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What Are You Worried About? Part 3 Food ‘Obsession’

Posted by on Jun 10, 2014 in Blog Posts | 6 comments

This is part 3 of a 5 part series on food preoccupation. Read Part 1, Max’s Journey of Healing  and Part 2, Is My Child Obsessed with Food? This is a long post because the fear of fat and the consequences of that worry are harmful, and barrier to supportive feeding…

The food preoccupied child is anxious and works hard to get food. The worried parent keeps food from the child. The harder the child works to get food, the harder the parents have to work to keep food away, even resorting to padlocks on the pantry. The worry in this scenario behind the counterproductive feeding is almost universally about weight. The child is perceived as challenging to feed because he is “too big,” might get to be too big, or his appetite is “too big” (the worry is still that the big appetite will make the child fat).

worry cycle with cr

Parents receive harmful feeding advice, even from the experts they turn to, who are often unaware of the research and don’t understand that restricting children is harmful and can harm the feeding relationship. Trying to get a child to eat less, or banning “forbidden foods” can lead to a child who is preoccupied, eats more when she has the opportunity, and may weigh more than nature intended. First do no harm.

What Is “Overweight” or “Obese?”

Until we address the fear that drives the restriction, parents will have an almost impossible time trusting the child with eating. As Max’s mom shared in Part One, “I don’t think I can accept having a fat child… I worry about his health.

When I use “overweight” or “obese” in quotations, I refer to the cutoffs and labels on the standard body mass index (BMI) and growth charts. The child growing above the 85th percentile is considered “overweight,” while the child growing at or above the 90th percentile is labeled as “obese.”

 

Picture 4This girl is considered “overweight.”

 

article-1258614-08C06575000005DC-84_468x678This boy is “obese.”

 

Are these labels meaningful? Consider:

  • In other countries, the cutoffs for “normal,” “overweight,” and “obese” differ. Does it make sense that a child at the 90th percentile in America is “obese,” but if he travels to England, that same child is merely “overweight?”  They use different cutoffs. This is a clue that these labels are not necessarily clinically meaningful for an individual child.
  • A decade or so ago, the child growing at the 90th percentile was considered “at risk” of becoming overweight, and as with adults, the cutoff points and classifications were lowered. Overnight, almost 30 million American adults went to bed “normal” and woke up “overweight,” with no change in actual health.
  • In a young child, five pounds can span the label of “normal” to “obese,” and 1/8 of an inch can change the “diagnosis.” While the clinical significance of a few pounds is questionable, the label is not.

Labeling children has not been shown to improve health and is more likely to make your child less healthy. Regardless of actual weight, children labeled “overweight” or “obese” feel worse about themselves, exercise less, and are more prone to practice disordered eating, diet, and gain weight. Parents who are told their child is overweight tend to resort to trying to get the child to eat less, with more dieting and, ultimately, weight gain. “Knowing” is not necessarily a good thing.

 

Remember that a child growing consistently—even at a high percentile—is larger than the majority of her peers. But to label her as “overweight” when she may be healthy weight for her is wrong, implying a health risk that may not be there.  (This article on assessing growth curves explains, “Many children who are otherwise perfectly normal exhibit growth percentiles at the extremes of the growth curves.” It’s worth a read.) Almost always, the child of the parents I work with is a larger-than-average but healthy child, enjoying good nutrition, with a lot of effort on the part of the parent. Then a worry, either from the parent or from a health care provider who labels the child as “overweight” or “obese,” sets off the cycle of worry, restriction, and food preoccupation, and often accelerated weight gain. Like Max, whose initial growth was perceived to be problematic in Part 1, with higher than average but steady growth, and resulting restriction.

What Children Weigh Now Does Not Reliably Predict Adult Weight

I cringe when families tell me that restriction and outright diets (and diet soda) are recommended for a child of two or three years. As larger-than-average children grow up over the years, they trend toward slimming IF they are supported well with eating and activity. (That is a big IF on purpose.) Child BMI is not reliably predictive of adult BMI. According to the U.S. Preventive Services Task Force, “a substantial proportion of children under 12 or 13, even with BMIs higher than 95th percentile, will not develop adult obesity.” (Note: There is increasing predictability as BMI increases, and the older the child.)

The youngest age at which I have seen restriction recommended was for four-and- a-half-month-old Mia, an exclusively breastfed baby. The pediatrician told Mom that Mia was “obese,” to cut out nighttime feeds, and to try to hold Mia off her feeding for 30 minutes when she seemed hungry. Within weeks, mom’s milk supply was down to nothing, and this family was on the road to dealing with a child with an increased interest in feeding. In this case, the doctor recommended feeding in a way that was not responsive to Mia’s needs (or her moms), which set up their feeding struggles.

“But, can my child be healthy if she’s above average weight?” This is the fear. I hear you. This was my main stumbling block as I was learning.

This section will seem to defy every cherished belief about weight and health that our culture and most medical practitioners hold true: The idea that every “extra” pound shortens your lifespan—that weight is linearly related with death and sickness. It is not. There are many healthy people at a variety of weights. Yes, some conditions are correlated (different than causation) with higher weights (mostly adult BMI of 35 or 40 and above), but in studies when fitness level and other disease risk factors were taken into account, the level of fatness did not predict disease. In addition, more research is confirming that health improves (as evidenced by blood pressure, blood sugar, and cholesterol improvements) with healthy behaviors, even without weight loss. You can be fat and fit. If you are reacting strongly to this statement, you are not alone; I remember literally scoffing the first time I heard this.

My main point is that if you hear yourself saying, “Yes, but she can’t be healthy and be overweight,” I urge you to read and learn more. If you don’t believe your child can be healthy if she isn’t slim, it will be difficult to trust her and help her become a competent eater. The following books can help start the process:

Rethinking Thin by Gina Kolata
Big Fat Lies: The Truth About Your Weight and Your Health by Glenn Gaesser, PhD
Health at Every Size by Linda Bacon, PhD
Intuitive Eating by Tribole RD, and Resch RD
Your Child’s Weight: Helping Without Harming by Ellyn Satter, MS, RD, LCSW

It took me two years of reading, challenging my training and my biases to embrace the Health at Every Size (HAES®) Approach.

HAES® is not an excuse to “indulge” children or ignore accelerating weight, as some critics may claim. Feeding a child well and supporting healthful behaviors takes effort and planning. Ellyn Satter’s Trust Model and Health at Every Size® simply endorse and support health rather than weight as a goal, and a more stable and healthy weight often results.

When a client says, “Yes, but I don’t want her to struggle with her weight like I did.” I find it helps to ask, “If your child continues to be restricted, food-obsessed, and binging when she gets the chance, what do you see for her future relationship with food and her body?” After some discussion, we usually come to the same conclusion: that the child will struggle with her eating as an adult—and be heavier than nature intended her to be.

What are you worried about?

 

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.

 

Read Part 1: Healing a Child’s Food “Obsession”: Max’s Story

Read Part 2: Is My Child “Obsessed with Food?

Stay tuned for parts 4 and 5…

Parts of this post are excerpted and adapted from my book, Love Me, Feed Me

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6 Comments

Join the conversation and post a comment.

  1. Natalie

    Thank you so much for this information! My 3 year old son exhibits all of these behaviours and tomorrow i will start to stop restricting his portions and asking his to eat slowly etc. It makes me so sad to see him so desperate for food. But i do have a question…when i do let him eat a lot, he has massive problems emptying his bowels. He poos sometimes three/four times a day and often it ends up runny and uncomfortable for him. He often has to stay on the toilet for half an hour waiting for all the poo to come out. Is this part of the process too? I feel terrible as i watch his little body go through that. Also, is it common for the food obsession to be accompanied by defiant and deeply emotional behaviour? Today for example, he cried almost the entire day and seemed clumsy and irrational. Thank you for this information. It has definitely given me some hope xo

    • katja

      Good luck as you figure this out. No, stooling problems are not typically part of this process. I recommend you talk over your concerns about bowels with his doctor. He might for example, be lactose intolerant or have other food issues. Having a thorough physical is a good idea. Please get as much information as you can before you jump in, it’s a scary process, and many parents try a few things only to get scared or frustrated and go back to restricting. Asking him to eat slowly might backfire too for example. Your Child’s Weight, Helping Without Hurting, or my book, Love Me, Feed Me will give you more information as you address this issue. It takes time, and knowing as much as you can will help. Best of luck!

  2. growing up green

    Amen to this! My2.5yo was born at 25% percentile then quickly grew to 90% and has stayed there ever since . Every Dr or nurse visit has been a warning on weight without consideration of her activity or food that she eats. As a healthy adult who was also bigger but not obese as a kid I continually brush them off but geez it takes some fortitude of character and I’m happy to find this reinforcement.

    • katja

      I’m so glad I could help. This makes me nuts. So much harm is being done by this blind reliance on a false indicator (incomplete at best) of health. Good for you! I will excerpt and share your comments on facebook to help other parents if I may. We need to come together and stand up to this practice!

  3. Maryann

    I am so glad you are doing this Katja. I will let my readers know about the series and facebook page. So many of these parents struggle in silence.

    • katja

      Thanks! Yes, there seems to be so much shame around this issue. I hear folks say about severely selective or ‘underweight’ kids, “Well, at least he’s not obese.” The fear, or having a child who is chubby seems these days like a badge of poor parenting. There is so much judgment, and it’s so unhelpful!

Trackbacks/Pingbacks

  1. Learning to Tune In: Part 5 Food ‘Obsession’ | The Feeding Doctor - […] 2: Is My Child “Obsessed with Food? and Part 3: What Are You Worried About? and Part 4: Trying …
  2. Trying to Get Kids to Eat Less Backfires: Part 4 Food ‘Obsession’ | The Feeding Doctor - […] This is part 4 of a 5 part series on food preoccupation. Read Part 1, Max’s Journey of Healing, …