Health Care Providers Recommend Restriction
Like the rest of us, many clinicians simply aren’t aware of the research. They cling to simplistic ideas like, “It’s just calories in, calories out,” and the belief that cutting a few calories here and there adds up, like a math equation, to a certain number of pounds lost. But the issue is far more complex.
The vast majority of primary-care physicians get little training in nutrition and often none in relational or responsive feeding, despite stacks of research. I did not know, and will admit to being ill informed when I was in clinical practice as a family doctor. I had to learn for myself, seek extra training, and even undo a lot of misinformation. I do not accuse my colleagues of bad intentions; I know they are dedicated, caring, compassionate professionals who really want what is best for children, but they are unaware, and this has serious consequences.
If you are a health care provider, ask yourself how it feels to practice in the current approach (decreasing calories, portion control, restricting access to highly-palatable foods, pushing exercise, focusing on weight…) Does it work? Do you dread talking to families about weight? Are you confident that what you are doing is helping and not harming? These were the questions that helped me approach this issue with an open mind. I was not satisfied with my outcomes with the standard approach, which both my patients and I seemed to intensely dislike.
Clinicians, like the rest of us, tend to focus on what children eat and ignore how children are fed. They assume the child who is accelerating with weight is simply drinking too much sugar-sweetened beverages or eating too much fat or too many calories. Their approach most often will be one of cutting calories or trying to get the BMI below the 85th percentile, even if a higher number may be healthy for your child. One pediatric dietitian (RD) shared that the goal at the weight-loss center she worked at was for all children to reach the 50th percentile! (See Part 3 for thoughts about weight and BMI…) And, a handout with calorie limits, 60 minute exercise recommendations and a list of fat-free or sugar-free foods is faster for the time-strapped clinician than learning about and supporting the complexities around eating, feeding, meals and more…
One mother reached out after the RD she saw at a university-based pediatric weight loss clinic recommended diet soda and Crystal Lite as “preferred beverages” for her two-year-old. This felt wrong to her, and despite following the calorie and “red-light-food” limits for six months, her daughter became more food “obsessed” and her weight was accelerating.
A Diet By Any Other Name is Still a Diet
Most of us know that diets don’t work, and while most clinicians are more savvy and no longer recommend outright “diets” for children, they still talk about letting “weight catch up with height,” “portion control,” “green-light, red-light,” and other kinder and gentler descriptions. (Many clinicians still do recommend outright diets with strict calorie limits.) The bottom line is that if you are trying to get your child to eat less so she will weigh less, it’s restriction, it’s a diet, and it will almost always increase her interest in food and probably increase her weight as well.
Which of the following tactics have you tried or have been recommended to you?
- Using a highchair tray longer than necessary to keep food out of reach.
- Pre-portioning foods and refusing when she wants more.
- Making the child wait 20 minutes before she can have more.
- Distracting with toys, video etc. to get the child to eat less.
- Pushing low-calorie, “green-light” foods.
- Not allowing favorite high-calorie or high-fat foods (red-light foods).
- Trying to fill the child up on water before eating.
- “Running out” of favored foods.
- Shaming or scary talk about health risks or fear of fat, praising or selling low-calorie foods.
- Repeatedly asking the child if she is “full yet” while eating.
- Making the child exercise a certain amount to cancel out calories.
These tactics backfire because they undermine internal regulation, or eating based on signals coming from inside the body regarding hunger, appetite and fullness. The parents’ job is to provide balanced offerings, at regular times, eat together, and the child’s job is to eat as much or as little as he or she wants from what is provided at those planned, sit-down meals and snacks. This is known as the Division of Responsibility. Things go wrong when the parent tries to do the child’s job (decide how much to eat) or when the child is allowed to do the parent’s job, or when the parent doesn’t reliably provide enough food.
Note: Some food “rules” seem to ‘work’ for some kids; temperament, genetics, history around food, pleasure from food, restriction etc. will determine how your child reacts. If one child doesn’t miss the “junk” food when it’s removed from the home, fine, but for the child where the removal and restriction increases the focus, pushing harder and limiting more is unlikely to be the answer.
For extra credit, here’s an article challenging the idea of food “addiction” from Evelyn Tribole RD, co-author of Intuitive Eating: A Revolutionary Program that Works.
If you would like to join a new private facebook group for parents (moderated to be a safe space), send a “friend” request to Bonnie Appetites (little girl with pony tails) and you will be invited to join the group (and then she will promptly unfriend you). She’s not being mean, just protecting privacy.
Stay tuned for the final installation, part 5, Learning to Tune In…
Parts of this post are excerpted and adapted from my book, Love Me, Feed Me