physical activity for kids– but someone could get hurt!

Hi! I'm back. It feels good, but also lots to catch up on, and my email seems to be swallowing things, so if you're the mom from Colorado who emailed a while back, I think I have a contact for you :)

So, part of having a healthy relationship with our bodies is moving them. Kids often do this more spontaneously than adults. I marvel at the energy level, the sheer joy many children have as they run, or dance. Even my relatively sedentary child (compared to some of the little guys I know!) has such a clear joyful abandon when she's moving.

So, on a recent day off school, I took M and a friend to the Como zoo (a local zoo that is donation-entry) to burn off some steam. It was a beautiful fall day and the zoo was almost empty. I wanted to give them the opportunity to run and play. (Just as with food, there is a Division of Responsibility with activity. I provide the opportunity for M to move her body in joyous and unpressured ways and she takes it or leaves it...)

Anyway, so they are running from one thing to the next. As I said, there are very few people there. I asked them not to run if there were others around, but otherwise was thrilled that they were having fun and getting exercise.

Then an employee shouts at them to "walk! No running!" There was literally no one around. I said kindly, "May I ask what your concern is?" She looked at me like I was crazy. "Well, they can get hurt! We had a kid split his lip here before!"

Really!? I didn't quite know what to say. "OK, well thanks, yes, kids do get hurt I suppose!" I wandered off and let them run at will. A child can split a lip falling from a walk as well. It seemed odd. I could understand if they were running into people, or if it was crowded. I wanted to say, "I am willing to accept that risk," or, "Are you kidding me? Of course some kids will get hurt. That is unavoidable." (Will we soon be signing liability waivers at public places?)

What does this mean? Will we outlaw running, climbing etc because of liability concerns? Already, the playgrounds of our youth with merry-go-rounds are gone. The high-dive at the swim-club is long gone and climbing structures barely get off the ground. (In contrast, in France, where they have 10% of the lawyers we have here, the playgrounds I have seen look like something out of Fear Factor...)

I felt bad encouraging my child to ignore an adult authority figure- but come on.

What do you think? Do you think our caution, our fear of injury is making it harder for kids to find enjoyable ways to be active? Have you had similar experiences?

wasting food, hunger, and finding that "stopping place"

Here we are at Cracker Barrel, which was across from our hotel on our recent drive (2 days in the car!) to see family. I skipped the Kids Menu, and M ordered rice, chicken, corn and milk. I had roasted chicken, beans, stuffing and corn. We ate maybe 25% of what was on the table. I ordered her a main meal because all the kids stuff was the typical fried, limited fare that M doesn't love anyway. She had biscuits for the first time. She liked the corn bread too. We had a pleasant meal, but here is what we left. (I suppose we could have shared entrees had I realized how much food there would be...)

It got me thinking again about poverty, food insecurity (or restrained or unreliable feeding) and how it effects what we eat and how much we eat.

• I waste food because I can afford to. (The photo above is at the end of our meal.)
• I can stop eating because I know I will have enough, good-tasting variety of foods before I get truly hungry again. (Reliable meals and snacks.)
• I can try new foods and introduce my daughter to new foods because I know I will have other things to eat, and because I have enough resources to try something that might not get eaten.
• I can stop because I can eat any of those foods when I want to. (I don't need to eat 2 biscuits because if I want to order them again sometime, I can-without guilt.)
• I leave food because I have never been truly hungry (childhood food insecurity and hunger often has long-lasting effects, with adults who experienced it more likely to feel anxious or panicky with food, and more likely to binge when foods are available-a smart survival strategy at the time...)
• I leave food because I have learned to eat in a way that is tuned-in to my internal cues of hunger, appetite and satiety.
• I am lucky...

If I weren't so lucky, I would have ordered food for M that I KNEW she would eat. If I didn't know when the next meal was coming, I would order reliably filling foods with lots of calories for the least amount of money. If I hadn't eaten all day because I was "saving points" for dinner, or didn't have any cash, or felt guilty about how I blew my diet yesterday... (you see where this is going.)

(BTW, M doesn't really have to "think" about any of this, or know it on any rational level. In spite of my inclinations as a chatty extrovert, I don't explain or rationalize any of this to her. I do my jobs with providing reliable, good-tasting foods every 3-4 hours. She just shows up and listens to her body... She stops eating when her body tells her to.)

Poverty, how much we eat, what kinds of foods we eat, are more complex than most (especially in the public health world) would have us believe. Food is at it's heart survival, and making it simply into a moral issue without a deeper understanding of the complexities–the physiology and psychology of hunger (monetary or self-inflicted)– is dangerous and short-sighted.

How do your childhood experiences of hunger (in any form) effect your eating today?

worry about weight, two reader perspectives...

Here are two reader comments I couldn't resist sharing. Related to my last post about worrying about weight in very small children. They are well-worth the read. My readers, your inspire me! What is being done to families, mothers, fathers and children in the name of weight is wrong and harmful and unnecessary. Read on...

"I really appreciate these suggestions to lessen the focus on weight, especially for the very young.
I have twins and my daughter was tiny from birth. She has never been on the charts and at 6 months weighed only 12 pounds, which triggered a number of GI specialist appointments, the coordination of a dietician, etc. I was nursing her but had to begin supplementing with high-calorie formula in an attempt to increase weight gain. No physical issues were ever found, and she continued to grow steadily, just...slowly. The GI doctor at one point warned me that if she didn't gain more weight, her cognitive functioning could be harmed.

Of course I was terrified and this sparked a terrible pattern for us, in which I constantly tried to cajole/encourage/trick/force my daughter into eating more, and she, naturally, pushed back from day 1. It saddens me to look back on this and think that we were going through this power struggle even when she was a baby. It continued on and on, because at each appointment, she was still "not on the charts". Our doctor suggested some helpful, healthy things to increase the caloric density of her foods, but also some unhealthy things (such as feeding her Carnation Instant Breakfast, which she would never touch anyway). I had to monitor the number of calories my daughter consumed every day. On a good calorie day, I was thrilled, on a low calorie day, I was frightened, miserable, and often cried.
My daughter was 16 lbs at a year and 21.5 lbs at 2 years. This intense emphasis on her weight set up a terrible relationship to food and feeding. Shortly after she turned 2, my mother located all of my baby records from birth up to 2 years. And it turns out that at every single appointment, I had actually weighed slightly less than my daughter at the same age! My husband and I are both small, slim, people. The difference is that back then, in the 70s, my doctor didn't consider it a problem, and wrote notes such as "she's doing well" or "she's fine" to my mother.
At that point I realized my daughter is playing out her genetics and her well-meaning pediatrician's focus on her smallness had helped us set up a bad dynamic in which our mealtimes were disasters and my daughter wouldn't eat out of a need for control. Shortly after she turned 2 I swallowed hard, began following the Child of Mine advice, and backed way, way off. I no longer try to convince/bargain/trick her into eating. I provide healthy meals at specific times, and I allow her to eat what she wants. I don't comment on it, and I don't bribe with dessert. At first it was REALLY hard because of our historical weight issues, but I soon found that she actually eats much, much better now! She tries many more things, and her weight hasn't suffered. Now mealtime is no longer a terrible battle, and instead we can enjoy ourselves. Given how small she is it's still hard for me to grit my teeth and say nothing if she decides not to eat much at a given meal, but I try to take a whole day, or whole week approach and realize that she actually does eat a good variety of foods."

and...

"I am a mother of an 11 month old boy that lives in the Peninsula area of the San Francisco Bay Area. Oh, man have I been getting the messages.
I'm fat. Not heavy, not 'overweight' - I'm fat. I weigh 275 pounds at 5'4". My husband is also fat. He's 280 at 5'10".
The weight talk started at my son's six week appointment. I keep hearing moms talk about their doctors worried that their kid is not gaining enough. Ours discussed with us if we had concerns about him gaining _too much._ I said "No, not really. I mean, his gain is normal, right?" and the doctor replied "Low end of normal, actually, but I see that both you and the baby's father are... uh... " "Fat? Yes, we are fat. Are you suggesting a preemptive diet for my six week old?" "No, I just thought you might be concerned." Oy. I mean, really. I let the doctor know that I was not interested in feeding schedules, limiting baby's intake so early or "supplementing" with water. (And let me say, calling my husband "the baby's father" repeatedly instead of my husband, while he sits there is kind of insulting. I've heard this doctor tell other women "Your husband... " but somehow, mine is "the baby's father." Maybe he can't believe a fat woman is married?)
The doctor suggested switching him to whole cow's milk at 9 months - I said that WHO didn't recommend that and I wasn't interested. He again brought up that my husband and I are fat. I asked if he would recommend that a thin mom and dad switch their higher-weight baby to whole milk at 9 months. He said no, breast was best until 2/formula until 1. I said again, that I wasn't interested in going against WHO recommendations and general practice just because we're fat. He then asked if I would be willing to limit intake. I asked if he would suggest that for a higher-weight baby of thin parents. He said no. I said, again, no.
What's sad is that I have interviewed several pediatricians, all of whom want to put him on feeding schedules, limited intake, switch to cow's milk, switch to water for all but two bottles a day - I've gotten some crazy suggestions. When I ask about higher-weight babies with thin parents, they tell me that they wouldn't recommend any of this to them because "the babies will just thin out someday." My common refrain in the doctor's office these days is "What would you recommend to thin parents?"
For what it's worth, my son is 97th percentile for height, 95th percentile for head size and 90th percentile for weight. Part of my hesitation (okay, more like deep unwillingness) to do feeding schedules and limited intake is that my parents did it with me. My father tells everyone he encounters with a baby about how I cried and cried. They followed the schedule the pediatrician gave them - so many ounces every so many hours. My mother pumped so they could measure the milk and later switched to formula. They took me to countless doctors, some diagnosed me with various conditions. I was "diagnosed" with a pyloric valve issue and they wanted to do surgery. There was a grandmother in the doctor's office that my parents were at to discuss this and she told my father "There's nothing wrong with that baby except HUNGER. You need to feed that baby." My father says he explained to her the feeding schedules, the pumping and measuring, the formula. She told him to "Knock that nonsense off, keep making bottles until the baby isn't hungry anymore." My father - fed up, tired and at the end of his rope went home and did exactly that. He said that it was the first night I slept at all for more than 30 minutes - he kept checking to see if I was alive. After that? No feeding schedules. I am the oldest of three children and the only overweight adult. The other two have no issues with food, exercise (as in, I require a lot of it to maintain and even more to lose) or weight. Ancedata, perhaps, but enough for me to say no to feeding schedules and metered intake.

Sounds familiar? What do you think?

Put slim-fast in that bottle!

Center for Eating Disorders did a nice little piece on why our current obsession with weight, extending now to the VERY young is problematic.

BTW, the study they quoted in the article is a pretty poor design and is counter to many, many studies which show that the majority of larger babies will slim down over time (United States Preventive Services Task Force, Serdula, Huh...)

One of my favorite studies was a long-term (birth to adolescence) study in California showing that the two factors most associated with unhealthy weight gain in adolescence were 1) parents who were worried about their young child becoming fat (and presumable fed to try to avoid fatness) and 2) problems in the early (toddler/preschool) feeding relationship (conflict, power struggles...) Being breast fed, feeding low fat milk, waiting to start solids were not protective against adolescent weight gain. (The study did not address eating disorders.)

We can do more to prevent childhood obesity (and disordered eating) by supporting best feeding practices from birth...

Here is an excerpt from the article:
Consider moving away from a hyper-focus on weight, body type, BMI or any other calculator of weight. Like most efforts involved in parenting, it’s not an easy task to accomplish particularly when it seems like every newspaper article, concerned relative, or public service campaign is telling you to do the opposite. Do your best to focus instead on your child’s overall health (remembering that weight does not = health). Honor and accept your child’s natural body size and shape. Create positive goals around eating that involve paying attention to your baby’s or child’s internal hunger and fullness cues instead of relying on external messages about how much is “too much”.

*The photo is me around 1 year. "Obese" by today's standards and bottle-fed!!! E-gads!

Are you a mom of an infant? Are you worried already about your child's weight? What messages are you getting from your doctors, the media?

body diversity in Children's shows II: Lilo and Stitch

Most Children's shows seem to take their cues from Keeping up with the Kardashians with the Bratz-doll look-alike Disney fairies and an apparent obsession with short-skirts, glitter, fake eye-lashes, dating etc.

Most shows that do feature children of different size have the caricature of the fat child or animal (think the gluttonous and out-of-shape cat on the latest Shrek) who is funny, lazy, silly, stupid, mean, or all of the above.

I wrote awhile ago about a show called Caillou for the younger set, and I've recently let M watch Lilo and Stitch (Netflix, commercial-free electronic babysitter while my childcare issues continue...)

Lilo is active, has friends of all sizes who are active. There is no mention of "being healthy" or using someone fat as a cautionary case.

As a bonus, none of the little girls seem sexualized. I have to say, I don't like all the teasing, the "mean-girl" language about how she is "weird," but overall it's one of the least offensive shows out there.

Are there books, shows etc that you like in terms of body-diversity? (I'd be curious if there are any ethnically diverse shows out there in any real way...)

nutrition "education," calorie counting for the preschool age

I was enjoying the local farmer's market this weekend and sitting next to my daughter who was coloring at a lovely little shaded area with beanbag toss (based on the food pyramid-ugh) when I read this piece of cow-dung. I was only happy that my little M doesn't know how to read yet.

The bottom part if you can't read it says: (exclamations are theirs, not mine)

Circle the healthiest choice (fewest calories)!

Ring the cowbell!

1/2 cup diced fruit salad (60 calories)

1/2 cup diced fruit salad with 2 Tbspn orange juice (88 calories)

1/2 cup diced fruit salad with 2 Tbspns light yogurt (96 calories)

Oh, where to begin!!

Nutrition education for children has the potential to do great harm. I wonder why adding yogurt is not "healthy" or the assertion that the definition of "healthy" is low calorie. Low-calorie and low-fat diets fail nutritionally for small children (and fail for adults too.) I won't elaborate on why this is garbage "nutrition" info which is more harmful than helpful. (Think of a table of first grade comparing calorie and fat counts in the name of health-it's happening people.)

I spoke with the nice folks who worked for this farm/education group and explained that I was a family doctor and feeding specialist and that their info was wrong and dangerous. I also said I would not stick around for the cooking demo (fruit salsa, could be great, but don't want M hearing about "healthy" eating from these folks...) The lady explained that they had a dietitian come up with the materials and that they "struggled" with them.

Brother. Stop. Don't wade in where you are not qualified, don't promote more craziness around food. Why not just color in the picture and talk about all the delicious foods at the market, talk about how gorgeous the colors are. Do your demo, be positive, be happy, let us taste the amazing fruits of our farmer's labors, just leave "health," calories, fat out of it. It managed to do what so much nutrition and health info does these days, take such potential and passion and energy- and poison it with misinformation and misguided food moralism.

(BTW, I couldn't help saying, "More cowbell!" ala SNL. I thought I was pretty clever...)

Keep your eyes out for garbage nutrition messages aimed at kids. Share them here! I think you'll be surprised what you find when you open your eyes...

feeding with ED in the kitchen, will you share your experiences?

This comment to a recent post made me teary. This is why I do what I do.

I am finding that about half of the mothers I work with on feeding issues will share a history of an eating disorder with me. This is an area I am really interested in. Would you share your story? How does feeding children trigger or heal you? Can you see potential for your own healing through feeding your children? Tell me whatever comes to mind. Are you struggling in recovery? Did you grow up with a sister or mother or brother with an eating disorder? Do you worry about it when you feed? Is it changing/spoiling your feeding?

"thanks for your blog....i have been bulimic for 18 years now (wow thats more than half my life) that i STILL struggle with... I am scared to DEATH of passing on my ed to my kids...and your easy intro to the family eating question has me making healthier choices and feeling far more at ease with what my kids eat....i have learned to quit freaking out when one child refuses to eat nothing but meat and potatoes (she obviously needed the fuel...she shot up 2 inches in the following week...and went back to normal eating after the growth spurt) ...and to see their rythms as natural....i have healthy food available for snack times and cook balanced meals.... thank you for taking the great fear around food and the family that i had."

I am out of town, but am working on some thoughts about feeding when you or a loved one are in recovery, your comments will be really helpful...

the aspirations we have for our little girls... depressing

Girls book of Glamour. A Guide to being a godess..

(Girl in the tub scrubbing her dainty, surely 'fiercely' polished toes...)

The Boys Book of Greatness, how you can be the best at everything... (boy playing hockey)

This in the tween section at Target.

Ugh. This makes me crazy, but doesn't surprise. Anyone who has been shopping in the traditional toy stores see "girls" items: dress-up princess clothes, "heel-highs" as M calls them, slutty looking dolls, make-up kits, spa-play, tiny compact mirrors, cell-phones. The most active her make-believe roles might get is to make-over animals at the puppy salon, or be a contestant on American Idol...

I am out of town... Will try to reply to comments when I get back...

Boys on the other hand can be fire-men, police, work in construction, sports, rockets, etc. (OK, so there isn't really the accountant or MBA action figure, but their roles and fantasy lives are not encouraged to be based solely on their looks and outer appearance.)

It seems to be getting worse, it seems unstoppable. It makes me sad. It makes sense that most tween girls are dieting when they have been fed a steady intake of body-image damaging and distorting garbage from birth it seems... Sorry for the rant.

ignoring the weeds and loving our bodies

I've spent a bit of time in our yard recently and realized that I don't enjoy it. I only see the weeds. I sit in my swing that I longed for, and pop up after about 3 minutes to pull weeds. Yesterday I walked by the side of the house, bent down to pull a bunch of weeds–my head was 3 inches from some gorgeous and delicate pink roses– but I didn't even notice them. I stood up to move on and caught a hint of their delicate perfume. I stopped. Looked at the roses, bent down and inhaled their fragrance. It calmed me, it made me happy. It got me thinking.

I hear moms say all the time, "I don't want to pass my body issues on to my kids." How many of us spend our lives only seeing our own "weeds" and ignoring our wonderful bodies? Do you look in the mirror and only see the pimple, the tummy roll, the bulge under the bra strap? We miss out on so much wonder and beauty, and spoil the experience of being in the garden ("life"-sorry for the cheesy metaphor) when all we see are the weeds.

It's not easy to turn this around. But here are a few thoughts. Consciously think about good things about your garden-body. At first this will likely take considerable effort, but let's rewire those brains and see what happens!

Write them down if you have to. Five things every day. Like,
1) "I went for a walk today and my feet didn't hurt." (I've had major feet problems over the years.)
2) when I smile, others smile back at me
3) It felt good when I got a hug this morning. M likes sitting on my knee and giving me hugs.
4) My hands can cut a red pepper into one long strip that coils up and is fun to eat.
5) I liked talking to my friend on my walk today, and I wasn't out of breath, even on the uphills

Focus on what feels good, what attributes you are proud of. This is not easy. We have largely been raised in a culture that encourages us to judge our worth based on our appearance, with a wholly unattainable ideal to compare to.

If you worry about passing on a negative body image to your children, maybe fake it at first. Start with being very conscious about not saying things out loud in front of your children. ("I hate my thighs," or "I can't wear a bathing suit with my tummy hanging out...") Both comments I have heard from women varying from sizes 0 to 18. I know I have far fewer "bad body" days since consciously watching what I say and think (it's pretty effortless now) for the sake of my daughter initially, but I have been happier as well.

I'm currently reading "Life Doesn't Begin Five Pounds From Now" by Jess Weiner about stopping the fat talk. I've also read Roth's "When You Eat at the Refrigerator, Pull Up a Chair." which I thought was fine as well. And remember, studies show what we know in our hearts, self-loathing and shame are not good motivators for being happy and taking care of ourselves. So back to the garden metaphor. Take time to smell the roses, and ignore the weeds. Fertilize your little garden with things that refresh and fulfill you. A walk? Some funny TV, spiritual practices, a few minutes with a book and some good chocolate?

A disclaimer: I am not an expert on this issue, and would love to hear from my readers about helpful resources etc. Am I off-base? How have your lives changed if you've been able to "rewire" your brain and forget the weeds, even if just for a little while?

serenity in feeding

Well, summer camp has started, I'm on day two of antibiotics for strep (3rd time in 2 years-any adults out there had their tonsils out? I'm a little nervous...) so I need a little serenity. This is something I've been mulling around for awhile, though probably not the most original.

Feeding kids can feel crazy, from their irrational food preferences that change by the minute, to the societal pressures moms feel to do everything "right" (have a kid who happily eats all fruits and veggies, has impeccable manners, has a BMI between the 25 th and 50th% if she's a girl and between the 75 and 100th % if he's a boy...)

But, there are things with good feeding that we can and can't control. Feeding with the Division of Responsibility is a leap of faith. It's countercultural so you often won't get support from your family or friends, it goes against every media story or cultural norm to suggest that children can be trusted to eat a balance of good foods, get nutritional variety and eat the right amounts of foods, IF we do our jobs with feeding.

So here's my serenity prayer for feeding...

Grant me the serenity to accept the things I cannot change

• my child's genetic weight (may be high or low, can be healthy)
• my child's temperament
• my temperament
• my feeding history
• my dieting or eating disorder history
• finances? kitchen set-up?

courage to change the things I can

• feeding without pressure
• being reliable about family meals and structure
• offering a variety of foods
• my attitude about my body
• my attitude about others' bodies
• my cooking skills
• my "picky" eating
• focus on healthy behaviors, not numbers on the scale

and wisdom to know the difference

• education
• trust
• seeing those little changes and building faith
• reading books, resources, attending workshops...
• getting help

(Knowing the difference is the key! This is where I hope to spread the word...)

Mom, what's a "diet?" Dealing with the "D-word"

Sunday morning I'm reading comics to my daughter and found again that there were at least three that I had to "edit." (Pretty typical for the 'comics' these days.) One was about gastric bypass (the snowman missing the middle ball) another, "Do these pants make my tentacles look fat," and another about dieting. It brought back a comment a reader wrote after my last post.

"I'm livid that we live in a world where a 4 year old is already getting messages about what is and isn't acceptable in terms of body size and food choices! I thought I wouldn't have to start fighting this until about age 10 (which is when I unfortunately discovered dieting).

My 4 year old daughter brought home a "learn to read" book about being healthy...I saw "eat lots of fruits and vegetables"--okay, I can live with that. And "get exercise"--okay. But there it was on page 4: "eat only a little bit of fat" Argh! My daughter was puzzled--what's fat? Why can't I eat it?...
And then a week ago one of the teenage instructors at the ice rink told my daughter that if you eat a lot of pizza you'll get fat (I have no idea what the context was). Suddenly my intuitive eating child is questioning her choices. (read my comments on the blog for my reaction to this gem of an ice-skating teacher...)
So the question is, when the topic comes up how do I talk about dieting in a way that does not encourage the behavior?"

Remember, we're talking about four-year-olds here- they are pretty unsophisticated. (I remember working at a summer camp and getting the kids ready for swim time. The 3 and 4 year olds were all running around naked and one kid had underwear on and they all teased him, "I see your underwear!") My first advice is "EDIT" when possible (notice it's an anogram?) As much as possible, try to edit, or not expose them to notions of dieting, weight loss etc. But, as my reader noted, it is near impossible in the world we live in.

First, when a child asks you about a diet, or fat, or Weight Watchers, ask them what they think. You may learn that they are not really that clued in, or that there is something that you can clarify. EDIT your answer, a 4 year-old doesn't get the complexities, and you need to be careful not to confuse with too much information. Try to stay neutral and pleasant during the conversation. If you are unable, because of issues with the D-word, ask a partner, or trusted adult to take on the issue. Again, a few sentences might be all it takes. I would also be careful not to lie.

Here are a few ideas, then I'd love to hear from you all.

On the topic of eating fat, you could say,

"That book is wrong, and we know better now. Fat is good to eat, we need to eat fat to live. Avocados, nuts, ice-cream, salad dressing and butter have fat in them. Fat can taste pretty yummy! We're lucky we get to eat lots of different foods, including fat."

On "dieting,"

"It means that people don't eat as much as they want, or the foods that they want to eat. They might feel hungry allot. I wouldn't like to feel hungry all day. We don't eat that way in our family. We eat when we are hungry and stop when we have had enough."

or

"It means that you don't listen to your tummy to decide how much or what foods to eat. When people diet, even if they are hungry, they might not eat. That's not good for your body. A good way to eat is to eat when you are hungry and stop when you have had enough, and to enjoy lots of different kinds of foods like we do!"

Ask your child if that makes sense, and then move on, change the topic.

Older kids will have more of a framework and logical thinking to explore the topic further and I will address that in a future post. I am not a child psychologist, but just a few thoughts! I'd love to hear what you think. It's a great exercise to have the words ready for when the inevitable questions come up... Am I way off base? How have you handled this?

nutrition education overload and the power of peer pressure

My almost 5 yo daughter suddenly wants to be a vegetarian. I'm getting quizzed if her packed lunch has "meat" (see post on telling kids where meat comes from) or not. The swift onset of the power of peer pressure is awe inspiring. One of the "big girls" (6 year olds) is a vegetarian as is one of the teachers. I asked why she wanted to be a vegetarian and she said, "Because E is."

M loves meat, she loves turkey curry and a wide variety of foods. I assume (hope) that like Princesses and Care Bears this will be a passing interest.

I don't lie, but I don't really come out with all the details. "Is there meat?" To which I will answer, "You have noodles and ratatouille and steak and mushrooms," or, "Just shrimp today." That seems to satisfy her. When she casually said she wanted to be a vegetarian I simply said, "In this family, we eat meat." (Similarly how one can respond to the diet questions, "In this family, we don't diet, let's talk about this some more...")

I found out that at her school, they go around the table talking about what "protein" they have in their lunch. Makes me cringe. M has no idea what protein is. "Is melon protein?" She asked this morning after months of listing lunch-time proteins.

Kids don't need that much information. It's not her job to worry about whether she is eating protein or carbs. It is my job to balance her offerings, and her job to chose to eat them or not. (Division of Responsibility in feeding) Maybe later when she starts to think about planning meals and snacks we will talk about protein and food groups in the name of balance.

For children aged 3-6, a more appropriate questions might be, "What's your favorite thing in your lunch box today, or let's see how many colors we have in our lunch boxes today."

A big problem with nutrition education today is information overload, too much (often useless, even harmful info) too soon. One reader told of her 6 yo girl sitting at lunch counting calories after a nutrition class...

Are your children having "nutrition" lessons? What are they taking from them?

Kids labeled as overweight are LESS likely to be physically active: implications for Let's Move

Here's a post from Kataphatic that is a great example of a point I make in my workshops all the time: Children who are labeled as overweight (regardless of BMI) are less likely to be physically active.

"I didn’t hate gym class until I was in fourth grade, when the gym teacher singled me and several other fat kids out for extra gym classes and an “exercise worksheet” that I had to do at home (sit ups, push ups, stuff like that). Oh the shame of having to hang that thing on the fridge, not only as a visible reminder to the whole family that I was a fatty fat fatty, but also to remind me every time that I wanted to eat anything out of the fridge that I was a fatty fat fatty (hello eating disorder!)."

This is but one example of how we are harming more than helping with our efforts to combat the "childhood obesity epidemic." It is one of many that I have heard. It's not a stretch to think that schools will be doing more of this.

One of the Obama's Let's Move summary recommendations states: Developers of local school wellness policies should be encouraged to include strong physical activity components on par with nutrition components. (Oh, and pediatricians and dentists should measure BMI and be sure to do obesity prevention at every opportunity... More labels anyone?)

Take this next quote into account as well from Jon Robison PhD in an article, "The Childhood obesity epidemic," what is the real problem and what can we do about it? about the very people who will likely be developing those "wellness" policies...

“In a recent study, teachers who were most likely to be involved in a childhood obesity prevention program demonstrated a low level of knowledge related to nutrition and weight control and a very high level of body dissatisfaction and self-reported eating disorders.“ He goes on that eighty-five percent of the teachers recommended very low calorie diets (one of the most discredited diet strategies of all with a greatest potential to harm) to adolescents- many of whom were also in their adolescent growth spurt.

Just saying. Kataphatic brings it home. Generalizing and funding a wide-scale repetition of her experience makes me want to scream (and home school.)

On another note, I still remember as part of the Presidential Fitness program (which Let's Move is trying to expand, expand, expand) I had my skin-fold measured which we were told measured body fat. Though I was crazy fit and swam and ran competitively, I had the highest measure. I still remember Mr. B announcing it and feeling embarrassed and confused. I can only imagine if I was bigger or was teased how that would have compounded things. The point is, it was a big deal. It is etched on my memory. (My friend and track rival had the lowest level, which was also a boasting point for her...) How pointless it all was, with such potential for harm.

What were your experiences in school around weight and physical activity? Did well-meaning interventions hurt you?

Me and Meme Roth on the same page!?

Meme and I present two very different approaches to dealing with the pediatric "obesity epidemic."

Current paradigm of control, restriction, avoidance, external cues for eating...

or

Trust Model of eating with balance, following internal cues, feeding with structure and permission...

What do you think? Have you tried one or the other? What have the results been?

an article about weight that does not induce panic?

"Researchers and doctors are starting to understand that eating healthy foods and getting exercise can matter more than the number that appears when you step on the scale."

"A little physical activity" twice a week was enough to ameliorate some of the harmful effects of a sedentary lifestyle."

"An Australian study found that people in their 70's who were overweight were less likely to die in a ten-year time span."

These are a few quotes that are refreshingly different from the general hysteria about weight from a recent Post article. A few months ago the Post exhorted women to partake in 60 minutes of vigorous physical activity a day if they wanted to stave off weight gain associated with aging. (The natural and as these studies suggest-protective weight gain associated with aging...) Every time you turn around you read about the perils of being "overweight" or "obese," how your pudgy child will die an early death of diabetes and misery.

There is a whole body of research out there that questions some of our most basic assumptions about weight and health, and the fact that even some of them are getting press is exciting.

I think it's a nice start. (Though the article fails in it's discussion about "obesity" in that most studies do not separate once folks get above a BMI of 30. Much of the risk associated with "obesity" does not appear statistically significant until the BMI is over 35 or 40... Just a note on how the statistics can be manipulated or not fully disclosed or understood.)

Thoughts? Did you see this or other "whistles in the hurricane" of health hysteria?

"watch your size" or "accept your body" are not the only options

"How can you simultaneously encourage your daughter to watch her size and accept her body?"- Asks a recent article in the NYT.

Already annoyed by the title. It implies that your daughter isn't capable of accepting her size and accepting her body simultaneously. It implies that she can only accept her body if society deems it "acceptable."

Accept her body, or "watch her size" which means consciously trying to maintain or change her size. One large Minnesota study found that teenage girls who practice "healthy" dieting or weight management measures like "watch what they eat," "watch portion sizes" and "try to eat more fruits and vegetables," are heavier than their peers who have never dieted.

Aside from the title, the article also implies that making "small changes" will result in big weight loss. Small changes might make someone healthier or feel better, but likely won't make them lose weight. I wish the article had been a bit more rigorous, less lazy in it's acceptance of many assumptions about weight and more.

I remember a mom of a healthy nine-month-old girl in one of my first talks crying, "Every time I feed my daughter I feel like I'm on a knife-edge between anorexia and obesity." She was one of the reasons why I started Family Feeding Dynamics. I hear similar questions, though less extreme (or honest?) particularly from parents of tween girls. Fear and anxiety are pervasive in some mothers (and fathers) and is effecting the way they feed their children.

What is largely missing in the discourse of obesity vs "healthy" or eating "right" is the model of normal or wellness. (Setting aside for a moment the weightist assertion that you can't be "obese" and be healthy, or that you couldn't be eating well if you are "overweight," or the assumption that low body esteem causes eating disorders...)

Parents, you don't have to live on that knife-edge. Your only options are not obesity or anorexia. It's not just- "let your kid eat whatever they want and not give them a complex, or crack down on portions and forbidden foods and risk a child with low self-esteem and an eating disorder."

There is an alternative. There is normal eating, there is eating competence, feeding well. You can lead by example, feed with love and structure, provide a variety of tasty foods at a pleasant table and not make a big deal about it. Lecturing about eating to prevent disease and illness, feeding from fear and control doesn't help children do best with eating or feel best about themselves. (Two awesome resources are Child of Mine:Feeding with Love and Good Sense, and Your Child's Weight: Helping Without Harming, both by-you guessed it, Ellyn Satter.)

What do you think?

don't let your child's doctor label your child "obese"

Recently I talked to a pediatrician who shared that any child with a BMI over 85% ("overweight cut-off") whether there is a health concern or not will get an official "diagnosis"code of overweight or obese. This means it will become part of the child's medical record list of diagnoses.

Once this BMI > 85% is recorded, that family gets a handout on how to do things better (that handout means the doctor can then bill for services on obesity counseling.) It has advice like: no more than 2 hours of TV a day, no more than 4 ounces of juice, and my favorite- one hour minimum of uninterrupted aerobic activity outside of school (how likely is that for most kids every day.) Strap a pedometer on your kid for 10,000 steps a day! That's like, 4 miles plus. Or, don't let your child be sedentary for more than 30 minutes at a time. So do you have a stopwatch while Timmy is doing homework and have him run laps in the basement?

I digress...

Why does it matter if your doctor "diagnoses" and codes/labels your child as "overweight" or "obese?"

1) your child is open to possible discrimination in terms of future employment, health insurance etc (not sure I believe totally that the health insurance reform will deal with the "pre-existing conditions.") There have been cases where children have been denied insurance because they were "overweight," and also "underweight."

2) labels and shame are not good motivation for positive change. (Are you listening Jamie Oliver?) In fact a child labeled as overweight or obese, regardless of BMI is more likely to feel flawed in every way, more likely to diet, practice disordered eating and gain weight. They are also less likely to participate in physical activity. Words matter.

3) once something is in the chart, it is hard to get out. Think about this. Before any physician, lab tech or nurse meets your child she will see that label on the list of diagnoses. It is well known that medical providers have a bias against "overweight and obese" patients.

• CDC: "BMI is used as a screening tool to identify possible weight problems for children." and "BMI is not a diagnostic tool. For example, a child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings." I doubt that the diagnosis of obesity put into the chart is based on anything other than BMI which often mislabels the individual...
• "BMI is not a reliable predictor of health": American Heart Association
• Child BMI not reliably predictive of adult BMI: United States Preventive Services Task Force: "a substantial proportion of children under 12 or 13 even with BMIs > 95% will not develop adult obesity." (note, there is increasing predictability as BMI increases and the older the child is)
• a child growing consistently, even at a high percentile is (by definition of the bell curve) larger than the majority of her peers, but to label her as "over" weight when it is likely a perfectly healthy weight for that child is wrong and implies a health risk that is likely unfounded.

Thoughts:

At your next pediatric visit, if your child's doctor discusses your child's weight consider this:

1) ask that she do so without your child present

2) ask that the physician not code for or put the diagnosis of obesity in the chart unless there are further diagnostic tests (take in the above quotes.) Point out that BMI is a screen, not a diagnostic test.

3) ask to see the growth chart. If your child is large, but the growth is stable, there is likely not a problem. Ask your doctor to look at the rate of growth. They may not understand or accept this.

4) it is reasonable to look further if there is acceleration of weight gain, or your child is increasing in percentiles. There could be a medical problem, or getting help with feeding might help. (Read Your Child's Weight: Helping Without Harming, Ellyn Satter.) It could also be a pre-pubertal weight gain or otherwise normal pattern, but acceleration or deceleration on the growth chart warrants further eval.

if you get handed one of those handouts consider this

1) ask the physician if their children do one hour of uninterrupted daily exercise outside of school or wear a pedometer.

2) mention that if it's such useful advice, every child should benefit from it

3) point out that there is at best conflicting evidence about the efficacy of any of the interventions mentioned. Don't get me wrong, watching 8 hours of TV a day is not ideal for any child, but no studies have shown that recommending limiting screen time in the primary care clinic setting lowers BMI

4) if you are already doing the behaviors on the list, let them know

Just a couple of thoughts. What do you think? What have your experiences been with your children and getting labeled by the doctor?

Casualties in the war on "childhood obesity"

Please read this poignant blog post by a "former obese child."

She covers eloquently, all the reasons why we have to be so careful with language and our public health campaigns and zeal to "help." I fear that this is going to get worse before it gets better.

Label a child as obese or overweight (whether or not that child is healthy or growing in a way that is right for him/her) and s/he will:

• feel flawed in every way
• feel less capable
• be more likely to diet (and gain weight,)
• be more likely to engage in disordered eating behaviors
• be less likely to engage in physical activity

And yet, there is a huge push to identify and label children. It doesn't help and often makes matters worse. (With the electronic medical record I fear a whole new layer of harassment and misdiagnoses.)

FYI, the little boy in the picture is "obese" according to current CDC guidelines via BMI...

Share your stories about you or your child being labeled and the consequences?

Here are a few lines from the post from Fatshionista:

"I never had any weight-related health issues...But I began to diet. I did! In elementary school... My pediatrician sent me to a dietician, who prescribed daily menus in strict portions.... As the years passed and I ventured into the numbers-obsessed indoctrination of Weight Watchers and Jenny Craig, my standards become tighter and the “good” food list grew ever shorter... " (My note-this would be the "control model" of eating and dieting.)

"I was extremely hungry, you understand. All of the time... When I’d managed to eat so little as to feel tingling in my extremities and a racing feeling in my chest, I knew I was Doing Well On My Diet."

"Eventually I would surrender, devastated, heartbroken, and eat normal food again, and then the lost weight would return, plus more. And then, after that, I would marshal my forces and make a fresh attack on my fatness, one which would be doomed to failure like all the rest. I would return to exercise; but not the exercise of my younger days, playing games with friends, having fun. Exercise became a chore."

what is competent eating?

I really like this blog post over on fatnutritionist.com

I met Michele. She's amazing and doing important work. We are both trained in Ellyn Satter's Eating Competence model.

book review: End of Overeating

Bottom line: skip it (the book, not my brilliant review)

David Kessler MD shares his quest to find out why he is a "conditioned hypereater," why certain foods "won't relinquish their hold" on him. The good news- the book has some valuable insights about the American food industry and its calculated, money-making opioid-releasing mixes of fat, sugar and salt, but misses out on major players in why we eat the way we eat- namely restriction and physiology.

There is one paragraph in the book that basically dismisses restriction and dieting as contributing significantly to out of control eating, yet most of his anecdotes pulse with avoidance, restriction and the ghosts of failed diets.

He relates going to NYC and thinking the whole time about a certain ice-cream parlor and how his wife is like an AA sponsor who keeps him from indulging. Maybe dopamine (the "I want it") hormone spikes BECAUSE he thinks he "shouldn't" eat it. There are studies that show that scarcity of food increases dopamine, so why wouldn't self-imposed scarcity (diet and restriction) lead to higher dopamine and obsession with food? He goes on and on about dopamine and the intense wanting of "forbidden foods" but blames fat, salt and sugar alone. Sounds like a fun trip to NYC. (Plus his repeated graphic descriptions of fat on sugar on salt felt like self-indulgent food porn.)

He also barely mentions physiology and blood sugar, hormones or the stress response...

Are these "cravers" providing regular balanced fuel for their bodies or crashing from famished to stuffed with similar spikes and drops in blood sugar and insulin levels? Are they skipping breakfast and lunch to save up calories only to lose control at the office? A person who has fasted all day will be frantic with hunger, and the NORMAL survival instinct is to eat- a lot.

His solution?

Restrict more! Be "flexible," but only eat things that don't trigger you. Have a meal coach berate you for eating too much. Be responsible to your family so that when you "fail" you will feel that you let them down. (Lovely, more guilt and shame, which we know are not positive motivators for change.)

His one size fits all prescription of avoidance, more restraint (though with lots of nice cognitive behavioral language around it) is really more of the same. Want a treat? A single piece of chocolate or a small frozen yogurt should do it- but not yet-maybe after several months of complete abstinence! He implies weight loss will happen if you can just say no-enough.

Dr. Kesslar does not once mention the notion that you CAN learn to eat in a competent, inclusive and joyful way that is grounded in permission, joy and discipline (yes, you have to provide regular meals and enough variety for yourself.)

There is no joy, no balance, no permission.

Consider a competent eater scenario... (see Ellyn Satter's definition of Normal Eating)

Why not look forward to the ice-cream in New York? Plan to enjoy it. Savor it, be in control and then move on and enjoy the other wonderful things in NYC. Eat a good breakfast with some protein, fat and carbs, then plan on a nice meal and ice cream for dessert or skip the meal and enjoy the ice-cream for lunch. Enjoy window shopping and walking through Central Park. (Imagine, actually enjoying NYC, not obsessing about how you can't have ice-cream the whole time!)

Yes, fat and sugar and salt taste good, and they release pleasure hormones, but it doesn't mean these foods can't be enjoyed by competent eaters in a positive way-does it?

The book left me dissapoointed and sad for the many who will read it and think all they have to do is try harder.

"Food might not be addictive on its own, but prohibiting it can set off a cycle of anxiety, craving, and overconsumption that for all purposes looks like addiction."

(can't remember the source, but I love this!)