Institute of Medicine recommendations on prevention of obesity in children just came out. I dreaded reading this PDF, but was pleasantly surprised- for the most part. They got closer than any other document of its kind that I have seen. (Note, I only read the summary recommendations. And, another “note.” I wish that the focus was on wellness, not weight. I wish they would recognize that most adults who struggle with weight were “normal” or “underweight” as children. Most of the recommendations are in fact, appropriate for all children. I do also have a problem with their risk definitions, with BMI >85%, and a parent with a BMI >30, but won’t rehash that here… They at least do mention weight acceleration.) With that big caveat…
I agreed with the recommendations to increase PE and active-play opportunities for kids (though I thought the enforced “tummy-time” was kind of funny since M hated tummy-time more than anything and it was just one more thing to feel guilty about.But perhaps in a regulated childcare opportunity it is helpful to spell out that the opportunity should be provided…) I agree with limiting screen time to 2 hours a day and removing TVs from bedrooms.
I was intrigued and pleased to see some attention to the HOW of feeding in this piece. Most of the time it is totally missing, so this was a significant step in the right direction. They mention structure, adults eating with children (though arguably an adult with a control agenda can do more harm than good. Like today, M casually mentions they can’t wear hats during lunch so the teachers can see that “you don’t gobble up your candy first…” Oy. )
Read the excerpt below, and tell me what you think. What is missing? How do you read it? Perhaps I am being too sensitive?
“For toddlers/preschoolers—providing meals and snacks as part of a daily routine; requiring adults to sit with and eat the same foods as the children; when serving children from common bowls (family-style service) allowing them to serve themselves; when offering foods that are served in units (e.g., sandwiches) providing age- appropriate portions and allowing children to determine how much they eat; and reinforcing children’s internal cues of hunger and fullness.”
What interested me, was the apparent emphasis on supporting the child’s internal regulation. I loved that they said to let the children serve themselves, that adults should eat with the kids (I wish they had gone further and said, “and then shut up. Don’t lecture them about healthy eating, your thighs or getting fat”.) But what was curious to me is they seem to advocate portion control, mentioning “appropriate” portions a few times (in the infant section, they mention putting an “appropriate” amount in the bottle) and then “letting the child decide how much.” To me, it implies (by omitting explicit permission) that the child should not have another portion if they are still hungry. What if the baby finishes her “serving” but is still showing signs of hunger? Or the toddler in a growth spurt who suddenly can’t seem to eat enough- can he have another “child-sized” sandwich unit, or maybe even two? If the child is “at risk,” can he still be trusted?
Yes, the child with a smaller appetite or who just isn’t hungry that day or that meal shouldn’t be forced or even encouraged to finish a portion- this they seem perfectly comfortable with and advocate for- as do I. But– what about the child who wants MORE than an “appropriate” portion that day? Shouldn’t their internal cues of hunger and fullness be trusted as well? This seems o be the crux of where folks get stuck. Where people say they believe in the Trust Model and the Division of Responsibility, but can’t quite do it. They can let kids not finish a portion, but can’t seem to let go of portion control, can’t quite trust that we can self-regulate, that bigger kids can be trusted too…
What do you think? Reading the above, am I overreacting?