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?

moms speak out, "two-bite rule" and listening to your gut

Thank you to those who filled out the survey. I can only assume from those who chose not to that I am doing everything perfectly! (Just kidding, but why not go with the self-affirming assumption?)

Many wanted to hear from other moms who are in the "trenches."

Here is a great comment from a reader about the two-bite rule (or the on-bite-rule or the 'no thank-you bite'...)

"I am personally sooo sick of hearing about "just try it" and "two bite" rules. Especially the accompanying insistance that their application will turn my son from a neophobic eater into an adventuresome eater. I can only assume that this technique works for some kids because it sure is popular.

We only had to try it a few times to realize that it didn't work for our son. The instant that he is told he has to try something he immediately assigns it to the "I don't like it" category. And foods are seldom removed from this category once they are placed in them... Also, to actually get him to try something he doesn't want to requires an EXTREME amount of pressure, so extreme that I know it has to be wrong."

The pressure moms feel to get their kids to eat "right" is also extreme. Many, knowing that it feels wrong, slog through joyless meals, miserably doing as they are told to get the pyramid into their kids every day. My favorite quote? "Dinner feels like 45 minutes of hostage negotiations." The reader is right, it does 'work' for some kids, the easy-going, adventurous kind perhaps. It even works for one sibling, but not the other. Trust when you feel that something isn't working. If you dread feeding and meals, something is wrong.

Or the mom with the son who is rapidly gaining weight who was scolded by the doctor, "You're the parent here! Step up and don't bring that crap into the house!" Well, now her son is being shunned by friends because he cleans out their pantries of all the forbidden foods when he hangs out at their homes. She KNOWS it feels wrong, and it's not working, but the doctor told her to do it, and hey, she's a bad mom if she doesn't, right?

What feels wrong to you?

"But I'm too full for dessert!": and dealing with pressure from family/friends

When we were with family last month, we did things a little different. I try to follow the general flow of others when we are staying with family or friends. I don't ask for dessert with the meal for example. (I do, however stick up for my child if she is being pressured to eat something or limited-and I will give a few examples at the end of the post.)

Well, we had wonderful foods, and occasionally we would have dessert. It often wasn't decided until the meal was almost over what and if dessert would be...

Poor M... A couple times she would finish eating and then our hostess would bring out these delicious little yogurts. I remember her crying, "But my tummy is too full for dessert! I want dessert, why didn't you tell me there was dessert!"

I didn't want to impose serving a child-sized portion of dessert with the meal as we often do at home (in fact, M has gotten pretty good with food regulation-knowing how much to eat-that we often give her the choice of when to have her dessert at this point.)

So, I talked with the cook/main meal-planner before the meal to determine what she wanted to do for dessert. I then told M before the meal if there was dessert so she could "save some room." This seemed to work out fine. I wasn't sure how it would go, but I remained curious, stayed true to the Division of Responsibility, and it worked out pretty well. (I often was happy for her to have "dessert" yogurt since she is still not a big milk drinker and we try to offer other sources of calcium-rich foods.)

It showed me again though, that she is listening to her body. She did not stuff it in just to enjoy the dessert. We also remained flexible and curious to see how things would go. We don't always get things right the first time :)

A few examples of pressure you might encounter and what you might say:

grampa: "If you take that piece of toast, you have to finish it all."

you say: "Actually Dad, that's not how we do it. Please follow my lead. Billy, why don't we start with half a piece, and if you're still hungry you can have more."

waitress: "You can't have dessert sweetie, until you finish your broccoli!" (really!)

you: "You are getting no tip." (just kidding)

try: "We're doing just fine here. Please bring her dessert now. Thank you."

gramma: "Let's hide his bottle. He's distracted. He eats too much and haven't you heard that obese babies will be fat adults and die before you and get diabetes and, and, and ..."

you: "Gramma, we like to let little Timmy decide when he's done eating. He'll let us know. May I have his bottle back, please?"

Uncle Bob: "You'll hurt Betty's feelings if you don't eat any of her sauce."

you: "Oh, Bob, that's silly! We love Aunt Betty, and thank her for making dinner, but we don't eat anything we don't want to. I'd like some sauce, please."

School: "You have to eat at least half your main food before you can have dessert."

see post... on teaching kids to overeat

how do you deal with it when family/friends/teachers pressure your child with his eating?

interview on PsychCentral: feeding kids and our cultural "ab-norm" with food

Please check out an interview I did with Psych Central coming out in three parts this week.

Today's topics:

Where did we go wrong

more about the feeding model I work with and how I found it

what are the keys to raising kids who are competent eaters

We have our water back, but it's brownish and supposedly full of lead. I'm starting to pack and do final preps for a conference in Colorado Thursday and Friday, so again I am grateful for the lazy post! Moms who work outside-the-home (or home business,) how do you juggle it all! How long do you ever feel you have the 'balance' between work and family down? (I sure don't right now!)

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?

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...

morning TV and the best quote from Governor Huckabee

So I was walking on my treadmill yesterday flipping through morning TV (we are going to get a DVR box as I can't stand live TV, especially in the mornings...)

So the Huckabee Show was on Fox. He had three "experts:" Meme Roth, Miss Plus-sized Elite and Kathy Ireland. Same old same old from the guests (Meme-"but obesity is the devil!!!"/Miss Plus-sized "accept and love yourself...") but Huckabee came out with a few choice lines given his history...

I paraphrase as accurately as possible without a rewind or text:

"For the six weeks I'm doing this show, I'm back on my rigid health plan and I've lost 14 1/2 pounds in two weeks!" cue wild audience applause... (BTW, he looks somewhere in between the two above photos if you're interested...)

"But it's not about weight, it's about eating right and being healthy, and doing it for your Creator, or your family..."

Huckabee is the former governor of Arkansas (Also author of Quit Digging Your Grave with a Knife and Fork...) who brought in BMI monitoring to Arkansas schools, intense obesity prevention- in the standard approach- and celebrated having the first state to halt the increase in overweight in children (0.1% reduction.) Except that this was actually a national trend that other states also experienced without the expensive and potentially harmful intervention, and over the same time period in Arkansas, African American girls experienced continued dramatic weight increases, and the number of "underweight" children increased...

I try not to be snarky (not trying very hard this morning) but I guess he decided to pick up that fork again. He talks like it's easy, that anyone can "eat right and exercise" (like Meme Roth who won't eat until she runs 4 miles a day, even if it's in the afternoon) that anyone who honors God should be able to lose weight. His personal story makes me sad for him. Years of misery, self-loathing and crash yo-yo dieting, jokes about his large children etc. What I don't feel sorry for is his preaching, his use of his position of power to shove the same nonsense about weight loss, restriction, dieting (though couched in more palatable terms) on the public at large.

Ugh. I hope someone out there appreciates that I watched a full 10 minutes of Meme Roth and Huckabee so you don't have to! (By the way, The View featured "cleanses" that were "healthy and not a diet" with between 1000 and 1200 calories, and also had a family that "banded" together (the whole family, minor children as well had lap band.) I did not watch this...

SUGAR: trust your body, not your brain, oh and fat women can self-regulate too...

Here is an interesting article about sugar, weight and internal regulation. This apparently replicated findings on a similar study done on 'normal' weight women.

Basically they took 'overweight' women (25-30 BMI) and fed two groups with a sweet beverage. One group had artificial sweetener and the other had a sugar sweetened drink. Neither group knew what they were drinking.

The coolest part? The women who drank more calories from the sugar sweetened beverage consumed less throughout the day. When their minds were taken out of the equation, their bodies regulated and compensated by consuming fewer calories. Those 'fat' women were able to self-regulate. They could trust their bodies.

(Different studies show that when women THINK they are eating low-fat yogurt for example, but it is high in fat, they actually eat MORE throughout the day. The so-called "halo" effect means people tend to eat more if foods are labeled low-fat or even organic.) The body does a better job than the brain. (Internal vs. cognitive control of intake.)

A few quotes from the article:

"The results show that overweight women do not suffer adverse effects, such as weight gain or mood fluctuation, if they do not know whether or not they are drinking a sugary or artificially sweetened drink. Instead women took in fewer calories elsewhere in the diet, to balance the calories in the drinks."

"Widespread publicity about the supposed harmful effects of sugar may make such effects more likely, as believing sugar to be harmful may encourage negative emotions after eating sugary food and lead to the abstinence violation effect."

Have you experienced the "abstinence violation" effect? In other words, the binge after the diet? The being 'bad' after the being 'good?' The "I've been starving all day and now I'm, stressed and can't hold myself back anymore?"

The good news is we can trust our bodies. We just have to learn how to get our heads and all the crazy around food out of the equation...

harmful assumptions abound; calorie counts and BMI

Recently a study found that most Americans don't know how many calories they are "supposed" to eat in a day.

"... some simple calorie know-how would go a long way toward helping people lose or maintain their weight. " Really?

It went on in the typical manner of "tsk, tsk, if the people only knew how many calories they needed to eat, we could finally tackle the obesity epidemic."

This is an example of a cultural belief that goes largely unquestioned that more information, more cognitive control, more knowledge of calories/fat grams would help. I would posit that it is as likely to be harmful. Are there any studies that show that when people know how much, or what kinds of food they "should" eat that they are more likely to do it? I would guess that many life-long dieters and disordered eaters know better than anyone how many calories they should eat, the exact calorie counts of foods etc and still struggle mightily with eating and weight. If only knowing how much to eat would solve the problem, then Weight Watchers Point System would work, when in fact they have a similar failure rate of most diets around 90-95%...

Another example of unquestioned assumptions is the general belief that if only parents KNEW their child's BMI, had that note or diagnosis labeling their child as 'obese' or 'overweight' that we would finally get this childhood obesity thing under control! It is this thinking that is pushing ever more aggressive screening at doctor's offices and schools. Intuitively it seems to make sense, but several studies suggest that labeling children with BMI leads to MORE dieting, MORE disordered eating, LESS physical activity and MORE weight gain for children. Handing that parent the red-slip is more likely to do harm than help the child.

I would just like to see a little intellectual effort in our public health arena and health reporting.

Can you think of other "assumptions" about eating, health or weight that go unquestioned but are highly questionable?

do you know what goes on at your child's school/daycare?

Is your child being fed well at school, or are the feeding practices there making things worse. Recently I shared that M's camp doesn't follow the Division of Responsibility. You know, making the kids eat all their "real" food before they can earn the treat. My friend also disclosed that her son was coming back from his school with his "treats" because he wasn't eating enough of the arbitrary amount that the 22 year old counselors thought was enough for him to earn dessert. (Sorry for the snarkiness, but this is not OK.)
A recent article in the Journal for Nutrition Education videod several early childhood providers and their interactions with the kids around food.

There were TEN TIMES as many verbal cues and pressure episodes to eat more, or different foods that did not take into account or encourage the child to eat based on internal sensations of hunger and fullness. (380 vs 38...) There was lots of "two more bites of this" and "you can eat your dessert when..."

Remember that over time, children can be fed in a way that overrides and burries their internal cues which means they are likely to eat more or less then they need.

picky eating, size concerns: "don't worry about it" means different things to different people

A mom called me to talk about her teen who has been eating -almost exclusively- microwaved lean pockets for 7 years. At every doctor's visit she was told not to worry about it, that it was fairly nutritious, and he would likely grow out of it. A young pediatrician recently wrote in (A., I read your comment but couldn't find it when I needed to post! Sorry) to say when parents come to her with picky eating complaints, she too tells them not to worry. I probably gave similar advice ('mac-n-cheese is fine! Just add a multivitamin!) when I was a new doc.

I look back now at how naive I was, how misinformed, and how unhelpful ultimately to so many parents. You see, I grew up with structure, family meals, enough money for a wide variety of foods that were largely presented in a pleasant atmosphere free of pressure. (I think part of me assumed that was happening in most homes.) I had no training in feeding other than how to concentrate formula and calculate calorie needs for the "feeders and growers" in the neonatal ward, and I didn't have my own kids. (OK, a few lectures on breast-feeding and perhaps a review of a handout about starting solids, always the what, never the HOW to feed...)

In short I had no idea how many families struggle with feeding, how many moms truly agonize over intake or a child's size. I had no idea how many of the moms I was seeing had themselves struggled with eating and were terrified of feeding their child. I didn't know how normal it was for most families to feed children one meal (often the same meal of macaroni and cheese and nuggets) and feed themselves later, and how much energy went into trying to get the kids to eat more or different foods. I didn't know that most of these picky kids were "good eaters" early on but systematically coned down to an accepted menu of brown and beige foods because parents didn't know how to handle normal feeding stages, or fed out of worry over nutrition or size (see last few paragraphs of that post.)

I didn't know that most feeding advice (if parents got any) was counterproductive. I didn't know that most folks today (kids included) seem to graze most of the day. I had no idea how much pain and conflict was inflicted in the name of weight and nutrition. (The moms who call crying because a child is refusing to eat and is losing weight, or another child is showing markedly disordered behaviors at age 7...)

OK, back from "tangent land."

point 1) your doctor might not have a clue. There, I said it. I didn't have a clue.

point 2) your doctor may be giving you bad advice. Again, I did...

point 3) health care providers, be careful about saying, "Don't worry about it" in terms of picky eating or odd eating behaviors.

More on "don't worry"

for health care providers and parents, just to make it extra confusing :)

First you need to ask more questions about feeding. A normal weight or growth curve should not give false confidence that feeding is going well. As a parent, if you see a health care provider and you're worried, and you are not getting your concerns addressed, ask yourself some more questions, get help... (Or if you get advice that sounds off like, "Just serve beef and green beans for 3 days, he'll learn to like it..." don't give up!)

Docs, ask: (moms, ask yourselves...)

How is feeding going?

How do you/I feel about feeding?

Are you/we eating meals as a family?

Do you/I struggle with eating?

Do you/I continue to offer a variety of foods?

Are you/we getting into battles around food?

Are you/we worried about your/our child's size?

Are you/we familiar with or following the Division of Responsibility?

Because, "don't worry about it" might be just the right advice for a family that is otherwise doing well with feeding. Support and optimize good feeding practices.

But –and here is the sad part– a family that is really struggling who is told, "don't worry about it," as is often the case, is a missed opportunity. It is much easier to turn around a feeding issue when a child is 5, vs 15... "Don't worry about it" to some means, keep serving mac-n-cheese and nuggets every night so you don't have to fight about is as much. Keep bribing and pressuring, keep worrying. And maybe 5, or 20 years go by (seriously) where the child only eats 5 foods, or maybe the dieting starts or the disordered eating...

Ask the feeding questions, optimize best feeding, educate yourself (Child of Mine should be required reading in all med schools as far as I'm concerned...) or at least have some titles or handouts you can refer parents to. Don't worry, but do have family meals, do offer variety, don't feed with pressure, do eat foods you enjoy, and follow up.

Moms, have you been told, "don't worry about it?" Did you still worry? What wacky advice have you gotten about your feeding concerns? From whom? Family? Docs?

are "obese" people "hedonists" when it comes to food?

Yesterday's Wall Street Journal had an interesting article, Eating to Live or Living to Eat?
It talked about the impression that 'obese' people react differently to sweets and forbidden foods than 'normal' weight people. The notion that 'obese' people are hedonists and can't control themselves, that brain chemistry can explain the addiction to food. (See my review of End to Overeating for a brief discussion...)

Lots of the same old same old, 'obese' people are gluttons with a physiological explanation, but a few sentences stood out and gave me hope that we are starting to consider the feeding/eating relationship. They never come right out and say it...

"It's possible that these changes reflect how the brain has adapted to eating patterns in obese people, and that could create a vicious circle, putting them at risk for even more disordered eating," says Dr. Small.

I would have loved to see them talk about those "eating patterns" can we just spit it out? Dieting? Avoidance? Restriction? Years of yo-yo dieting where all of these foods have been forbidden, where maybe the obese subjects have a higher probability of having engaged in dieting? I would like to know. Did they include those factors in the study? (Of note, most obesity studies in children do not take into account at all the feeding relationship...)

There are plenty of other metabolic mysteries, too: Why are some "foodies" who get intense pleasure from eating able to stop when they're full and others aren't? Is the tendency to eat way past fullness genetic or learned behavior, and how much can it be changed?

Did they bother to ask about their eating styles, their dieting histories? Have their brains been wired for years that these foods are for pleasure or are these foods associated with shame, guilt, restriction and intense desire...

On people who have lost significant weight and kept it off through diet and exercise alone:

"They are very controlled individuals, and they are very rare. We had to fly some in from Alaska,"

I think that last part is my favorite sentence. Goes in the face of everything we hear about how simple it is to just eat less and exercise more!

Some of you may remember my favorite quote that these researchers might benefit from:

"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."

What do you think?

But I'm not hungry!! How it feels to be pressured to eat.

Twice in the last week or so I have been pressured to eat when I didn't want to. Most of us can easily tap into the feelings we get when we are not allowed to eat, or when we are on a diet. Most adult Americans are currently ON a diet. I know that if I can't eat for whatever reason for an extended time (more then four hours) I will get anxious, irritable, grouchy and food pre-occupied. But, it is not often that adults get overt pressure to eat more...

Last week I was eating lunch with M and Hubby and I was chewing something. M leaned over and kept trying to put a chip in my mouth. "Just eat it Momma!" I would turn my head away, and when I turned my head back, there was the chip, pushed up to my lips which I kept clamped shut. (Does this sound familiar? I watched an almost-toddler go through this very thing at a restaurant last week. Dad kept pushing chopsticks with food at her mouth and she repeatedly turned away, adding a swat every now and then...) "No thank you, " I said after I had swallowed. I think she thought it was funny because she poked the chip at me one more time. I could feel myself getting angry. My body was tense, I was irritated and focusing on my frustration with her, rather than on the eating experience. "In this house we don't eat anything we don't want to. Please stop."

Then again, last week, I enjoyed a large and satisfying lunch only to have the next stop unexpectedly be a place with lots of wonderful foods– and the chef was there. The chef was so eager for me to try the foods that she verbally pressed me at least a dozen times to eat X, Y or try Z. I found myself getting really angry. In spite of several apologies that I was already uncomfortably full (I also topped the meal off with a hot coffee on a hot day) she persisted. I finally said, "I am so full that I am uncomfortable, I am sure your food is delicious but I am just not hungry. It's actually making me upset that you are pushing me to eat." Yet, she persisted... Finally I tried a few bites, and I specifically said, "I am not hungry, but I will eat this to make you happy." (The food was delicious, which I assured her.)

What surprised me in both instances was how upset, angry and physically tense I became. I resented that I was being pressured and pushed. I do this work all the time, talk to parents about how pressuring with feeding backfires, but I had usually been most able to empathize with pressure to eat less, not more food. It was fascinating!

I can only imagine if I was a toddler with the hair-trigger temper, where my main job developmentally is to assert my independence and "do it myself," how I would have reacted! (Moms and dads of toddlers can picture this as well!)

In the first scenario, I might have gotten so upset that I stopped eating before I was full. (It is hard to focus on sensations of hunger and fullness when you're upset.) In the second case, I overate to please someone else. (Might a pre-schooler do this to please a parent or favorite teacher who insists that all the "growing food" gets eaten before dessert?) In both situations, the pressure made it harder for me to tune-in to my internal cues and eat the right amount, and it spoiled the fun!

How do you feel when you are pressured to eat more or less food than you want?

teaching kids to overeat

The summer-camp brochures probably don't say, "We'll teach your kids to swim, paint, get along with others, and overeat!"

My husband told me that while I was in Denver, M asked him to pack her less food for lunch. When he asked why, she said that the camp teachers have a rule that you have to eat all of your other foods before you get your "treat," and she was getting too full but still wanted to eat her treat. (Note, her lunches usually have leftovers like stir fry and rice, and one or two sides which might be a baggie of cherry tomatoes or red pepper, or pickles, maybe some tortilla chips, or yogurt, or carrots, and about twice a week she gets a mini candy bar or fruit snacks for dessert...As with every other meal and snack, the idea is that she gets to pick and chose from what I provide and decide how much or if to eat. I can't predict her hunger so I often pack extra. Some days she eats everything I send, others barely a bite...

Hubby said he was surprised by how mad it made him. (I thought this was cute :) He was upset that they are trying to push her to eat and are interfering- of course he left it to me to deal with so I get to look forward to dropping M off with a note in her lunch bag that says, "M is allowed to pick and chose from what we pack her. If she wants to eat her dessert first and only that, that's fine. Please do not make her eat or finish parts of her meal to get her dessert. She knows how to eat. Please call me if you have any questions." I have told M to hand them the note if they try to tell her anything about eating.

I'll talk to the director and her teachers to get them to "back the $%##!!& off," in a nice way of course. You see, I too am angry that they are interfering with her ability to tune in to hunger and fullness. We work hard to feed well, and it is getting harder as she goes out into the world more, to protect her from harmful interference.

Though, I imagine most parents come in asking the staff the opposite– to make sure the kids eat their "growing food" before the "treats." I am always amazed how many parents pick their kids up from school and the first question is, "Did you eat all your lunch?" while digging out the lunch box and inspecting the contents.

There are lots of reasons why making kids finish their food or arbitrary amounts before dessert mucks things up. Here are a few

1) it teaches kids to overeat. Dessert can taste so good they will often overeat to get to dessert.

2) it teaches kids that the only good food is the treat, and all the rest is what you have to slog through to get to it.

3) it takes over the child's job with feeding, deciding how much to eat.

4) it is hard work for the provider and a waste of effort

5) it sets up a power struggle and conflict

6) children eat LESS well (less fruits and veggies) when pressured

How do your childcare/schools support or undermine your feeding practices? How do you deal with it?

update: this morning I was putting the fruit chews in her lunch and Hubby mentioned that the same baggie kept coming back last week uneaten. M even asked me then not to put so much treats in her lunch so she wouldn't get too full. Annoyed beyond measure, but happy that my little one resisted the pressure and still stopped when she was full...

is emotional eating to blame for unhealthy weight gain?

Great Ellyn Satter newsletter (#46) on emotional eating. I couldn't say it better, or add much to this, so PLEASE take the time to click over and read it! Tell me what you think!

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...)

children's menus? around the world...

I wonder, my worldly readers, about Children's menus. Most US restaurants have them, according to readers in China and Switzerland, most restaurants DON'T. Where do you live, and do you have Children's menus? I wonder if it correlates with nutrition info aimed at children?
(My Swiss contact said, no children's menus and no nutrition info aimed at children. Coincidence?)

conflicting messages

On the junkmail catalog there was a big line on the bottom
"PLEASE RECYCLE"
How about, please don't send me this catalog that I didn't request...

But, I digress, back to food. At the Rainforest Cafe yesterday (first and last visit) the childrens' menu was a PBS "Curious George Hop into Health and Fitness" that made me want to scream.

"KNOW WHEN TO SAY WHOA! Try to avoid too many fried foods as well as sweets or snacks without any nutritional value." it admonishes the Kiddies as they ogle desserts bigger than their heads.

Meanwhile the children's menu offered grilled cheese, dinosaur chicken nuggets, hot dogs, mac n cheese, popcorn shrimp, coca cola products, fries (it did have carrot sticks and corn as an option) and the dessert featured was a volcano of chocolate brownie cakes with ice-cream and a chocolate lava big enough for half a dozen kids at least (menu said serves 2 or more...)

This nutritional info is aimed at small children. This is not OK. Labeling foods as good or bad confuses kids. It is not a child's job to decide what foods to chose, it is his job to decide how much and if to eat it. The focus for kids and food should be variety, good taste, and joy, not fear, shame or avoidance...

I could go on about why we have children's menus in the first place, but that is another post.

I ordered the nachos (gross with a cheese sauce, not real cheese) that was a huge portion for M and I to share and we left most of it behind. M had a mini burger and corn which was buttered so she didn't like it. She only ate half the mini-burger. That morning we had mangoes and tortilla with butter for snack.)

Would you all be willing to scout out "nutrition messages" that are aimed at small children in the next few days and report back? What do you notice? Are there "health" messages that might confuse kids? Pretty pervasive, no?