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Q&A about Your Child's Weight with Ellyn Satter
Your Child’s Weight: Helping Without Harming
Q & A with author Ellyn Satter, MS, RD, LCSW, BCD
In your book, you say that overweight is more of a parenting issue than an eating issue. Can you explain this further?
Childhood overweight is not just a matter of eating the wrong food. In order to do well with eating and growth, children have to get their emotional needs met. Today’s parents have difficulty meeting children’s needs. Money is tight, parents work long hours, extended families are dispersed, and the health care system falls short of teaching good parenting and feeding. Today’s parents are uncertain about how to take an effective leadership role with their children. Jobs, money and social advancement compete in importance with raising children. Often parents are not encouraged to make good choices on behalf of their children. As a result, a high proportion of today’s children are anxious and depressed. The emphasis in the media and health-care world on the ''epidemic'' of child overweight makes it even harder for parents. They hesitate to provide, and their confidence in feeding their children has been undermined.
It seems overwhelming. As a parent, how do I begin to tackle those problems?
Entering the whole situation through feeding gives a lot of hope. Learning to feed well will help you learn to parent well. The feeding relationship is a metaphor for the parent-child relationship overall. Keeping up the day-in, day-out of family meals provides the backbone for family life and gives your child an enormous sense of security. Being able to sort out your jobs with feeding from your child’s jobs with eating provides a concrete example of sorting out other control issues. Knowing when to take leadership and when to let go is the essence of good parenting.
FEEDING AND CHILDREN’S WEIGHT
Can you define Ellyn Satter’s Division of Responsibility in Feeding for toddlers through adolescents?
The parent is responsible for the what, where, and when of feeding. The child is responsible for the how much and whether of eating. This is a remarkably effective but simple tool that I talk about in each of my books. I can say with certainty it will revolutionize meal times at any home where dinnertime has become a battle that nobody wins. But beware, there are many who recite the division of responsibility without fully understanding it. For instance the American Dietetic Association, the American Academy of Pediatrics and Gerber foods featured the division of responsibility in a jointly sponsored anti-obesity handout for parents. Then the handout goes on to teach limiting portion size, limiting fat, pushing vegetables and avoiding high-calorie ''treat'' foods. Each of these tactics is a variant of restrained feeding and spoils the power of the division of responsibility.
You stress so much in Your Child’s Weight the importance of the ''family meal.'' But the reality is, with my four kids ranging in age from 4 to 14 and all their activities and two working parents, we barely see each other much less have time for a family meal. Are we dooming our children to a lifetime of eating problems?
You are running that risk. But the more-serious problem is that you are forgetting how important you are as parents and as a family with respect to giving your children a good start in life. Time spent with families at meals is more related to the psychological and academic success of adolescents than time spent in school, studying, church, playing sports, or doing art activities. Teens who had regular meals with a parent were better adjusted emotionally and socially, had better grades and went further in school. They had lower rates of alcohol use, drug use, early sexual behavior and suicide risk. The results applied for children of all ages, races and ethnic groups and who had parents of all levels of education, ages, employment, income and family structure. The results were the same for single-parent, two-parent and extended-family homes.
You say it’s not what my child eats but how my child eats that promotes overweight. Well, what if my child only ate McDonald’s all day? Wouldn’t my child become overweight no matter how he ate?
Not if you help him choose what to eat, sit down and eat with him and make it a pleasant family meal. You can follow the division of responsibility at fast-food places, the same as anywhere else. For the well-being of your whole child, the structure and ritual of family meals is all-important—far more important than the actual food that is on the table. Taking care of your child’s emotional needs helps him to eat the right amount and grow in the way that is right for him. On the other hand, if you give your child some money and send him off on his own, maybe. Instead of getting his emotional needs met, he will be left on his own to fend for himself.
Why make such a big deal of it? Children get fat because they eat too much! You can’t argue with that. Think about all those snack foods—sodas—fast food—not enough fruits and vegetables.
My book debunks the ''official'' wisdom that children are too fat because they eat too much of the wrong food and not enough of the right food. There is absolutely no research to support that. The research does say, however, that children tend to be slimmer when parents offer regular and predictable meals and snacks. It isn’t what you feed but how you feed your child that causes—or prevents—overweight.
It comes down to good parenting. If parents are doing their jobs of managing the what, when and where of feeding, children don’t have unlimited access to snack foods. On the other hand, children do need times when they are allowed to eat as much as they like of sweets and other high-calorie, ''treat'' foods. Otherwise those foods become forbidden fruit, and studies show that deprived children overeat on forbidden fruit when they get a chance and are fatter. The best strategy is to offer sweets at regular, sit-down snack times. Every so often, put on a plate of cookies and milk and let your child eat as many as he wants. Put potato chips on the table with the lunch-time sandwiches and make sure there are plenty to go around. At first your child will eat a lot, but the newness will wear off and he won’t eat so much.
Are you saying I should just throw open the refrigerator door and let my child eat anything he wants?
I would be a mighty poor nutritionist if I said that! Including a variety of nutritious foods at family meals is important for your child’s health. However, with respect to weight, poor food selection cannot defeat your child’s natural ability to regulate food intake. Children can’t be made to overeat with high-calorie food, big portion sizes or not enough fruits and vegetables. Remember, I told you it is the parent’s job to decide what food gets offered at meal- and snack-time.
Surely you can’t mean it is all right for children to eat super-sized portions of French fries and huge hamburgers and drink big glasses of soda!
Unlike adults, children are excellent at knowing how much they need to eat. Even if they are offered a lot of food, they stop eating before the food is gone because they feel satisfied. Children only learn to stuff down big portions when they are afraid they won’t get enough to eat or when parents insist they clean their plates. However, children can’t be good regulators all on their own. They need structure and support from grownups in order to do a good job of eating the amounts they need.
If it’s so important according to your theory that children should eat as much as they want, then shouldn’t I feed my child whenever she’s hungry throughout the day?
No! In Your Child’s Weight I explain why ''grazing'' is the real culprit behind the observation that ''children get too fat because they eat potato chips and candy or drink soda all the time.'' Although it may seem contradictory at first, what I recommend is not to feed a child all day long but to allow that child to eat as much as she wants during the regularly scheduled meal or snack times. An underlying principle of my practice is to prescribe three meals and two snacks a day for toddlers, preschoolers, school-age children and teenagers. This gives them enough fuel to carry them through to the next meal or snack time. In my clinical experience, it isn’t the food but the lack of structure and support with feeding that causes weight problems.
ACTIVITY AND CHILDREN’S WEIGHT
Isn’t the real reason for the childhood obesity epidemic kids’ being so sedentary in this age of television, computers and video games?
The common conviction that children become overweight because of low activity has no basis in research. In fact, research shows that overweight children expend just as much energy on activity as slim children. Heavier children may move more slowly and be less agile than slimmer children, but they can be flexible, graceful and have good endurance. All children watch a lot of TV, and the evidence is contradictory about whether overweight children watch more than slim ones. It doesn’t really matter, because restricting television is good parenting with all children. The American Academy of Pediatrics recommends keeping television viewing down to two hours a day or less for older children and discouraging it altogether for children younger than age 2 years. Restricting television nurtures children’s minds and bodies because it automatically encourages more interactive, active and creative pursuits.
Well, if you say so, but surely getting overweight children to be more active will slim them down, won’t it?
Not necessarily. Many ''overweight'' children are just normally large or heavy children who are growing well and already active. Trying to get children thin by making them more active spoils activity for them. As with feeding, parenting with activity requires a division of responsibility: The parent is responsible for structure, safety and opportunities to move. The child is responsible for deciding how much and whether to move. Children are born loving their bodies, curious about them, inclined to move and driven to be as physically competent as they can possibly be. The goal of good parenting with physical activity is to preserve children’s positive attitudes about their bodies and their joy in moving. Joyful activity is sustainable.
FEEDING & FEEDING PROBLEMS
Isn’t it my job as a parent to choose and prepare healthy meal options for my children?
While I would agree with you that it is your job to choose and prepare the food for your children, I take issue with the use of the word ''healthy.'' Like a lot of perfectly acceptable words our culture has spoiled by the way we use them, ''healthy'' has become code for ''don’t eat so much; don’t eat what you like.'' Yes, eating nutritious food is important for all our nutritional welfare. But the bottom line is family meals. Being faithful about meals is a lot of work. Rather than forcing yourself to choose and prepare ''healthy'' food that you find unappealing, you are most likely to keep up the day-in-day-out of family meals if you have food that you like and find rewarding. If you don’t like what you are serving, I can pretty much guarantee that your children won’t like it either. It won’t be long before you give up on meals altogether because they just plain are not fun.
That sounds good, but you can’t possibly know what kinds of really marginal food I make for my family when I am short of time. How do you feel about frozen pizza, or macaroni and cheese from the box or how about this—hot dogs and potato chips? We often eat at the breakfast bar in the kitchen while we watch the news on TV.
The only thing on that list I react to is the television set. I am impressed that you provide meals for your family, even when you are short of time. The foods you list have nutritional value. Serve milk as the mealtime beverage and you are doing well. Heat up some canned or frozen vegetables or open a can of peaches and you are doing even better! Remember, even the most reprehensible family meal is better than no meal at all. Studies show that children of all ages who eat family meals do far better nutritionally. But turn off the television set. Your children need your undivided attention at mealtime.
No matter how much I reward, threaten, bribe or otherwise try to entice my child to eat vegetables, he’s just not convinced. How can I make him eat his vegetables?
Eating a lot of fruits and vegetables will not keep your child slim. Fruits and vegetables are important for health, they are not magic bullets for weight management. We are back to the division of responsibility: You offer; your child eats—or doesn’t eat. Your child wants to grow up, and part of growing up is ever-so-gradually learning to eat—and like—the vegetables you eat. If you get pushy, your child will be less likely to eat vegetables, not more. Trying to make him eat something he doesn’t want to eat can create lifelong conflict and anxiety about eating and set him up to be fatter in later life.
My toddler is picky, picky, picky. There are only four or five foods she’ll eat, and of course, it’s only hot dogs, chicken nuggets, French fries…you get the idea. How can I get her to try new foods?
I actually wrote an entire book on this subject—How to Get Your Kid to Eat, But Not Too Much. I also address picky eating in Your Child’s Weight. Remember, you decide what goes on the table, which means you are limiting the menu to foods she will readily accept. Toddlers need a chance to learn, and they are as erratic about food acceptance as about everything else. Remember the division of responsibility, remember that your child wants to grow up, and remember that she is both curious and dubious about new foods. She will get herself to try new foods when she is ready. Do your part by being considerate but not catering with meal planning. Serve four or five food items at each meal, and know that your toddler will eat only one or two or three foods and ignore the rest. Pair unfamiliar foods or those she generally rejects with familiar foods she generally likes. Pay particular attention to the word generally. You can’t predict what—or how much—your toddler will eat. You can only do your part by getting the food on the table.
If my child doesn’t eat his broccoli (or beans or carrots or other ''healthy'' items on his dinner plate), doesn’t it go without saying that he forgoes dessert?
Only if you enjoy getting caught in ridiculous negotiations with your child. You will say, ''you must first eat your broccoli,'' and he will say, ''how many pieces before I can have dessert?'' Well, who knows? Even if you get past that pitfall, keep in mind that the ''first clean your plate'' tactic encourages your child to overeat twice—first when he eats to earn dessert, second when he stuffs down dessert although he is full from cleaning his plate. Instead, make desert a child-sized portion, put it at his place when you set the table, and let him eat it when he wants—before, during or after the meal. Once that single portion is gone, it’s gone. No seconds on dessert.
Isn’t that crossing the lines of division of responsibility? I thought you said that children should be allowed to eat as much as they want of what parents provide.
You got me there. Yes, I am being inconsistent, and here is why. Grownup, mealtime food is challenging for children to learn to like. For a long time, children just watch parents eat a new food. Then they taste it—10 or 20 or even more times (and take it back out again without swallowing). At last, they learn to enjoy it. Desserts are different. Since we are all born with a sweet tooth, with dessert you get one-trial learning. Dessert competes unfairly with other, more-challenging mealtime food. Children who are allowed to fill up on dessert aren’t interested in learning to like the other food on the table.
Couldn’t I make great strides in reducing my child’s weight by reducing my child’s fat intake?
Actually, no. It’s been tried. It doesn’t work. Huge studies in schools show that children make up for less calories in fat by eating more of other food, get the same calories, and maintain the same weights. Children don’t do well on low-fat diets. Fat remains a crucial element in childhood growth well past the commonly-thought-of 2-year mark. In fact, an effective tool for getting control of grazing is to make sure you serve enough fat at each snack and meal time. Preschoolers’ and toddlers’ stomachs are small; they need the staying power of fat and enough energy to get them from one meal to the next. School-age children and teenagers are hungry when they get home from school. They need filling and satisfying snacks. For children of all ages, there had better be some dip and a glass of (2% or whole) milk with those vegetables, peanut butter with that apple or cheese with those whole grain crackers.
ADULTS, THEIR EATING & WEIGHT
My husband and I have both struggled with weight all of our lives. Doesn’t this pretty much guarantee our offspring the same fate?
Yes, but not necessarily for genetic reasons. Large parents and their health care providers all-too-often try to ward off children’s obesity before it even begins by restricting the children’s eating. That restriction causes the very problem it is intended to prevent. Some people are naturally heavy, but since you say you have struggled with weight all your lives, you and your husband are probably heavier than nature intended for you to be. As with the children I talk about in Your Child’s Weight, restricting your food intake from the time you were children made you food-preoccupied, prone to overeat periodically, and highly likely to gain too much weight. Those habits learned in childhood persist with adults and continue to cause weight gain. Since we all tend to raise our children the way we were raised, you are likely to be restricting your children in the same way you were restricted and starting the cycle all over again.
Can the principles in your book about child overweight also be effectively applied to adults?
Yes they can. Adults who read Your Child’s Weight say it is tremendously healing for them to understand what happened to them when they were children to make them feel so much conflict and anxiety about their eating and weight. As with their children, I encourage adults to provide well and reliably for themselves, go to the table hungry and eat in a tuned-in and enjoyable fashion until they are satisfied. Then they can stop, knowing another rewarding meal or snack is coming soon and they can do it all over again. I cannot emphasize enough that food is meant to be delicious and meal time is meant to be enjoyed. If you make this your family’s way of eating, everyone in the family will benefit, regardless of age or size.
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Ellyn Satter Associates
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