Ode to My Mom

I’ve been on a blogging hiatus, and I appreciate your patience with my intermittent posts while I get my house in order. Family has been my top priority for the past few months.

My family has an interesting little quirk. One day, my mom and I were going through a stack of prayer cards from all the family funerals she has attended. I can’t remember how many there were, but as we looked through the dates, we both noticed that almost everyone passed away in the year they turned 79, between the beginning of April and the middle of June.

My grandmother, my grandfather, my grandfather’s parents, his brother and sister, an assortment of cousins, aunts, uncles… It’s like our best before date is stamped on our DNA. The only real notable exception was my great aunt, who declared she was going to live to be a hundred (because she desperately wanted to receive her letter from the Queen). And she did. And then she died.

This genetic time-stamp is somewhat comforting, insofar that unless something catastrophic happens between now and then, the odds seem stacked in my favour for a good long life to spend doing a good many things.

So when my mom turned 79 in April, she showed no signs of slowing down. She was still busy selling real estate, golfing as the weather permit, scheduling shuffleboard tournaments for the tenants in her building, and walking several kilometers every day. Other than an inner ear issue that caused unpredictable bouts of dizziness, she was in good health for her age, a fact she blamed on the wine and the scotch. When my brother and I tried to reach her one day and got her answering machine instead, we didn’t think anything was out of the ordinary. It seems she had just returned from a walk, layed down on the floor to wait out a dizzy spell, and passed away peacefully, at the end of the first week of June.

Suddenly losing my mom was a shock, but not entirely unexpected. Still, grieving is a process that we all go through in our own time. My mom would often say, “Life is too short to not enjoy living it.” She did exactly that, right up until her very last breath. May we all be so fortunate.

Love you, Mom. <3

Viral Obesity Fears: Based on Fat or Fiction?

Over the past week as I’m going through my Facebook newsfeed, Every. Single. One. Of the suggested posts was, in some way, food related. The food you should eat. The food you shouldn’t eat. The food you should eat to lose weight. The food that protects against cancer, heart disease and claims to stave off death indefinitely.

This idea that food is salvation is everywhere, especially if you are a parent, because policy makers know a mom wants nothing more than to protect her child from harm. In Ontario, parents were asked what it means to raise a healthy kid, and parents were very clear with their definition.

“When we asked parents what it means to raise a healthy kid, they said they want their children to grow up in a supportive community, surrounded by family and friends. They want them to know they are loved and valued, to be accepting of others, to “fit in” at school, to be self-confident, and to be able to make healthy choices throughout their lives.” (No Time To Wait: The Healthy Kid Strategy, Ontario Healthy Kids Panel)

Pretty straight forward stuff. Policy makers, however, translated this message as “[parents] need some support to help their children become and stay at a healthy weight.”

I’m not sure what being a healthy weight has to do with a supportive community, family and friends, being loved, valued, accepted. What does this mean for the fat and the skinny kids?

A recent video by Strong4Life has gone viral, spreading the message that parents are to blame for the future health consequences of their children. I won’t post the link, I don’t even recommend you watch it as it does nothing more than spread hopelessness and shame stigmatized individuals.

If the future health of your child was truly at the core of this video PSA, what you watched would have very clearly stated…

CHILDREN COME IN A VARIETY OF SHAPES AND SIZES, REGARDLESS OF WHAT KIDS EAT

“Among efforts to slim down kids or prevent them from becoming fat, one of the most popular tactics is to restrict energy dense foods — those are the “bad” foods high in calories. The thinking is that by filling kids up with low-calorie, low-fat, high fiber foods like fruits and vegetables, they will eat fewer calories and not get as big. This popular belief continues despite volumes of contrary evidence showing that children will naturally grow up to be a range of weights, shapes and sizes unrelated to their diets; and that the focus on “healthy eating,” restricting calories and fats, has harmful effects for growing children, both physically and emotionally…” Read more

But… but…but… if we don’t insist on a healthy diet in childhood, children will grow up to become adults at risk for cardiovascular disease. Right? Um… no.

CHILDHOOD DIET HAS LITTLE (IF ANY) EFFECT ON FUTURE ADULT HEALTH

“No direct evidence links childhood nutrition to cardiovascular disease in adulthood.”

The Dietary Intervention in Children Study showed that lowering dietary fat to less than 29% in 8 – 10 year old children to reduce LDL cholesterol had a negligible effect.  Not only does reducing dietary fat in a child’s diet do nothing to reduce the future possibility of heart disease, fat-reducing dietary intervention puts children at risk for nutritional deficiency. According to the Summary of an ASNS Workshop by John A. Milner and Richard G. Allison, “Dietary fat supplies essential fatty acids (EFA) and aids in the absorption of fat-soluble vitamins A, D, E and K. It is a substrate for the production of hormones and mediators. Fat, especially in infancy and early childhood, is essential for neurological development and brain function.”

Three separate studies tracked a total of 4,564 children with serum cholesterol above the 75th percentile and concluded that cholesterol screening in childhood is an unreliable way to predict high cholesterol in adulthood.

POLICY MAKERS ARE FIGHTING NORMAL CHILDHOOD EATING BEHAVIOUR

Nature, in all her creationary wisdom created the toddler – a mobile and infinitely curious being with little life experience. To prevent evolutionary failure of the human race, Nature made the toddler finicky and orally suspicious, with a natural aversion to things that taste bitter (and are more likely to be poisonous). Nature tries to plan for all possible contingencies.

Nature also created the vegetable, and in a cruel ironic twist, made the vegetable taste bitter. Humans discovered the vegetable and decreed that all human beings shall eat the vegetables in copious amounts or suffer an untimely cardiac event.

And Nature shook her wise, creationary head.

Then, in a stunning display of creating a problem entirely for the purpose of giving nutritional scientists something to do, humans tried to get the toddlers to eat the vegetables.

And Nature laughed and laughed… and laughed.

The best way to encourage healthy eating habits is to follow a Division of Responsibility. Parents are responsible for offering a variety of delicious food while being considerate to the eating ability of all family members, as well as when the food is eaten and where. Children are responsible for choosing how much to eat. Kids who are anxious around food need plenty of no-pressure exposure to new foods before they will consider that food safe to eat. Feeding children well has nothing to do with getting kids to eat healthy foods now, and everything to do with building a healthy relationship with food that will last through their entire lives.

DIETING! DOES! NOT! WORK!

Current policy targets “the obesity epidemic”, a problem that sudden changes to BMI cut-offs for obesity helped create.

Current policy recommends restrictive feeding practices to combat obesity – eat less of the tasty food to reach a “healthy weight.” What does that mean? Are we to assume that everybody’s normal weight is in the middle of the bell curve. Current ‘anti-obesity’ policy does not consider the genetic predisposition of those at either end of the bell curve, and the curve itself does not determine the physical ability or health of the individual at that weight.

If we apply this same logic to the other half of the BMI equation, current policy is much like telling a short person to stretch so they can grow taller. Just set a healthy height to include 1/3 of the general population and aggressively promote the list of health consequences for being short. After all, short people need to change – they were just too lazy to grow tall… never going outside in the sunshine. We’ll blame the video games played in dark rooms, and eating too many gravity-dense foods. What does genetics have to do with it anyway.

Maybe… just maybe it’s not the food? Are we really to believe we can all become athletes by sitting on the sofa, eating salad?

THE POLICY MAKERS ARE NOT INTERESTED IN HEALTH 

If the government directives for healthy eating were truly aimed at improving the health of the nation through dietary interventions, the focus of that national conversation would be on HOW to eat, not what.

“An excessive focus on fat can lead to undesirable behaviors by children and parents as well as to misdirected efforts by health-promotion organizations and the private sector food industry. Negative messages using terms such as avoid and limit and messages using terms that require integration across different foods such as percentage or total fat are more apt to be ineffective and counterproductive. Positive messages designed to assist consumers select foods for an enjoyable, varied diet appropriate to their lifestyle could result in significant benefit to public health.”

The Strong4Life video is not about the needs of children or the concern of parents. The flashbacks of drive-thru windows, video games and birthday cake depict behaviours that are not consistent with the real life of most people who naturally, normally, and genetically have a weight in the upper percentiles. The S4L video also demonstrates how parents are frequently left to solve feeding struggles on their own, without the support of the medical community. That much, unfortunately, is too often true.

When parents told the Ontario Healthy Kids Panel what it means to raise a healthy kid, they described a very recognizable hierarchy of needs. Safety, security, social acceptance and love are essential to the mental health of all human beings, none of which are, nor should they ever be, conditional on an individual’s weight.

Further Reading:

Viral Obesity Video Gone Wild: Response by Healthy Little Eaters

The Role of Dietary Fat in Child Nutrition and Development: Summary of an ASNS Workshop John A. Milner and Richard G. Allison 1999 The American Society for Nutritional Sciences

 

 

Mealtime Musings: Needs Matter

Anxiety is a typical response to any situation perceived as uncontrollable or unavoidable. Taking a test, giving a presentation, or any situation (including eating) where the outcome is unknown will create a sense of nervousness and apprehension.

In an educational setting, anxiety serves no useful purpose. Besides the fact that it can be debilitating, it is not a recognized exceptionality, (defined as something that significantly impedes learning), and is therefore ineligible for support. Instead, anxiety is a clue that something else exists (autism, AD/H/D, learning disability). In the absence of ‘something else’, what is a typical anxiety response (avoidance or ‘flight’) is frequently misinterpreted for deliberately defiant behaviour. When the perceived threat cannot be avoided, another typical anxiety response (‘fight’) is seen as aggressive and violent behaviour. While many conditions do contribute to anxiety, anyone can experience anxiety in any environment, and is often the result of neglected needs.

What exactly are “needs”? Abraham Maslow’s Hierarchy of Needs parallels several other theories on human developmental psychology, and for lay-speak, I find, is the easiest to understand.

Physiological Needs

These are basic needs that should be met before and above all others. Air, water and food are required for survival. Adequate rest is necessary for stable mental health. Shelter provides protection from the elements. Child or adult, no one functions well when hungry, tired, sick, or homeless.

Providing for physiological needs seems obvious – feed the hungry, shelter the homeless… Some families can’t afford medical care; hospitals are under staffed; food banks are sometimes in higher demand than they can supply. Homelessness has a significant impact on the outcome of mental illness, both of which are plagued by stigma and discrimination.

In the United States, 1 in 7 people live in poverty. That’s approximately 44 million people who struggle to find adequate food, shelter and access to health care in just one first world nation.

Safety Needs

After basic physiological needs for survival are met, the need for safety has a significant influence on behaviour. Living in a traumatic situation (war, natural disaster, abuse), economic instability or lack of disability accommodations create barriers that impede access to physiological needs. Even the behaviour of children between six months and two years of age becomes goal-directed to achieve the conditions that make it feel secure. (Prior and Glasser).

In any situation where we have little (if any) ability to influence our environment, trust is essential to create a sense of safety. A person will not eat food they do not trust; a child who doesn’t feel safe at school will not learn. Neglecting the individual’s need for safety can have long lasting, traumatic repercussions.

Social Needs

Humans are social beings who seek to create and maintain emotionally significant relationships. Social groups provide for the individual’s need to love and be loved. Many people become susceptible to social anxiety or depression when denied their need to belong.

Social anxiety is very common among selective eaters. A lifetime of being publicly shamed for their food choices makes social eating extremely uncomfortable. Not only is the need to build connections (family and friends) denied, but also the need for safety, and to satisfy hunger.

Children will use maladaptive behaviours to satisfy their need for attention and to feel included. Turbo, one of my daycare kids, is an excellent example. What appears to be defiance is more an attempt to create his own ‘community’. By accepting him unconditionally as a lovable and valued person, I created a place where he feels he ‘fits’ and feels safe. Consequently, the defiant behaviours have diminished significantly.

Self-Esteem Needs

Not only do we need to feel like we belong to a community, humans need to feel accepted and valued by others within that community. Self-esteem relies on a sense of personal competence, and the ability to accept our self for our unique gifts and flaws. Feeling unaccepted and devalued can lead to a sense of helplessness and depression.

Self Actualization

When physiological, safety, belonging and self-esteem needs are secure, the individual is unencumbered to pursue their aspirations, and strive for personal achievement (fame, success, creative, athletic, academic…). Maslow’s Hierarchy of Needs are often displayed in a pyramid, where one level must be attained before achieving the next. While fulfilling each level before the next has been shown to have an impact on one’s happiness, needs on the higher tiers can be achieved before obtaining lower, more basic level needs.

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Maslow believed that the only reason people would not move toward self-actualization is because of hindrances placed in their way by society.

The Rosenthal study tested the theory that children would become smarter if they were expected to. When teachers were told that certain children had greater academic potential, those children tended to be treated more warmly, and were made to feel more safe. The chosen children formed more trusting relationships with their teachers – they were protected from public ridicule when they gave the wrong answer, or received more help to verbalize a correct one. They were encouraged through verbal feedback, and non-verbal cues to strive for a higher standard of educational excellence.

Essentially, teachers believed in the chosen children’s ability to be competent students, and so, they were.

This works the same way with eating. Providing a safe (shame-free) eating environment ensures TJ eats for his physiological needs. Creating a warm, social mealtime atmosphere helps him feel safe around food. Respecting his food choices, his current eating ability, and accepting him unconditionally regardless of what’s on his plate supports his ability to become competent with eating. I believe he can, and so, he is.

“If we take peo­ple as we find them we may make them worse, but if we treat them as though they are what they should be, we help them to become what they are capable of becoming.” -Johann Goethe

* * *

Sources:

Maslow, A. (1954). Motivation and personality. New York, NY: Harper.

Prior V, Glaser D (2006). Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice. Child and Adolescent Mental Health, RCPRTU. London and Philadelphia: Jessica Kingsley Publishers.

 

Stowing The Feeding Agenda

It was my birthday recently, and as a treat, Hostage Dad suggested food from The Mandarin (a local Chinese restaurant). We ordered in, because while we stopped to celebrate yet another successful trip around the sun, we were also painting both of the kids’ bedrooms. In the midst of paint cans and roller trays, cooking was not high on the list of priorities, but eating certainly was!

The Mandarin’s portions are generous enough to feed our family of four several times over, and the containers are handy for storing left-overs. All in all, good bang for a buck.

We all sat down to dinner, and I laid out the variety of delicious food on our lazy susan. Mandarin food is something my son has seen many times, but never eaten, so I added some leftover lunch options for him. He won’t eat sliced bread from a loaf, so the first of several meals included french fries and pizza.

As I laid out the food, I noticed TJ looking with interest at the different dishes. That has never happened before! I know he worries about disappointing the adults in his company, me especially, so I wanted him to know that whatever he wanted to do with this meal was his choice, and he had my blessings. Content with permission to explore at will, TJ devoured half a dozen fortune cookies.

Gently testing the waters, I asked TJ which of the 5 bowls on the table were the most interesting to him. While he pondered, Hostage Dad prodded with a hypothetical scenario where we were trapped on an island and this food was all there was. Seeing TJ’s eyes grow a little wider, I countered by suggesting that if TJ was going to sit in front of a selection of food, it was only fair that the bowl he is most interested in is closest to him. He relaxed and chose the noodle dish. He didn’t take any, but in making that decision, he had a good look at all the options. The most impressive part of this whole exercise was TJ’s ability to remain calm and matter-of-fact about the food placed only inches beyond his plate.

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Our second dinner (photo above) included mini hamburger buns with a side of butter.

Lately, I’ve been wondering if TJ would be able to manage the occasional meal of available food without the safety net of his familiar food. The line between catering and considerate meals with a selective eater is extremely fine, and I wonder how close I am to crossing it when options that are appropriate for TJ have nothing in common with the meal on the table. I know better than to take safe food away, but at the same time, I would like to see him perhaps making a decision based on some actual gustatory input.

And then I came to my senses. The problem with that idea is my agenda to increase dietary variety in another individual. What I want has little, if anything, to do with what TJ wants, or is even ready to do. Pushing my wants onto my son’s eating is a sure-fire way to send up an insurmountable wall of resistance and undo all the progress we’ve made.

For our second meal of Chinese take away, TJ helped himself to several of the mini hamburger buns, and again, he declined servings of everything else.

And I call that a huge WIN!!!

Progress with extreme food selectivity can be very difficult to see. If I mark progress by increases in dietary variety, I will be disappointed. Looking at progress in terms of attitude is more realistic and ultimately, more beneficial for all concerned. Building trust takes a really, really long time, and fates willing, we have plenty of that.

Our ladder to increasing food acceptance looks like this:

  1. Being relaxed and well behaved at the table
  2. Eating enough food to satisfy hunger
  3. Being comfortable around unfamiliar food
  4. Trying new food occasionally, usually outside of mealtimes
  5. Experimenting with safe food at mealtimes
  6. Matter-of-factly trying new foods that have similar characteristics to safe food

There are many meals ahead of us yet. Before TJ ventures into the realm of the unfamiliar, he has to see eating as something he enjoys, and something that doesn’t threaten his personal safety. Every small step is progress in a positive direction.

Keep Calm & Buffet On

As dinner is winding down and we prepare to tidy up, TJ asks, “Mom, can I have a sip of your beer?”

Of all the things on the table, what is it that makes my beer so enticing? It’s not ever been forbidden, although it is an unusual dinnertime beverage. He took a small sip from the bottle, and promptly made a face of disgust. It was no big deal, after all, I will never expect him to like everything he tries. ;)

(By the way, the kids’ new bedrooms look amazing.)

Dear Healthcare Professional: What You Need To Learn About Feeding Children

Dear Healthcare Professional:

Recently, we visited your office about our child’s selective eating. We asked for help on weight, nutrition and feeding. Unfortunately, you seemed unable to answer our questions and instead attempted to address development, behaviour and your opinion about what our child should be eating. While these issues may be relevant to our case, your suggestions of “he won’t starve himself,” “just feed him fruit and vegetables for snacks,” and “he’ll get hungry eventually” contradict the best practice guidance I have been investigating since we met.

First, you did not seem to be aware of the DSM-V diagnosis of “Avoidant and Restrictive Food Intake Disorder” (ARFID). While a diagnosis is not in itself particularly useful, it does highlight that certain cases of “fussy eating” may be on the extreme end of normal or indicate the need for more rigorous analysis than the more straightforward cases you might commonly see. Regardless, there is always a reason why a child struggles with eating and very rarely, if ever, is it because the child is using food to manipulate the parent.

Second, you may not be aware that issues such as sensory aversions, post traumatic stress, anxiety and temperament are very relevant. In such cases, behavioural approaches can do more harm than good. You may also not be aware of studies by Dr. Irene Chatoor that show coercive and pressured feeding approaches are more likely to exasperate feeding issues. I also strongly recommend the work of family therapist and registered dietitian, Ellyn Satter, creator of the Division of Responsibility in Feeding and her approach to developing Eating Competence as a proactive and preventative model for your clients. Learning to feed our family from a place of trust has benefited not only my child, but our family as a whole.

Parents coping with a feeding challenged child live in a state of long term stress and anxiety themselves. I respectfully ask you to reconsider encouraging coercive feeding methods and to acknowledge the impact feeding struggles have on the entire family. We were unable to follow much of the advice you gave us, as your recommendations increased my child’s anxiety around food, and elevated the overall family stress to intolerable levels. I sincerely hope you find the linked references useful and beneficial as part of your continuing professional development.