raising a generation of binge-eaters

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???