Talking Fat and Thin with your Kids, Part I

Although body shape and weight have long been a human preoccupation, things have changed since today's current parents were children. Yes, kids back then knew about thin and fat, but only when they saw it right in front of their eyes: a bullied peer or a body image-obsessed parent. These days, the abundance of processed food, the adoration of thinness and the explosion of eating disorders have created a world in which kids are aware of the many meanings of thin and fat at much younger ages.

The chasm between parents' memories of blissful ignorance and a child's premature exposure to the idea of weight creates a confusing scenario for families with young kids. Scared and perplexed parents seek out my advice when their young daughter starts to talk about feeling fat. Although children routinely mimic the adults in their lives, and the result is often amusing, this example stirs fear in any parent.

Sadly, there is nowhere to turn for reliable guidance. Most reassurance from friends or a pediatrician blends platitudes with unfounded opinion. Often, the advice given to parents is to put the kid on a diet, or at least restrict certain foods. I can't  count the number of patients I've seen who say that it was the first diet that started their eating disorder.

In order to guide these parents, I have found that the best approach is to place their worries within the wider public health problem of eating disorders. This step acknowledges the fears are real while pointing out that one comment doesn't constitute an eating disorder.

Their child is just playing with the adult concept of weight, something innocuous on its own, when taken out of context. And a child won't really understand the context. Once familiar with the scope of eating disorders, parents can return to their own child's behavior with some perspective and, consequentially, develop concrete, practical ideas to steer their child clear of a worrisome illness.

When I describe my practice, to clinicians and laypeople alike, the choice to treat adults with eating disorders, but not adolescents, perplexes even the most knowledgeable and open-minded. The first eating disorder image that comes to everyone's mind is the emaciated teenager, lost and alone. Surely, that's who I must be treating. The existence of a practice treating exclusively adults with these illnesses implies a much larger problem than most people could imagine.

Binging, restricting and purging remain a by product of adolescence to most adults, symptoms of a bygone age of inner turmoil and impulsivity, quickly outgrown with the maturity of early adulthood. The few who aware of an eating disorder's wider reach have generally been touched by the illnesses directly. The rest, without cause to understand further, just see the chronically ill as a group of misguided women without the will or desire to eat.

A new subspecialty, which has emerged only in the past decade, further reveals how widespread the problem has become. The incidence of children ten and younger diagnosed with eating disorders has skyrocketed, now at about ten percent of all cases. Hospital units designed for eating disorder treatment report rising numbers of young children as patients, and the clinical community is scrambling to provide adequate services.

This phenomenon generates sympathy and horror, but, from a clinical vantage point, these are new illnesses which clinicians are only starting to learn how to treat.

As I have written, the longer the course of the illness, the more difficult the recovery. The behavioral eating symptoms, the most obvious and most disturbing, are the mainstay of diagnosis and priority of treatment. All children must start the road to recovery with weight restoration and normal eating.

But the path after that is unclear. What precipitates a young child to develop an eating disorder? How is relapse prevented? These are the obvious first questions to ask and the ones critical to parents wondering what to do about the young child who feels fat. 

Any clinician would agree that protecting these children vulnerable to an early diagnosis of an eating disorder is a priority. Exposure to our culture's weight obsession is unavoidable. Objectification of even a young child's body begins with idle adult comments or a first wearing of Gap skinny jeans, even for pre-pubescent kids. This is the world we live in.

Every child will grapple to make sense of the miasma of information and feedback that comes their way, but where is the line between normal psychological development and a problem? Keeping the broader context of eating disorders in mind, I'll try to answer that question in the next post, part two of talking fat and thin with your kids.

Dessert and Children: The Final Frontier of Food

Few issues generate more confusion and disagreement among parents than dessert. That extra little piece of chocolate or candy is the bane of many a parent's existence, and the true moment of success for a child.

These kids know how to get what they want. Adept at reading their parents' cues, they will home in on any ambivalence about dessert to cash in on the reward. In that moment ripe for exploitation, kids will pounce on the adult who, unaware of the ambush, soon relents and allows the desired treat. And why not? The pestering inevitably gets kids more sweets and they love it.

So it's no coincidence that nothing elicits more whining and crying than being denied dessert. Every meal, snack or even moment of downtime is a child's opportunity to scavenge for ice cream or a lollipop. A day with children can often feel like fending off one sweet entreaty after another until you've been worn down to a nub of fury. The final capitulation is all too familiar: "Fine! Do what you want! Eat every piece of candy in the house!" To a purely literal child, this is a simple, if angry, invitation.

An adult, after enduring this argument countless times, will sit down, rationally, and hammer out a dessert treaty. The results are predictable: a certain number of desserts is allowed per day or per week; perhaps one type of dessert is favored over others; and often the treat is linked to finishing a meal or completing a particularly onerous chore.

If only logic had a chance! Children can dismantle the best-laid dessert plan in minutes. Their relentless attack and single-minded goal undo a parent's good intentions almost instantaneously.

Just as with choosing a healthy family diet, a logical plan is only half the battle. Reaching an acceptable approach to dessert in the household may look like the solution, but, as children are well aware, every sweet rule is made to be broken.

The conflict between a child's developmental drive for autonomy and the equally strong need for security runs rampant in the daily dessert fight. It's the older kid's version of push me-pull me growing up.

The mind of a child hellbent on the prize represents nothing more than burgeoning independence. Something clearly deemed a treat, which also elicits an array of powerful feelings in an adult, is an irresistible hot button to a child testing the limits of parental patience. The wistful apology that follows the gorge is the requisite search for reassurance, saying, in essence: "Do you still love me Mommy?"

So the second half of the battle has to address the emotional conflict children see both in their parents' struggle with dessert and in their own developmental challenges. There are two critical steps to defuse the timeless family argument, which, although simple, are not particularly obvious to the frustrated parent.

The first step for parents is to tame their own dessert demons. Dessert is not evil or bad. It isn't something to be avoided like the plague. It need not trigger a level of guilt and shame that demands a weeklong diet or even a juice cleanse.

It is best to remember that the varied, healthful diet of an omnivore includes dessert. Like everything in this meal plan, dessert comes in moderation. No one thinks a nutritious meal is comprised of solely chocolate cake. Dessert, broadly defined, is a reasonably sized sweet after a meal or perhaps an afternoon snack.

The most powerful way for children to understand this concept is through action. What a parent does communicates much more to a child than what a parent says. In this case, that means sitting down to enjoy dessert with the children.

When a child sees you happily eat a piece of cake too, dessert starts to transform from daily family squabble to part of the routine. That undoubtedly takes away much of a child's ammunition. Without a parent's weakness to attack, the heightened emotions dissipate and the child loses interest. In today's world of food, one true gift from parent to child is to wrest dessert from its powerful perch as the ultimate sin and make it just another food.

However, children still do need dessert rules, even though they will immediately try to break them. As any law-abiding society can attest, rule enforcement is infinitely more challenging than rule creation. That leads to the second step to defuse the dessert battle: once parents create the rules, stick by the rules, most of the time.

Dessert has been the reward for childhood successes and the go to punishment for bad behavior for time immemorial. Kids live and breathe ice cream, candy and cake as the barometer of a good or bad day, and not only because dessert tastes good. The joy of pushing a parent to the breaking point and reveling in the extra treat is the real goal. Children get enormous gratification from pushing the rules until the parent breaks them.

In futile retaliation, the parent will then modify the rules to cover for their abject failure. In that moment of panic, dessert can magically be linked to any parental demand just so the adult can blindly reassert some power. Once the rules have changed, all children know the game is over. They have won.

Parents don't need to change the rules. They need to change the game. The answer is to approach dessert rules as a wise and thoughtful judge, not a hardened cop.

If the family dessert is laden with guilt and shame, thoughtless cop parenting is the only way out, but children know blind rule following when they see it. When dessert has become just another type of food, separate from punishment, reward or conflict, shifting the rules means something very different.

In the adult world, kids know that dessert can be a pastry for breakfast, something after lunch, midday or after dinner. The actual rules are arbitrary. They are guidelines to give children a way to learn how to eat.

The cop parent will follow the hard line: these are the rules and don't break them. A child finds that approach irresistible and will inevitably find a way to flout the rules. The wise judge parent will, unemotionally, follow the rules but can offer moments when the unexpected dessert becomes a regular part of life. That may involve stopping for dessert on a whim one afternoon or a special family dessert one evening. If these treats are emotion-free, the rules transform into guidelines, and the occasional deviation becomes a way to share something fun together.

An image that brings joy and a burst of nostalgia to many adults is the gleeful child, drenched in melting chocolate, licking an ice cream cone in summer. It is the rare adult who is able to replicate the same experience. Finding a place of sanity with dessert in the family can preserve these moments every child deserves.

The next and last post in this series will address how to discuss weight with children.