Last month, I got an email from reader Robyn:
My son is an amazing, precocious, active kid who has a love for all things sweet. He has always been on the higher end of the weight range but at this year’s annual visit things were more alarming and I realized that it’s time to start reigning things in. I am trying to figure out how to have age-appropriate conversations with him about eating healthy. My husband and I have struggled with our weight all our lives and don’t want to pass that along, but it also makes me question my own ability to address the topic with my son appropriately. I’m hoping you may have advice.
This is a great question, one that I’m not in any position to answer expertly, so I thought I’d call upon my friend Dr. Joanna Steinglass, a clinical researcher at Columbia Center for Eating Disorders. CCED focuses their research on eating behavior across the spectrum, including anorexia nervosa, bulimia nervosa, binge eating, pediatric and adult obesity and Joanna was nice enough to join us today to address Robyn’s question as well as a few others.
DALS: Welcome Joanna! Let’s start with some elementals. Say you have a new baby — a complete blank slate. What’s the ideal way to talk about food with this child from the start? What is the blueprint for fostering a healthy relationship with food and body image?
JS: First, there is no one “ideal” and no specific blueprint, so take a deep breath and relax. There are lots of ways to raise a healthy kid. It’s also important to remember that your baby is not really a blank slate and will bring his or her own temperament and personality, which will be a factor in how you go about nurturing a healthy relationship with food and body. Having said that, there are some core concepts that may be helpful. You can tell them “People come in all shapes and sizes. No one shape or size is better than another.” There is a nice children’s book called, Shapesville [1] by Andy Mills and Becky Osborn that illustrates this point for kids in the 2 to 5 range. It’s also important that parents set an example for kids in the way they treat other people. If your kids learn that you don’t judge others based on their size, they’ll be more likely to internalize that. It’s worth making this point out loud whenever the opportunity arises by saying things like, “People can be healthy at any size” or “I like people in lots of different shapes and sizes.”
DALS: What if you have a kid who has gotten into some bad eating habits and you want to re-route him. How do you talk to him or her about this without making him/her feel bad about himself/herself?
JS: Focus on health not weight. And emphasize function over form. Remind your son that a healthy body is what allows you to do all that you do in the world. Think of something your child likes to do – whether that is a sport or otherwise – and point out how it’s his body that does that. If your child is an athlete, he or she probably gets a lot of reinforcement for this idea. But even if what your child most likes to do is to sit quietly and read or draw, you can reinforce the concept. You can say, “Your body is what allows you to do [fill in your child’s favorite activity]” to foster your child feeling good about his body’s capability.
And remember, when it comes to making dietary changes, think about your family as a whole. If there are small changes that will benefit everyone — like switching from 2% to 1% milk, or increasing the use of olive oil and decreasing the amount of butter — then there is no need to point out or label one person’s behavior.
DALS: I know a mom who was very worried about her son’s weight and couldn’t stop herself from nagging him at the dinner table. She knows this isn’t good — “It feels awful” — but she can’t help it. Can you a) confirm that this is a counterproductive strategy and b) tell my dinner-loving readers what we should be doing/not doing at the dinner table?
JS: I think anyone who has ever had a parent knows that this has potential to backfire! Here are things to think about before you sit at the table:
- Always focus on the behavior, not the person. This cannot be emphasized enough. Avoid teasing. For example, even when you mean well, chides about weight can hurt much more than you realize. Parents sometimes try to make a joke to make light of the issue, but end up humiliating the child. Talk to your child away from the dinner table (we call this, “when the iron is cold”) about things they can do differently at the mealtime (e.g. smaller portion sizes, eating vegetables first, drinking water instead of juice) to increase healthy eating behaviors.
- No food is either “good” or “bad.” It is more useful to talk about foods as “sometimes foods.” Similarly, food is neither “healthy” nor “unhealthy.” But the phrase “Sometimes foods” is key.
- Increase the availability of healthy food choices at each meal. Eating behavior doesn’t change on a dime. Just keep putting more whole grains and leafy greens on the table. Make no assumptions about what kids will or won’t like. Offer much praise to anyone who tries it – just takes a taste. Kids’ tastes keep changing over time and if the food is there for them, you increase the odds.
- For some kids, it is useful to provide structured meal and snack times and encourage snacking in the kitchen or dining room, rather than other rooms of the house. This increases mindfulness around eating, and decreases eating in front of the TV which is a common source of extra intake.
- Positively reinforce a child’s healthy choices – this can be just in the form of noticing it and praising. “Good job trying something new!”
DALS: What are some more tangible steps parents can take to help their kids improve their eating habits?
JS: If you need to make some changes, it’s a good idea to keep a careful record of what is actually being eaten. This can help you target areas where changes will be easiest. If your child is young and you are the one providing the food, you can spend a week writing down everything your child eats (hopefully without them noticing that you are doing this). You may find that there are some simple, small changes you can fit in – if your kids are snacking in front of the TV, make sure they are snacking on vegetables. If you discover that they are actually ending up with desserts at lunch and dinner, cut back to one a day. It’s also helpful to remember not to focus so much on what your child ate in a single day; looking at what the child ate over the course of a week is a more helpful exercise, especially with young kids. If your child is older, you may want to sit down together and figure out ways to make small changes. You may need to find out what your child is actually eating outside of the house.
DALS: My daughter’s friends all play soccer, basketball, lacrosse, or take dance, but she’s just not the sporty type. How can I convince her that this is a crucial part of being healthy?
JS: There are lots of ways to be healthy and team sports may not be for everyone. Be broad in your own definition of what healthy is. Be creative. Being healthy is ultimately about lifestyle, not just sports. That means taking the stairs instead of the elevator; biking or walking into town or a friend’s house for a playdate; doing a scavenger hunt in your neighborhood; playing hopscotch or catch in the driveway. Lead by example – build family activities into your life. Go for walks together. Use what you already know about your kids to develop motivators. Little kids can be given jobs – to hold the map, to be the line leader. Bigger kids might be rewarded for finding interesting things, or given control over where to go. Aim for active vacations, with activities that will appeal to all members of the family. Also be mindful that children who are not ready for team sports at one age may develop an interest later.
DALS: How connected are stress and eating with kids? Do they eat more when they have a tough day at school? Or are there other triggers that we should be looking out for?
JS: For this question, I looped in my colleague at the Columbia Center for Eating Disorders, Deborah Glasofer, PhD, who has done work on obesity prevention in youngsters. Here’s what she says:
DG: Kids, like adults, do eat in response to emotions – both positive and negative emotions. In fact, lots of children and adolescents report emotional eating, with higher estimates in adolescents, overweight kids, and in those who report other forms of disinhibited eating (e.g., feeling a loss of control while eating). Emotional eating has been linked with the onset of binge eating episodes and can at times be associated with changes in mood.
If you notice a pattern of emotional eating in your child, begin a dialogue about stressors that might trigger and feelings that might underlie the eating behavior. Ask about what’s going on in their classes or outside activities, with their friends, or at home with their siblings. Helping your child develop an ability to talk, rather than eat, their way through emotions will help them to create a healthier relationship with food. Modeling healthy coping strategies (e.g., exercise to combat stress or low mood, non-food rewards for exciting accomplishments) for high emotion moments will also help.
DALS: Do you know of books, websites or tools that are doing a good job of teaching this stuff? We’d love to hear some recommendations.
DG: Check out chapters on overeating and obesity, picky eating, and body image in The Parents’ Guide to Psychological First Aid: Helping Children and Adolescents Cope with Predictable Life Crises [2], edited by Gerald P. Koocher and Annette M. La Greca. It covers a wide range of parenting topics in an accessible style and directs readers to other potentially helpful resources.
DALS: Thanks Robyn, Deborah, and Joanna! If readers have any questions for Joanna, please ask them in comment field below and she’ll do her best to address them.