Nutrition Unscrambled

Beyond Restriction: Setting the stage for kids to Self Regulate food intake

By Marcia Greenblum, MS, RD
September 13th, 2011

Hi Readers – today we have a post written by one of our Registered Dietitian Advisors, Mary Donkersloot. Enjoy!


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.

Egg consumption as part of an energy-restricted high-protein diet improves

By Marcia Greenblum, MS, RD
July 28th, 2011

Many health professionals and consumers have upon occasion admitted to me that they thought “the egg got a bad rap” during the 1980s and 90s, when eggs were seen as an icon for dietary and serum cholesterol. They are often proud to say that they personally defied common wisdom by continuing to consume eggs. As scientific technology improved and confounding variables were better controlled, scientific findings and dietary guidance moved away from looking at egg intake as a risk factor and now focuses on the many nutritional benefits of consuming eggs. However, one curious association has continued to plague the egg. Epidemiological findings have shown, at times, an association between egg intake and cardiovascular disease in the diabetic population. No mechanism has been identified to explain this association however, the fact that eggs are often accompanied by a high saturated fat, high refined carbohydrate and sedentary lifestyle may have made egg intake in this population an artifact or marker of poorly controlled diabetes.

Fortunately, a recently published study in the British Journal of Nutrition by Pearce, Clifton and Noakes (Br J Nutr, Feb 2011, 105(4):584-92) attempted to assess the effect of egg intake on biomarkers of cardiovascular disease in free living overweight diabetic adults who have been instructed to eat a high protein, calorie restricted diet with either 2 eggs a day or a substitute source of animal protein. Sixty five subjects, average age of 60 years completed the 12 week study. All consumed 1400 calories/d with a macronutrient distribution of 40% carbohydrate, 30% protein, 30% fat. Subjects were allowed to continue taking diabetic and lipid lowering medication as prescribed by their physician. The treatment group received 2 eggs/day with an average cholesterol intake of 590mg of cholesterol while the control group received a similar quantity of protein from chicken, meat or fish without eggs and an average cholesterol intake of 214mg/day.

As one would expect, both groups that consumed a high protein, calorie restricted diet, lost an average of about 6 kg or 13 pounds. The key finding was that a diet high in dietary cholesterol from eggs did not adversely affect blood lipids or cardiovascular disease risk in adults with type 2 diabetes. In fact, a diet high in dietary cholesterol from eggs improved several biomarkers of health including increased blood levels of HDL, lutein and folate more effectively than the isoenergetic diet which included alternative animal sources of protein. The authors conclude “These results suggest that a high protein energy restricted diet high in cholesterol from eggs may have nutritional benefits and assist in metabolic control in individuals with type 2 diabetes.” Many of us knew it all along.

Eating morning protein keeps you fuller longer

By Mitch Kanter, Ph.D.
February 25th, 2011

We’re all creatures of habit, and most of us tend to fall into a rut a meal time. Particularly at the breakfast meal. When you’re tired and sleepy it’s easy to go with the patterns you’re familiar with, and if getting up in the morning, pouring a cup of coffee and reaching for the breakfast cereal is your general routine, you’re not alone. But maybe you should take more time to think about your meal choices, particularly if you’re trying to cut calories. Did you know that a recent British Journal of Nutrition study indicated that when subjects were on a lower calorie weight loss diet they tended to eat fewer calories at lunch when they consumed a higher protein breakfast? Or that subjects who drank skim milk in the morning rather than fruit juice ate 200 kcals less at lunch (Am J Clin Nutr 2009)? Or that overweight subjects lost 65% more weight when they habitually ate an egg-centric breakfast than peers who ate a high carbohydrate breakfast of equal calories (Int J Obesity 2008)?   

If you know the literature in this area, none of this should be overly surprising in light of the fact that many studies suggest that protein is more satisfying than carbohydrate or fat. So it stands to reason that a higher protein meal in the morning might prompt you to eat less at subsequent meals. But high carb, sugar laden foods (think donuts and Pop Tarts) have been staples of the American diet for some time because they taste good, and they’re convenient. Good reasons to indulge, but poor choices if your waistline and your health are priorities. Something to think about next time you wake up in a fog and you head to the cupboard for the “old standbys.” Sometimes change is good, and changing your breakfast eating habits can yield positive results.    

- Mitch


Nutrition Unscrambled  is written by nutrition experts with the Egg Nutrition Center, which is funded by the American Egg Board. It is monitored and maintained by the public relations agency of record. The mission of the Egg Nutrition Center is to be a credible source of nutrition and health science information and the acknowledged leader in research and education related to eggs. For more information, click here.

About the Bloggers

Mitch Kanter, Ph.D. is the Executive Director of the Egg Nutrition Center. For more information about
Mitch, click here.
Marcia Greenblum, MS, RD is the Senior Director, Nutrition Education at the Egg Nutrition Center. For more information about Marcia, click here.
Anna Shlachter, MS, RD, LDN is the Program Manager, Nutrition Research and Communications at the Egg Nutrition Center. For more information about Anna, click here.

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All information provided within this blog is for informational and educational purposes only and it is not to be construed as medical advice or instruction. Please consult your physician or a qualified health professional on any matters regarding your health or before making changes to your diet or health behaviors.