Feeding Our Families in Our Diet-Centered Culture
By Anna Lutz, RD, CEDRD
Feeding. It can feel like the most basic part of raising a child. One of the very first things we do for our child, feeding is instinctual to mothers’ and babies’ bodies. However, feeding our families in our society has become confusing and complicated because of the concern about the obesity epidemic. There is fear-based, restrictive nutrition advice everywhere. Children come home from school with rules about what can and cannot be brought in their lunch box. There are public school weigh-ins and BMI report cards. There are books geared to toddlers about lifting weights and “not being so chubby.” I fear that the casualties of the “War on Obesity” are our children,1 children that are more likely to diet, be unsatisfied with their weight, and be at risk for developing eating disorder behaviors.2
As a mother and a Registered Dietitian that specializes in eating disorders, I am passionate about how children are fed. We know that many, many factors, genetics included, play a role in the development of an eating disorder. While feeding practices certainly do not cause eating disorders, the approach to food in a household may be protective. We know that children who diet are more likely to have eating disorder symptoms.3 Since our mainstream culture and our healthcare system seem to have fully adopted a diet mentality and dieting messages are truly everywhere, how can we feed our children in a sound, healthy, protective way? It’s a daunting task, but there are four truths that come to mind that I try to remember as I’m navigating my own family feeding. I certainly do not have it figured out and there are many days I’m fearful that I’m “doing it wrong.” Some of these truths may be common-sense parenting, but the food rules, nutrition lessons, weight-management clinics, BMI charts, and nutrition picture books, have gotten things way off track.
Truth #1: Children’s bodies can be trusted.
It is not a parent’s job to control a child’s weight, nor is a child’s weight a reflection of the quality of parenting. We are born with the ability to regulate our intake.4 We can observe this first hand when taking care of an infant. Babies know when they are hungry, and when they are not. With no external interference, children can retain this innate ability to self-regulate as they grow older. Children grow predictably along growth curves. Some children are more interested in food and may eat more and some may eat less, but both of these type children will grow predictably if given the opportunity to continue to listen to their bodies. Parents may follow well intended advice and begin to interfere with a child’s natural hunger cues by attempting to control how much their child eats.
Ellyn Satter’s Division of Responsibility (sDOR) is a model that can assist parents in feeding so that a child can keep (or recover) their innate ability to self-regulate and have a healthy relationship with food.5,6 In Satter’s Division of Responsibility, the parents’ jobs are to decide when it is time to eat, what is served, and where it is served. The child’s job is to decide if he’s going to eat and how much. Parents can do their jobs of putting together balanced, nutritious meals and assisting children in coming to the table hungry by having set meal and snack times. After the parent does his/her job, s/he can (try to) relax and trust the child’s body. This doesn’t mean a child won’t overeat or undereat at a meal. It means that with some structure, children’s bodies can be trusted to self regulate over time. I use this framework in my own home and find it extremely supportive. If I start to wonder what the best thing to do is, I take a deep breath and ask myself what my jobs are.
Truth #2: Bodies come in all sizes.
Just as there are many different colors of eyes, hair, and skin, there are many different shapes of bodies. Weights and heights are truly on a bell curve and are generally determined by genetics. The nutrition and weight messages aimed at our children are teaching them that being bigger/chubbier/fatter is something that should be avoided at all costs. It makes me so sad that well intended teachers, healthcare professionals, and parents are teaching children that some people’s natural body type is not acceptable. I, unfortunately, have seen this play out with our culture supporting size-based bullying of children from their peers and even from adults. In our society, body size seems to predict how children feel about their bodies and how they eat. One study showed that girls that are in the “at-risk-for-overweight” category at age 5 are more likely to restrict their food and have body dissatisfaction at age 9.7 In this study, as dietary restraint increased, there were greater increases in BMI. Not only does our diet culture seem to accept bullying children with larger bodies, we may be actually causing weight gain, presumably the very thing the war on obesity soldiers are trying to prevent.
This topic is a bit tricky for me as a parent. The one thing I seem to be able to do most consistently is to not have my children hear me comment on my own body or how other bodies look. I have to believe that this example is something that subconsciously is having an influence on them. Certainly, my children have described others as fat. When they were in preschool, it was a descriptive term, with no judgement. As they’ve become school aged, I can hear the effect of society and the word fat contains a judgement. I try to acknowledge that their observation is true –there are fat people and fat is a descriptive term–and at the same time teach them through example, that this is a neutral, descriptive term. I may say something like, “I see that. What else do you know about her?” We may have no immediate control over the outside environment, but we can demonstrate acceptance of all bodies within our home.
Truth #3: We want things we cannot have.
It’s human nature to want things we cannot have. Developmental psychological experiments have shown this over and over, whether it’s a toy, a job, or a food, we want the thing that seems forbidden or harder to get. We know that maternal restrictive feeding is predictive of children eating when they are not hungry and having increased BMI;8 again, presumably the exact things the parents are trying to avoid. An interesting study showed that girls that were restricted from highly palatable snack foods in their family ate more of these foods when they were not hungry, compared with girls that were not restricted from these foods.9 These studies highlight that for many children, if they are not allowed to have these foods or told these foods are forbidden, they will overeat them when their parents aren’t looking.
For a parent, this means that having all kinds of foods as part of your family’s life teaches children how to deal with highly palatable foods in a healthy way. This doesn’t mean a free-for-all on highly processed snacks and sweets. Remember, Satter’s Division of Responsibility; you decide the what and when. You are demonstrating what balance looks like, day to day. We can choose mostly nutrient dense foods, and occasionally include some so-called “junk foods” in our family’s meals and snacks to show children their bodies can manage a variety of different foods. Children don’t need strict rules for this or to be told these foods aren’t “good for them.” Children learn by example; if we don’t have chips at every meal, they learn it must not be what we eat a lot of. If we have a fruit or a vegetable at every meal, they learn that fruits and vegetables must be an essential part of a meal. They need the opportunity to eat these less nutrient dense foods alongside other food, without them being moralized. Chips are just chips; we need not fear or judge them. We don’t need to tell our young children these words, they learn it by experience. Then, when they go to a slumber party, chips are not a big deal and they don’t feel naturally compelled to overeat them just because they are not allowed to eat them when mom or dad are around. Decreasing the power and allure of these foods in this way also leaves room for children to discover a genuine liking for more nutritious foods, not having learned that “healthy” foods like fruits and vegetables are fundamentally different from their “junk food” counterparts.
Truth #4: Nutrition education needs to be age appropriate.
Just like sex education, age appropriateness is important to consider in nutrition education. We don’t tell a 5-year-old all the details of the birds and the bees. Similarly, a 5-year-old does not need to know all the details of nutrition, information that is extremely nuanced and subject to highly individual factors. Young children are concrete thinkers, they cannot think abstractly until middle school or beyond. One must be able to think abstractly on some level to understand nutrition. Adults can understand that a slice of cake may not be nutrient dense, but that our health is not affected if we have a slice of cake every once in awhile. We can also understand that carrots contain a lot of vitamin A, which is good for our eyes, and that not eating carrots doesn’t make us go blind (which I truly have been asked by a child). Parents can use nutrition information to guide their meal and snack planning (deciding the “what”), but they can consider the larger picture of several days or weeks of meals constituting overall nutritional balance. Children often cannot make that abstract leap. Inappropriate nutrition education is either just not understood accurately by children10 or in some cases can cause harm. One report documented four case studies in which healthful living programs by a health professional, such as myself, appear to have triggered a child to develop an eating disorder.11 One response to the obesity epidemic has been to teach children, even preschool children, specific nutrition information, typically including “good/green light/always foods” and “bad/red light/rarely foods.” Appropriate feeding is a parent’s job and a very risky burden to put on our children. Age appropriate nutrition education for young children would include where particular foods come from, food and culture, and cooking. As a child gets older, middle and high school aged, they can begin to learn more about nutrition information and how to put meals and snacks together.
Parenting in general today can be an amazingly daunting task. Because of what I do, I am most fearful of the restrictive and diet messages my children already come in contact with daily. They hear little comments, like an adult saying she’s not going to eat the pizza at a birthday party because she’s being “good” today or a teacher commenting on what a child has in her lunch. I cannot protect them from those comments, but I can work towards having an environment within our family that models balanced eating and values all bodies. It can sometimes feel like an impossible task. I certainly make many mistakes and have moments I do not know what to say to my children. But I always try to come back to these basic tenets, knowing that if I do my jobs well most of the time, I can trust my children’s bodies to grow and thrive.
About the author:
Anna Lutz is a Registered Dietitian with Lutz, Alexander & Associates Nutrition Therapy in Raleigh. NC. She specializes in eating disorders and pediatric/family nutrition. Anna received her Bachelor of Science degree in Psychology from Duke University and Master of Public Health in Nutrition from The University of North Carolina at Chapel Hill. She is a Certified Eating Disorders Registered Dietitian through the International Association of Eating Disorders Professionals. Anna previously worked at Children’s National Medical Center in Washington, DC, and on the Eating and Body Image Concerns Treatment Team at Duke Student Health. In addition to her private practice nutrition therapy, Anna provides presentations and trainings to other professionals, school personnel, student, and parents. Anna has three young children and enjoys supporting and coaching parents about family feeding.
- Zavodni K and Lutz A, “Non-Diet’itians – Integrating Eating Disorder Wisdom in All That We Do,” Renfrew Foundation Conference, Philadelphia, PA, 15 Nov 2014.
- Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA. Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventative Medicine. 2007 Nov;33(5):359-369.
- Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. 1999 Mar 20; 318(7186): 765–768.; Stice E, Presnell K, Spangler D. Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychol 2002; 21: 131–8.
- Fomon SJ. Recommendations for feeding normal infants. In: Fomon SJ, ed. Nutrition of Normal Infants. St. Louis, MO: Mosby-Year Book, Inc.; 19[93:45]5-458.
- Ellyn, S. Child of Mine: Feeding with Love and Good Sense. Boulder: Bull City Publishing, 2000.
- Shunk JA, Birch LL. Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. Journal of the American Dietetic Association. 2004 Jul;104(7):1120-6.
- Fisher JO, Birch LL; Restricting Access to Foods and Children’s Eating. Appetite. 1999; Vol 32:3, 405-419., Birch LL, Davison KK, Fisher JO. Learning to over- eat: Maternal use of restrictive practices promotes girls’ eating in the absence of hunger. Am J Clin Nutr. 2003;[78:21]5-220.
- Fisher JO, Birch LL; Restricting Access to Foods and Children’s Eating. Appetite. 1999; Vol 32:3, 405-419.
- Lytle, Leslie et al. Children’s Responses to Dietary Recommendations: A Qualitative Study. Minnesota Department of Education, 1993.
- L, McVey G, Walker KS, Norris M, Katzman D, Collier S. Trading Health for a Healthy Weight: the uncharted side of healthy weight initiatives. Eating Disorders. 2013; 21(2):109-115.