Karges, a registered dietitian who specializes in child nutrition, says reports like these have become more common at her San Diego-based practice since the pandemic began — an observation supported by recent research showing, how prevalent eating disorders have become among children in the United States and around the world. In December, the American Academy of Pediatrics reported that the number of children admitted to hospital emergency rooms for eating disorders has skyrocketed during the pandemic and has not returned to pre-pandemic levels. Last month, a meta-analysis in the journal JAMA Pediatrics found that 1 in 5 children worldwide showed signs of eating disorders, meaning they were exhibiting behaviors characteristic of eating disorders (such as calorie counting, restricted eating or over-exercising) but not the threshold for a clinical diagnosis. The meta-analysis, which included 32 studies from 16 countries, found that these behaviors were more common in girls, older adolescents and also in children with a higher body mass index (BMI).
American children and adolescents also experienced significant weight gain during the pandemic, and the AAP recently issued its first clinical practice guideline for the evaluation and treatment of children and adolescents identified as overweight or obese. The guideline has been criticized by some pediatric dietitians and eating disorder specialists, who say the guideline’s focus on BMI — as well as its inclusion of aggressive treatments such as weight-loss drugs and bariatric surgery for adolescent patients — could increase the likelihood of developing it Eating disorder.
By focusing less on a child’s weight and BMI and more on how a family approaches nutritional practices at home, some nutrition experts believe parents can help protect their children from developing disordered eating behaviors. Karges belongs to a growing field of child and family nutritionists who aim to establish internally self-regulated eating habits and foster a positive relationship with food while rejecting the principles of food culture—eating restriction, fixation on the scale, strict adherence to dietary guidelines.
When families come to Karges for advice, she explains that the root of their children’s eating habits is not in the child. “Usually it stems from the parent’s fear of the child’s height or appetite,” she says. “One of the most important things I do is to coach parents to see that their child’s appetite and height are not wrong and create a structure that helps them understand the role of food policing or micromanagement to give up what the child eats.”
Some parents are concerned because a pediatrician has told them that their child’s height is a problem, says Karges.
“I’ve had kids by the age of 2 where the parents would be told, ‘Your kid is eating too much,’ or ‘Their weight is developing in a way that looks kind of unhealthy, so you really need to pull the reins.'” She says. “And unfortunately, when parents try to control things, there are very negative consequences – but a perceived restriction on food or restricted access to food that leads directly to a child’s preoccupation with food.”
Jennifer Harris, a Registered Dietitian and faculty member at the Ellyn Satter Institute, notes that one way for parents to create a healthier environment for nutrition and to develop their children’s eating literacy is to use the registrar-established Allocation of the Responsibility in nutrition” is implemented by nutritionist, family therapist and nutrition expert Ellyn Satter. The responsibility-sharing model dictates that parents are responsible for the “what, where and when” of nutrition, and children are responsible for “if” and “how much” of food.
“Parents are often asked, ‘Is your child eating five fruits and vegetables a day?'” says Harris. “But to reconcile that with the Satter model, the question would be more like, ‘Can you offer your child some fruit or vegetables every day?'”
Satter’s approach also focuses on the idea that all foods can be part of a nutritionally healthy diet — including birthday cake — and a portion of dessert can be offered with dinner without having to eat vegetables first. “The whole goal is not to create an environment where certain foods are so novel that I eat them all as soon as I get them,” says Harris. This is one reaction children might have when they fear a particular food will win out. not offered again, otherwise they must not be fed up. “That is the purpose of serving a portion of dessert within a meal that can be eaten at any time during the meal. It’s important because if you stick to the guideline “eat your meal, Then you can have dessert,” the child may finish eating, feeling somewhat full and satisfied, but will still eat dessert because it is a treat and something special. Now we have taught the child to overeat.”
It may seem counterintuitive to offer a plate of biscuits at snack time and let the child eat as many as they want, says Harris—”and in the beginning the child eats more.” But if you continue with this very neutral food offering, you rob it of its power, and the kids can walk away from it just as easily because it’s not that special.” The structure of this type of diet allows kids to develop internal regulatory skills, says them, and offering them foods they like, promotes positive eating attitudes: “These are the two areas of eating literacy that are consistently affected in people struggling with an eating disorder. ”
Some parents may initially have trouble adjusting to this style of eating, which is likely a big change from their own childhood eating experiences., says Anna Lutz, a registered dietitian in North Carolina who specializes in eating disorders.
“Everywhere we look, we’re being told that we should control our child’s food, that it’s the parent’s responsibility to control their child’s weight in some way, that it’s kind of a reflection of the parents,” says Lutz. “And if a parent struggles with restrictive eating themselves or has their own history of eating disorders, that can be challenging, too.”
Parents shouldn’t feel like they’re to blame for their child’s challenges, Lutz emphasizes. “We know there are many, many risk factors for eating disorders, including genetics, trauma, temperament, mental health, exposure to the media, and any type of diet,” she says. A family’s dietary habits alone don’t guarantee a healthy outcome, she says, “but thinking about how you’re feeding your child is a protective factor, regardless of your child’s height.”
It’s important to remember that healthy children come in all sizes, she says, and just focusing on weight or BMI can have dangerous implications. “If we start telling a young child that there is something inherently wrong with them just because of their height, we could set that child up not only for a lot of medical issues from weight stigma or weight change or eating disorders, but also for the effects on their self-esteem, who they see themselves as, their mental health.”
Karges says she’s always pleased to see how quickly alarming eating behaviors can correct themselves when parents adopt an approach that puts the child’s autonomy first.
“The best thing about my job is that families reach out and say, ‘You won’t believe it, we went to a birthday party and my daughter loved cake but she had a slice and went on and played with it kids,'” and they feel like they have their kid back,” she says. “A lot of this helps parents see that when you’re stressing about food and your child is scared about not having enough access to the food they need – the stress it causes is more damaging to them than literally anything else they could.” eat.”
The resulting freedom is life-changing for parents, too, she says. “Being able to take that pressure off of feeling like you need to be a gatekeeper of everything your child eats — it also improves the relationship between a parent and their child.”
