humans.

But even studies done on humans are fallible, since diets change from week to week, and certainly year to year. How many of us are eating the same dinners now as we did a few years ago, despite children having grown up, a favorite grocery store closing, a discovery of a new ethnic cuisine, and eating out more or less as finances change?

Nutrition studies also may depend on reports of what respondents ate in a given week. (Do you remember what you ate for lunch yesterday?) And, finally, it’s very difficult to apply the gold standard of research to nutrition studies. That would require researchers to randomly assign one group of individuals to eat a set diet, measured out for them, over several years, while another group ate another diet, similarly measured but with the items in question, such as calcium, high fats, or meat, removed.

Nevertheless, while there may be no scientific consensus about the merits of eating a particular food to prevent a particular illness, there are some broad strokes that are well documented by researchers. In general, the health status of American children has actually improved over the last thirty years in terms of lowered rates of infant mortality and declines in nutrient deficiencies of the past, like rickets. But, the rates of overweight kids dramatically increased from the 1980s until 2000.⁵

However, recently, childhood obesity rates have plateaued, or even declined slightly in developed countries, particularly among preschool children (ages two to five).⁶ This positive trend is probably attributable to public health programs and growing public awareness of the need for physical activity and the harm of TV watching and soft drink consumption.⁷ Despite this glimmer of good news, two-thirds of children age two to eight are not consuming the recommended number of servings of fruits, and three-quarters of those youngsters are falling behind in their consumption of recommended vegetables. And about three-quarters of American children exceed the dietary recommendations for total or saturated fats.⁸ According to the American Dietetic Association’s 2014 review, too many American children are eating diets that do not meet the minimum recommendations for a healthy diet.⁹

The reasons for this substandard state of affairs are also well documented. American kids are eating more of their food at fast-food restaurants and as snack foods, both pathways to higher fat and sugar consumption. About 40 percent of family food dollars are now spent on food eaten outside of the home.¹⁰

Michael Pollan, a writer and journalism professor, blames our Western diet, as it has manifested over the last few decades, for the rise in obesity, cancer, heart disease, and diabetes in Americans. Specifically, he targets the focus on highly processed foods and refined grains, the use of chemicals to raise plants and animals for food, an overabundance of sugar and fat, and a narrowing of biological diversity in favor of growing a few plentiful, hardy crops—particularly soy, corn and wheat.¹¹

Mindful that there is much we don’t know, I offer some suggestions to help parents make sense of the confusing landscape of food choices. Drawing on interviews with pediatricians and nutritionists, as well as on the research from Marion Nestle and Michael Pollan, I have culled the best advice available to make dinner as healthy as possible without becoming a battlefield for calorie-counters and fat-fighters. Parents need help, both in simplifying the known data and understanding what isn’t yet known, so that they don’t get bogged down in the latest food fad.

SERVE A VARIETY OF HEALTHY FOODS

Different vegetables and fruits confer unique benefits to our immune systems and to the health of different organs, such as our skin, eyes, and liver. As one pediatrician told me: “A colorful plate is a healthy plate. Colors are better for you, while white foods tend to be less good.” Pollan offers the same advice: “Eat your colors.”

INVITE YOUR CHILDREN TO TRY NEW FOODS

It’s much more fun to cook for a family that is willing to try new things, but getting children to eat new foods is often easier said than done. Children, particularly those from ages three to eight, can be very neophobic, or suspicious of new foods. Sometimes these rejections are accompanied by disgust, the last emotion to show up in our developmental repertoire. It turns out that happiness arrives first, anger at about four months, and fear or surprise at six or seven months. We learn disgust through potty-training, and it’s a welcome evolutionary step since disgust protects children from ingesting toxins as they become more mobile and start to explore the world, often through their mouths.¹² It’s a bit of a puzzle why some children are more timid than others about trying new foods, and differences can vary within a family, even when children and parents eat similarly. My sons, for example, love raw and cooked red meat, while I feel queasy at the very prospect of these foods.

One answer to the question “Where does pickiness come from?” is genes. A study of more than 5,000 pairs of twins, ages eight to eleven, found that food pickiness was mainly inherited: 78 percent of food aversions were reported to be genetic, while only 22 percent were attributable to environmental factors, such as the level of tension at the dinner table or the way new foods are introduced or the quality of the cooking.¹³ Perhaps, my sons’ taste buds were inherited from their father, who will try anything and finds almost everything delicious.

Given that food pickiness is largely hard-wired, what can parents do with the 22 percent that has to do with environmental factors? How can parents encourage children to become more open to new foods?

Food pickiness tends to peak during toddlerhood. So try to introduce a variety of foods before that time, and try again when your child is older. Don’t label your child as picky, as you might find that her taste buds become much more flexible during later childhood.

There are other strategies that can help. Children who participate in cooking meals are more likely to want to try their own creations. In a study at Columbia University, 600 kids in kindergarten through the sixth grade who took part in a cooking class were much more likely to eat the foods that they made than those who didn’t take the class.¹⁴

Another strategy to promote adventurous eating is for parents to model their enjoyment of a broad range of foods. In one study, preschoolers tended to like or reject the same fruits and vegetables as their parents. “Oh, how I love these roasted Brussels sprouts” might inspire your little ones to get in on the action. Children of all ages will pick up on other food cues, too. Children of parents who talk about weight and dieting will be much more likely to use unhealthy weight-control strategies such as binging and purging. It’s better to focus on healthy eating than on your concern about your child’s weight.¹⁵ And even more important than the talk is the parents’ behavior: Those who are on diets are more likely to have kids with eating disorders.¹⁶

It’s also important not to give up too soon. Many nutritionists offer the “rule of fifteen,” or presenting the same food at least fifteen times to see if children will accept it.¹⁷ The idea behind the rule of fifteen is that kids tend to like food that’s familiar, so repeated exposure to a food will make it familiar. “Oh, this old snap pea; it’s been around here a lot. I guess I might as well try it.” A corollary here is to use foods that have gotten your child’s stamp of approval to act as a bridge to new foods. For example, if your child wolfs down carrot sticks, you might introduce celery sticks, which have the same crunch, or sweet potatoes, which are similar in color. Or add a new vegetable into a stir-fry that contains some recognizable vegetables. Even if a child picks out the interloping broccoli florets, these new vegetables will become more and more familiar.

For most eaters, what we find repugnant in new foods is the texture. Tomatoes, mushrooms, and onions are the three most often rejected nonanimal foods.¹⁸ If your child repeatedly rejects a food, you might try offering it in a new form with a different texture. You can sauté the mushrooms and onions first, and then puree them into a soup with trusted vegetables like carrots, which might render the slimy rascals more palatable.

Researchers at Duke’s Center for Eating Disorders use relaxation techniques to help young children expand their food repertoires. While you might not want to chant “Om” at the table, a relaxed mood, conveyed by soft voices and restraint from critiquing a child’s table manners, can go a long way to creating a calm atmosphere at the dinner table.

A counterintuitive piece of advice I’ve heard from pediatricians, which is also supported in the research literature, is for parents to refrain from rewarding kids for eating a particular food. It turns out that saying to your kids, “Eat your cauliflower and then you can have a piece of chocolate cake” will often backfire. What happens is that kids come to dislike foods they have been rewarded to eat.¹⁹ And—a double whammy—their preference for the reward food increases.

Restricting such foods as cookies and potato chips is also a losing strategy. Researchers at Penn State University demonstrated that children want more of foods that are forbidden. Kids who were given unlimited access to cookie fruit bars ate fewer than those who were told they had to wait ten minutes. In fact, consumption of the restricted cookies tripled as compared to consumption of the freely available cookies. Those verboten cookies also elicited more positive comments than ones that were freely available.²⁰ Ever since the Garden of Eden, forbidden foods have been more attractive.

Offering a variety of fruits and vegetables to children is a great starting point, but it’s not the whole story, because children aren’t little bear cubs. They also need protein, dairy, fats, and grains. The U.S. Department of Agriculture (USDA) offers a helpful visual aid for balancing these different food groups—MyPlate.gov, which was unveiled in 2011 by Michelle Obama and Agriculture Secretary Tom Vilsack. The icon is a plate that is suggestive of proportions for a healthy diet:

• Make half your plate fruits and vegetables.

• Fill a quarter with a protein, such as lean meat, tofu, eggs, or fish, trying to vary your choices.

• Use the remaining quarter of your plate for grains, aiming for whole-grain choices for at least half of these.

• A small dairy recommendation is connoted in the shape of glass at the side of the plate.

At The Family Dinner Project, we recommend using the MyPlate programs’ food list to help children brainstorm and broaden their food choices while also helping with the planning of meals. After explaining to kids how MyPlate works, invite them to choose foods from each of the five categories that they like, or think they might be willing to try. Then you can write down these choices on a downloaded icon of a plate and post it on the refrigerator for easy reference. Since kids’ tastes are notoriously fickle, you will need to update the lists. In addition to helping with the cooking, identifying a variety of food choices is another way to get your kids involved in dinner making. An involved child is often a more engaged eater. Of course, you are the one ultimately in charge of making the choices and should use your own wider and deeper experiences to introduce foods that kids didn’t put on their lists.

Michael Pollan also offers advice about healthy eating, positing that all you need to know is that there is no one diet that is preferable to any other, except for our current American diet, which is making us sick with processed food, meat, fat, sugar, and non–whole grains. He condenses his advice to a seven-word maxim: Eat food. Not too much. Mostly plants. This message, elaborated in his 2008 book, In Defense of Food, and in its more whimsical spin-off, Food Rules, is not quite as simple a set of dictates as those seven words would suggest. The command to “eat food” is about avoiding foods with ingredients you can’t pronounce, foods that have sugar listed in the top three ingredients, foods that are sold in the middle aisles of the supermarket, and foods that won’t rot. The injunction to “eat mostly plants” is aimed at encouraging eating mostly fruits and vegetables, and very little meat.

The command “not too much” flies in the face of how I grew up, when I was urged to “waste not, want not”—an admirable credo aimed at grateful frugality, and forged out of my parents’ experiences with Depression-era scarcities. In many homes, children were told that they had to join the “clean plate club” before they could leave the table or get dessert. But with so many Americans overweight, and portion sizes ballooning, Pollan counters with the idea that it’s better to stop eating when you’re full, even if that means leaving food on your plate. In order to know when you’ve had enough, Pollan’s last set of rules focuses on the context of eating—eat meals (rather than a series of snacks throughout the day) slowly so that you know when you are sated, eat with other people, and eat at a table (not in a car, in front of a TV, or at your computer).²¹

Ellyn Satter, a nutritionist and family therapist, and internationally recognized authority on eating and feeding, offers a very reasonable credo: “Feeding demands a division of responsibility. Parents are responsible for the what, when, and where of feeding; children are responsible for the how much and whether of eating.” What follows from this philosophy is consistent with the research. Parents need to offer healthy, varied, attractive, appealing food, but they should not get caught up in cajoling, tricking, bargaining, or negotiating. Children need to learn to trust their own bodies to know when they’re hungry and what they need to eat.

EMBRACE QUICK FOOD NOT FAST FOOD

Eating well requires some cooking. If you grew up with a parent who didn’t cook, you might feel overwhelmed and clumsy in the kitchen. If you are a woman who feels that cooking has oppressed women for centuries, you might avoid the kitchen on principle. If you are already working one or two jobs, making a meal every night can feel like a bridge too far. And just as some people hate to swim, or read, or watch football, you might hate to cook. I sympathize with each of these objections.

One remedy for the culinary-challenged and the time-challenged, and even those who just never warmed up to cooking at all, is to keep things simple and speedy in the kitchen. Forget about the twenty steps required to make Julia Child’s fish quenelles, or making gefilte fish from scratch in the bathtub. Instead, focus on “fast food,” which doesn’t have to mean unhealthy, oversize meals with high fat and sugar content served in Styrofoam containers. That notion of fast food entered the Merriam-Webster dictionary in 1951, but fast food has actually been around for thousands of years. Ancient Romans grabbed a quick breakfast of bread soaked in wine from street vendors, and Europeans in the Middle Ages scarfed down pies and waffles sold on the street.

My mother, a feminist, believed in another version of fast food: She loved family dinners, but she hated to feel “stuck in the kitchen,” so she got in and out as quickly as possible. Fast food in our home meant a meal that took less than half an hour, from fridge to stove to table. Heaven help you if you went in the kitchen while my mother was cooking. Fast food meant that she spun around in our small galley kitchen, grabbing vegetables with one hand, wrapping a potato in tin foil to throw in the oven with the other, and overseeing a chicken that spun itself on a rotisserie. She was a whirling dervish—her frantic pace left no room for help from family members until it was time to set the table and bring the food out. As for me, while I’ve always admired my mother’s efficiency in the kitchen, I prefer to bring others in to cook with me, so I don’t feel stuck there alone.

I am a big fan of fast food when I think of it as quick-to-prepare food that is also inexpensive and healthy. I will call it “quick food.” There are many strategies for creating quick, healthy, delicious dinners. Here are a few:

Have some “go to” meals that you can make from what is usually on hand

You’ll obviously save time if you don’t have to rush out to the store. Here are two of my go-to meals when I haven’t planned ahead, don’t feel like going out, and want something quick and nutritious.

FRITTATAS (FOR 4)

8 large eggs

¼ cup milk Salt and pepper to taste

2 tablespoons oil or butter

3 cups vegetables (any combination of onions, asparagus, red pepper, scallion, cherry tomatoes, mushrooms, or whatever else you have on hand)

⅓ cup shredded Parmesan, cheddar, or Swiss cheese

Crack the eggs in a large bowl and whisk with milk, salt, and pepper.

In an all-metal skillet, heat the oil or butter, and then add the vegetables. Sauté for 5 to 10 minutes, or until the vegetables are softened.

Pour the egg mixture over the vegetables, and let this concoction sit over moderate heat until it looks mostly cooked through—less than 5 minutes. Sprinkle the cheese over the egg mixture, and place the pan in the oven under the broiler for about 5 minutes, or until it looks golden. When you remove the pan from the oven be sure to use a pot holder.

Serve the frittata with a hunk of bread and a salad, and you’ll have a healthy, cheap meal made in less than 20 minutes.

BLACK BEAN BURGERS (FOR 4)

1 red bell pepper, chopped

2 carrots, minced

1 onion, chopped

2 garlic cloves, chopped

2 (15-ounce) cans black beans, rinsed and drained

2 large eggs

1 tablespoon cumin

1 tablespoon chili powder

1 cup breadcrumbs

Rolls or buns

Sauté the bell pepper, carrots, and onion in a small frying pan for about 10 minutes, or until the vegetables are soft. Add the garlic during the last few minutes (it needs less time than the other vegetables or it will get brown and bitter).

Mash the beans in a medium bowl by pressing down with a fork. In another bowl, whisk the eggs with the cumin and chili powder. Combine the vegetables, eggs, seasonings, and breadcrumbs with the beans, mixing into a sticky consistency. Form the mixture into four to six patties.

Sauté the patties in a skillet over moderate heat for 3 to 5 minutes on a side, flipping to brown on each side. Serve on toasted rolls or buns. (If I have an avocado on hand, I mash it, and add salt, garlic, lemon, and a dash of cayenne pepper. Then I put a dollop of this mixture on top of the black bean burger.)

Use only one bowl, pot, or pan

This cuts down on the cleanup and tends to focus one’s concentration. I think it’s also a time-saver not to have to keep referring to a recipe as you proceed step by step. Instead, mix and match according to what is seasonally available or with items floating around in your fridge. A good example of this is the Meal-in-Bowl Salad.

MEAL-IN-BOWL SALAD

I haven’t made a salad with carrots, cucumbers, and tomatoes in decades. Why limit yourself when you can incorporate every food group and have a complete meal? Here is a palette to choose from.

Pick a green: arugula, Bibb lettuce, spinach, kale, dandelion greens.

Pick a fruit: plum, peach, watermelon, grapes, pears, strawberries, raspberries, blood orange (my favorites).

Pick a vegetable (or more than one): tomato, avocado, mushroom. Or use leftover roasted asparagus, broccoli, squash, or cauliflower.

A favorite variation on this salad is to choose a vegetable and fruit that resemble each other in taste or appearance: a tomato and a plum; a cucumber and a grape; a peach and roasted squash.

Toast some nuts: walnuts, pine nuts, almonds, and pecans. Toast them in a dry pan over low heat for about two minutes or until you start to smell the nut (toasting helps release the flavor).

Add some optional whimsy: Parmesan chips (made by grating table-spoonfuls of Parmesan cheese that you bake on a baking sheet and in a 350-degree oven for about 7 minutes, or until golden brown). Or pick some edible flowers in the spring and summer seasons—violets, dandelions, chive blossoms, bee balm, basil flowers, lavender, mint flowers, Johnny jump-ups, marigolds, or nasturtiums will all do the trick.

Make a dressing: Mix three parts oil (try walnut, hazelnut, olive) to one part vinegar (try balsamic, raspberry, strawberry). For extra flavor, whisk in a little mustard and any herbs that you like.

Pick a protein: grilled shrimp, leftover roast chicken, black beans, tofu, and kidney beans.

Top with cheese: Sprinkle or shave some Parmesan cheese on top.

My favorite combination is arugula, peaches, shrimp, avocados, and walnuts, with Parmesan chips. Another one I really like is spinach, plums, tomatoes, pine nuts, and chicken.

Make a meal that is easily repurposed into a second meal

You can get two meals from one trip to the supermarket by preparing a dinner that yields leftovers that can be the basis for tomorrow’s dinner. A classic version of this is a roasted chicken with vegetables that gets transformed into a hearty chicken soup the following night. If you really want to save time, start with a rotisserie chicken picked up at the grocery store and skip the roasting instructions.

ROASTED CHICKEN

1 (3- to 4-pound) chicken

Vegetables, such as potatoes, fennel, carrots, squash, cut up

4 garlic cloves, unpeeled

Salt and pepper to taste

1 lemon or orange

Olive oil

Paprika

Preheat the oven to 400 degrees. Place a bunch of cut-up vegetables and garlic cloves in a large baking pan.

Rinse the chicken inside and out, removing any giblets, and pat dry with paper towels. Season the chicken with salt and pepper inside and outside. Stuff a lemon or orange (or half of each) into the cavity of the chicken. Drizzle oil over the chicken, using a brush to distribute evenly. Sprinkle with paprika if you want some nice color on your chicken. Place the chicken on top of the vegetables.

Bake in the oven for about 90 minutes. You’ll know it’s done when the leg wiggles easily and the juices run clear, not bloody. Remove the chicken from the oven and let it rest for about 20 minutes before serving.

CHICKEN SOUP

Leftover chicken Chicken carcass

1 (16-ounce) carton chicken stock (optional)

2 carrots, peeled and chopped 1 stalk celery, chopped

1 large leek, cleaned and chopped

1 onion, chopped

2 cloves garlic

1 tablespoon olive oil

1 cup barley, rice, orzo, or quinoa

Diced parsley

Splash of lemon juice

For its second incarnation, remove the leftover chicken from the bones; dice the chicken and set aside. Remove and discard all skin. Place the carcass into 2 quarts of water. (I often cheat by adding a 16-ounce container of chicken stock because I don’t have all day to boil the bones to make a fabulous stock.)

Sauté the carrots, celery, leeks, and onion in the oil in a medium frying pan until soft. Add the garlic and sauté for another minute. (Another time saver is to skip the sautéing and just throw the vegetables into the pot with the chicken.) Add the softened vegetables to the simmering stock.

Add the barley, rice, orzo, or quinoa; let simmer for 20 to 25 minutes. Remove the carcass. Add the shredded chicken, parsley, and lemon juice.

If your family starts to bellyache about leftovers, or if you make an excess of soup, don’t forget your secret weapon—the freezer. Many dishes can easily be frozen for weeks or even months. Then when you pull them out again, voilà, they’re no longer leftovers—it’s as if you had a sous-chef doing the cooking for you while you were sleeping or practicing head-stands.

Use a versatile cooking method that allows you to improvise with foods you have on hand

I’m particularly fond of creating different “schmears” to put on top of fish; then I bake or broil them in the oven. Bluefish, an aggressive and homely fish, is relatively inexpensive. It can be prepared quickly, and the results are very tasty.

BLUEFISH WITH SCHMEAR (FOR 4)

1½ pounds bluefish

1 tablespoon fennel seeds

⅓ cup mayonnaise

2 tablespoons mustard

1 garlic clove, minced

Canola oil

Rinse the bluefish and pat it dry. Roast the fennel seeds in a small dry pan for 2 minutes until they start to release an aroma; set aside.

For the schmear, combine the mayonnaise, mustard, garlic, and roasted fennel seeds in a small bowl.

Lightly oil a baking sheet, and place the fish on it, skin side down. Spread the schmear on the flesh side of the fish. Place the pan under the broiler for 15 to 20 minutes, or until the fish is flaky.

Other Schmears:

• In a food processor, mix 3 tablespoons butter, a handful of fresh basil, and a garlic clove. Smear this on a piece of fish that you bake in the oven at 375 degrees for about 15 minutes, adjusting for the thickness of the fish.

• Chop a blend of herbs, such as parsley, mint, and chives (about ⅓ cup each), and mix with 1 tablespoon Dijon mustard and juice from half of a lemon. Slowly add ¼ cup olive oil, until you have a nice paste for a topping. Wash and dry a piece of fish (about 1½ pounds of salmon, halibut, snapper, or haddock). Top the fish with the herb mixture and bake at 375 for 15 to 20 minutes, or until the fish is flakey.

Pasta is another food that allows for versatility in toppings. Since my children were toddlers, they have enjoyed a variety of pesto on pasta, with roasted chicken or grilled shrimp added in. Children as young as age three or four can help by pulling herb leaves off their stalks. The pesto recipe is simple.

PESTO

2 cups basil, parsley, watercress, or arugula (or a combination)

⅓ cup toasted pine nuts, walnuts, pecans, or almonds (or a combination)

¼ cup shredded Parmesan cheese

2 garlic cloves

Salt and pepper to taste

Olive oil

In a food processer, mix together all the ingredients except the olive oil. Blend into a thick paste. Slowly add olive oil until the pesto is a consistency that you like. Serve over pasta.

Customize dishes

Yet another strategy to help with healthy, fast, and delicious food—particularly when you have eaters who range from cautious to gourmand—is the “customizing dish.” Rather than turning yourself into a short-order cook, make one basic dish, and then let each member finish it to order. An extra bonus is that you can expose the cautious members of your family to other foods that they may venture to try next time.

My family’s favorite version of this kind of eating is a Cambodian recipe, adapted from The Elephant Walk Cookbook. It’s a basic chicken rice soup, or jook, to which each member adds what he or she wants; it’s like making a sundae!

JOOK ADAPTATION (FOR 8)

4 chicken legs

2 cups jasmine rice

10 garlic cloves, divided

2 tablespoons vegetable oil, divided

3 tablespoons fish sauce (available in the Asian section of most supermarkets)

1 teaspoon sugar

1 teaspoon salt

½ pound mushrooms, carrots, red bell peppers, or a vegetable of your choosing (or a combination)

1 cup bean sprouts

1 lime, cut into wedges

1 bunch scallions, white parts, thinly sliced

Chili pepper flakes

Bring 2 quarts of salted water to a boil in a large pot. Add the chicken legs.

While the chicken is cooking, rinse the rice. Sauté two of the garlic cloves in 1 tablespoon of the oil in a large saucepan for 1 minute. Add the rice, stirring often, for about 5 minutes. When that’s done, throw in with the chicken.

After the chicken has cooked for about 25 minutes, remove it and set aside, leaving the rice to continue cooking for about 15 minutes longer. Then add the fish sauce, sugar, and salt. Continue cooking for another 20 minutes. When the chicken cools, remove the skin, and pull the chicken off the bone, shredding it into bite-size pieces; add back to the soup.

Chop the remaining 8 cloves of garlic and sauté in the saucepan in the remaining tablespoon of oil for a minute or two, or until golden. Place the garlic in a small bowl.

Sauté the mushrooms, carrots, red pepper (or whatever combination you want) in the saucepan for a few minutes (add more oil if needed) or until tender; place them in another small bowl.

Place the bean sprouts, lime wedges, and scallions in individual bowls. Bring all the bowls to the table, along with the chili pepper flakes.

Serve each person the chicken rice soup. Let each person sprinkle in items of their choosing from the bowls.

I would be remiss not to confess that my ace in the hole is my husband. I cook like a cormorant spotting her prey for dinner: I focus straight ahead and never look back. In the process, I leave a trail of dirty dishes, onion peels, and vegetable detritus. My husband long ago took on the role of dishwasher, which he does in a mostly uncomplaining manner. Even when I do my own cleaning up, I hate to stop in the middle of cooking to tidy. I just like to go for it, even if that means I end up working on just the last few remaining inches of overcrowded counter space.

Any of these strategies is improved by having help and company in the kitchen. Like my mother, I don’t like being stuck in the kitchen. But if my sons, husband, or a friend offer to chop the onions (a task I loathe), stir the risotto, or take over with me playing sous-chef, I don’t care how long dinner takes to make. Then the focus is on creating something together and starting the dinner table conversation before we even sit down.

ILLNESSES, ALLERGIES, AND DEVELOPMENTAL DISORDERS THAT AFFECT EATING

It’s hard enough to plan meals that everyone in your family will enjoy, but when one member has special dietary needs, the challenges multiply. Here are some considerations for a few problems—diabetes, autism, and food allergies—that might complicate eating. For each one, I offer some tips from experts about how to maintain a dinnertime ritual.

When a family member has diabetes

There are two types of diabetes. Type 1 diabetes used to be called juvenile diabetes because it was the type of diabetes that most often affected children. Over the past few decades, however, a worldwide epidemic of childhood obesity has been accompanied by a dramatic increase in the incidence of Type 2 diabetes in children.

Type 2 diabetes, which used to be an illness that only occurred in adults, now accounts for 8 to 45 percent of new pediatric cases.²³ It is especially prevalent in low-income and minority populations, most likely because of the ease of accessing fatty, sugary fast foods and the difficulty of accessing healthy, fresh foods. With both types of diabetes, the intake of whole-grain carbohydrates (brown rice, whole barley, millet and wheat berries, whole-kernel bread) is recommended because these foods are digested slowly, which keeps blood sugar levels more even. Foods—such as white bread, pasta, soda, snack foods, canned fruits, cookies, and ice cream—which quickly turn food into sugar, should be avoided or minimized.²⁴ Other dietary recommendations are to eat lean protein at most meals, to eat nuts, and as many vegetables as desired. In other words, to a large degree, the diet for a diabetic is a healthy diet.

Ellen O’Donnell, a psychologist at Massachusetts General Hospital, works with kids who are having a hard time adjusting to a diabetes diagnosis. She knows this territory from the inside out because she was diagnosed with Type 1 diabetes when she was a senior in college. As she recalls, it was her parents that had the hardest time adjusting to the diagnosis. They tried to help Ellen by adapting their cooking into “diabetic” foods, but in the process many dishes were rendered inedible.

Ellen remembers her first Thanksgiving after the diabetes diagnosis. Her mother made her signature apple pie with Splenda. “It was terrible,” she says. “I told them to make the foods the way you make them, and I’ll just eat as much as I can.” Her family also adjusted the timing of meals so that they were more regular. She had to eat within an hour of her injections.

Much has changed since Ellen was diagnosed about twenty years ago, when nutritional information was hard to find. She used to have to estimate her carbs. If she had a serving of rice the size of her palm, it was so many carbs. It was mostly trial and error. She would estimate how much insulin to take, and then check her blood levels, and adjust. She had to restrict her diet to foods for which she knew how much insulin to take.

Now she relies on several Smartphone apps, such as Epicurious, to figure out how many carbs are in a recipe so that she will know exactly how much insulin to give herself. She learned early on not to choose foods that were labeled low sugar, because she ended up substituting with fat. Instead, she shifted to looking for whole foods.

Now a mother of two young sons, Ellen says her family dinner is lively, if a bit complicated. Jonah, who is three, has a dairy intolerance—he gets puffy and bloated when he drinks milk or has cheese, yogurt, or ice cream. Her husband, Eric, has an allergy to tree nuts and is also lactose intolerant. Her son Luke, age nine, is the only family member without any food restrictions. Most nights, they try to eat the same basic meal but with lots of little modifications. When they have pasta, they get regular pasta and check the number of carbs, rather than buy the healthy pasta with chickpeas that her husband is allergic to. When they have pizza, Jonah has to have his without cheese. Only Ellen and Luke add nuts to their salads.

The kids have known about their mother’s diabetes since they were preschoolers. Ellen recently overheard Jonah singing his own version of the hokey pokey: “Press your blood sugar in, press your blood sugar out.” They understand that sometimes the family action has to pause so that their mother can eat. On a family outing, she might end up consuming all the snacks so as to prevent the plummeting of her blood sugar. And when the boys see their mother’s hands shaking because of low blood sugar, one of them will ask if she needs a banana.

When I asked Ellen what advice she had for families when a member has diabetes, she used a cooking analogy. “Diabetes should always be on the back burner,” she says. “If you’re cooking pasta and making sauce, the sauce is on the front burner and you need to pay attention to it so it doesn’t splatter. The sauce is the most important part of the dinner because it provides the flavor. The diabetes is like the pasta—well controlled enough so that it’s not boiling over. But it should be on the back burner. You want it be under good enough control so that you can focus on the other things that are more important.”

She tells me another lesson, using her mother’s apple pie to illustrate. If you are eating well during the week, there is no reason not to have a piece of pie on the weekend. Rather than having the diabetic version of apple pie, with a sugar substitute, she says “it’s better to have the pie that I want rather than make it all about diabetes.”

When a child has autism spectrum disorder

Autism spectrum disorder (ASD) is a group of developmental brain disorders characterized by impairment in communication and social interaction, as well as by repetitive behaviors such as rocking, and by obsessive interests in a particular subject like vacuum cleaners, numbers, or elephants. It affects an estimated one in sixty-eight children.²⁵ ASD often permeates eating—even past the age when most kids outgrow food pickiness, kids with ASD continue to be selective eaters. They can be very sensitive to the texture of foods, accepting only crunchy foods or pureed ones, or they may have idiosyncratic eating behaviors, such as only drinking from a sippy cup.

Stephen Shore, the author of a memoir about having autism, wrote this vivid description of his relationship with food: “Canned asparagus was intolerable due to its slimy texture, and I didn’t eat tomatoes for a year after a cherry tomato had burst in my mouth while I was eating it. The sensory stimulation of having that small piece of fruit explode in my mouth was too much to bear, and I was not going to take any chance of that happening again.”²⁶

Carol Singer, Ph.D., is a child psychologist in the Boston area who specializes in working with kids on the autism spectrum. She explains that there are several ways that family meals can be challenging for kids on the spectrum, particularly when any changes in the routine create anxiety. A holiday dinner with added guests, a change in the timing of dinner, or even the introduction of new foods can be changes that are upsetting to children with ASD.

When kids feel anxious Dr. Singer teaches them skills to practice at the dinner table or while taking a break from dinner. One is to develop a hand signal that a child can use when he is feeling overwhelmed or can’t stay at the table. Learning to use a hand signal is far preferable to waiting until the child is so upset that he becomes disruptive. In addition, Singer suggests that when children are anxious that they play “Freeze-Melt”—the child is told to tighten all his muscles and “freeze” for a moment, and then relax all over. Or a child can practice “mindfulness” by describing an object without judging how she feels. Does the object feel heavy, cold, soft? These skills could be helpful for any child (or adult) to practice when feeling overwhelmed by an interaction at the table.

Kids with autism often are very sensitive to noise, which can make it hard for them to sit through a dinner when several people are talking at the same time. If it’s a holiday dinner, with many more voices at the table, the child with ASD can find it hard to keep up because of disturbances in his auditory processing. This difficulty might quickly translate to feeling anxious, which will, in turn, make it more difficult to participate at the table.

The sensitivities that often accompany ASD can interrupt dinner in another way. Sam, an eight-year-old boy whom Dr. Singer saw in therapy, developed an exquisite aversion to hearing his sister, Dahlia, clear her throat.²⁷ This aversion had begun when Sam awoke in the middle of the night to find red lights flashing and sirens blaring. His sister was having an asthma attack and needed emergency intervention. Afterward, whenever Sam heard his sister clear her throat, he was terrified that she would have an asthma attack. And Sam was afraid that if he was around someone clearing his throat, he could catch it and give it to his sister. Unfortunately, Dahlia often cleared her throat at the dinner table, and Sam would go flying away from the table when she did.

Dr. Singer used exposure therapy to restore the dinner hour. First she wrote the letters “TC” for throat clearing, and then spelled it, and then she said it. Once, Sam could bear these exposures to throat clearing, Dr. Singer recorded the sound of throat clearing off the Internet, then recorded her own voice making the noise. Then Dahlia recorded herself clearing her throat. Finally, Sam was asked to stay at the table three nights a week while Dahlia made the noise. With the process of gradually acclimating himself to the sound, Sam learned to tolerate it.

As with any disability affecting a child, siblings need to adapt and respond. If a child with ASD is allowed to eat pasta at every meal while his siblings must eat a healthier diet, or if he is allowed to leave the table to watch TV when the others must stay until dinner is over, it might feel unfair to the other children.

A child with ASD usually has many fewer peer contacts than her siblings and wants to spend more time with her siblings than vice versa. The parent might require the children without ASD to be home for dinner as much as possible, to provide modeling and companionship, but those children can be chafing to spend more time out of the house with friends. The parent will likely feel torn between the different needs of her children.

When a child has a food allergy

The number of kids with food allergies—when the immune system goes into overdrive in response to substances usually considered harmless—increased from 3.4 percent in 1998 to 5.1 percent in 2011, according to the National Center for Health Statistics.²⁸ These kids’ bodies release too much of an antibody, immunoglobulin E, in order to fight off the food allergens. As a result, the body releases histamine and other chemicals, which can make it hard to breathe, and hard for the blood to circulate. Epinephrine will halt a life-threatening reaction to a food allergy, but a better strategy is to avoid contact with the offending food. The most common allergies—peanuts, tree nuts, milk, eggs, wheat, soy, fish, and shellfish—account for 90 percent of allergic reactions.

Jen Haugen, RD, LD, works as a registered dietician in a supermarket, Hy-Vee, in Rochester, Minnesota, teaching healthy eating in one of the best classrooms—the grocery store aisles. While at the supermarket, she urges parents to read labels carefully, using a food allergy list that’s updated yearly and covers the eight major allergens.²⁹ She also recommends serving the same meal to all family members by making small adjustments to accommodate a food allergy. For example, soymilk is a good substitute for cow’s milk when a child is lactose intolerant, sunflower butter can be exchanged for peanut butter when there is a peanut allergy, and gluten-free bread works well for someone with celiac disease.³⁰

Maintaining a sense of normalcy around healthy eating should be balanced by a suitable dose of vigilance. If an allergy is life threatening, that food should be banned from the house because the risk of an accidental ingestion is too high. And cooks should be mindful of the dangers of “cross contact,”—utensils, dishes, and cutting boards cannot be used for both verboten and permissible foods. A knife that has been dipped into the peanut butter jar should never be the same one used to spread jelly for a child with a peanut allergy. While food allergies are usually lifelong, there are some studies afoot to see if adults with allergies can become desensitized to lose them. My friend Tristan is ingesting a few milligrams of peanut powder each week, increasing the amount gradually, so that in two years he expects to be able to eat two Reese’s peanut butter cups. No one, however, should attempt to overcome an allergy without the advice of a medical professional.

All of these conditions require extra planning, flexibility, and resourcefulness on the part of the cooks and fellow diners. Regardless of the eating challenges, preferences, or idiosyncrasies of individual family members, the goal of preparing food is the same—to bring family and friends together to the table. The food creates the occasion for dinner, but dinner is about so much more than the food.

We turn now to the additional elements of dinner that transforms it from a time to eat to a time to play and have fun.