How to Think about Kids and Food

About once per week I receive an email from a parent about a problem feeding his or her child. The concerns vary from picky eating to arguments at mealtime to overeating to diet advice. Sometimes the child is at risk for an eating disorder, but more often this is a normal family struggle about food.

My instinct was to ignore the emails and pass the worried parent on to the child's pediatrician, a child feeding specialist or perhaps her own therapist. I came to realize there was a reason I was receiving these calls for help. The parent was looking for both reassurance that the child was relatively normal and guidance to handle the current issue. These emails highlighted a gap in resources available to parents. There is plenty of advice about what to feed your kids, but parents always want to know if they are doing the right thing. I know I cannot answer that question but I could discuss what seemed to be the missing link. How to think about your kids and food?

There are a few common themes. First, parents don't know where to turn for a coherent strategy for feeding their children. Second, parents are terrifed of passing their own imperfect or even disordered eating onto their children. Third, families are very isolated from community--both relatives and friends--and choose to ignore old world advice in a new world of dietary challenges.

The marketing of foods to children and the transformation of our food supply have changed the landscape of parenting about food drastically. Useful, accurate information is hard to find. The best educational materials are often just skillful marketing tools, misguided public health statements or nutritionism (turning eating into a chess game of nutrients and minerals). By creating an array of foods made to appeal to our deepest desires, the food industry undermines our faith in our ability to regulate food. We all struggle to find a healthful, balanced diet and are plagued by the constant temptation to stray. How then can a parent become an expert in feeding his or her own child? Where does a well-intentioned parent even start?

Parenting is marked by moments of self-doubt and even despair followed by an important, usually self-evident revelation. In this instance, that moment begins when a parent realizes she already knows how to feed her child. If a parent can accept this premise, the outside influences are not as confusing. Any advice from society appears to be tainted by ulterior motives. Any professional suggestion needs to be balanced with a parent's understanding of her child. People have survived with eating advice passed down through families and tradition for centuries. Why, all of a sudden, would we all be clueless about how to feed our kids? In fact, the real worry is who will protect them? Although the movement to regulate the food industry is gaining steam, it is unlikely to have broad impact for many years. So parents are left to fend for their children on their own.

Let me be clear about one thing: parents know how to feed their children. The real issue is how can a parent harness that instinct. In recent years, the national mantra is that parents are to blame for their childrens' eating habits. But it is clear that the individual parent is powerless in the face of massive societal forces. Shielding children from advertising, television and junk foods is impossible. Teaching children about their own bodies remains very effective. The key is simple. When the child is hungry, she will eat. When she is not hungry, she won't. However, applying this concept is much harder. First, a parent has to trust the child's instincts implicitly. Second, the parent has to learn how the child experiences and acts when she is hungry or not hungry. Third, the parent needs to translate the child's experiences into words and to teach her to know when she is hungry or not hungry. Last, the parent has to learn to avoid his or her own vulnerabilities about food and not pass them on to her children.

Even though this application seems straightforward, nothing is ever easy in parenting. Industry and government still dictate how we all think about food. No movement has yet had much impact on our culture of food. However, a parent can focus on other components of eating--ones that have been drowned out by the myriad confusing messages--to help the child navigate this confusion.

This has turned into a topic too big for one post so look for the next several to address these topics more fully.

Families and Recovery

One necessary but often neglected component of recovery is the role of family and significant others in the treatment of an adult patient. Even with a cohesive, supportive and knowledgeable team, the patient has to navigate many hours and many meals alone. The people in her life who love and care for her can provide daily support. However, more often than not, this is not the case. Some families do not have the emotional stability to aide in recovery and others, much more rarely, are the source of the illness itself. Even for families capable of contributing to the treatment process, most patients exclude their family from recovery. This lost resource is the result of two problems in communication. First, families struggle to find education and guidance about their role in treatment. Second, patients feel misunderstood by their families and do not know how to ask for what they need. This rift only leads to an impasse and an unnecessary, added obstacle to progress. 

The essential piece of advice for families is don't talk about food ever. Don't ask about a meal. Don't ask if she ate. Don't ask if the food was good or bad. Just don't bring it up. If the patient talks about food, any response needs to be encouraging and brief. The patient's internal thoughts about food are critical and relentless. This means she will misinterpret any comment about food to mean that she ate too much or ate the wrong food or is fat. The entire process of eating causes intense emotional pain that she needs professional help to navigate. Any caring family will want to address what appears to be the problem, food. If only she would eat, the problem will go away. The hardest step is to recognize how discussing food is counterproductive. In fact, this is how the family becomes the enemy, not the source of support and comfort.   

So what does help the patient? Because she is bombarded with critical thoughts, she needs kind words of support and encouragement. By the time a patient is in treatment, families are already very worried and frustrated about how powerless they feel. This is primarily a reflection of how powerless the patient feels. The presence of the eating disorder makes normal, loving family interactions seem impossible. The daily conversation needs to shift away from food and back to the topics from before the eating disorder. Showing interest in the person outside of her illness will remind her of the other parts of her life. She needs to remember that she has relationships that matter to her. She needs to know her family cares about her, not just if she eats.   

Another important aspect of recovery is that progress is often not visible, especially early in treatment. Setting up a treatment team, establishing treatment goals and putting initial plans into action takes time. The changes begin in small ways. Many key transformations can be internal and involve quieting the eating disordered thoughts. But this progress is often not seen by families who want immediate, concrete changes. They want their loved one to eat meals and be herself again, almost instantly. This desire comes from love and caring but translates quickly into disappointment and frustration. As a therapist, I focus on progress and patience in therapy. This approach helps the patient learn how to treat herself with compassion through the process of recovery. When the family realizes how powerful patience and compassion can be, recovery can move forward even more quickly.      

If the patient will allow it, one session with the primary therapist can be very helpful. The goal is to understand the most effective ways to support the patient in recovery. This meeting allows the patient herself the opportunity to express what she needs. It also sends a clear message to the therapist that the family wants to be a source of support in recovery.  

Last, the family needs to recognize that eating disorder recovery is a long and trying process. Every family will be frustrated and will make mistakes. It is best for the patient if the family works hard to educate themselves about eating disorders and to find their own support. There are associations for families to provide these services. Individual and family therapy is also effective. Seeing her family seek out their own support will help the patient understand that everyone is working hard to be well and that she does not need to take care of the family too.  

This post has led me to consider the family's role in a different light. In my first post I wrote that I received a call from a father about how to feed his daughter. That conversation brought up the obvious question: how to feed your children? From my vantage point, if the goal is to help your children understand how to think about food, I think there is a more important question. How do you talk about food with your children? Look for the next post.