By Jean Balchin 14/12/2017

“I’ll start eating healthily… tomorrow.”

We’ve all said it, and inevitably, we’ve all fallen prey to that tempting slice of pizza or that luscious slice of chocolate cake. But it’s clear that a healthy diet has its benefits, and recently, an international team of researchers have found a link to better self esteem for kids with a healthy diet. According to a study published in the open access journal BMC Public Health, healthy eating is associated with better self-esteem and fewer emotional and peer problems, such as having fewer friends or being picked on or bullied, in children regardless of body weight.

The study also found that children who ate healthier had fewer emotional issues and fewer issues with bullies or friends, regardless of how much they weighed. The researchers reviewed data collected from 7,675 kids aged two to nine from eight European countries – Belgium, Cyprus, Estonia, Germany, Hungary, Spain and Sweden.

Dr Louise Arvidsson, from the Sahlgrenska Academy, University of Gothenburg, said: “We found that in young children aged two to nine years there is an association between adherence to healthy dietary guidelines and better psychological well-being, which includes fewer emotional problems, better relationships with other children and higher self-esteem, two years later. Our findings suggest that a healthy diet can improve well-being in children.”

What is the Healthy Dietary Adherence Score?

A higher Healthy Dietary Adherence Score (HDAS) was associated in children with better self-esteem and fewer emotional and peer problems two years later. The HDAS aims to record one’s adherence to healthy dietary guidelines, which encourage a limited intake of refined sugars, reduced fat intake and plenty of fruit and vegetables. A higher HDAS indicates stricter adherence to the guidelines, so in effect, healthier eating. The guidelines are common to the eight countries included in this study.

It was found that weight was not a factor in the relationship between a child’s HDAS and wellbeing. Dr Arvidsson said: “It was somewhat surprising to find that the association between baseline diet and better well-being two years later was independent of children’s socioeconomic position and their body weight.”

Data from the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants Study (IDEFICS) was used. IDEFICS is a prospective cohort study that aims to understand how to prevent overweight in children while also considering the multiple factors that contribute to it. Beyond pure research, IDEFICS offered activities for health promotion and prevention in kindergartens and schools. These prevention programmes were developed, implemented and evaluated within the IDEFICS Study.

Initially, parents were tasked with reporting how often per week their children consumed food from a list of 43 items. Depending on their consumption of these foods, children were then assigned an HDAS score. Psychosocial wellbeing was assessed based on self-esteem, parent relations, emotional and peer problems as reported by the parents in response to validated questionnaires. The height and weight of each child was also reported, and all questionnaires and measurements were repeated two years later.


This study is the first to analyse the individual components included in the HDAS and their associations with children’s wellbeing. It was found that the recommended fish intake (2-3 times per week) was associated with better self-esteem and no emotional and peer problems. Intake of whole meal products were associated with no peer problems.

The associations were found to go in both directions; better wellbeing was associated with consumption of fruit and vegetables, sugar and fat in accordance with dietary guidelines, better self-esteem was associated with sugar intake according to guidelines, good parent relations were associated with fruit and vegetable consumption according to guidelines, fewer emotional problems were associated with fat intake according to guidelines and fewer peer problems were associated with consumption of fruit and vegetables according to guidelines.


However, the authors did caution that children with poor diets and poor wellbeing stood a greater chance of dropping out of the study and were thus underrepresented at the two-year follow up. This complicates the study’s conclusions about the true rates of poor diet and poor wellbeing. Moreover, given that the study is observational and relies on parents reporting on their child’s behaviour, no valid conclusions regarding cause and effect can be drawn.

Dr Arvidsson said: “The associations we identified here need to be confirmed in experimental studies including children with clinical diagnosis of depression, anxiety or other behavioural disorders rather than well-being as reported by parents.”

The study was published today in the journal of BMC Public Health.