Hi Readers – today we have a post written by one of our Registered Dietitian Advisors, Mary Donkersloot. Enjoy!
Marcia
When a child is overweight, truly overweight, what is the remedy? The first reaction is often restriction. A doctor may send the patient to my office with a calorie prescription; “put this kid on a 1200 calorie diet” the note will say. But we dietitians (and Oprah) know that restriction often backfires. Restriction promotes eating in the absence of hunger. When food becomes available, the child (or adult, for that matter) is likely to overeat; such is the body’s primal need for food. Hence, the phrase, diets don’t work.
The trust model
When I was studying nutrition in college, several decades ago, we were taught about the trust model, developed by Ellyn Satter. I still use this model with my patients today. It goes something like this: It is the job of parents or caregivers to provide meal structure, breakfast lunch dinner and snacks. The parent is also the gatekeeper, determining what food is in the house, and what is on the menu for breakfast, lunch and dinner. The child’s job is to decide what and how much they will eat at these meals and snacks. According to this philosophy, children know what their bodies need to grow and feel good. If provided a balance of food, in a structured setting, they will eat an appropriate amount of food. By giving the child autonomy, the child learns to self-regulate their appetite. Sometimes we can correct weight and feeding issues simply by working with the parent to implement this routine.
We proceed based on the assumption that young children will naturally adjust their food intake over a day’s time to result in a consistent number of calories. But researchers are observing that this long relied upon regulatory system is being altered by our changing feeding patterns and the foods we feed our children today. We know the ability to self-regulate decreases with age, year after year, especially with girls.
Susan Johnson directs the Children’s Eating Laboratory at the University of Colorado Health Sciences Center, said that research as evidenced a population-wide shift over time. She told me in the 1980’s children were compensating for about 90% of extra calories they were getting. By the 1990’s they were compensating for about 45% of the excessive calories.
The reward system
In my own practice, I have found that what children eat doesn’t depend solely on the body’s desire to balance its calorie equation. There is something else we must factor in to the trust model. This is known as the reward system. And in many overweight children (not to mention adults) the reward system is winning.
What makes the child want more when we know their calorie needs are met? There are three things the parent needs to factor into the trust model:
1. The lack of structure can predispose the child to what we call chronic over-feeding. The child wants food frequently and may use the food to self-soothe.
2. The super-stimulating effect of the food may cause the child to want more and more. When we eat food that is high in sugar, fat and salt, a cookie for example, we stimulate neurons, the basic cells in our brain. These neurons are part of larger circuits that form a complex communication system, that create a positive feeling when we eat the cookie. This information, the yummy factor, is stored in the brain and helps to control behavior in the future. Studies with rats and sweet foods have shown that the more these neurons fire, the more sugar a rat will consume. In other words, we will work harder to get more of the cookie, steal another when mom isn’t looking. But you may note that not everyone goes after those cookies with the same gusto. Some people are more likely than others to find the food reinforcing. What we know from scientific research is that sugar and fat can condition the behavior of those who are vulnerable.
3. Kids may have become accustomed to large portions. When they are served more, they eat more. We nutritionists call this “portion distortion”. We become accustomed visually to a certain volume of food, and tend to expect a similar portion size it on at subsequent meals. Some kids lack the control only to eat when they are hungry. Those are the kids that are more vulnerable to eating beyond their calorie needs when they are served large portions.
Does my child have a problem?
Ask your pediatrician. First he or she will assess your child’s weight and body mass index (BMI). You might expect them to plot your child’s BMI on a special pediatric growth chart to show you the category of weight your child is in. They can advise you how to proceed. If your child is considered at risk of overweight or overweight, you may be referred to a registered dietitian to help you map out a plan to improve your child’s weight and health through a better diet.
