Having Your Cake and Eating it too….what to do about “junk food” for you and your family

IMG_7692Let’s face it. Do you really and truly think you should live the rest of your life without having a good old homemade chocolate chip cookie? The cookies pictured here were baked by my mother-in-law for a recent family gathering. I was fortunate to grab some that I packed away in a freezer bag for later cookie cravings. Anyway, after a recent post about childhood obesity and the damaging repercussions about an unhealthy food environment, I got some feedback about how children should not be restricted as this will likely contribute to binge eating, and an increased focus on food.

While I totally agree with the principles of hunger-motivated eating and “intuitive” principles of eating, I also know that it is not as simple as it sounds. My husband has always joked when I have said “listen to your body” because his body says to eat the entire bag of Lay’s! Of course this is not exactly true, and I have never seen him consume an entire gigantic bag of chips, however this is an issue that comes up often when “intuitive eating” and “listening to your body”is promoted. What is a parent to do when a child does appear obsessed with whatever sweets are in the home and can’t wait until he or she can get a hold of it? What is an adult supposed to do when they are dieting and truly craving something sweet? or salty such as chips?

We are a culture of “all or nothing” thinking. You have heard it before….the dangers of being “on” a diet, then “off” a diet. People follow the craziest and most restrictive diets for a variety of reasons, but when, inevitably, they can’t maintain the restriction (usually due to a powerful physiological response to starvation coupled with an environmental trigger, such as exposure to a particular food), well, after they break the diet, everything changes.

After having that cookie, or eating a handful of those chips, total mind games take over. The “all or nothing” mindset kicks in and people lose control (who wouldn’t?)

The problem is that if we want to encourage our children to eat healthy, but also don’t want them focused too much on eating and food, then we need to be careful about the messages we send. We want them to make healthy choices, however, we don’t want them to feel guilty about having a cookie. What is the best advice to promote a healthy relationship to eating and especially, to “fun food”? Here are my 5 Tips for Having Your Cake and Eating It Too….

  1. Never withhold food from a child, especially a sweet or dessert, until they have finished the main meal. This serves to reward them with sweets and teach them that something is very wrong with the food they are being served and something is very special about the sweet they are being rewarded for. Instead, let them have the sweet right along with their meal. This bothers many parents because they were brought up back in the day when sweets were used as reward, or withheld for punishment. Many of those brought up this way tend to continue to reward themselves with sweets when they are finally adults and can do what they want. I remember one patient I saw for binge eating. She had gained and lost hundreds of pounds over the years. Her mom used to restrict her to make her lose weight, so when she finally was out on her own, she was all about getting back at her mom and started to use food (sweets especially) as a reward for almost everything. Now as an adult, her mom still made comments about her weight and eating, and it bothered her, even though she was 50 years old.  I remember her telling me after her mom passed away that she still was feeling restricted and it was hard for her to accept now that her mom was no longer alive, she did not have to sneak or get back at her. It still was hard for her as she had been doing this for so long (binge eating sweets). So the message is, beware of restricting sweets or making them special as it will likely mess up your child’s relationship with eating (or if YOU have been restricted, maybe it is time to think about sweets in a different way?)
  2. Pay attention to your child’s reaction around food (and pay attention to your own feelings when food is around). Accept that everyone is different. You may discover that your child has little interest in eating (I see these kinds of kids all the time in the Feeding Team, where children are referred for feeding issues). Or maybe the opposite is true, and your child seems obsessed with food. This sometimes is due to a child’s food intake being restricted, or too much attention placed on a child’s eating or weight. Other times, I have seen it just be that the child simply enjoys food and eating.  Even as an adult, some people seem to be bored with eating (“eat to live”) while others are somewhat obsessed with it, love cooking, love eating, and spend lots of time on it. This is not a bad thing necessarily, however if it is due to previous restriction, or dieting as an adult, then this kind of eating and food obsession tends to come with guilt, not pleasure and enjoyment.  The bottom line is you need to pay attention and accept that everyone is different. If you have a child obsessed with eating for whatever reason, or if you are for whatever reason, then it is important to create an environment where everyone is able to enjoy food and eating, but not be triggered into binge eating. This means having those fun foods on a regular basis because you enjoy them, but not going to Costco’s to buy the mega cookie tray to leave on the counter where there is a child who is not going to be able to stop. Or do what I do, and put them in zip lock freezer bags so you can take out what you want when you want it. No one is deprived and no one is triggered. Yes, I have had patients who are not able to do this as they will binge on them frozen. Know yourself, and do what you need to do to have balance in your eating.
  3. Again, I have said it before and I will say it again. Don’t treat children (or adults for that matter) differently when it comes to sweets, or what foods you allow them to eat. If you want to make sweets or some other fun food (chips, fries) a part of a meal, let everyone, no matter what their weight or body size have it. Don’t make comments like “that is enough”. Let everyone have what they want and need. Encourage listening to your “tummy”. How do you feel? Do you feel satisfied, stuffed, still want more? It is important to help children, and also important for adults to learn how to eat ALL foods in amounts that make them feel good. Not stuffed, not uncomfortable, but good. Satisfied. The only way to do this is to have these foods on the menu.
  4. Talk about being healthy, and not about how “good” or “bad” a food is. I personally think it is ok to educate even children a bit about nutrition. It is ok to say “milk makes your bones strong!” or “this broccoli has lots of vitamins and makes us feel good” or “that has a lot of sugar in it, so we need to brush our teeth so we don’t get a cavity”. But is it not ok to talk about food and weight. Don’t say “cookies are bad for you! If you eat too many you will get fat!” Instead, have cookies as a part of a meal that provides some good nutrition (such as a dinner with meat, vegetables, grains, a glass of milk). It is really amazing how children will not devour all the cookies first as you would expect when they are given in a neutral manner, without judgement along with the rest of a healthy meal. Yes, if you have been restricting sweets, kids will go to them first. But after awhile, they won’t be special anymore. This will work for you, too. Although if you have been dieting or restricting excessively, you may need the help of a dietitian and therapist to guide you. Don’t feel bad if this sounds impossible. For many who struggle with eating disorders, it is. That is why knowing when you need help is important.
  5. Realize as a parent or as an adult, you make the decision about what your food environment will be. You go to the grocery store and you bring home whatever you buy. It is not restrictive or wrong to decide to predominantly have healthy foods in your home. If you know how to cook, healthy meals are really yummy! You are the one to decide if food is left on counters or in cabinets where children can help themselves. Don’t villainize the food, but instead, have it be a part of your normal healthy meals when you really feel it fits (and you want it). We all have our family favorites. When I grew up, ice cream was our thing. We would go every Sunday on long drives in the country and eventually stop at the same farm where they made their own ice cream. We all got what we wanted (I always asked for the green ice cream, also known as pistachio…still my favorite). In my husband’s family it was Grandma Harmon’s cinnamon buns. They are a pain to make, but when my husband does, he makes a lot, and we freeze them. We make them last!

So the bottom line is that it is smart to normalize “fun foods” so they are not so special after all. There is less need to be obsessed with them when they are treated neutrally, and when we get to have them. At the same time, we want to feel good. Therefore, it is smart to have our favorite fun foods as part of our normal healthy meal. It does not mean we need to have these fun foods at every meal. It could be once a day or a few times a week, or even a few times a day. As long as everyone gets the nutritious foods we all need to survive, that is what matters.

Also, it is imperative that we don’t talk about any foods in harmful ways (“this will make you fat”). Instead, talk about how yummy it is and enjoy it. With a focus on a healthy lifestyle (adequate sleep, fun physical activity, balanced healthy eating, relaxation) a normal amount of sweets, chips or other fun foods is fine.

So what is YOUR family traditional fun food?

5 Things You Should Never Do if Your Doctor Tells You Your Child is Overweight

We all have heard it a thousand times. We have an obesity epidemic among our children and we need to do something. Back in July of 2013 when the American Medical Association declared obesity a “disease”, pediatricians took action. If a child’s Body Mass Index (BMI) was equal to or greater than the 95th percentile on a growth chart the child would be labeled “obese”. If the BMI was equal to or greater than the 85th percentile then they were “overweight”. Parents needed to be informed so they could do something about it.

There is lots of controversy about using BMI as a criteria to determine health. To calculate BMI all you need is a height and weight. Unfortunately, although this is what pediatricians use to diagnose and label “obesity”, BMI has little to do with health. Check out this BMI article for some great scientific background on why BMI is not a useful tool.  Anyway, if you are a parent, and you take your child for a yearly check up, you may be informed of your child’s BMI (especially if your child is out of range according to the Center for Disease Control (CDC) growth charts) See CDC Growth Charts.

What should you do if your pediatrician tells you your child is overweight or obese? Here is my advice on what you should NOT do:

  1. Never assume your pediatrician is correct to have any concerns about your child’s health due to his or her BMI. Instead, ask to see your child’s growth chart. Typically, children tend to follow along a curve. So, if your child has always plotted around the 50th percentile for weight, that is their “norm”. If they have always plotted along the 95th percentile for weight, then that is their “norm”. If their length or height has always plotted along a certain curve, the same holds true. Therefore, if a child happens to genetically be on the lower side for height and on the higher side for weight, their BMI may fall into a range that is above normal for BMI. Does that mean something is wrong? No! In fact, I have had several children come to see me who were referred for “overweight” who were actually very healthy and growing normally. One case I clearly remember is a little boy, about 10 years old I will call Johnny. Poor Johnny looked terrified when he came into my office. When I asked what brought them here, he blurted out “The doctor said I am overweight! Am I going to die? Am I too fat?” It was sad to me how frightened he appeared. When I looked at his growth chart, it was clear he was one of those kids who was a bit shorter and a bit higher on the weight chart. He was an athlete who played several sports and appeared very muscular and was definitely very fit and healthy. I had to tell him “your doctor made a mistake! He forgot to look at your growth chart! You are growing perfectly! But let’s go over what you eat anyway so I can be sure you are getting everything you need, ok?” He showed a visual sign of relief as he let out a big breath and sighed. I thought, this is so wrong. This athletic young boy should never have to worry about his weight. The doctor should have looked at the growth chart and known that this kid will probably never have a BMI that falls in the “normal” range and that his healthy lifestyle was what mattered. So the bottom line is be sure to ask your doctor to see your child’s growth chart. If, on the other hand, your child has veered off of his or her normal growth that may be a different story. Sometimes when there are big changes in lifestyle (that are not conducive to health, such as getting a new video game and discontinuing playing outside everyday to sit on the couch and play videos), well, weight can increase in a way that is not normal for the child. In that case, working on decreasing screen time and going back to healthy outdoor play is what is important. Again, working on having a healthy lifestyle is what matters, not the number on the scale, and certainly not a child’s BMI.
  2. Putting your child on a diet. Yes, after getting the news your child is overweight, a good parent wants to fix it. Often, a parent will come to me and ask for a “diet” for the child. Because of all of the cultural emphasis on dieting to lose weight, parents fail to stop and think that these are children, not adults we are talking about. And, the ironic thing is that research has proven that even adults are not able to diet successfully. Dieting leads to binge eating. Why would we think children can do it?Don’t you think if an adult ends up sneak eating and binge eating after restricting that the same thing will happen to children? It will.  Diets don’t work, not for adults and definitely not for children.
  3. Expecting your child to do something you can’t or don’t do. Do you expect your child to eat vegetables and fruits and salad, yet you don’t eat them? Do you drink soda yet expect your child to just drink water? Do you sit for hours in front of the TV yet expect your child to go exercise on the treadmill? Children do as we do. You can talk until you are blue in the face about the benefits of eating fruits and vegetables, and about how good exercise if for your body, but if you have an unhealthy lifestyle, glued to the TV, bringing home fast food every day, then your child is likely to be just like you. If, on the other hand, you have a healthy approach to eating and moving, with a focus on being healthy, then your child will likely adopt the same healthy attitude and lifestyle. This does not mean living on health food and driving yourself into the ground with exercise. It means using a healthy guide such as My Plate to help make your meals healthier. It means taking your child to the park to run around and have fun instead of handing them a video game to sit in front of a screen for 4 hours. It means planning some outdoor play and limiting the use of screens (TV, cell phones, video games) to less than 2 hours a day (yes, it is easier when they are occupied in front of a screen, but not healthy for their bodies if it is excessive). So work on this instead of thinking your child is going to be able to diet.
  4. Treating children differently when it comes to food depending on their body size. This is a pet peeve of mine. When a family says they have cookies in the house, or chips, or soda, because “her brother is skinny, he needs it”, this drives me crazy! What typically happens is the child who is overweight sits there in my office looking guilty. Their head is down, no eye contact. The mom goes on to say how little Cindy is sneaking her brother’s cookies. Mom also caught her sneaking some of her brother’s Doritos. Could I please tell her that she does not need them? Maybe she will listen to the dietitian! So what do you imagine my response is? I whisper (loudly), and look straight at the sneaky little criminal “you know what? I would be sneaking those chips too!” Now at this point, the mom usually looks at me like I am crazy, until I explain. How would you feel if your very favorite food were in the home and yet you were the only one who could not have it? It simply is not fair. Instead, I believe in trying to have a healthy food environment. This means having healthy snacks in the home, not having soda around (since most kids might fill up on it and say heck with the milk). Have soda when you go to parties, don’t restrict it, however be smart about it. The same goes for chips. Make them a part of a meal with other healthy foods (like a tuna sandwich, you really do need a few chips with that). Just because brother Johnny is skinny does not mean he does not deserve to be healthy too. He should also be eating fruit and vegetables and not filling up on soda. Everyone needs to care about health. It has nothing to do with body size. So stop treating children differently depending on their weight. It does not help anyone and it only serves to make the labeled child feel bad. It also usually increases a focus on food and sneaking. This is not a way to move toward healthy eating.
  5. Talk about weight at all. Your child’s weight, your weight, your friends weight. Just stop talking about it. In fact, I would also recommend you have a talk with your pediatrician to request he or she avoid commenting about BMI or weight at all in front of your child. If there are any concerns, ask that they talk to you privately. You do not need your child worrying about weight. This is not a good thing at all and only serves to make them feel bad. Instead, get the details about their growth chart (ask to see it, ask them to explain it and why they are concerned). If your child truly has gone way off of the chart then don’t talk about it. Instead, look at your entire family and the habits you have fallen into. Work on getting more physical activity for the entire family. Look into healthier cooking and less eating out, and other strategies to promote a healthy lifestyle. Seek the help of a registered dietitian by going to Eatright and finding a dietitian in your area. Or check out the My Plate link above and work on it yourself. But don’t talk about weight in front of your child. It is not helpful and will most likely be harmful. Think about it. How would you feel if everyone was watching every morsel that you ate, and pushing you to exercise when everyone else in the family was sitting on their butts playing video games? It is simply not fair.

So there you have it. There are also many things you definitely should do to promote the healthiest body possible for your child. Stay tuned for that. In the meantime, give your child a hug and accept them for the beautiful blessing that they are in your life.

Does Your Child Have Avoidant Restrictive Food Intake Disorder (ARFID)?

picky eater

This article is a must-read for any parent of a young child with “picky eating”. Although it is normal for a toddler to go through phases of being fussy about food, it is wise to pay attention if it continues. I work on a “Feeding Team” at a children’s hospital and before this diagnosis was introduced, we referred to these kids as having “Feeding Difficulties” however now we understand how complex the issue can be! We refer many of these children for outpatient “feeding therapy” to help them overcome their issues. It is sad when physicians and parents don’t worry just because a child is growing well. In time, the result is a teenager who only eats a small variety of foods and whose growth as well as social life has been compromised. And it all could have been prevented with early intervention.