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Part 2:
Supporting the Eating Regulators: Optimal Feeding
Since last fall, I’ve been giving workshops about kids
and weight for childcare providers throughout Michigan. One
of the most interesting comments I heard from a participant
came from a young woman who was a mother of five children
(she seemed surprisingly sane!). We had been talking about
how it used to be common knowledge that kids come in a variety
of sizes and that chubby kids often outgrow their “baby
fat.” This woman raised her hand and said, “You
know what the problem is? People don’t have big families
anymore and so they can’t see that you can feed kids
all the same and they turn out all different.” She continued,
“I’m thin and my husband’s a big guy—some
of the kids resemble me, and some look like him. But we’re
all eating the same meals.” Bam! She nailed the genetic
reality of kids and body size. So, again, to sum up a point
that I bring up over and over: kids will grow the way they
are supposed to grow and some kids are meant to be chubbier,
some are skinny, the rest in-between. The last column discussed
the powerful internal regulators that guide children to grow
the way they are supposed to grow.
Kids Naturally Come in All Sizes, But More Kids Are Having
Trouble Regulating
We also know, however, that something is happening which is
leading to an increasing number of kids with growth problems
who get heavier than they were intended to be. Some go so
far as to say we’re in the middle of an epidemic of pediatric
obesity which is leading to diseases of adulthood showing
up in childhood (such as diabetes, high blood pressure, and
so forth). Because there is so much concern about weight,
the pressure is on to DO SOMETHING about childhood obesity—namely,
to try to get kids to eat less and exercise more. There are
some big problems with this approach, which we’ll discuss
later. But the first flaw in this approach is that it doesn’t
address WHY—why is this happening? It’s pretty clear
how and why kids are moving less. But it’s less clear
why they’re eating more if they’re born with eating
regulators. The solution (eat less, exercise more) is being
imposed without necessarily getting to the root of the problem—which
may be leading to the wrong solutions and making the problems
worse.
We’ve spent several columns leading up to this discussion:
why are there so many more kids these days who are having
trouble regulating their eating and thereby their weight?
I’ve made the point that it cannot be simply that there
are too many fast food restaurants with large portions. Kids
are born with very powerful regulators which tell them how
much to eat. Kids can regulate on a whole variety of food.
If they are able to stop when they’re full and to eat
again when they’re hungry, then something in their bodies
is keeping track of the number of calories they should have
in a day. For kids to not be able to listen to their internal
regulators, something very persistent has to be disrupting
this balancing act, over and over again.
What Kids Need to Successfully Regulate
For kids to be able to listen to their internal regulators,
they need help from the adults around them, however. When
plentiful food is presented in a consistent way by parents
or caregivers, and adults don’t overcontrol eating, children
are able to regulate. They feel safe and provided for. They
eat their meals, stop when they’re full, and move on
to do other things. They don’t tend to overeat—and
if they do because something is really tasty, they tend to
eat less later on. Around growth spurts, they’ll be super
hungry and eat more for awhile, then taper off. They’ll
eat less of high fat food, and more of low fat food to get
the right calories.
So which kids can’t regulate? The kids who can’t
regulate are the ones whose adults aren’t doing their
part in the best way—for a variety of reasons. Let’s
take a side trip to discuss a key concept when talking about
excellent childhood eating: the feeding relationship between
child and adult, which includes the division of responsibility.
Ellyn Satter’s Division of Responsibility
Ellyn Satter is a registered dietitian and a clinical social
worker whose lifework has been to define the “division
of responsibility” in feeding children (she coined this
phrase). Through her writings and workshops, she educates
professionals and parents about how to use this concept to
support optimal growth and nutrition for children. It’s
a simple concept but one so powerful that we use it for both
prevention and treatment of growth problems. This is it in
a nutshell: adults are responsible for some features of childhood
feeding, children for others. All goes well if you don’t
cross the lines of division of responsibility—and it’s
the adult who has to make sure this doesn’t happen. Let’s
look at the particulars. (By the way, when we’re discussing
feeding and we talk about “parent,” we mean the
adult in charge of feeding a child—of course this might
be the grandparent, child care provider, and so on.)
Satter’s Division of Responsibility for Infants—Demand
Feeding
Parent’s Responsibility
What—parent decides on & offers type of milk feeding
(breastmilk or formula) when baby indicates she’s hungry.
Infant’s Responsibility
When, How Much—infant lets parent know when she needs
to be fed & how much she needs.
Satter’s Division of Responsibility for Transitioning
Toddlers On Up—Welcome to the Family Table!
Parent’s Responsibility
What, When—parents still decide what comes into the house
& what’s on the menu, as well as setting structured
meal and snack times (no short order cooking!)
Child’s Responsibility
How Much, Whether or Not—child chooses what and how much
to eat from what is served at meal and snack times (no more
“on demand” eating!)
Without an optimal feeding relationship which centers around
the division of responsibility, trying to improve nutrition
doesn’t stand a chance. So, we want kids to eat more
vegetables, drink milk instead of pop, consume more fiber
and eat leaner protein for better health and optimal weight?
We need to start at square one with HOW we feed rather than
WHAT we feed to reach that end goal.
Ellyn has written three books on childhood feeding which center
around and expand upon this concept: Child of Mine: Feeding
with Love and Good Sense [Bull Publishing, 2000] (discusses
newborn through preschool feeding); Secrets of Feeding a Healthy
Family [Kelcy Press, 1999](the how-to book, including recipes,
to help busy families get a consistent, yummy meal on the
table); and How to Get Your Kid to Eat...But Not Too Much
[Bull Publishing, 1987] (the problem-solving book for childhood
feeding issues up through teen years). Twenty years ago, I
was lucky enough as a dietetics student in Wisconsin to meet
Ellyn. I so loved her philosophies that I embarked upon extensive
training with Ellyn and have used her methods ever since,
both professionally and with my own three kids.
Following the division of responsibility establishes two very
important abilities for kids: food acceptance and food regulation.
Food acceptance means kids learn how to like a variety of
foods and become competent eaters. They can be satisfied with
food in a variety of settings. If adults serve a nice variety
of nutritious foods, it means kids can’t help but consume
nutritious diets. Food regulation means children can listen
to their internal regulators and eat the right amount and
grow the way they’re supposed to. There’s a lot
to discuss about how to nurture both food acceptance and food
regulation. Right now, though, we want to know about when
it doesn’t work and how it’s related to growth,
particularly growth dysregulation and childhood weight problems.
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