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Part
3: Interfering with Eating Regulators: What Goes Wrong
What Happens When Children Can’t Regulate
In the last column, I said that for children to not be able
to attend to their eating regulators, something very persistent
has to get in the way—repeatedly. When children can’t
listen to their regulators, their eating becomes dysregulated,
which can disrupt growth. Kids can either gain a great deal
of excess weight and become very heavy or begin to grow poorly
and fall off their weight curve. Let me give some examples
of situations in which kids have difficulty regulating. In
all these cases, a failure of the division of responsibility
is involved.
The Child Whose Food is Restricted in Amount or Type
Lack of Food
When humans are deprived of food, they have a completely predictable
response: they become obsessed with seeking food. We have
seen this over and over again in studies of people deprived
of food throughout history, for example, survivors of concentration
camps, prisoners of war, or people lost in the wilderness
after accidents. This is obviously less severe, but more familiar:
have you ever been on a diet? When you’re dieting, it’s
the last thing you want to happen, but it does: you can’t
stop thinking about food and if (when) you break down and
eat, you tend to binge, especially if you’ve lost a lot
of weight quickly. Janet Polivy, a researcher in Toronto,
Canada, has conducted many, many studies which demonstrate
that restricting food intake leads to food obsession and binge
eating.
As well, millions of children in America do not have consistent,
reliable access to food because of poverty. It is estimated
that one in nine Americans is food insecure and that households
with children, especially young children, are much more likely
to be food insecure. For some of these families, any time
they get access to food, they are likely to eat as much as
they can. In fact, a recent article in the Journal of the
American Dietetic Association (December 2002) described observations
of workers in emergency food pantries. These workers related
stories of parents who advised their children to eat as much
as possible because they weren’t sure when they’d
get to eat again. Who can blame them? It is well known that
there is a very strong relationship between childhood poverty
and obesity, not only in our country but thoughout the world.
This would only be seen, of course, with a fluctuating food
supply. If food is always extremely scarce in a certain region,
and the entire population is chronically starving, then children
become malnourished and growth stunted and may even die—of
course. It is heartbreaking but true that one third of the
world’s population suffers from hunger and malnutrition.
For children who are exposed to other great stress in addition
to food deprivation, the tendency to eat compulsively is very
strong. We may see this in traumatized children placed in
foster care. I have worked with and heard repeatedly of foster
care families concerned about their new arrivals who could
not stop eating, including getting up in the middle of the
night to raid the cupboards. (I’ll talk about the solution
for this at the end...) If the family table is a stressful
or violent place, with or without food insecurity, kids can
develop severe anxieties about eating: some kids may turn
to food for comfort, others may have difficulty eating.
Dieting Households
Another class of kids who are restricted are those whose parents
are worried that they’re getting too fat or could get
too fat. Sometimes withholding food is done on the physician’s
advice. Parents may be advised to restrict portions or not
to give seconds. Or they may decide this on their own. But
it’s not just amounts of food that may be restricted.
In an effort to avoid obesity or to get healthier, many parents
banish certain types of food from the home—it used to
be high fat food, now it might be high carb food (not much
left!). Moderation is one thing—but chronic restriction
is another. Kids who never have tasty, fun food at their house
become food obsessed and they learn how to get food on the
outside, either at their friends’ homes when they’re
little or with their allowance when they’re older. Or
maybe at grandma’s...I’ve heard many stories of
huge ongoing battles over family feeding when mom or dad doesn’t
want Ashleigh or Brandon to have sweets and grandma repeatedly
provides everything that’s missing—in great abundance.
Again, returning to the problems of poverty, an adult client
seeing me for compulsive eating problems once told me her
family literally had enough food to consume when she was a
child—because they ate lard and bread sandwiches over
and over. But she remembered longing for delicious restaurant
food that her family could never afford. (My most challenging
cases of eating disorders in adults usually involve childhood
food deprivation of one sort or another.)
The Child Who is Forced to Eat
On the other hand, children who are pressured or forced to
eat, especially if the food is unappealing to them, back away
from food and may even shut down and refuse to eat at times.
Instead of learning to like more foods, kids typically just
learn that eating feels very unpleasant and huge battles for
control may develop. Research supports that children who are
pressured to eat are more reluctant to try new foods or to
eat in general.
Effect of Eating Dysregulation on Growth
In all these cases, children are not able to attend to their
internal regulators. Kids may be deprived of food because
of lack of access, deliberate restriction, or difficulty with
eating due to huge stress at mealtime. For all, the result
is that kids become obsessed with food and tend to overeat
when exposed to food, or, due to tension and anxiety, potentially
undereat. The effect on growth is what one might predict:
kids who are deprived of food and who overeat tend to gain
excess weight; kids who are pressured to eat may grow poorly.
Many studies have shown that overcontrol with feeding is related
to development of childhood weight problems. A particularly
interesting study done with girls showed that the girls whose
parents restricted their food at home ate more “treat”
food in a lab setting than girls whose parents did not restrict
their portions, even when the girls felt they weren’t
supposed to eat those foods.
The Effect of Lack of Meals
By now you may be thinking of all the really chubby kids you’ve
seen. You may be wondering what’s up with those kids.
You’re pretty sure that they’re not traumatized
or going without food. But there’s another way of feeding
kids that undermines internal regulation of eating. In these
households, there’s plenty of food of all types, no one
is pressuring kids to eat certain foods, and there’s
nothing particularly unpleasant about mealtime—except
that it doesn’t exist. It is a rather modern American
notion that we no longer need family meals, if we just keep
the fridge stocked. Most families are still having mealtimes
for younger kids, but as kids get older, this may not be the
case. Adults may be able to manage with grazing, but what
about kids?
Well, for children, lack of consistent meals tends to have
the same destabilizing effect that food restriction has. First
of all, it doesn’t feel good to kids to not have an adult
creating meals for them and eating with them—it may even
feel frightening at some level, if not just lonely, especially
the younger the kids are. Secondly, if children are not in
a rhythm of having hunger satisfied at regular and frequent
intervals, children may not know how to tune in to satiety—their
stopping place. Not being able to tune in to a stopping point
would account for kids continuing to eat past the point of
fullness, especially if they’ve gone too long without
food. This would explain why kids would continue to eat past
satiety when served large portions of fast food, for example.
The problem isn’t necessarily the huge portion size (besides
the fact that excess food is expensive and wasteful). It’s
that kids have been systematically trained to ignore their
internal regulators by not having the necessary structure
in place to support listening to these regulators. If you
watch kids who are internally regulated sit down to a meal
that’s too big, they don’t eat it all. But if they’re
not internally regulated, they may not stop when they’ve
had enough.
Children are not capable of managing it all—the timing,
the food selection and preparation, the calm of a structured
meal. Just as it takes repeated socialization at a table to
teach children how to eat a meal with others politely, it
takes consistent structure to help children grow up attending
to their internal regulators. It is the adult’s responsibility
to establish the meals, not the child’s. The greatest
trouble with overweight in children comes in older children.
Is it any coincidence that this is when the family meal begins
to fall apart, right about at junior high when everyone’s
schedules get too busy?
In sum, while we often focus on the WHAT of eating to explain
why children are increasingly struggling with weight problems,
we need to attend to the HOW of feeding to establish an optimal
framework in which kids can grow up accepting a variety of
foods and being able to listen to their internal regulators.
You can see that restriction of amounts or types of food ends
up having the opposite effect of what we’d like to see—it
tends to lead to overeating. But reinstating the family meal
(however our families are configured these days) is a solution
we all should strive for. Studies on the family meal consistently
show that nutritional quality of a child’s diet improves
when there’s a family meal: more milk consumed, more
fruits and vegetables, more fiber and so on.
Household Meals For Prevention And Treatment Of Childhood
Eating Problems
This structure is essential for prevention of eating and weight
dysregulation. But it’s also a cornerstone of treatment
for emerging problems. Remember the foster care families with
the newly arriving kids who ate like there was no tomorrow?
How do they work with this? I’ve seen many families who
figured out the solution pretty quickly: reassure the children
over and over again that there will be enough food and that
they can have as much as they want at meals and snacks. With
the security of regular meals, the children come to believe
it—and their eating calms down, within a matter of weeks.
A child care provider at one of my talks recently also spoke
about the same phenomenon with disadvantaged children in her
program. When the children first enter the program, they tend
to eat frantically, practically binge eating at meal and snack
time. Her solution? She opens all her cupboards and tells
them, “I won’t run out of food. Slow down and enjoy
your meal—there will be more next time.” It works
very well. When children’s eating is well-regulated from
the inside (with adults’ help), we’ve solved half
the battle of having their weight will be appropriate for
them—whether they’re supposed to be skinny, average,
or chubby. Once we get the consistent meal established, what
do we have to say about physical activity? See the next column!
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