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"It’s all about portion control" or is it… Talking about DOR

Posted by on Mar 5, 2013 in Uncategorized | 12 comments

“I’m a registered dietitian, I have two small children (who eat totally different from each other, one picky, one adventurous), and I support and practice the DOR. I have been having some pretty heated (ok, it’s probably just me) conversations with some of my coworkers (not dietitians) about the feeding relationship. I feel like in trying to describe the DOR, I end up getting defensive and maybe a bit pedantic. Any advice would be greatly appreciated. ” -facebook question

This made me think of the conversations I have when people find out that I am a childhood feeding specialist, helping parents with weight concerns, among other things. Almost always, the person I am chatting with launches into explanations for the “obesity epidemic,” you see, we all know, “it’s the portions!” (Or High Fructose Corn Syrup, or not enough recess, or lazy parents, or the food industry…) Picky eating? They inform me it’s just “parents who don’t know how to cook,” or who are “too permissive…”

It’s a unique experience to be well-read and versed on research and clinical experiences and then to have everyone think they know the answers. I imagine bridge builders don’t have the same experience… “Oh, you’re a bridge builder! You know, the problem with all these bridges falling apart is that you need a wider base to hold them up with, we all know that!”)

First off, for new readers, DOR is the Division of Responsibility, which basically says that if parents do their jobs with feeding: provide variety of tasty foods, structure, family meals, no pressure, then children can be trusted to decide how much to eat from what is provided.

It trusts that humans are capable of self-regulation. And this is where people get stuck.

Many Americans think, “Humans are not capable of self-regulation, and if we don’t teach kids portion control, who will?” (This is a literal quote from a feeding therapy trainer to a room full of OTs and STs, who are the ones “teaching” kids to eat in feeding therapy sessions, and not one person challenged that statement. I’ve also heard pediatricians and others say that humans can’t self-regulate.)

Here is what we all “know”: fat kids are fat because they eat too much, skinny kids need to eat more… The DOR does not accept this. It accepts that even children growing in a healthy way at the extremes can be trusted to self-regulate, and therefore is totally antithetical to how most people think about food, feeding etc. Which is, “it’s all about portion control”, and,  kids can’t self-regulate so we have to do it for them. If you can’t trust that kids can self-regulate, then you can’t trust them to do their jobs, and you can’t do the DOR.

The first question came in just after I tried to explain to a Dad in the park that it’s not all about portions, at least not the way he thinks it is. But let’s say that some people eat lots more than they need to, well beyond satiety, and some do. Here’s how I approach talking to folks about the model I work in, and note, this is a work in progress!

1) I accept that I won’t convince anyone of anything in one brief chat.
2) I often share how I used to believe in “portion control” or calories in, calories out, but I saw that it didn’t work with my patients and it didn’t work for my family. “You know, I used to think so too, but after spending a few years reading, seeing it work in my own home, and transform the lives of my clients, I’m pretty convinced…”
3) I acknowledge that it took two good years of reading the research to convince myself that the Trust Model is the way to go. I also acknowledge that every experience, interaction and study I’ve read since then has strengthened this conviction.
4) I acknowledge that some folks eat beyond full, and I suggest that culturally we actually train children to do so. 85-90% of Americans feed their children with the control model, which most often for young children means asking them to eat more, take two more bites, and not believe them when they say they are full. So, in essence, we teach children, who are BORN with the ability to self-regulate, to overeat. We teach them through clean-plate rules, or veggies and protein before dessert rules, to eat for reasons other than the signals coming from inside their bodies.

So, the answer is not to impose arbitrary portion limits, diets or restricting. I tell folks that we’ve tried that, FOR DECADES, and it’s not working. The answer is to help people learn to get back in touch with cues of fullness and satiety. To feed themselves well, with foods that taste good, at regular intervals—not to diet.

I find a few phrases helpful:
“We’re working really hard to get kids to be good eaters, to get them to eat more or less, or different foods, and most of our efforts make things worse.”

“How is what you are doing now working for you?”

“It doesn’t have to be so hard.”

“Kids are born with a wisdom, knowing how much to eat. Is it about portions? Maybe, but only because the way we feed kids in America trains many children to overeat. We can either feed kids in a way that supports their internal skills, or we can feed them in a way that suppresses and buries those cues of hunger and fullness.”

I hope that helps get you thinking some more. Would love to hear what you have tried…

Thanks for writing in and fighting the good fight! Part of why I wrote my book, Love Me, Feed Me,  is to explain all this to parents and professionals in an accessible way.

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12 Comments

Join the conversation and post a comment.

  1. Emolee

    It all depends on what you mean by “regulate” or eat “too much.” I eat so much that I constantly gain weight. However, I don’t eat more than I am physically hungry for (90% of the time), and the amount I eat would not be considered “a lot” by most people (who had not seen my body!). But my body burns about 1000 calories a day. And my body is hungirer for MORE THAN IT USES. I think this is the disconnect in the calories in- calories out debate. Technically, yes, thermodynamics and all that. But the amount that a person is *physically* hungry for will not necessaily equal the amount the body “needs” or “burns.” Any advice?? Am I doing it right to eat waht I am hungry for and just gain weight constantly? Thanks so much.

    • katja

      Without knowing more specifics, it’s hard to say what is going on. A great resource on adults and eating is The Fat Nutritionist. There may be some weight gain when learning to eat competently, which can be really hard. My understanding is that eventually, the body will reach an equilibrium as one learns eating competence. (From my colleagues who work with adults, they see some clients gain, some lose, some stay weight neutral). Genetics, history of dieting, restriction, medications, hormone issues,stress, sleep, grazing, lack of structure, exercise, balance of intake (fat/protein/fiber/carbs) etc. all affect metabolism. I absolutely believe that there is impressive variation among individuals. With kids, I have just not seen a continuous weight acceleration when feeding is going well.
      There is so much here. Have you read Ellyn Satter’s Secrets of Feeding a Healthy Family? Also another great resource.

  2. sannanina

    This is really not a comment on this post, but I wanted to share the following article on NPR.org on how to get kids to eat veggies: http://www.npr.org/blogs/thesalt/2013/03/04/173275456/selling-kids-on-veggies-when-rules-like-clean-your-plate-fail
    The article in itself is not that bad (it could be better, but it most definitely could be worse, too), but a lot of the comments are the usual stuff along the lines of “they are children, they eat what you tell them to eat” and ” if you add sugar to vegetables your kids will never eat them without it again”. If you have the time, it would be really, really great if you could leave a comment.

    • katja

      Ah yes, this is always my dilemma. I have spent hours and hours replying to this kind of thing, never with any sense that I’m getting anywhere… it’s also a question of time and budgeting. I saw it too.

  3. Kate

    Portion control is tricky. For me, I dieted for so long that I when I wasn’t dieting, I still ate everything on my plate out of habit. Eventually, I started putting less on my plate with as stated above, explicit permission to go back and get more if I wanted it, but it took a lot of positive self talk to get comfortable with taking that step. Eventually I learned to tell when I was full.

    • Rachel

      This is my problem. Still clearing my plate from dieting for so many years. For so long I put on my plate exactly what I was allowed to have and ate it all. When I stopped dieting or when I’m at a restaurant I now have a he’d time self regulating. Any tips or experience on going through that phase?

      • katja

        Great resources are Intuitive Eating (Tribole and Resch) and Secrets of Feeding a Healthy Family. Michelle Allison, the Fat Nutritionist also sees clients to help with tuning in and mindful/intuitive eating. When I allowed myself the foods I felt I had little control over initially, I enjoyed them and ate lots! Fairly soon, I found though that a bag of chips might go stale in my pantry, rather than gone in a few hours. Permission, joy, all foods on an equal playing field, banning “shoulds”, approaching with curiosity are a few words off the top of my head. Good luck on the journey!

  4. Zahra

    I believe in DOR, but I still struggle with portion control for me. I think part of my problem is that I don’t want to waste food, and sometimes I feel full 5-10 mouthfuls from finishing my plate. When that’s all that’s left of a particular meal, the internal compulsion is strong to just finish it so there’s no waste. I guess the old “But little africans are dying because you’re not finishing your portions!” stayed with me more than I wish to. Consciously, my reply to that one is “Whether I finish my plate or not does not give more food to little africans”, but the subconscious is a strong thing. For what it’s worth, I’m the same about the little bit of wine left in a bottle: I’d rather drink it and get tipsy than leave it out there.

    Actually, it would be a good idea to address the whole “waste” issue in the DOR model. (“But I cooked those beans because my child likes them usually, what do I do if she doesn’t eat them today? Or eats only half of what she usually eats?”). When you’re worried about making ends meet, can you really practice DOR? Or is the risk of wasting food (and thus, money) too great to try the DOR?

    • katja

      This is a very hard one! is it “portion control” or food waste that is the struggle? Not wanting to waste is a VERY hard impulse to get over, and I do address it specifically in my book. One person “redefined” waste as she struggled to to eat based on her internal cues. (She defined wasted food as eating food she wasn’t hungry for…) I’m glad it seems that your body is aware of those cues, that you are able to identify that you are satisfied. You have accomplished that hard work of acknowledging what is happening, what your body is feeling, and why you are eating those bites you aren’t so hungry for.
      A few thoughts. I have small tupperware containers for this very thing. The 2-3 cherry tomatoes, the other day I even had a bowl in the fridge with some juice from mandarin oranges, that I love, but didn’t feel like at the time… Perhaps serve smaller portions, with explicit permission to get more if you need it.
      With kids, it is hard. There is more waste to feed with the DOR, and I acknowledge that. More waste now, but less later. Yesterday, I cut into the second mango from the store that was bad/off. Felt good, looked good, but was brownish and tasted funny. From my last grocery run, we had two mangoes ($2 each) and a $1.99 Greek yogurt that had gone off too (it was one day before the use by date.) Families who are working on getting enough calories do not have the luxury of trying mangoes, or kiwis, or fancy yogurts. It’s not fair, but it’s the reality. If you don’t have enough money, you buy what you know is cheap and will be eaten. If you live in a food dessert, or your fridge in your apartment doesn’t work, or you live in a 4th floor walk-up, you might not lug your kids and the mangoes and potatoes up the stairs, you might have better luck getting a box of mac n cheese home on the bus… So, yes, there are lots of challenges! Thank you for writing in. This issue of waste, particularly for those who grew up without enough food can be very, very hard to overcome. Would love to hear from readers how they managed this issue. (I’ll search for my old blog post. Are you on Facebook? follow the feeding doctor. I’ll try to post it there too…)
      http://thefeedingdoctor.com/waste-now-save-later-2/

      • Zahra

        Thanks! Right now, our finances are strained (but not so much that we can’t waste a little bit of food).

        The other hard part right now is that my family is forever feeding my son when I go see them, even when he’s saying “no” to food. I think this is going to be a hard part of letting my son do his part in DOR: try to limit pressure from outside sources, especially family. Fortunately, we often go see my grandparents at snack time, so it is an “eating” time, but I think it’ll get harder when we go to the big get-togethers: New Year’s Eve, summer extended family weekend, etc.

        • katja

          Ho Ho! This too is under my “how to deal with meddlers” section in the book :) If it’s an occasional thing, I wouldn’t lose to much sleep over it. Planning visits at meal and snack times helps. If it gets really pushy, consider stepping in. I have the whole “follow my lead” line that I think works pretty well. Also in the book, but I’ll post a link to a post I did while back on FB…