The Feeding Doctor on Pinterest

raising a generation of binge-eaters

Posted by on Dec 12, 2011 in Blog Posts | 12 comments

This article on Psych Central, “New Model for Childhood Eating Disorders,” astounded me. (I can hardly stomach my google alerts most days…)

Basically they took 36 “overweight and obese” kids and their parents and tried something “new” to try to get them to lose weight.  (Because it wasn’t a classic diet and sit-ups…)

Children and parents in the appetite awareness group brought dinner into the clinic and practiced monitoring their hunger and satiety cues throughout the meal. Children and parents in the cue exposure group brought in their highly craved foods and “stared them down” – holding, smelling and taking small bites of the food – for up to 20 minutes while rating their cravings, after which they threw away the food. (This is somehow a profoundly sad paragraph to me, doing this to an eight-year old…)
and

“significant reduction in such overeating was found in the cue-exposure group, even six months post-treatment, though there was very little long-term impact on overeating in the appetite awareness group. There was only a small effect on body weight and no effect on reported calories eaten in either group; however, both approaches resulted in decreased binge eating in children and their parents.”

“By reducing overeating and binge eating, we hope to provide a new way of preventing weight gain and providing children with a sense of control over what they chose to eat. This is really important, because a loss of control can lead to depression and other psychiatric problems, and of course childhood obesity.”

I have so many problems with this piece…

• sloppy, sloppy sloppy article/title. What is the “eating disorder?” The obesity? The weight? The binging?
• What did it mean that they reported “less” binging, but the overall calories remained the same? Why was this not addressed? It certainly is interesting to me. Is this evidence of self-regulation? Evidence of poor study design: relying on self-report for a shameful activity? (Also, I wonder how many actually completed the six-month follow-up. Usually a fair number are lost, and if each group only had 18 kids to start with… Were the dropouts significant, and were they perhaps more honest, or did not decrease the binges?) I’d hate to see people use these methods based on this one study…
• If their premise is that eating out of control (binges) leads to obesity, why did they not explore that the group that had reported less binging did not lose weight? (Small amount of weight loss can be translated to not significant, meaning, they could not show that any weight loss was due to the study, a finding that is basically meaningless in terms of a study.)
• Why were there no lean kids who binge in the study, if the behavior is what is concerning and being studied? In other words, this was a weight loss study…
• and, weight did not change. No surprise there.
• If you take a group of people who are presumably dieting or trying to be “good” (eat less than they want to) and maybe have been for years, who don’t eat meals or have structure, who are eating in a totally artificial setting,  I don’t think they really are able to fee the more subtle hunger and fullness cues right away. By that I mean beyond famished and stuffed. Dieting and binging cycles make feeling those subtle signals really hard. In my mind you learn to tune in to those cues only with time,  permission, regular meals and snacks that are balanced, and coming to the table without anxiety or conflict. With my clients, the toddlers I have been working with recently took about 4-6 weeks to see the abilities re-emerge with eating, after careful adherence to the Division of Responsibility, structured meals and snacks…
•This was an eight week intervention. Kids are people-pleasers at this age largely, so might they self-report less binging behaviors?
• How were people recruited for the study? If they were volunteers, the results are more likely to be meaningless or skewed. (I get the sense that this article is simply a re-written press release from the study authors, a sloppy and common trend…)
• I haven’t read the whole study, but the basis still seems to me to be a focus on deprivation, and “bad” foods. You can’t eat the bad foods, you must control yourself, and you are inherently not trust-worthy around these foods.
• Perhaps the “depression” they mentioned is not due to lack of control, but to body-image dissatisfaction, feelings of low self-worth (kids who are identified as “fat,” regardless of BMI feel less good about themselves in every way, are less physically active…) vs feeling out of control with food. Perhaps the depression associated with dieting triggers the binges? Perhaps deprivation and craving triggers binges?

Here’s a little about what we know about children and binging or, eating in the absence of hunger (EAH)

  • The more restricted kids are (girls age 4-9 in one study) the more they binged. Yes, four year-olds…
  • When “forbidden” foods are overly-restricted, four-year-old girls report feeling guilt and shame, and yes, increased EAH.
  • People who have a history of dieting or restriction tend to binge or EAH with stress.
  • Parents who restrict and binge raise kids who do the same.

So, to me, this is not a “different” approach, sure, it’s not behavioral therapy (which the article itself says doesn’t work for weight loss), or diet diaries and boot camp, but the message the kids get is the same. You can’t be trusted with foods, there are bad foods you must not enjoy, you need to eat less and lose weight. This does not a competent eater make…

Let me switch gears and examine the notion of binging and kids and eating disorders. Are we labeling binge-eating in 8-year-olds as an eating disorder, what about in a six-year old? I am getting more and more calls from parents of 6, 7 and 8 year-olds who are binging, and it’s not just fat kids being gluttons, like this article would have us believe…
It’s the lean six-year-old neighbor girl sneaking into your house to drink juice boxes and Ritz crackers because those are forbidden in her home.
It’s the 7 year-old who’s weight is “normal” but increasing. She’s been on “portion control” and no treats since she was four, because she “has no stopping place.” Now she’s sneaking frosting containers out of the trash.
It’s the “obese” 12 year-old-boy who’s mom has tried desperately to keep him on “green-light” foods, and who followed her doctor’s orders to not “keep any crap in the house, you’re the parent, act like it!” So, on his way home, this boy bikes past the grocer and binges on a dozen donuts… (Read the poignant comments from my post about “just don’t keep it in the house,” from adults who learned to binge as kids and why.)

Take the 8 year-olds’ mom who called and said, “My neighbor found my daughter locked in their bathroom. She had eaten a whole box of Oreos in about three minutes. I think she has an eating disorder.” We talked a little, and she proudly declared she doesn’t have “that crap” in her house, and that her kids don’t get sugar or white flour. I told her that after a careful evaluation, my intervention philosophy is one based on permission and learning to incorporate forbidden foods into a regular routine of balanced sit-down meals and snacks. I did not hear from her again. Something tells me, we wouldn’t have worked well together.

What I am getting about, in my usual tangential way, is that in my opinion, the cases above are not eating disorders

– yet.

But they are the result of distorted feeding practices. (Note, I did not do full evaluations in all the cases.) These kids are not trusted, so whether they are binging because it’s the forbidden food, guilt, being on an outright diet and being really hungry, or a combination of the above-  it’s not that the kid is a sugar addict or can’t control himself. This is not something that a “fix the kid” approach will help. This article and experiment takes the backwards approach of only addressing the binge, not getting at the underlying relationship these families have with food. And, these methods have the potential to further disrupt a normal relationship with food.

I fear that we are raising a generation of binge eaters with all the focus on what they can’t eat, and the shame, the extreme scrutiny about body-size, “health” and “nutrition.” I hear about them now, at 4,5,6… I suppose it’s job security for myself, and  those in the eating disorder field, but we must do better. I don’t want to keep throwing these kids away while we figure out that the current approach isn’t working, but as we race towards rock-bottom with kids and food, I fear that is exactly what we are doing.

What do you think? What can we do about it???

 

Share and Enjoy:
  • Print
  • Digg
  • Reddit
  • StumbleUpon
  • Tumblr
  • del.icio.us
  • Facebook
  • LinkedIn
  • Twitter

12 Comments

Join the conversation and post a comment.

  1. Heather

    As a small way of whistling, do you (or maybe on Ellyn Satter’s website) have some information geared towards pediatricians? We have a well-child visit for my son this week, and at our appointment last year, the doctor was asking my son questions about what foods our ‘healthy’ – questions he couldn’t answer because that’s not something we talk about at home. I didn’t have a good response at the appointment last year because it took me by surprise, but I would like to be prepared this year. In other ways I like our doctor and don’t want to switch just because of this, but would like to have an educated response about how we feed our son this time around.

    • katja

      Ah yes, It’s on my list, but the list is too long! A handout might not be well received. Ironically, our own pediatrician heard me give grand rounds at the children’s hospital, and still asked, “Do you like vegetables?” I think they have to check it off on a list that they did “nutrition counseling.” Anyway, my response has always been positive, and as much for M. Something like, “Yes, we love eating all kinds of food, vegetables like broccoli, tomatoes, oh, and we love ice-cream, and noodles!” If the weight discussion is possible, I suggest speaking to the doctor or leaving a note in advance, that weight is not to be discussed in front of your child, and if they have a concern, they should speak with you privately. If a parent is blind-sided with the “You’re getting a little chubby, maybe not eat so much desert, or just trim 200 calories” (actual quotes) be prepared with, “Timmy’s body is wonderful! It can do so many thing, like soccer and swimming. We all enjoy a variety of wonderful foods!” If the clinician persists, politely indicate you are happy to talk about it later, or at another time and try to move on…

  2. Denise Bickel

    Just want to say, as an adult who had an eating disorder ( purging anorexia) for 16 years and managed to recover ( which I think is statistically nearly impossible)……I COULDN’T normalize my eating until I stopped restricting…I was on an almost no-fat diet..and even taking in “enough” calories my body craved essential nutrients, and my spirit craved the experience of food as something more than fuel…Learning to eat “normally” is a tough process for someone who went on their first diet at 5 yrs old…I had no “home base” for remembering what it was like for there NOT to be very, very strict rules about food. The exercises in this study are no different from what my mom had me do 30 years ago…watch your brother eat donuts, do not touch them. there is soda in the fridge, do not drink it..Same old thing we’ve been doing to fat kids for years…then when you can’t control the craving anymore, you lose it and eat a whole thing of oreos. Now I buy NO diet or low-fat products ( except for Pepsi Max, but I am stuck on diet soda, my mom started me on Tab in pre-school), I use real salad dressing, real mayonnaise, etc. I WISH they would focus more on HAES and “eating competence” with ALL kids…I am an avid hiker, cross country skier, etc…if when I was a kid someone had encouraged me to try things rather than saying I was “too fat ” to do things, and stopped micro-managing my diet, it would likely have saved me a lot of pain and trouble ( not to mention that half my teeth are missing.) We limit overweight kids in all kinds of ways in our society–like if you don’t lose weight and eat right you can’t make the team, be in the play, go to the dance…And force them to devote tons of emotional and mental energy to NOT eating…when they could be doing so many better things…If my mother had let me devote all the energy dieting required to writing, I might have finished my first novel at 12 instead of 37 ….

    • katja

      yes, yes, and yes… I am so sorry that happened to you and you weren’t better supported. It is why I read these studies and feel so very, very sad for these children, knowing we can do better, but feeling powerless to really help the families and children who are tormented with food and weight issues. I work with parents who desperately love their children, and who are being told by doctors, nutritionists, family etc that their children are obese, and these kids are being put on diets, and they believe they are doing what is in the best interest of the child. Of course, the ones who find me know something is wrong and are looking for a different way. I really feel sympathy for everyone involved, but particularly the children. I too chuckled a bit at their claim that this was a “new” approach. I see so many children who are learning to binge due to restriction, and it saddens me. As binge eating disorder is planned to be included in the new DSM diagnostic criteria, as I said, I fear we will raise legions who only know this pattern of eating. We who are blessed to have normalized and joyful, tuned-in, permission-based eating will be an even smaller minority in the years to come.
      I am so thankful and happy that you have recovered, and can imagine the hard work it took to heal. Thanks for sharing your story. Any ideas on how we can begin to turn back the flood? Ellyn Satter says, we are whistling in a hurricane, but if enough of us whistle, can we be heard? How can we whistle??

  3. Jennifer Hansen

    What I’m doing about it right now amounts to opting out. I chose to homeschool for several reasons; wrong-headed government initiatives that force local public schools to do things that are against the best interest of children are definitely on my list. My kids are protected from the setting up of foods as forbidden treasure. (Somewhere in your archive is a comment about a sign in an elementary school classroom featuring a giant cupcake under a circle and slash!) They are protected from programs designed to fight obesity (=shaming fat people for existing and teaching children to be frightened of their own hunger). They don’t hear us talk about “good” and “bad” foods. They still pick up fat talk and so on from the world around them. We don’t have commercial media in the house, so we don’t have endless ads for the yogurt that will make you thin and the ice cream you can enjoy as a forbidden thrill and blah blah blah. But I do let them watch PBS, and they get some of it there. Agh!

  4. Sam

    I always appreciate reading your thoughts, Katja, and am grateful that you share them with us! This research is certainly bothersome to me. In my opinion, so much of this issue comes down to trust, as you mentioned in your above comment. It’s lack of trust in our own bodies and lack of trust that we can handle food and make balanced decisions about eating. In your examples, it is clear how parental fears play out and the result is the exact opposite of what the parents want! Clearly standard approaches are not working, and I’m not sure what it will take to make changes. I regularly teach the DOR and a non diet philosophy, with the hope I am making even a small difference for individuals and families.

  5. ako

    You know, if you want to desensitize kids to the foods they binge on, try treating those foods as regular food, not training the kids to think of them as some tightly-restricted drug-like substance they can only have in a laboratory setting.

    But no, doing that will mean that, while they’re finding whatever equilibrium works for them, some kids will eat more than some adult thinks is appropriate. And that is the worst thing in the world.

    • katja

      Kids need to experiment to figure this out. Learning to tune in to those cues, and figure them out (vs, being sad or bored) takes time and “mistakes” including eating beyond hungry sometimes to learn what that feels like. Hey, I still eat beyond hungry not that infrequently, if something is really, really good, or I was too hungry to start. It’s OK, it evens out. When did we get so scared and unable to trust ourselves and our kids with food??

  6. Becky Henry

    Have you seen Dr. Cynthia Bulik’s talk at Karolinska Institute in Sweden? She specifically talks about Oreos and a study with rats. This is very scientific and technical for researchers. The title: “Hip Hop or Viennese Waltz? The Complex Dance of Genes and Environment in Eating Disorders: Cynthia M. Bulik, University of North Carolina at Chapel Hill. November 15 15h00 . Location: Nobel Forum, Karolinska Institutet, Solna.” Laura Collins shared it on her blog – the link is long here: http://www.laurassoapbox.net/2011/11/environment-and-genetics-what-kind-of.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+AreYouEatingWithYourAnorexic+%28Are+you+%22Eating+With+Your+Anorexic%3F%22%29#!/2011/11/environment-and-genetics-what-kind-of.html

    Thanks Katja for addressing these tough complex issues.

    Becky Henry
    Hope Network, LLC

  7. Heather

    That study creeps me out. The ‘cue exposure’ seems really mean to do to children, and it seems like it would just increase the tendency to obsess over certain foods.