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The perfect storm: adoption, malnutrition, obesity panic, and food “obsession”

Posted by on Apr 13, 2012 in Blog Posts | 11 comments

I am heading to NYC this weekend to speak at the Child Welfare Symposium. It’s been a busy several months, with finishing my manuscript, supporting adopting and fostering families with feeding challenges. (see below)

I look forward to leading a workshop on the feeding relationship, and fostering and adopting. In particular I want to share the stories of the latest casualties I am seeing in our war on childhood obesity: these children who have experienced malnutrition and even starvation, only to come home with their families in the U.S, and be placed on calorie, or portion restriction, to avoid or “treat” childhood “obesity.”

I work with and hear from many families of adopted children, primarily right now from Ethiopia, and mostly girls between the ages of two and three. Most families have had their children with them for between 1 and 2 years, and are dealing with food obsession. These little survivors, who have already been through so much, are being harmed by our collective panic about obesity. The physicians and dietitians the families turn to for guidance and support, are encouraging distorted feeding practices that harm the feeding relationship, and bonding and attachment in general.

Moms share…

“We’ve been doing this for two years, and it’s destroying our family.  All I do all day long is deny her food! How can she trust me?”

“We’ve spent thousands on attachment specialists, and this constant battle over food is ruining our relationship.”

“Everyone said, she’d get used to “normal” portions. Well, she hasn’t.”

“She screamed after every bottle, but my doctor was very clear that I was to limit how many ounces and how often I could feed her.”

These children may gobble, eat quickly and very large amounts initially (survival behaviors and totally normal) and then, the child does catch-up growth, which can be impressive, at twenty times the normal rate.  As weight increases (and height) some may even pop into the “overweight” and “obese” range, the alarm bells are sounded, often by the child’s doctor. As a physician myself, I think we must be very careful to remember, first do no harm…

The child is then restricted, put on portion control, strict calorie limits, given specific ounces of formula and schedules. The youngest I have seen was an eight month-old adopted from Ethiopia, at a height and weight of 75th percentile, which the parent was told was “unhealthy.”

Once these children are not trusted, and are restricted, it seems to trigger a terrible anxiety, a perfect storm- an all-consuming worry about when and how much they might next eat, and wondering if their parents will provide for them and meet their most basic needs. These children are described as listless, clingy, not interested in toys, or play, ONLY interested in getting food. I cannot overestimate the misery this brings to these vulnerable children, and the parents who desperately love them and want to do the right thing. The bonding process is disrupted, with parents telling me of families destroyed by restricting the formerly-malnourished child. (In general, restriction is damaging to families and brings in conflict, but seems particularly so for these children who are working on trust, and  growing and eating.)

The good news is, it doesn’t have to be this way. I have shared my manuscript with a few families, and seen similar results as I have seen with the clients I work with. These children CAN be trusted. Parents need support and good feeding information from day one. Child of Mine, or Your Child’s Weight, Helping Without Harming, both by Satter, are invaluable resources. And my hope is that my book, coming late summer/early fall, will help families avoid this problem, or climb out of the distorted feeding hole.

Here are some quotes form parents who have read my manuscript and are seeing improvements with the transition.

“My husband and I longed for our son, and worked so hard to bring him home, and the last year has been miserable. Less than a week into this, it hardly seems possible, but he has rediscovered his happiness, and we are enjoying our family for the first time.”

“He has discovered spontaneous play and movement, he used to only cling to me, now, he plays with his brother…”

“She told me, ‘I’m done mommy.’ I haven’t ever heard her say that. She has left food on her plate, and left the table happily for the first time ever.”

“He dumped out all the bottles of shampoo. I was so happy! He’s two, and he had never had the energy for normal two year-old things. It’s as if, free form the anxiety about food, he can now be a normal child.”

These children are worthy of our trust…

Sign up for my newsletter for information on when Love Me Feed Me, The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles, and More… is coming out. The book also deals with special needs, oral-motor and sensory problems, low weight, picky eating and more. Get a free sneak peak, and info on specials and pre-orders…

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  1. Lisa

    As the mother of an adopted daughter (adopted from China at 18 mos and underweight)this post makes my heart race. SO distressing!

    I know I’ve posted here in the past about our experience, but I want to comment on something your post has made me think about. My daughter, now 6, is beautifully attached to us and seems to have no negative ‘fallout’ from her early childhood and adoption experiences. So far, so good.

    When we adopted her she was clearly underweight. The first few weeks we had her, she put herself to sleep at night by pretending to eat out of her hand. She’ll still make eating motions with her mouth when she turns over in her sleep. But she MOURNED the loss of her ‘aunties’ and was appropriately suspicious of us, etc…. all the hallmarks of a well loved child going through a major change.

    My theory about her low weight at adoption is that food was generally scarce due to money issues, and everyone was likely eating less that they wanted. That is a VERY different experience than these adopted children who can see that food is abundant **and yet they are being denied by the people they rely on for all their needs**

    My daughter could not get enough food in her when we first had her. She ate two handed. She was particularly fond of fat and would eat whole pats of butter off her plate. Trusting her, I fed her on demand as you would a newborn. And after a few weeks of heavy eating, she slowed down. She gained weight rapidly those first few months. I continued to feed her on demand until she was about 3 when we transitioned to the DOR model. She continues to be beautifully attuned, and her growth pattern has remained consistent.

    I know these parents are making their choices informed by a sick culture so I’m trying not to judge, but I feel so sorry for those children and so grateful I know about intuitive eating, competent eating, the DOR and HAES!

    I can’t wait to read your book, Katja!

    • katja

      I love this! On mt phone, but will comment more when I get back from NYC. I love your message of trust. I want to empower parents to trust their instincts and trust their children. They are all worthy of our trust!

  2. JenC

    How can a pediatrician look at themselves in the mirror after telling adoptive parents to deny food to formerly starving child? It’s absolutely disgusting.

    • katja

      they do it because they believe it’s the right things to do. They do it because they believe that “obesity” is the worst possible outcome, and they believe that calories in and calories out is all there is to it. I know they care deeply for the children they see, they just don’t know. I didn’t know either. They are not exposed to any of the research that contradicts the standard line… I know when I learned all of this information, that I had harmed patients without knowing it. I want to help educate providers, so they can truly help families…

  3. JupiterPluvius

    The thing is that in the US and Canada, a high percentage of children identified as “obese” by BMI range are also identified as “undernourished” or “energy insufficient” in terms of daily calories alone, let alone nutrient content. This study is pretty shocking; there was a smaller study with similar results in Nova Scotia, Canada, in I think 2005.

    • JupiterPluvius

      So the knee-jerk response of giving children with higher body weights fewer calories may be tremendously counterproductive, given those findings…

      • katja

        In my view, yes… It harms all children, but these children I am working with seem to be even more profoundly impacted…

    • katja

      At least half the intake analyses I see for the “overweight” or “obese” or “food obsessed” child shows the intake is at or below the “norm” or recommended amount…

      • JupiterPluvius

        This doesn’t surprise me, but it certainly saddens me! The non-stop “get fat kids to eat less” blather from the mainstream media is terrifying.

  4. Twistie

    My heart breaks when I read/hear about children coming from want only to be denied enough food. I know these parents are doing the very best they know how for their children, and it angers me beyond expression that they go to experts only to be told to underfeed children with a history of being grossly underfed.

    It’s not even just the food – which is more than enough reason to feed them enough – but as you say the question of trust, as well.

    And has everyone in the world other than this non-parent her typing forgotten that children grow out right before they grow up? I remember being a kid and knowing when one of my brothers was about to get a lot taller because he put on some poundage around the middle.

    If an eight year old can grock that connection, why is it so many doctors – who went to school for this and everything – can’t seem to?

    • katja

      It is tragic. There is such a panic about weight… I see these amazing growth charts with little “waves” in the height for weight. weight goes up, then height…. then weight, then height. Woe is the child who is seen when the weight is going up, particularly a larger than average child. It is my mission to inform the “experts” (having been one of those uninformed “experts” myself) so that we can support all families and children… So much of this suffering is so needless, and I want it to change…