Study on Kids and Weight: The Missing Piece of HOW Kids are Fed, or Restricted

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 I was curious to read this study, Eating Habits Matter Most With Overweight Children but was surprised that restriction wasn't taken into account. (I have only read this article so far.  This is a quick post with musings on the topic.) "Our results show that in relative terms, the BMI of children who are particularly triggered by food increases more when compared with others. But we also found the opposite effect: a high BMI leads to children becoming even more triggered by food over time (at around 6 to 8 years old). As they get older, they are even less able to stop eating when they're full," and"...many of these children find it difficult to know when they are full and therefore need their parents' help to regulate their food intake (for example, one serving at dinner)."

I wish their findings had been examined through the lens of restriction, that is parents trying to get the child to eat less to weigh less, or to prevent weight gain. There is research that restricting children is associated with increased EAH (eating in absence of hunger) and higher BMI. And restriction can trigger more interest— thinking of a study I read once with Kindergarteners given graham crackers restricted to certain times and amounts. Result: the children were WAY more interested in them throughout the day (and ate more) than when they were simply available without comment or restriction. Studies comparing overt ("You've had enough!") and covert (not having certain foods available) restriction add to the puzzle, but I would love to have seen more discussion about restrictive feeding in this article.

My take? Children who are restricted from early on are not supported with the developmental task of self-regulation and the process is sabotaged and the skills are buried (not lost I believe). I believe this phenomenon may be at least partly (if not wholly) what the study is describing. (Setting aside for the moment, the problematic labels and categories of "normal" and "overweight" in the first place, this study does seem to look at trajectory over time.) And there is controversy about what comes first, the large appetite, or the restriction, but I would argue large appetite when supported with responsive feeding is not problematic...What I see most often with clients is the infant or child with the hearty appetite, who may be larger than average, then someone sounds the alarm about obesity (I've had a handful of clients who were exclusively breastfeeding told by MDs to cut out nighttime and other feedings for 4 and 5 month old babies who were "o*ese"...) Parents then restrict (or the parent restricts from the start worried the child will be "o*ese"), and the child who was growing steadily, perhaps larger than average, becomes very interested, preoccupied, or 'obsessed' as many parents call it, and then the weight acceleration can really take off (as it did for the child graphed above).

This study summary seems to further the idea that bigger children can't be trusted to self-regulate, or that we should worry about larger appetites and children who find food pleasurable. It seems to encourage parents to restrict children in the name of teaching portion control since it implies these children are not capable of knowing when to stop. (Ironically, many of the parents of children with extreme picky eating that I work with are often told that their children are incapable of sensing hunger and are told to push food on their children...)

I think the parallels of adults and dieting and the flip-side of tuned in eating can help adults empathize. What do adults think about on diets? What did you think about on your last diet? (Mine was about 15 years ago on South Beach, and I was obsessed with having a bowl of cereal, but I digress...)  Adults often become preoccupied with thoughts of food, and tend to disinhibit (those four bowls of cereal on day 10 were ah-mazing!) Adults may have enough social graces and cognitive control not to pester everyone around them and beg and whine for food all day like a toddler or preschooler might...

And finally: "...we know that in order to promote the development of normal eating behaviour, it is important for children to decide how much they want to eat. If children are pushed to eat everything on their plates, they may stop relying on their own body's signals, and eat until the parents are happy." The author acknowledges that allowing children to decide how much to eat promotes normal eating behavior. Making children eat more than they are hungry for, she warns, can drown out the body's signals. Why is there such resistance to the idea that making children eat less than they are hungry for also means they can't rely on signals coming from their own bodies? I welcome research and discussion in this area, but worry that studies like this may lead folks to a false conclusion that makes matters worse, not better.

We CAN trust children with hearty appetites and larger bodies to tune in to hunger and fullness cues.

For more: I did a series about Max, a  3 1/2 year-old client with food preoccupation and how it was the restriction that fueled it, and responsive feeding through the Division of Responsibility that allowed the child to self-regulate and no longer obsess about food. I could write more about this article and statements I found problematic, but I think this is enough for today! I'd love to hear what others thought about this summary. Please join the discussion on facebook.