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Sunday, Nov 22, 2009
Above all, the word "diet" is suggested by many of these experts to be as deadly as the word "fat." We know, of course, that quick-fix diets found in just about every women's magazine -- "Lose 10 pounds in two weeks!" "Trim your thighs before bikini season!" -- have done little to help girls and women maintain a lifelong, healthy body size. And "yo-yo dieting" is demonstrably responsible for long-term excessive weight gain. Children are even more susceptible to the damage of dieting. In fact, most pediatricians concur that while a child is growing, it is actually dangerous for that child to lose weight.
Instead, the preferred method for dealing with excessive weight -- favored by Nathanson and others -- is to allow children to "grow into" their weight. In this approach, a parent's goal is to help his or her child maintain their current weight, until they catch up in height. But it isn't nearly as easy as it sounds. Nathanson herself points out that it can take, on average, more than a year and a half to work, which doesn't help the young obese girl who is in danger of early puberty and its attendant risks of excessive weight gain in childhood. And once that girl hits puberty, it's pretty much over as far as "growing into" her weight is concerned. "The most important thing for parents of chubby girls entering puberty to remember," writes Nathanson, "is that it is futile, fruitless, and cruel to expect their daughters to slim down at this point. Restricting food, 'having a chat' about diet and exercise, imploring the pediatrician for prescriptions for appetite suppressants -- these cries of anxiety from parents produce only guilt and anger, self-consciousness, and a feeling of helplessness in a young girl."
"The obvious thing that everyone understands now is that you can't put a child on a diet," says Laura Fraser, author of "Losing It: America's Obsession With Weight and the Industry That Feeds on It." Fraser defines a "diet" as any external means of control about food, including such things as restricting calories and keeping food diaries. "They will rebel, both psychologically and physiologically, by overeating and sneaking food. It's a recipe for obesity." Indeed, parents typically are told that they should never divide food into "good" and "bad" categories, for fear that banning a food will only fetishize it; nor should they use food as a reward or bargaining tool -- i.e. eat your broccoli and you can have a piece of cake -- because it sends the message that broccoli is less desirable than cake.
The authors of "Let Them Eat Cake" argue that the most dangerous aspect of denying food to a child is the consequences to that child's self-esteem. "Outlawing certain foods and snacks and criticizing food choices can lead to a no-win power struggle that sends a clear, negative message to the child that he or she has a 'weight problem.' As this in itself is more damaging than the presence of excess pounds (low self-esteem lingers on long after weight disappears), food and weight should never be made a big issue for children, regardless of what the charts show."
This sort of heart-rending assertion has held sway for years, especially among parents who have soaked up guilt like sponges. The threat of serious health risks has derailed this philosophy for some parents and a few "feeding experts," but the voices in the wilderness calling for food control and even diets remain weak.
Parents are more likely to turn to experts like Ellyn Satter, the author of three books on feeding children including "How to Get Your Kid to Eat -- But Not Too Much." Satter, a nutrition guru, is primarily concerned with developing "eating competency" in children, which involves teaching a child to love food, and respecting a child's autonomy -- though in practice, it suggests a sort of denial in disguise. She operates a clinic in Madison, Wis., where "the division of responsibility" between parents and their children is the core principle. Satter says it is up to parents to decide "what, when and where" a child eats. The child decides "how much and whether" to eat. In other words, "junk" food and between-meal snacks aren't taken away -- they simply are not made available in the first place.
The idea is that the child will learn gradually to regulate his or her own food intake and thus develop eating competency. It is a sensible approach meant to tread lightly on self-esteem, but like much of the parental advice already available, it works best, as Satter admits, if you follow the guidelines "from birth on up."
And what advice does she give the parent who missed Satter at birth and now has an overweight 8-year-old approaching puberty? Won't the child notice if her parents suddenly stop buying potato chips and start structuring meal and snack times?
"Well, in that case," says Satter, "you would have to do a secondary intervention. You need to have someone who understands feeding do a complete evaluation. Is the child really gaining weight, or are they just plumping up pre-puberty? If they are gaining weight, how much? Is the family following the division of responsibility with regard to food? Are they restricting the child's food intake, causing the child to rebel? Is there stress in the family which is causing the child to use food for comfort?"
Satter's secondary intervention includes a review of medical records from birth, nutritional analysis of seven days' food intake, office interviews and a videotaped observation of several family meals. It is a process, she admits, that is certain to alert a child to her parents' concern about weight, but, says Satter, sometimes a child is ready to be open about the problem.
