by Lisa M. Pearl, MS,RD,LDN, CEDRD, CEDS
This is an ongoing conversation in my office with parents who are faced with the challenging dilemma of what to feed their children. The conversations run the entire spectrum of feeding concerns from simple requests for healthy meals to the more nuanced situations of food sensitivities, sensory integration issues, or food refusal. At times the reason for the concern is fairly complex and requires a team intervention for disordered eating. At other times, it is more of a parenting conundrum that is relevant for all of us because we live in a culture that is full of mixed messages regarding our diet. Whether we are giving the messages or receiving them, together we have to look at the big picture of how our message is being heard.
Let me give you two examples:
Amanda is in the 4th grade. She recently learned in her health class that eating certain fats will give you heart disease and that eating too much sugar will cause diabetes. She has become very fearful of eating anything with sugar or fat and has recently lost weight.
Amanda is a child who has learned to fear eating the wrong food. She believes certain foods will make her fat or very sick. The problem here is that the emphasis is on bad food and disease when it needs to be on the joy of nourishment and health. Children who are afraid to eat can develop a very big problem indeed. Once the fear takes hold, there are many sources of information about how food is hurting us and many lists of the foods we must avoid. If a child already has a propensity towards being anxious or perfectionistic, linking foods with disease can heighten their fears about eating and possibly push them towards the type of dietary restriction that will effect their growth, development, and mental health. Many patients who present in my office with an eating disorder report similar stories to Amanda.
Here’s another example:
Jonathan’s parents first learned of his allergy to peanuts at a baseball game. This special occasion turned into a nightmare as he had to be rushed from the game to the hospital in an ambulance. Since then he has had allergic reactions to dairy, soy, and certain fruits causing him to vomit in public places. Additionally, he recently was diagnosed with a gluten sensitivity. At 10 years old, Jonathan is avoiding social occasions with friends and refusing to go to restaurants. His eating has become more restrictive causing him to develop symptoms of malnutrition: mood instability, lethargy, irritability, and weight loss.
Jonathan is a child with serious food allergies and sensitivity issues that have triggered in him a food and social avoidance problem. As you can imagine, his parents have tremendous concerns about how to keep their child safe and help him have normal social/emotional development.
The mutual goal of the client and the nutritionist in both of these cases is to help the client develop a positive relationship with food and to diminish their fears about eating. The first order of business is to create menus with enough food to address any nutritional depletion. The body needs to be in positive energy balance in order to have the cognitive ability to understand and work through the negative beliefs and fears about eating. Many nutritional, relational, and emotional issues will need to be addressed by a team of specialized nutritionists and psychotherapists. This recovery work can last a lifetime and help these families navigate a path back to a safe and nourishing relationship with food.
However, a larger question remains for the rest of us. How do we maintain a positive message of nourishment and health when our culture is full of food fears? And how do we attend to the growing incidence of food allergies/sensitivities without promoting the fear and rigidity that can lead to eating disorders?
Nutritional research and functional medicine can offer important guidelines on how to promote health, but keep in mind research can be limited and result in misguided recommendations. The Framingham Heart Study and it’s suggested restriction of egg yolks is a good example. The American Heart Association retracted the egg yolk restriction years ago when it was realized the correlation between egg yolk and heart disease was incorrect. Yet the public health message already had made such an impact that many people continued to restrict a valuable source of fat, vitamins, and lecithin from their diet. The irony from mother nature is that the nutritional elements of eggs are just the ticket for helping with heart disease.
So, at the very least any information about what not to eat has to be offset with LOTS and LOTS of ideas of what to eat that will nourish our bodies. In this way, parents can talk with their children about how the food they are eating will help them to grow into strong and healthy bodies. This simple and positive framework provides the safety and reassurance families need in order to feel good about their meals. The promotion of the healthy, nourishing benefits of food, can teach children how to make choices. Moreover, it helps all of us develop a positive relationship with food instead of a fear based relationship.
Currently many families are trying to limit certain carbohydrates in their diet. In most cases this requires shifting to a much higher intake of fat and protein in order to satisfy the body’s need for nutrients and energy. In my next blog, I will offer ways to implement these changes within the framework of healthy eating and a normal relationship to food.