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?

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.

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?

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!

no harm done? TV weight loss shows. We're all losers.

TV weight loss shows are all the rage, but of course are doing more harm than good, both to the cast and the audience watching. Here is an interview with one contestant about her experience, the eating disorder it triggered and how she is still not recovered.

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?

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?

poor Oprah, the "non-diet" weight loss show

Ugh. I have to say it is fun to watch Oprah and call it work, but my goodness. What a mess. Oprah's guest, Geneen Roth has written Women, Food and God. I haven't read it yet, but just finished When You Eat at the Refrigerator, Pull Up A Chair by Roth. Sounds like a lot of a similar message. A couple things stood out to me.

• The focus seemed to be still on weight loss (surprise!)

• The only two people they showed had conspicuous "before and after" pictures. I'd love to know what the percentage of folks who go to her workshops or read her books or "do the work" in the books actually experience weight loss. Have you failed if you don't lose weight? Are you "doing it wrong?" The implied promise seems to be long-lasting and serious weight loss.
• They kept talking about women who eat when they are not hungry. I bet many of these women ARE hungry when they eat or binge. Women tell me they skip breakfast, or eat a small lunch and are ravenous by the time they get home and eat in an out-of-control way. I wish they had at least brought up that restriction(dieting)+ stress = loss of control. It is the stress, hunger, emotions that makes the effort of restriction almost impossible in adults (and children) who have dieted. A vicious cycle. But, many women are indeed, very, very hungry.
• I am curious about Geneen Roth. In Pull Up a Chair, she talks about her strict vegetarian diet that she ended only a handful of years ago and her panic at gaining five pounds. I wonder again at the focus on weight. It's just something that stuck out while I was reading. This panic was at a time when she was already the Guru in the non-diet approach? When she already talked about self-love and worth and beauty etc, but still had that reaction? Is that OK? Am I overreacting? Does that take away from the potential power of her message? Is this her eating disorder and her experience in recovery?
• Oprah asked about eating if you can't diet, "then how do you do it?" A point that I think is valid with Geneen's work. Perhaps not enough concrete advice on how to learn to eat when you are hungry, or even learn to recognize sensations other than famished or stuffed. A great companion book would be Secrets to Feeding a Healthy Family (Ellyn Satter) which, though it says "family," spends a great deal of time explaining how to feed yourself first.
• Oprah talked about her binge on a pound of lettuce with lemon juice after an upsetting phone call. Oh, Oprah. That just made me sad. I'd be hungry, deprived and cravingly obsessed with real food if I ate lettuce with lemon juice, regardless of whether I had been beaten by my grandmother as a child or not.

This issue of eating to numb-out or deal with emotions and stress is not new. (Some studies suggest that "overweight" individuals do not partake in that particular coping mechanism more than their "normal" weight counterparts BTW.) While it's a piece of the puzzle for many, again the show (the book?) ignored physiology, hunger, hormones, feeding and dieting history and the complex interplay...

Did you watch it or read the book? What did you think?

how to make family meals happen and a note to the nutritionists at grand rounds!

Had a great time presenting to the pediatricians at Grand Rounds today on feeding dynamics and the current approach to childhood "obesity." Great group, great questions. (I didn't see anyone texting or sleeping, and since many were sleep-deprived residents, I'm pretty happy!)

I do want to mention that I shared some "horror stories" of bad advice clients have gotten from physicians and nutritionists, but I want to stress that there are many, many nutritionists and physicians who do wonderful work, who work within the feeding dynamics model. I was happy when a Children's dietitian spoke up at the end to let her colleagues and physicians know they work in the model, and don't just recommend organic mac-n-cheese as the solution to all your feeding concerns! I would say to the teams that take care of kids, know what models your team members work with. Get to know your nutritionists, read their evaluations. Send families to experts who support your message, not sabotage it.

A common theme that came up was the families they work with say they "can't" or are too busy for family meals. Too many sports, activities, eating fast food in the car...

I just keep coming back to being firm about how important structure and family meals are, encouraging families to make it a priority. Family meals mean kids eat better, have stable weight, less disordered eating, less picky, eat more fruits and veggies, overall success in life, less drugs/alcohol/tobacco...

One of the awesome tech support guys told a fun story after the talk. His son's girlfriend used to complain that the son's family dinners cramped the young couple's style, that she didn't like making plans around family dinners. Now though, she seeks them out, joins in and enjoys them. Starting with family meals may be hard, kids might complain at first. Stick with it. It is that important. As the genteleman said, "Our family meals are where we have the best times, the best memories." I would say it's more important than being in a third activity. Help your kids prioritize.

Have any of you made a successful transition to family meals? How did you make it happen?

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?

Children should gain weight to prevent head and face injuries!

I'm trying an experiment... This post didn't get much feedback so I am reposting with an attention-getting title. Sorry for those of you who already read this. Another post coming soon...

I recently picked up a medical journal. (April 2010, Journal of Pediatrics) Found this article:

Injury Patterns in Obese Versus Nonobese Children Presenting to a Pediatric Emergency Department.

Results section:

"Overall, obese and non-obese children had the same percentage of upper extremity injuries. However obese children were significantly more likely to have lower extremity injuries compared with upper extremity injuries than were non-obese children. In addition, obese children had significantly fewer head and face injuries than nonobese children.

Conclusion:

"Obese children are significantly more likely to sustain lower extremity injuries than upper extremity injuries and less likely to sustain head and face injuries than nonobese children. Strategies for preventing lower extremity injuries among obese youth should be sought."

Read those two paragraphs again. When you hear about weight bias this is one example.

Here is the lay-media reporting on this article:
"Obese Kids Suffer More Leg, Foot, Ankle Injuries: Study " on Medicinenet.com
same headline on the NIH's website (National Instituet of Health) called Medline plus "Trusted Health Information for You." Babycanter.com reports "Obese kids suffer more leg, foot injuries, study shows" same for health.msn.com... Of the dozen or so articles on my quick search, two did mentioned the finding that obese children suffer from less head and face injuries...

Where to begin?
First off, the researchers themselves come to a biased and incomplete conclusion. I wonder, as head injuries are generally more severe than lower extremity injuries, were there also more deaths or permanent morbidity in the nonobese group? Then of course the lay media, without serious science journalists usually just picks up a press release without bothering to even read the actual study or even the synopsis and it gets picked up on hundreds of websites where the average reader gets one more dose of weight-based hysteria.

Imagine these headlines in an alternate universe– based on the same study results...

Nonobese children more likely to suffer serious head and face injuries!

Obesity in childhood protective of serious head and face injuries!

Children should gain weight to prevent head and face injuries!

Get a helmet for your child? Gaining weight might keep them safer!

Why your skinny child may be more at risk of dying-story at 11!

Just wanted to show one small example of how the data can be interpreted, picked up and reported by lay media. Why does the conclusion not also say, "Strategies for preventing head and face injuries in the nonobese population should be sought..." My guess is that childhood obesity is a hot topic right now. Lots of attention, lots of press, and maybe lots more funding for studies that focus on this issue...

What do you think? Does this make sense? Does it surprise, annoy you?

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?

why don't health care professionals know about non-diet, HAES or feeding dynamics?

Had a great time talking to the LPNs at their annual conference in Alexandria this week. Great questions from these dedicated health care professionals. I got to introduce some important topics like Division of Responsibility in Feeding, Health at Every Size, being careful about growth charts and labeling patients...

One woman astutely asked, "Is this in the curriculum in medical school? Patients are going to trust their doctors on this."

Alas, the answer largely is "no," health care providers aren't getting the whole picture. There were huge chunks of data and information I was never exposed to in my training. Part of my mission is to spread the word to health care providers- at least expose them to another side of this complex story.

Here's what one internist said after she heard me at a conference last year. "Hearing Katja's presentation was really eye-opening. In some ways, I didn't know what I didn't know. The ideas and evidence she presented are revolutionary and it is unfortunate that it is not taught in our medical training. I am working on incorporating some of these ideas into practice and doing my own study of the research. I feel it is helping my relationships with patients be more positive and encouraging and I feel I am better able to help them." (Melissa, MD)

Then another nurse asked, "Why aren't we learning this stuff?"

Still trying to answer that one...

What do you think? Why aren't health professionals (I know a nutrition/public health grad student who has never heard of HAES or Satter's work...) hearing about this stuff? Are you in health care? Were you exposed to these ideas?

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?

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.

food addiction?

I finally looked up the source for one of my favorite quotes. It's from Psychology Today in an article called, "The Science of Willpower." I hope you read it.

Here's the quote:
"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."