Ellyn Satter, MS, RD, LCSW, BCD, is not your typical dietitian/nutrition consultant. In fact, her advice in her latest book, Your Childs Weight: Helping Without Harming (Kelcy Press, 2005, $19.95, 458 pages with appendices and references), actually runs counter to some traditionally held views of other experts.
Satter doesnt see a few extra pounds on a large childs frame as necessarily bad; she considers the rate of growth, noting whether there is a sudden acceleration within the percentile rangeand the factors that cause these changes.
Satter sees the successful feeding of children (birth through teens) as a Division of Responsibility, which she has made a maxim. Her Division of Responsibility for infants is: The parent is responsible for what the child eats, and the child is responsible for how much (and everything else). For toddlers through adolescents, the parent is responsible for what, when, where; the child is responsible for how much and whether to eat.
As a family therapist and feeding specialist, both in her series of books and individual counseling sessions with families, Satter tries to inject a good dose of common (but not commonly tried) sense. Since each child is an individual and grows at his or her own rate, Satter says the child normally will balance out unusual eating patterns and knows instinctively how much he or she needs. Problems arise when parents try to impose controls on their feeding regimen and throw the childs natural regulators out of balance, either forcing a child to eat more than he needs, forcing him to eat food he doesnt like, or depriving a truly hungry child by restricting food to get him to conform to some pattern. Often, well-meaning parents are misled by the advice of relatives, friends and even medical doctors who think the child should fall into a particular weight category at any given age.
One rule Satter stands by is to always provide bread. She tells parents to have plenty of bread available on the table; even if a child fills up on bread to the exclusion of almost anything else, eventually he or she will gain confidence to try other foods. The hardest part is for parents to stand back without interfering and let the child find his or her own balance of nutrition.
She notes that outside pressures are ever present. Societal weight standards filter down to childrenthrough physicians, parents, teachers, extended family…and give them the message that they are too fat and should therefore lose weight. Satter cites a research study from Pennsylvania State University that followed relatively large girls (BMI at 85th percentile or above) from ages 5-9. Compared with girls the same age whose weights were closer to the mean, says Satter, the relatively large girls were more likely to feel bad about their bodies, to be concerned about weight, and to try not to eat as much as they were hungry for. But these large girls gained excessive amounts of weight as they got oldertheir weight gains accelerated.
Satter finds this research extraordinarily concerning, not only from the point of view of childrens weight gains per se, but also from the point of view of identifying a serious and pervasive iatrogenic condition. Iatrogenic means physician-induced. In this case, I use it to mean societally-induced. The problem wasnt the girls high weight per se. The problem was the societal expectation that they should therefore eat less and get thinner. Because of this expectation, the girls became preoccupied with food and were prone to overeat when they got the chance. And they got even heavier.
Satter notes that parents are pressured as well and are expected to do something about an apparently overweight child. She refers to the Expert Committee Recommendations on Obesity Evaluation and Treatment, which expects parents to engage in this virtually impossible task of trying to force their childs weight down (or maintain it at its current level) but not become preoccupied with the childs weight because such a preoccupation may damage the childs self-esteem. If weight, diet or activity become areas of conflict, the relationship between the parent and child may deteriorate. When problems such as these occur, clinicians should refer the family to a therapist…
Satter says it is not possible to enroll your child in a weight control program without causing adverse psychologic or emotional effects. Rather, parents should find a nutritionist who will support them and start with a careful assessment of the child. Then they can establish a program suited to the individual child and his or her own weight pattern, and gradually help the child become independent in feeding himself or herself and help the child regain physical self-esteem.
The book is available from Kelcy Press, 4226 Mandan Crescent, Suite 57, Madison, WI 53711-3062, or can be ordered from your bookstore.
From the June 14-20, 2006, issue