Monday, February 6, 2017

Healthy Habits: Children and Overeating

The childhood obesity rate remains staggering. It can be tempting for parents to hope that their child’s overeating is “just a phase,” but the price of inaction is too high. There are serious and immediate physical and psychological effects to being overweight and obese, such as prediabetes, bone and joint problems, social issues, poor self-confidence, along with many other problems.
In Free Your Child from Overeating, Dr. Michelle P. Maidenberg provides 53 strategies rooted in mindfulness and cognitive-behavioral therapy that will help children and teens:

·         Identify triggers, cravings, and self-sabotaging thought patterns
·         Learn about emotional eating
·         Differentiate between hunger, thirst, desire, and cravings
·         Recognize common rationalizations for overeating

 And help parents:

·         Address their children’s overeating without discussing their weight
·         Make change at the family level and model healthy behaviors
·         Deal with social media and marketing influences
·         Work through bullying and weight discrimination

I had a chance to interview Dr. Maldenberg to learn more. 

The Motherhood Moment blog Interview

How common is overeating in children?

Childhood and teen obesity has grown to epidemic proportions in the United States. The numbers are stark and speak for themselves. As of 2010, more than one-third of the children and adolescents in this country were overweight or obese. The Centers for Disease Control and Prevention, the United States National Center for Health Statistics, and the Journal of the American Medical Association have confirmed that childhood obesity has more than doubled in children and tripled in adolescents in the past thirty years.
The percentage of children six to eleven years of age in the United States who were obese increased from 7 percent in 1980 to nearly 18 percent in 2010. Similarly, the percentage of adolescents aged twelve to nineteen years who were obese increased from 5 percent to 18 percent over the same period. In 2011 to 2014, 8.9 percent of two- to five-year-olds had obesity compared with 17.5 percent of six- to eleven-year-olds and 20.5 percent of twelve- to nineteen-year-olds. Although the prevalence rates of youth obesity did not change from the periods of 2003 to 2004 through 2013 to 2014, there has not been any decrease and the rates remain staggering.

What are some common triggers for overeating and how can they be managed?

Thinking tends to start with a trigger, something that makes us want to act. When triggers block more complex thinking, we react quickly and impulsively. We rationalize (create explanations or excuses for) our behavior to justify it to ourselves or others. Here’s the way it may appear for a child:
Trigger Cycle
They get triggered -> Someone offers them a third slice of pizza.
They experience a thought ->    “The pizza looks good.” “It smells so good.” “The last one was so tasty.” “I want it.”
They rationalize -> “I deserve it because I had a challenging day.” “It will help me feel better.” “I usually don’t have three slices.” “It will be just this once.” “I will eat less tomorrow.”
They act -> They eat the third slice of pizza even though they feel slightly full. They haven’t waited the twenty minutes for their brain to recognize and report back to them whether physically they were in fact feeling full or not.
After they act, they think -> “Why can’t I control myself? I’m so weak and out of control.” “I am really annoyed with myself because I did not want or need that third slice of pizza.” “What’s the point of trying? I might as well accept that I’m bad at this and not much is going to change.”
They feel -> Angry, frustrated, sad, and hopeless.
Examples of triggers include:
Feeling bad after a bad day at school (emotional)
An argument with a loved one or friend (social)
Tiredness/exhaustion (physiological)
An advertisement for food or eating something (situational)
Thinking about how things “should” or “shouldn’t be” (thinking)
Parents can collaborate with their child to identify if their triggers are on all five levels. They can chart their triggers, thoughts, rationalizations, actions, and their thinking. By helping children to get to know themselves, they’ll gain an understanding about what triggers them to engage in unplanned eating, overeating, and unhealthful choices. They will become more in tune with themselves and conscientious when they are taking action.
For example, a child identifies a trigger situation: when the Girl Scouts come around selling cookies. In the past, they told themselves they would just stop at eating two Girl Scout cookies, but this rarely sticks, and they typically end up eating half the box. They recognize that there is good reason to believe that it can happen again if they don’t plan in advance. Their plan may include portioning out the cookies, eating two and throwing the rest out (better to be wasted in the garbage than wasted in her body), or giving the rest away. They learn to consult with family members about what works best for them and collectively thinks about their own needs.
Most kids and teens don’t think before they act and go from trigger to action before they realize it and have a chance to transition their behavior. Though this is partially due to where they are developmentally, kids and teens still have a great capacity to learn about their thoughts and feelings and to make changes in their behavior. By understanding her triggers instead of acting on impulse, your child gains the chance to act by choice.

How can parents address overeating without making it specifically about weight?
How parents communicate, both directly (through speech) and indirectly (through body language), conveys their judgments and expectations. Whether they say something out loud or just grimace, kids read them loudly and clearly.  

Kids forever remember when they first heard that they are “fat,” “chubby,” or “overweight.” As much as parents would like to protect their children from the labels that cause them to question their own self-worth, parents can’t protect them from other people. They can only make sure the messages they communicate (through words and behaviors) do not convey judgment, disappointment, or disdain.

As a parent, it is essential to convey acceptance of their child without any contingencies. In a large study of adolescents and their parents, scientists examined the associations between parent conversations about healthful eating and weight and disordered eating behaviors in adolescents. The study showed that parents who engaged in weight-related conversations had adolescents who were more likely to diet, use unhealthy weight-control behaviors, and engage in binge eating. Overweight or obese adolescents whose parents engaged in conversations that were focused only on healthful eating behaviors were less likely to diet and use unhealthy weight-control behaviors.

In the study, the weight-related conversations included discussion of their children’s weight and size. Parents conveyed to their children that they were heavy or going to get fat if they continued to eat the way they did. The results clearly indicate that children used desperate, unhealthy, and often dangerous methods to “work on” their challenge because of feeling that their parents would be more approving and accepting of them and may love them more if they were thinner.

Kids hide away during adolescence; they are trying to form their identity. They seek independence and autonomy, balanced with a sense of belonging and feeling like they are approved of.
Parents should never shame their child or call them names. Even though a parent may mean it playfully, their child may not take it that way. Teasing isn’t positive unless both parties perceive it as fun. That’s often not the case. The teasers perceive it as lighthearted and fun, while those teased often describe the same situation as malicious and irritating.

Calling a child “chubby cheeks” or “muffin top” may sound really cute but can be quite damaging to a child’s confidence. Parents who approach weight in counterproductive ways, such as teasing, put children at higher risk for developing disordered eating behaviors like anorexia, bulimia, and binge eating. It also puts young women at risk for selecting romantic partners who make hurtful comments about their weight. They internalize the teasing; they think they are deserving of it and should expect it from those who are close to them. In addition, taking parental modeling into account, if children see their parents participating in teasing, they may think it is permissible, and it gives them free rein to tease others.

Behaviors that are not helpful for fostering open dialogue:
1. Teasing a child about his weight or body.
2. Badgering a child about his weight and eating habits.
3. Nagging or preaching to a child about what to eat, when to eat, and to eat less than they’re eating.
4. Talking to a child about diets.
5. Rewarding or bribing a child to eat differently.
6. Commenting on weight loss or weight gain.
7. Weighing a child.
8. Rejecting them for any changes in their body weight.

A roadmap for having open and enriching discussions:
  • Thanking a child for their willingness to speak to you and for expressing their thoughts and feelings.
  • Parents have to be aware of how they are directly and indirectly communicating. Encourage a child with reassuring sentiments (“You can do it” and “You are really putting a lot of effort into this”) and warm and supportive body language (smiling and being affectionate).
  • Using empowering terminology when discussing a child’s health (e.g., use words such as “healthy”, “flexible”, “agile”, “fit”, “strong”, and “active”).
  • Using open-ended questions to decrease the chance that a child will give one-word answers, so the discussion can develop.
  • Parents being sure to listen more than they speak. Parents can get caught up in teaching and lecturing; they run the risk that their child will tune them out because of feeling talked at and bored.
  • Hearing a child out fully and at the outset; find out what they need and what they are looking for and expecting from a parent. Parent should avoid offering advice or solutions prematurely.
  • During the conversation, parents check in to be sure they understand what their child is trying to communicate to them. Parents can effectively accomplish this by paraphrasing (restating in your own words), summarizing (summing up concisely), and mirroring back (reflecting back verbatim) what their child says.
  • Parents always offering to collaborate and work together as a team. The more support a child receives, the greater the chance that they will be open to talking about this topic, ask for help when they need it, and put effort into making changes.
  • Keeping the conversation open. Parents letting a child know that they will always be available to speak to them and that there’s an “open door” policy regarding communication.
  • Respecting when a child doesn’t want to speak and parents letting them know that they are around when their child is ready to open up.
  • Normalizing the challenges. Convey that kids can face a variety of health challenges, like asthma or allergies, for example, and that challenges do not define who they are and their potential for success.
  • In our popular media, being thin is most desirable and the seeming definition of “beauty.” This can be demoralizing for a child. Parents obviously won’t be able to completely counter these influences; however, you can emphasize what’s important. The key with communicating is conveying empathy: overall acceptance, care, and unconditional love. This should consistently be the underlying theme.
Rather than discussing “weight”, parents can communicate to their child that:
  • Before and after puberty, our bodies change dramatically, and weight gain can be a normal part of the process.
  • Our health is important because it helps our bodies grow, function properly, and become strong.
  • By engaging in healthful behaviors, she is helping her body stay energetic and not have to overwork her organs (such as the heart, lungs, etc.). If the body is overworked, it will have less energy to do the things she wants to do that make her feel joy. You can give a personal example she can relate to, such as a sport she loves to play. For example, if she overworked herself in practice, it would take away from the joy of playing the sport because it would sap her energy and she could injure herself.
  • Part of loving herself means taking care of her body and keeping it strong and healthy by eating healthfully and exercising. Our physical bodies do not determine our worth, and that her body does not determine her worth.
  • Physical attributes in general do not determine our worth. Her worth to you is not determined by her shape or size or what she looks like.
  • How much she weighs is not a measure of who she is as a person. Who she is (a caring friend, a conscientious student, etc.) is the true measure of her as a person.
  • You have unconditional love for her.
  • You would love her just as much if she looked differently and had, for example, a different height or hair color, or was heavier or thinner.
  • Our body size and shape are in part due to heredity, much the same as eye color and height.
  • You appreciate diversity and differences. Emphasize to your child that her size and shape contribute to her uniqueness. Uniqueness contributes to her individual beauty. You can use examples such as fish and flowers, which come in different shapes, sizes, and colors. Stress that each is special in its own way.
  • She is taking positive action toward her health by doing ___________. (Avoid focusing on all that she may not be doing).
  • There are challenges to being and staying healthy (you can relay your own) and the benefits of better health are worth the time and effort you put into it.
  • What is truly important to you is the effort, rather than the results, and that you are proud of her commitment made toward her health.

What influences do society and marketing have on overeating?
Being a modern-day kid comes with challenges. There are many pressures from outside influences that may sometimes take away from the joys of growing up. If a child is overweight or obese, they are likely struggling with additional pressures stemming from the media and our cultural obsession with “thinness.” In addition, there are intense pressures related to the constant bombardment of information on social media—Instagram, Snapchat, Facebook, and Twitter depict their peers and celebrities as having fun, being social, and looking perfect and this can lead to unrealistic expectations. The biases in our society about being overweight or obese may lead a child to fear that they are not fitting into the “ideal,” which may promote low self-confidence, isolation, and shame.
Adolescents and teens are seeing images in the media for many hours each day. Some examples of how social media is impacting adolescent and teens’ self-perception and body image include posting videos on YouTube of themselves asking “Am I ugly?”, posting selfies on Instagram with the hashtag #imugly, #notugly, etc., or not receiving “likes” or instead receiving negative feedback. Whether eager for validation or posting in pride, they are leaving themselves vulnerable to criticism and cyberbullying by putting themselves out there in such an overt, public way.

An adolescent or teen  has most likely heard the sentiment that being overweight is not attractive. They may fear that if they become too overweight, they will not get married or ever have an intimate partner. They may also most likely have heard that overweight people are not good athletes and are less likely to get picked on a team. These messages are often internalized because of what a child has heard, observed, or personally experienced.

A child is also confronted with stereotypes that overweight people are lazy or unmotivated, have no discipline or willpower, are impulsive, like all things in excess, and are to blame for their circumstance. These biases are so embedded in our culture that we often do not realize when we are exposed to and are impacted by them.
Technology and Instant Gratification
Adolescents and teen live in a fast-paced world where there is constant motion and stimulation by their TV, computer, smartphone, and the media—they probably rarely if ever unplug. The pace of media reinforces their need for perpetual movement in order to pay attention and maintain focus. This high-speed input negatively impacts the ability to tolerate delayed gratification and hinders a child from taking the necessary time to process, problem solve, and build up frustration tolerance. This also leads to unrealistic expectations, intense pressure, and exhaustion.

Many parents I spoke to while conducting my research expressed concern about their kids needing instant gratification and how they feel this carries over to their eating and health behaviors and their perception of themselves. One mother said, “When my son wants something to eat, it has to be now, at that moment and not a moment later.” Another mother said, “My daughter doesn’t know how to be uncomfortable, not even for a minute. How is she ever going to withstand a craving or hold off from eating something she wants but isn’t the healthiest of choices?” This can also leave kids feeling frustrated when they don’t see results or feel like their hard work is going unnoticed.
Advertising and Marketing
More kids are overweight and obese today than ever before. The media contributes to this epidemic by marketing unhealthful eating and drinking. Beverage companies spent $866 million to advertise drinks like sodas and caffeinated energy drinks in 2013, four times as much as they spent advertising fruit juice and water. The number of ads for children’s drinks on youth websites increased by 15 percent from 2010 to 2013.

Despite promises by major companies to be part of the solution in addressing childhood obesity, reports show that companies continue to market their unhealthful products directly to children and teens. They have also rapidly expanded marketing in social and mobile media that are popular with young people and are much more difficult for parents to monitor.
Portrayal of the “Ideal”
While commercials coax kids into choosing unhealthy foods and beverages, a child is also exposed to the race for the skinny ideal and the undercurrent that thin is “better” and “more desirable” and leads to success and happiness. They see this sentiment conveyed by the way magazines and other media portray the airbrushed waif models who are 5 feet 11 inches tall, weigh 117 pounds, and essentially make up 2 percent of the entire population. It is no wonder that 69 percent of girls in 5th through 12th grades reported that magazine pictures influenced their idea of a perfect body shape.

This is also seen in the desire to fit into “skinny jeans” and striving for a thigh gap and protruding collarbone, which kids aspire to despite being unrealistic. There are numerous magazine articles written and online instructional videos on how to achieve these ideals.

Given all that a child is experiencing and is exposed to, it isn’t surprising that they may be left with misperceptions and distorted views about their weight, body image, and health in general. It is important to take an inventory of what their perceptions are and to educate them about how they are influenced and could perhaps change.

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