I am reading a book by nutritionist Elleyn Satter entitled Your Child’s Weight: Helping Without Harming (Birth Through Adolescence). Now, before you stop reading this article because your kids don’t have weight problems, neither do mine! This book was recommended to me a nutritionist because I was griping about feeding my family: when I put in effort to cook a tasty, healthy meal, no one ate it; when I made only what the kids liked and offered nuggets and hot dogs for dinner, I felt guilty because of the low nutritional value and I certainly didn’t want to eat it with them; and, some nights I was a short-order cook running around like a mad woman trying to please everyone so that each child would eat at least something.
What this book is about is realizing the parents’ role in feeding and the children’s role in eating. It’s forgiving and gentle, not Puritanical in any way. There are no forbidden foods. There is no restricting. There are no fads that are advocated. It’s not about portion control. It is about children trusting their parents to put tasty and nutritious foods on the table, parents trusting their children to eat as much as they want (not too much, not too little), and families eating their meals together. I promise there is something that you can take away from my summary of this book that follows.
Satter says that the most important thing for your child is knowing you love and accept him for who is, and much of this is communicated through the feeding dynamics.
She has developed a division of responsibility in feeding that is key to feeding well: the parent is responsible for what, when, and where to eat; the child is responsible for how much and whether to eat. This is not easy! Especially if you have a picky eater or a child who seems to never be full. But based on the research and her case studies, I am convinced that it is effective.
Chapter 1: Helping Without Harming
With her clinical experience as a nutritionist, Satter says that no matter what form it takes, restricting a child’s diet is destructive. It is destructive to the feeding dynamic and the child’s relationship with his or her parents. Restricting results in parents who police what their children eat and children who become food bandits. It also communicates to the child directly or indirectly that he is too fat and should eat less, making him feel bad all over.
Satter began realizing that the overweight children she was working with became fatter over time, not thinner. They may have lost weight initially, but they would end up gaining it back…and then some. These children were food-preoccupied, and food-preoccupied children are prone to overeat when their eating isn’t strictly monitored. She had to start over with her approach to feeding children and came up with 3 main principles for parents:
1. Feed well.
2. Trust the child to eat as much as he or she needs.
3. Let the child have the body that nature intended.
This is radical to me! I have never trusted that my children will eat as much as they need. I have pushed healthy foods and limited junk foods and desserts as a result. Satter suggests that children are born with keen eating capabilities: the ability to know when they’re hungry, to stop eating when they’re full, and to eat a variety of foods over a period of time that meets their nutritional needs (even if it doesn’t look like it on any given day). Those capabilities can be eroded over time with poor feeding practices, but when they are lovingly supported to eat well, children tend to do it!
Satter talks about clients she had, overweight and underweight children, and their parents who were pulling their hair out trying to get them to gain or lose weight. After coming up with the division of responsibility in feeding, she had major regrets about how she had managed past clients and said how she would do things differently in the future:
1. The author would examine their growth charts from the pediatricians’ offices to see if they’d always been a large or small child or if they had experienced a rapid jump or drop in their percentiles at some point in their growth. Accurate judgments about children’s weight can be made only by comparing their weight over time with the percentile curves shown on the charts.
2. She would find out how the children were fed: if the family had regular meals together or ate separately, if they had predictable snack times or were allowed to graze, if there were forbidden foods or restricted portion sizes, or if they were forced to eat foods they didn’t like. Satter says that she and her colleagues found that children’s weight often accelerates over percentiles when food restriction is first imposed. Children who have food pushed on them become turned off by food and tend to undereat. Those who give in to the pressure learn to ignore their feelings of hunger and fullness.
3. She would teach them the division of responsibility in feeding (parents: what, when, and where; children: how much and whether). Following the division of responsibility will help slow weight gain in overweight children, but it will not get them to lose weight. It’s not flashy or glamorous, not a quick fix.
4. She would emphasize that they needed to protect themselves from interference, those family and friends who pressure the parents to do something about the children’s weight. The would need to trust their children to eat the right amount and grow in a way appropriate for them.
It is normal for children to grow normally. Children are excellent at eating the amounts that they need. It takes a lot to disrupt that natural ability to a point that it distorts growth. To cause distortion in growth, those influences would need to be powerful and continuous. Satter has found that children experience unusual weight gain for one, some, or all of the following reasons:
1. Their normal growth has been misinterpreted. If they had grown along a consistent percentile, even if that percentile was high or low, then there was no problem. If they had inconsistent percentiles with accelerating or decelerating weight gain, that would often indicate that there was a problem. And then the question would become, what is undermining these children’s abilities to grow in a way that is right for them?
2. Their feeding has been restricted. This is usually the main cause of accelerated weight gain in children. Food restriction makes children afraid of going hungry. Being casual about providing meals and structured snacks has the same effect. Those children don’t know if they will be fed so they become food-preoccupied and prone to overeat when give the chance, even in the absence of hunger. Food-deprived children eat what they can when they can. We all do it to some degree, trying to eat less or less-appealing food then overdo it by overeating on the foods that we really want and have been trying to avoid.
A Buffalo study showed that children who were exposed to experimental stress and who were fed in a restricted way ate more than those who were exposed to the same stress but were fed in an unrestricted way.
3. There are poor feeding practices in the family. Research shows that parents who are concerned about their children’s weight and try to keep them thin end up with fatter children. A study out of California showed that child who were fat were more likely to have had feeding problems and been fed in a less structured way when they were younger. The problem was with how they were fed, not what they were fed. Do you see the difference? A Danish study showed children who had been neglected tended to be fatter from the lack of structure around feeding. Waiting for a request for a snack or meal from children, or short-order cooking for them, and eating on the run are examples of unstructured eating.
4. The children are under stress. Parents are often given bad advice about feeding their children (forcing them to eat certain foods or restricting others) which ends up creating stress around eating. That stress undermines the children’s natural ability to eat in order to grow well. The children have a hard time distinguishing feelings of stress from feelings of hunger, and end up eating for emotional reasons. Children learn to eat for emotional reasons when parents frequently use food to soothe or entertain them. This usually happens somewhere in the first 4 years of life.
What about encouraging exercise? Unfortunately, children who have been labeled as too fat tend to feel bad about their bodies. When given opportunities to move physically, they hold back or become self-conscious, and pressure to do the activity makes it a chore. All of these things result in overweight children exercising less. The division of responsibility for feeding is the same as the division of responsibility for physical activity. Parents provide structure, safety, and opportunities for movement. Children choose how much and whether to move as well as the manner in which they move.
Satter says, “Children are capable, and they can be trusted. If you parent well with respect to feeding and activity, even your large child will eat and grow in a way that is right for her.” She encourages parents to put their effort into parenting and feeding well and into feeling good about their children. She also notes that overweight children are going to need better-than-average social skills in order to succeed, and these skills are taught by parents.
Chapter 2: Feed and Parent in the Best Way
Eating should be a positive, rewarding, and important experience for children. How parents feed is more important that what parents feed. Weight problems in children are behavioral; they’re not about food selection.
Satter talks about one of her clients who was overweight and whose mother closely monitored and restricted her eating. She emphasizes that the eating and weight issues were the least of the girl’s troubles. The worst thing by far was the impact that the mother’s feeding had on the girl’s emotional welfare. By depriving of her food, the mother was depriving her of nurturing. Nourishing with food is synonymous with nurturing overall. Children don’t distinguish between flaws with their weight and flaws with themselves.
Those children who are large for size and don’t feel bad about their bodies have parents with positive attitudes toward them and their weight. Being large doesn’t socially handicap those children. A study from Penn State showed that young girls who were in the 85th percentile or higher for weight, and whose parents were just concerned about their weight, felt bad about themselves. Even worse were girls of the same size who parents restricted their food intake. Children who are thought of as being too fat and whose food is restricted will suffer emotional harm and be subject to periods of overeating and weight gain throughout their lives.
Innately, children have a powerful sense of appetite. They are tuned into taste, smells, textures, and pleasure from eating. The parents jobs are to support their eating without being controlling, to given the children autonomy in their eating without the parents neglecting them.
Children can be capable eaters only if their parents do their job in feeding and truly trust them to know what and how much to eat. Children will do best when parents take appropriate leadership with feeding, establishing structure, and giving them choices within that structure.
Studies show that fat babies, toddlers, and children are no more likely to grow up to be fat than the thin baby. In fact, It isn’t until a child is between the ages of 9 and 13 that he has an equal likelihood of remaining fat later in life as he does becoming thin. Most overweight adults were not overweight children.
When it comes to junk foods, portion control may be overwhelming to adults because our ability to regulate our food intake has been damaged with a lifetime of trying to eat less or less-appealing foods than we really want. But children naturally regulate this on their own! They do not have to be served a steady diet of nutritious low-calorie food in order for them to eat the right amount. If a food is high in fat and sugar they tend to eat less. If it’s a low-calorie food they tend to look for something else to supplement it. If it’s a big portion size, they tend to leave some left on their plates.
A huge study in San Francisco that followed children from the age of 6 to 16 showed that, when compared to slim children, overweight children ate no more calories, ate no more high-fat or high-sugar foods, were no more likely to have been formula-fed, were started no earlier on solid foods, and were no more likely to have been given high-fat milk. The difference was in how they were fed. The children who became fat had less structure in their feeding and parents who were worried about their children’s weight.
Satter says parents need to plan meals around foods that they enjoy, not just foods that the kids will eat. She encourages parents to include “forbidden foods” in their meals: offer Doritos with lunch sandwiches, have cookies or candy for dessert. This isn’t to say she isn’t concerned with nutrition – she is. But people eat what they like and what is rewarding to them. They often feel that emphasizing nutrition takes all the fun out of eating. They feel guilty about what they should eat and it disrupts their ability to eat consistently and well. When adults honor their food preferences, they tend to do pretty well nutritionally and are consistent about feeding themselves.
If parents offer a variety of foods to their children, over time the children will learn to eat a variety of foods. The process of getting there may be hard to identify and may look something like this over the course of a few months: child looks at food and watches mom eat it, child puts it in his mouth and spits it out, child puts it in his mouth and spits it out, child puts it in his mouth and spits it out, child puts it in his mouth and spits most of it out but swallows some, child won’t even taste it, child eats several bites, child puts it in his mouth and spits it out, etc. He may love a food one day and decide the next he hates it or only eat a few foods for several days. Provided parents are doing their job of feeding, their children will eat a variety of foods and get an adequately nutritious diet.
Satter says, “If I had to settle for one piece of advice to give you about preventing child obesity, I would say, ‘have meals.’ Family meals are the cornerstone for parenting and feeding throughout your child’s growing-up years. Because you provide the structure of regular meals and sit down snacks, your child will go to the table hungry, take an interest in the food there, and eat until he is satisfied. Then he will stop, knowing that there is another meal or snack coming when he can do it again.”
She tells parents to not let their children graze on food or drinks between meals and snacks, even if the food they want is nutritious, because grazing makes it harder to eat the right amount, makes children less interested in the nutritious foods at meal and snack time, and encourages children to behave poorly at meals because they’re not hungry. Children need to know that there is a time where their parents will offer food and a time when they won’t, and it is the children’s choice as to whether they eat then or not. If they choose not to, food will be offered at the next meal or snack no matter what, and there will always be something that they will like. In fact, Satter suggests having bread and butter at the table for all meals so that your children won’t have anxiety that they won’t have anything to eat. The issue isn’t the bread, it’s the reassurance that they will eat.
If your house is like mine, meal time isn’t always pleasant. Satter says, though, that the one ingredient that children need to have a pleasant meal is the company of their parents. Parents should help the children get served, make conversation, eat with them and avoid nagging, prompting, bribing, cheerleading, or playing games to get them to eat. Children will become more adventurous with respect to eating and behave better if their parents are eating with them. And it’s important to not make eating compete with other activities (like watching TV or playing on a phone) because children who are distracted aren’t as tuned in to their feelings of hunger or fullness and may over- or undereat.
Satter discourages parents from offering desert as a reward for eating vegetables or taking a bite of everything on their plate. Pressure, whether it is positive or negative, causes children to feel overwhelmed, scared, or angry, and the children focus their attention on those feelings rather than their feelings of hunger and fullness, possibly resulting in over- or undereating.
Children who are pressured to eat end up eating less well, not better. In fact, children who had cancer are more likely to be overweight as adults. It is thought that they were likely pushed to eat when they had lost their appetites from the cancer treatment. They learned to ignore their hunger cues, and their ability to regulate their eating was undermined.
Some children need more food than others to sustain their energy output and their growing bodies. Whether they need a lot or a little, children know instinctively how much they need. Children can overeat or undereat at times and make up for that eating over the next few meals or few days. Their instinctive regulators of hunger and fullness even things out for them.
Putting all of this into practice can be overwhelming, but for all feeding problems, Satter says, “the solution is the same: establish and maintain the division of responsibility in feeding.” If parents have been controlling portion size, it takes nerves of steel to watch their children initially eat to their heart’s content, sometimes with no apparent stopping point. Parents need to stick to their commitment and trust their children to do their job of eating. Eventually, those children prone to overeat will become attuned to their internal controls and regain equilibrium.
Parents who have difficulties surrounding food will likely have children who have difficulties around food. Satter encourages parents to look at their own attitudes toward feeding and eating. It’s hard for parents to trust their children to eat the amount that they need when they don’t trust themselves to do the same. She encourages parents to “feed yourself well, move in ways you find rewarding, and learn to love the body you have, not the body you wish you had.”