Hope

By the time most people with eating disorders seek treatment, they have little hope their lives can really change. The symptoms and disordered thoughts are relentless and, without any perspective, it feels impossible to imagine seeing the world any other way. The impetus to seek help comes instead from either external pressure or internal desperation. So much of what I have written about recovery boils down to maintaining hope. The daily battle of questioning the eating disordered thoughts, trying to eat and engaging with the world is exhausting. Without a sense of purpose or direction, the emotional pain feels pointless. All too often, the hope dies and the treatment along with it. Dropout rates are notoriously high, so much so that just continuing therapy is a predictor of improved outcome. Circling back to hope as a touchstone--a benchmark of progress--is one of the therapist's primary responsibilities, at least until the patient feels ready to share this duty too.

Living with an eating disorder means being grounded solely in the present. The past and future are irrelevant: the thoughts about food and weight in the moment are all that matter. Any decision either follows or breaks the rules of the eating disorder. It is a success or a failure. By definition, this sense of immediacy cannot coexist with perspective--an ability to step out of the moment and see the bigger picture. And perspective is a necessary component of hope. Without that psychological and emotional distance, any progress or change gets buried under an ever-present sense of inadequacy and shame. But the immediacy that makes the eating disorder powerful is also what makes it safe. Lack of perspective means lack of an identity separate from the eating disorder and that feels special, as if the person has life figured out, as if she a free pass from the daily struggles everyone else has to deal with. Perspective means starting to disentangle the patient's own identity from the eating disorder. Even acknowledging this is a possibility has far-reaching consequences. It implies that a different path may lie on the horizon. I have mentioned several ways to gain perspective in previous posts: food journals, medical effects of eating disorders, regular review of progress and developing a meaningful therapeutic relationship. Each of these steps will cause fear and apprehension but also cultivate hope in a future of recovery.

With perspective comes a very different emotional understanding of the eating disorder. The thoughts that are so harsh, demeaning and critical remain powerful only when the patient is consumed by the urgency of the present moment. People with eating disorders are, by and large, compassionate when contemplating other people's struggles. Some distance from the eating disorder stirs up that same sense of compassion for their own plight. The conflict between these two internal reflections is a pivotal part of maintaining hope. Once the therapy touches upon compassion for oneself, distinct from pity or self-recrimination, progress becomes palpable. The therapist can regularly remind the patient of her own sense of compassion for others and the possibility of feeling that way for herself too. Hope springs from the gradual process of learning to see oneself with understanding instead of reproach.

The other important result of having perspective is how it shatters the idealization of recovery. Many patients view their own potential recovery through the black-and-white prism of the eating disorder: perfection or utter catastrophe. The fear of prolonged misery, even after starting to eat normally again, girds the patient from any sense of hope, compassion or change. With some distance from this narrow scope of the world, the prospect of recovery changes too. Life, with all of its messiness and complexity, becomes clearer and lets the patient off the hook from needing to attain perfection. As terrifying as things look from this vantage point, the therapist can help the patient learn to be grounded in this new reality and feel as if she can survive, mainly by emphasizing hope. The ability to even acknowledge a world of confusion and complexity is a phenomenal step forward. The latent desire to move away from the security of the eating disorder is the patient's own way of seeing hope for a different life.

Occasionally, a patient who has been a stalwart believer in the immediacy and identity of her eating disorder glimpses how the other half lives. After months of hearing me go on and on about perspective, hope and compassion, she will let slip a word or phrase that suggests she has been listening. It could be a side comment about the eating disorder as separate from her; or an acknowledgement that the treatment has affected her eating disorder; or a hint at the progress in recovery; or even a session with limited discussion of food and weight. At that moment, it is clear that something has shifted. Any one of these comments or omissions implies that the patient has begun to have some perspective from the eating disorder. More importantly, it shows she is ready to share the mantle of hope for recovery. Perhaps what appeared at first to be complete fantasy may indeed start to feel very real.

The next few posts will shift in a new direction. I will address the impact of media on the culture of thinness and strategies to cope with its broad influence on our lives.

Medical Complications of Bulimia

Unlike starving, the symptoms of bulimia--primarily binging, purging and laxative use--cause immediate harm to the body. No patient can deny the physical toll these symptoms take. For many, the pain and weariness is a welcome relief from the emotional misery of the eating disorder. Although most patients are terribly afraid of the potential long-term damage, they are just as likely to ignore the risks of their behaviors and signs of deteriorating health. Patients often confuse the immediate physical effects of bulimia with the chronic medical complications and thereby underestimate the serious long term risks. Like with starvation, the body has to adapt to malnutrition and nutrient deficiencies, in this instance from lack of digestion and malabsorption. Unlike anorexia, which the body has an evolutionary inclination to weather, bulimic symptoms are a trauma to endure with a cascade of increasingly toxic effects. 

The gastrointestinal system--the part of the body most immediately affected--functions through peristalsis, the muscle contraction initiated by swallowing that pushes food through the system's entire length. Binging, purging and laxatives all disrupt this muscle contraction in quite similar ways. Binging expands the stomach and slows or even stops the muscle contractions temporarily, an effect even more pronounced after purging. Laxatives actively stimulate the colon leading to forceful and often painful diarrhea. These tramuatic shocks to the GI system lead to a period of slowed peristalsis with limited digestion and constipation. After recovery, peristalsis gradually resumes; however, prolonged symptoms can impair the body's ability to return to normal function. For instance, laxatives are addictive and chronic use makes it extremely difficult to have a bowel movement without them. Persistent binging may permanently slow digestion as the stomach is regularly overwhelmed with too much food or expects the contents to be purged. Consistent purging can lead to GI reflux (the food goes backwards into the esophagus) which is experienced as esophageal pain and bleeding.

One lingering effect of bulimic symptoms is electrolyte abnormalities, most notably a low blood potassium level. Purging, laxatives and diuretics all lead to excretion of this essential mineral and a gradual decline in the blood level. Life is considered untenable as the potassium level nears 3.0, but to many doctors' shock and dismay, bulimic patients have been known to walk around with levels under 2.0. For some people, the body adapts to the low level and manages to survive, for a time, but this is the most sudden and lethal complication of bulimia. Low potassium affects the heart rhythm and can precipitate cardiac arrest. Chronic low potassium also leads to kidney damage, and patients with bulimia even end up needing kidney transplants.

These complications are the most destructive, but the list of medical complications is long and equally mind-numbing as that for anorexia: hormonal abnormalities including infertility, slowed cognitive function, breakdown of dental enamel, persistent fluid retention and swelling. Most patients sit quietly waiting for the medical lecture to be over and are too afraid to see the full impact on their bodies. Two factors can help break through the powerful denial and help patients begin to process the risks of their behaviors: fear and timing.

The most common binge trigger is fear: fear of emotions, fear of new situations, fear of people and, ironically, fear of really being hurt by the eating disorder. The last fear is pervasive but hidden deeply beneath the need to binge to survive daily life. Using this fear to chastise the patient drives a wedge into the treatment: no one recovers when being consistently hammered with clinical facts. The therapist needs to broach any discussion of medical complications from a place of genuine compassion and caring. Too often families, friends and, sadly, clinicians place the blame on the patient and undo much of the progress. By trying to understand--and perhaps imagine experiencing--these fears, the therapist can make it safe for the patient to let down her guard. Feeling understood for the first time will allow her to express these feelings and acknowledge her desire to be well and to live fully.

A therapist needs to choose the right time to discuss the medical issues. Even with a sense of safety, a mistimed discussion often becomes an ignored lecture. If a patient is feeling vulnerable and confused but also safe and understood, the medical information can get through and help her face the reality of the eating disorder. This component of therapy relies heavily on the therapeutic relationship and on the therapist's ability to surmise that the patient is ready to trust the treatment enough to face her reality.

These two posts highlight how damaging and even lethal eating disorders are. Patients and therapists are often afraid to discuss these consequences and risk overwhelming the treatment. At the same time, any therapist who avoids this discussion is remiss. Engaging in this part of eating disorder treatment successfully sidesteps the patient's most valued protector, denial, and opens the door for another deeper question. How do you maintain hope during treatment for an eating disorder? Look for the next post.

Medical Complications of Anorexia

Most people with eating disorders feel that they are superhuman and impervious to the various medical complications that inevitably arise during the course of the illness. Books and articles present lengthy lists of the ways the body deteriorates from an eating disorder. I find the medical details numbing and completely disconnected from the reality of the disorder itself. I end up drifting when I try to absorb the information and I really want to remember it! If I cannot maintain focus, imagine how much a patient--deeply ambivalent about recovery--will actually remember. It makes much more sense to organize the information into a series of necessary steps the body takes in order to survive chronic starvation and vomiting rather than a laundry list of impersonal problems.

Let's start in this post with the effects of starvation. In the short run, eating less means the body uses more energy than it takes in. The body initially burns fat--the energy storage unit--to make up the extra needed calories. This line of reasoning is familiar as the natural result of a diet. Once the fat stores are depleted--a few months at best--the body adapts to survive the apparent famine in three interconnected ways: the use of protein as the new energy source, harboring limited resources for the most basic functions and a gradual slowing of metabolism.

Once the body begins to break down protein as an alternate energy source, survival becomes a zero sum game. Fat storage exists largely as a reserve to protect against lean times. Any use of protein as energy means using up this valuable and necessary resource. The body initially burns up skeletal muscle protein leading to atrophy and decreased strength. In time, however, any protein will do including cardiac muscle which leads to a weakening heart--one of the myriad ways eating disorders kill. Essentially, the body slowly eats away at itself to create as much energy as possible to survive, no matter the cost. However, the body was not created to survive through self-cannabalism. There are many deleterious effects, and one of the most severe is that protein metabolism leads to different waste products that need to be cleaned out of the bloodstream. The kidneys are damaged by the prolonged exposure to protein waste products, and even recovery will not always fully repair renal function. If this were the only adaptation to starvation, anorexia would kill people much more quickly so let's shift to what happens to metabolism.

During this prolonged famine, the body has to decide how to use its limited resources. For people with eating disorders, this concept is not evident because food feels like an unnecessary indulgence rather than a critical resource. Sometimes an analogy can emphasize why these circumstances are so dire and circumvent the denial of a patient. Consider a community experiencing severe drought. At first, people may decide to stop watering their lawns, a minor inconvenience. As the drought worsens, desperation sets in and the residents may agree to flush toilets less frequently or may limit each household to a maximum quantity of water per day. Finally, plumbing may be shut off completely so that individuals need to go to pick up their daily ration of water at a local well. Similarly, the body takes increasingly drastic steps for survival. For example, two common initial sacrifices the body makes during starvation are decreased peripheral circulation and trouble focusing--two functions not needed during a famine. The next step might be prolonged fatigue and dizziness, from not using energy to pump blood up to the head. More severe famine necessitates drastic changes: slowed heart rate and very limited mental function. The body may gradually eliminate all needs outside of the heart and lungs: the basic needs for minimal survival. Although the body will do anything to continue to live, the sacrifices are enormous.

The third way someone survives famine is a gradual, steady decrease in metabolism. The body, almost miraculously, adapts to become an extremely efficient machine. Each and every calorie of energy extracted from food is used as wisely and judiciously as possible. The gastrointestinal system slows down until it is almost paralyzed. In part this is atrophy from lack of use but also is to ensure extraction of every bit of energy from the limited food intake. Then the body slows down all of its functions in order to maximize the use of the energy taken in and minimize self-cannabilizing. There are countless examples. Liver function slows down leading to excess waste products in the bloodstream. Immunity is weakened and leads to increased susceptibility to infection. Heart rate slows down to levels commensurate with limited survival. The menstrual cycle stops because it isn't possible to be pregnant with limited resources and the menses itself wastes valuable resources.  Maintenance of healthy bones ceases. These adaptations severely limit what people with anorexia can do and often lead to irreversible damage.

This intuitive approach to the medical problems of anorexia is much harder for patients to dismiss. Humans have learned to adapt to famine in order to survive. Anorexia only exploits these genetic adaptations. It is unclear to me how effectively medical knowledge leads someone towards recovery, but I find that patients are more likely to process and remember the information presented in this way. The next post will describe the medical effects of binging, purging, and laxative and diuretic abuse.

Adult Binge Eating

Within the obese population, there is a subset of patients who first exhibit binge eating symptoms in their late twenties and thirties and who are increasingly recognized and treated by eating disorder professionals. However, these patients too often fall below the radar of the eating disorder community and remain unseen and untreated for long stretches of time. There are several components of this eating disorder that make both diagnosis and treatment more challenging and different.

Because people who binge eat are overweight, this disorder is often overlooked and lumped in with the general rise in obesity. The misdiagnosis leads to an ineffective and potentially dangerous course of treatment. A weight loss program is disastrous for someone who binges: the hunger triggered by calorie restriction only increases the urge to binge and the shame of binging. Even more damaging, these patients are considered candidates for Bariatric weight loss surgery. The screening process for these procedures should exclude people who binge eat, because even a physical restraint--gastric bypass or banding--will not curb their emotional and psychological need to binge. However, many find a doctor to perform the surgery anyway. The failure of this drastic surgery leads to even more hopelessness. The same treatment for binge eating disorders outlined in previous posts is equally effective for these patients, but the primary problem is accurate diagnosis.

The key difference for people who start binge eating later in life is that they have spent years as an adult at a normal weight. Typically, these patients have a long history of abnormal eating but were able to maintain normal weight and keep the disordered symptoms from fully disrupting their lives. As the binging escalates, they believe this is a short-lived phase and that they can regain control of their eating. In our culture of thinness, weight is seen as the central problem, and doctors often readily agree. This single-minded approach allows the eating disorder to stay hidden. As I have written several times, eating disorders are most powerful when they remain secret.

Typically, people who begin to binge at a later age have difficulty with the pressures and expectations in life that develop as they get older. In high school or college, students struggle with the early stages of independence and personal identity. In their twenties and thirties, people shift their focus to relationships, family and career development. Unfortunately, binge eating and gaining weight have a significant impact. People who are overweight report feeling invisible both personally and professionally. For someone terrified of intimacy and professional challenges, gaining weight reinforces feelings of inadequacy and worthlessness. The constant pressure to lose weight becomes life's central focus and supplants any other goals or dreams. If only they could lose weight, these patients say, their lives would be so different. After rounds of inaccurate diagnosis and ineffective treatment, patients retreat to the solace of food, lowered expectations and the veil of obesity. Often they seek psychiatric help as a last resort.

The key to diagnosis lies in the patient's own assessment of her problem with food and weight. Someone who overeats but does not binge will understand that food and weight are problems to be handled alongside her concerns in daily life. Patients with an eating disorder see food and weight as their only problems. They say their life is on hold until they lose weight. This obsession with weight loss is the most debilitating symptom because it takes over the patient's life. The result is a sense of paralysis and hopelessness simultaneously hated by the patient and coveted--because it helps her avoid the fear and anxiety daily life would otherwise trigger. The longer the disorder continues undiagnosed and untreated, the farther the patient is from fully addressing the issues at this stage of life.

Once the diagnosis is clear, the treatment is straightforward but challenging. First, the nutritional goal is normal eating with regular meals and snacks, with adequate--but not restricted--caloric intake. Patients will lose weight slowly because they aren't binging and will adjust to a sustainable meal plan. Once the binging has subsided, the treatment goal is to avoid restricting. Tempted to lose weight quickly, the patient will start cutting calories, get too hungry and then start binging again. That cycle allows the patient to remain focused on food and weight. When a patient can follow the meal plan, she will not have the distraction of the eating disorder. Then the patient will start to become aware of the initial triggers that started the binging and begin to tackle the fear of moving forward in life. This is the core treatment of the therapy, and what differentiates it from other obesity treatments: shifting the focus away from weight and towards helping the person feel grounded and content in her life.

The next post will shift the focus to address some of the medical consequences of eating disorders. It is easy to find a list of specific medical issues but little that explains what is happening to the body and metabolism in general. Stay tuned.

Building Our Food Community

I heard a very disturbing story the other day. A woman --not a patient--spoke about a group of young mothers all of whom see a doctor for weight loss. These are all thin women who want help to look even thinner. The doctor employs two main tactics: he prescribes diet pills and he screams at them to eat less and lose weight. Apparently, some people go to doctors to induce anorexia! Is that really how we share food in our community?

This story finally brought me back to reality: food no longer brings us together. For some, it is an enemy to avoid at all costs, even by seeking out dangerous pills and abusive doctors. Food may still help drive a sense of community but not in traditional ways. We share diets or weight loss stories. We swap stimulants or juice fasts. Or we all trek down to the local McDonald's for processed food that has replaced real meals. We have all had to put down our political stake in the world of food. Many people opt out of the entire food debate. They just eat. For those who do enter the fray, there are many decisions to make: Organic? Vegetarian? Meat-lover? Fast food? Farmer's markets? Pro-industry? Striving for thinness? Food network? This is our current community: find a political (or apolitical) stance and connect with like-minded people. Is there room for another way to share food? Can anyone shift the way our society thinks about food?

I don't believe this society can go back to seeing food as culture. Each home can refocus the conversation around food as I wrote in the last post; however, global food commerce, powerful multinational food corporations, compliant federal regulatory agencies and omnipresent nutritionism are all too influential for the world to turn back now. Obesity, dieting and eating disorders are persistent public health problems. The new community of food resides in this current reality. 

What does it mean for a society to define food through abstinence or gluttony? How does community persist when The Biggest Loser and pro-Ana websites represent such strong cultural voices? Food has become the vehicle for capitalism, for entertainment and for the post-feminist woman. I see food as one of the loudest and most powerful forms of communication. Our approach to food quickly reveals, to anyone paying attention, our approach to life. As disturbing as it is, the group of women seeing the weight loss doctor knows what is most important to them. In their community, these women find a sense of belonging. We all can find people who speak the same language of food, who share the same meaning of food. Whether food represents health, culture, control or safety determines which community of food fits one's lifestyle. By no means are we then bound to that one point of view: as we change what food means to us, so can we change where we belong. 

These dramatic changes in food and culture place a large burden on individuals and parents to find a new balance. Taking responsibility doesn't have to mean taking the blame: the core food industry message. Although government--and to some extent industry--has a duty to protect society from undo harm and public health hazards, everyone must decide what they will eat. We all need to make that decision every day. Change on an individual level--by making informed decisions about food--is necessary for our world of food to change. Our own active role and decisions matter for us, for our families and for our community. 

The next post will bring the blog back to eating disorders, more specifically binging and overeating later in life.

Talking Food with your Kids

Over the past century the basic social structure we live in has changed from isolated communities to a hyperintegrated world. This has had a profound effect on raising children. Parents dismiss the guidance and wisdom of the older generation: how can they understand the brave, new world? In a community of so much homogeneity, the experience of peers is meaningless: why should they know more than anyone else? Even commiserating with like-minded parents has become a thing of the past. Although mothers share many of their own frustrations and worries with each other, it is almost taboo to reveal too much. The most basic struggles of parenting remain a dirty secret borne by isolated mothers.

This void leaves ample room for experts--via self-help books, talk shows and practitioner specialists--to swoop in and provide relief with often unsubstantiated advice. Nowhere is this more evident than in feeding children. Local cuisine is overrun by omnipresent fast food. Parents and children are bombarded simultaneously with junk food
marketing and contradictory nutrition advice. Meanwhile, the societal pressure about food and weight is spreading like wildfire all over the globe. Numerous studies have shown that when fast food enters a new country, obesity, striving for thinness and eating disorders are sure to follow. It's clear who is most influenced by these cultural shifts: kids. It's equally clear who feels powerless as a result: parents.

Many food writers have started to ask a simple question. What did we all do before the food industry, agribusiness and nutritionism decided what we should eat? I think the same can be said for families. How did we all feed our children before carbonated beverages, marketing to children, childhood feeding specialists and childhood obesity and diabetes? When it comes to the culture of food, the global community has stripped people of a sense of identity and, by proxy, a sense of belonging. The spreading influence of capitalism and marketing into our food supply and our food choices has replaced tradition with brand loyalty, family recipes with the local fast-food joint. For generation upon generation, food has represented culture and country on a large scale and home for the individual. Embedded in the identity of food is the knowledge of nutrition and healthful eating. Recipes and meals
represent the good feeling of spending time together and the generational knowledge of how to eat well. Feeding children was a shared family and community responsibility to teach them about culture, heritage and health. Food was a source of pride, not a repository of endless shame. There was no need to seek expert advice because everything we needed to know was right in front of us on the dining room table.

Cut off from family and culture, kids look more and more to peers and school for an identity through what they eat. The marketing machine relentlessly exploits the absence of parental oversight by connecting kids to brands. The food industry has self-righteously edged its way into schools and labelled their marketing strategies as educational. Schools then provide junk foods--the only thing kids apparently will eat--while the company justifies the profit-taking by providing schools with sorely needed funds. In this food environment, peer pressure only encourages pursuit of the tastiest morsels of processed foods now available to kids throughout the day. Meanwhile, family dinners, home-cooked meals and a culture of food has largely evaporated. Kids have become the most coveted capitalist asset: an investment paid back with years of brand loyalty.

These external pressures can feel suffocating. The covert message from the food industry is that parents are powerless to affect children's food choices and are simultaneously responsible for childhood obesity. Government interventions also undermine parents' authority by suggesting a meal plan that kowtows to nutritional standards directly influenced by the food industry lobbyists. The overall effect is that parents feel as if they cannot trust anyone, least of all themselves, to know anything about food. The fallacy of this argument is that parents still decide what takes place inside the home.

How does a parent change the conversation in the big, bad world of food capitalism? The answer lies within the home, perhaps no longer on the dining room table but in recent--and easily accessible--family memory. Children remain fascinated by understanding their place in the world. Marketing experts have learned how to manipulate that desire in children into connecting through consumerism. Kids can get a sense of identity from the latest caffeinated, sweetened beverage, or parents can steer the conversation about food to tradition and heritage and
reopen the door for children to belong in a different way. This may mean cooking and eating recipes passed down from older generations. It may mean talking about the role food and cooking played in the family. Or perhaps it is just making grandma's favorite dish for dinner. Parents have the ability to shift the childrens' focus on food to
tradition and culture. Although children will still feel the societal pressures, they will have a different way of thinking about food. Parents can create a home influenced but not dominated by our current culture of food. In a way, each time a parent's voice is heard eliminates a marketing opportunity for the food industry.

One thing I still have not addressed is how parents can feel less isolated when it comes to feeding children. Bringing new ideas about food into the home opens new opportunities for conversation, but the families are still alone. The bigger question--to be addressed in the next post--is how to recreate a community around food.

How Not to Pass Your Food Issues onto to Your Kids

Every parent wants her child to eat normally and healthfully. Every parent wants her child to be free of the societal pressures to eat less and lose weight. However, most parents struggle with their own demons when it comes to eating. No one is immune from the pressures to be thin, the newest fad diet, the endless stream of food advertising or the onslaught of confusing nutritional advice. The unspoken truth is that children carefully observe their parents' behavior around everything, including food. Kids will be aware of the discrepancy between how their parents eat and how they eat. They will notice how daddy skips breakfast or how mommy sneaks dessert or how daddy is always on a diet or how mommy is ashamed of how she looks.

The obvious answer is for parents to fix their own food issues. But parents, at age 30 or 35 or 40, have been trying to solve their eating problems for years. Although parents often report a shift in their eating habits after having children, there is no magic fix. Sooner or later, parents will find the same old thoughts and behaviors creeping up on them combined with the added pressure of trying to hide these embarrassing habits from their children.

So is this just another unavoidable source of parental guilt? Are children doomed to the same endless cycle of food and weight preoccupation? Are parents not equipped to teach their children a new way of eating? Based on the last post, I laid out the concept that children have an innate sense of when to eat and when to stop. A parent's job is to teach kids how to identify and recognize their bodies' needs and then act accordingly. It isn't necessary for the parent to solve her own food issues in order to teach her children about their own internal cues. The parent doesn't have to be perfect because it is not about modelling behavior but learning about your body. The conversation shifts from junk food and thinness to healthful eating and hunger. Every family will have to handle the same outside pressures, but creating a new avenue for discussion will allow children an alternate way to talk about food inside the home.

As the parent refocuses the discussion from conforming to societal norms to child-based learning, she needs to know how to handle her own food issues. Any parent will be tempted to do one of two things. The first is to hide her concerns about food because they are too shameful. The second is to impose her own rules on the child. This would simultaneously lift the pressure on the parent and confuse the child by obfuscating her ability to learn how to eat.

The most effective strategy is to expect that food and weight are complicated topics any family will tackle slowly over time. Parents will struggle how to explain this issue to the best of their ability, just as with the age-old discussion about where babies come from. Success rests on two points: sharing just enough information appropriate to the child's age and showing just enough humility. Children will be curious but usually need a simple answer to satisfy them. Too much information confuses them and too little only piques their curiousity. Many parents will either avoid the topic completely or feel obligated to have a long discussion which goes way over the child's head. In this instance, the parents' clue to stop the conversation comes from the child. Children will ask questions until they understand enough and then move on. Parents should move on too. The conversation is likely to continue on and off for years. Once children know their parents are open to discussing food and weight, they will understand it's all right to ask more questions. 

There is no need to hide that the parent is still learning about food or thinks about weight. It can be comforting to the child when a parent is honest. Since the child will observe a parent's behaviors or hear her discuss her worries, a sincere response will match the child's thoughts. Hiding or lying forces a child to reconcile her confusion often in deleterious ways. This approach to discussing food won't shelter children but instead will allow them to understand and hopefully, in time, find a different way to think about food.  

Younger kids need to learn about food and their bodies. Older kids are more curious how people think about eating or why others talk about being thin. As kids get even older, outside pressures will become more powerful. How can a parent even begin to compete? What do these conversations with kids look like? This information rests in the home, family and community. And that is the topic of the next post.