The Path to Food Acceptance

There was a time when cheese was known as That-Thing-Which-Shall-Not-Be-Named in the presence of TJ. I would mix cottage cheese (shhh) into his smoothies (he added it), but because he couldn’t read the words on the packaging, it was easy to boost the protein and fat content without bringing a lot of attention to what exactly the ingredients were.

The mere mention of the word “cheese” caused a lot of stress nobody benefited from. Cheese went by other names. “Nothing” pizza, cottage cheese was known as “smoothie pudding”… Cheese was the elephant in the kitchen that we just didn’t talk about for a really long time.

And then one day it slipped. Somewhere along the way, he learned that the ‘nothing’ on the pizza was indeed ‘cheese’.  (Oh dear gracious keeper of accepted food, please don’t take pizza away!!) I held my tongue (and my breath) while he attempted to avoid the cheese on his pizza. He peeled and picked it off, and I said nothing. He ate some with the cheese on, and I said nothing. For a few months, he pondered the ramifications of cheese on his pizza and whether this was something he would embrace or eliminate. I watched all of it, white knuckling permanent grooves into my dining room chair, and made absolutely no comment about how much of the pizza he ate or how he chose to eat it.

Once pizza made its way back into the accepted-without-question category and he had developed a level of comfort with cheese – enough to consider it food, I started to notice a little something in TJ that hadn’t been present in him around food before. There was this look about him… the same sort of look you see in someone who has just returned from the summit of Everest. The monster we dine with was battle weary and replaced with a tangible sense of accomplishment.

When the mozzarella on his pizza changed to provolone, he immediately welcomed the difference. Just recently, on a trip to the grocery store, he spotted a piece of blueberry cheesecake. “Cheese? In a cake? Can I try it?” The dessert was barely paid for when I (and the entire grocery store) heard the verdict. “This is the BEST CAKE EVER!!”

Mozzarella, provolone and now cheesecake. Last week I asked him if he wanted to try cheese on his pizza sub (bread and pasta sauce, toasted).

“Okay.”

What… wait? Where is the disgust, the oh-hell-no rejection? I just said ‘cheese’ in reference to food he will soon be eating … and he is totally fine with this. Stay calm. Keep it together, mama.

“I have lots of different kinds of cheese. Which one should we use, the orange kind or the white like the cheese on your pizza?”

“Orange.”

Bravely going where no orange cheese has gone before, I added thin slices of cheddar to his pizza sub and served it with dinner. He ate 3/4 of the 12″ sandwich before finally deciding cheese made his sandwich different. The jury is still out if different is a good thing or not.

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Here in the feeding trenches, there are various therapeutic approaches to feeding. Two of the most popular are Sequential Oral Sensory (SOS) and Food Chaining. Both of these therapies, in the hands of a competent therapist, are good approaches. Here in the Hostage household, we use elements of both, revised to remove any hints of a feeding agenda.

Sequential Oral Sensory (SOS)

Sequential Oral Sensory is a progressive desensitization strategy to move child and target food closer together. We effectively achieve the same with no-pressure meals that focus on building trust rather than dietary variety. TJ gets lots of neutral exposure to a wide variety of food. I do not ask him to interact with any of it (anymore). He can look at what he wants, he can get acquainted with various smells, and he is welcome to get as close to any of it as he chooses. When he decided (not me – him) to explore cheese, I did not applaud, cheer, or otherwise praise him for being brave. He did not get a toy, stickers, or any kind of reward for being curious. Tasting cheddar was entirely TJs idea and the reward for his effort is discovering something delicious. Food that doesn’t taste good is a simply a learning experience.

SOS is more useful to me as a way to gauge how comfortable TJ is around certain foods, and where he is most likely to branch out into new territory. He willingly exposes himself to new foods all the time. It’s when he has equal parts of feeling comfortable, courageous and curious, that he will try something of interest to him. There is no possible way I can predict the alignment of all these variables. All I can do is provide eating opportunities and trust TJ to push himself along at a pace that is right for him.

Food Chaining

Food Chaining is introducing new food that has similar sensory characteristics to what the child already accepts. From the book, I was only able to understand the most basic overview. There are courses that are very inconvenient for me to get to and after watching TJ, I realized he does a much better job guiding his own eating that I could ever encourage him to do.

The chain looks like this: mozzarella cheese pizza –> provolone cheese pizza –> pasta sauce on a bun –> cheddar cheese with pasta sauce on a bun… or something logical like that. Earlier this year, TJ decided to try mint chocolate chip ice-cream. The next day he was eating chives from my garden. I don’t know how that math works, other than both are shades of green. Perhaps the ice-cream planted the seed that green things are safe to eat? Who knows!! TJ often makes connections and chains with food that make sense to him that would never occur to me.

Lately, TJ has been imitating behaviours around how we eat different foods and mix them together. For example, while my husband, daughter and I wrap tortillas around meat, vegetables and cheese, he started wrapping a pancake around french fries. When I made crepes out of a recipe for zucchini pancakes, TJ led the charge wrapping up strawberries, blueberries and bananas. Taco night now has a combination of both crepes and tortillas. For me, it’s a combination of dessert with the main meal. For TJ, it’s an opportunity to feel normal around food and experiment with different textures.

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TJ is doing impressively well with food, but as I look to a bright nutritional future for him and for our family, I don’t dare forget the place of fear and anxiety we’ve come from. TJ didn’t get to this level of food acceptance with an agenda to eat certain foods, or with stickers, or with rewards, or with praise or punishment. We didn’t get here with by talking about nutrition, or by restricting access to ‘junk’ food, or by insisting on eating only ‘healthy’ food.

We got here together with trust and by following a division of responsibility with feeding. The path ahead is long, but at least I know we are going the right way.

 

Being A Considerate Holiday Host

T’is the season for decadent food and holiday entertaining. As host, we want our guests to feel welcome and to enjoy themselves in our homes. Entertaining frequently includes providing our guests with an assortment of delicious snacks and edible fare. While many enjoy savouring a variety of different foods around the holidays, the obligation to eat in a social setting can be extremely stressful for others.

The host cannot know every guest’s personal relationship with food. One guest may be struggling with her weight, another may be quietly suffering from an eating disorder. One may have food allergies, another might be sensitive to strong smells or certain textures. Food is deeply personal and reasons that guide food selection are equally so. The list of physical, ethical, medical and emotional reasons for why we each choose to eat what we do is long. What can a gracious host realistically do to not contribute to eating issues we may be unaware of?

holiday plate

The RSVP

Ask guests to indicate if they have any food allergies or preferences. Most who live with food allergies are well aware that the likelihood of cross contamination in a kitchen that isn’t allergen free is high. Even if the host is aware of an allergy, it requires diligence to prepare guaranteed allergen-free food.

The RSVP can also ask guests to indicate food preferences. Guests with sensory challenges can be unusually anxious in social eating situations, stress that can be significantly reduced by finding enough food to eat.

In either case, the host can ask guests to bring a favourite dish that is safe to eat in enough quantity so that it can be shared with others. Not only does this help reduce work and cost for the host, it ensures that all guests will have something they can enjoy.

pancake meal

The Presentation

How the food is served is often the easiest way to consider everyone’s preferences. A buffet line allows guests to pick and choose from what’s offered, but also makes it more difficult to keep serving utensils uncontaminated. It also provides an opportunity for well-meaning guests to critique the contents of another guest’s plate.

Be mindful of where serving dishes are placed to minimize contamination risk. Also, be ready to interject with a distraction if you notice one guest being politely badgered for not trying the green bean casserole. These situations can be avoided by offering your food sensitive guests a discreet opportunity to serve themselves first.

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The Conversation

Expect words of appreciation for hosting a lovely event, but remember, the food isn’t the center of attention. Turn the spotlight to your guests, and encourage them to be proud of their recent accomplishments. Remember to keep the focus on the company present and off the food. Few people are eager or willing to discuss their personal eating struggles in public.

basket bread

Best Bets?

Follow the tradition of world class dining. A basket of rolls or a loaf of bread are usually appreciated for those who are anxious around food. For pasta, potatoes and rice, offer sauces on the side, or have a plain option available beside the mixed dish.

What If?

Nobody can be all things to all people. If you do have a guest who isn’t eating, it likely has nothing to do with your cooking. You may quietly inquire if there is anything you can do, but you do not have to interrupt your entertaining to make a separate meal for one person. Those who struggle with food often have their own socially acceptable ways of coping with social eating events. Trust your guest to take care of her own eating needs. You can help by not drawing attention to her empty plate.

Happy holiday entertaining!!

Please leave your considerate hosting tips in the comments.

And please… don’t drink and drive.

 

Meals: It’s Not About The Food

You’ve prepared a delicious meal. Great care and expense went into the finest ingredients, and you’ve successfully fielded dozens of questions from the kitchen without losing your composure, or forgetting to glaze, flip, add and stir on time. You proudly lay it all out on the table, and for reasons only the small people in attendance understand, chaos in the name of all that is holy breaks loose.

And you wonder why you bother.

Parent, I feel your pain. It’s probably not your cooking and honestly, it has nothing to do with your perceived parenting failures. Take a deep breath, maybe two, three or ten. Trust that your children really want to do a good job with eating and are not trying to use mealtimes as a medium to annoy you.

So how does a tired parent sit down to a thoughtfully planned meal without turning the event into a hostage negotiation?

Simple. Take the focus off the food.

Family meal

I know you think food is why you’re all there gathered around the table. I mean, it’s dinner – a time to eat, right?. Ironically, the food is not the purpose behind having a family meal.

When you go out with friends for coffee, you don’t go for the purpose of discussing the contents of your mug. Drinking coffee is something you do while you chatter on about this, that, and the other thing. And so it is with the family meal.  Food is simply a convenient excuse to gather the family together. In this day of hectic schedules and social media, it has never been more important to turn the TV off, put the electronic devices away and reacquaint ourselves with the art of face-to-face communication. You know… spend some time… together.

The Internet has been abuzz with the challenges of preparing good, wholesome food for families. Again – the Internet has missed the point. If there is no joy in the kitchen, how can we expect to bring joy to the table? And when did food suddenly take precedence over family? Whatever method (home-cooked, ready to reheat, boxed, canned, frozen or delivery) puts food on the table was never more important that the people you have invited to share that food with.

New to concept of the family meal?

Start with what your family enjoys eating right now. If you wish, introduce a new family ritual – set the table together, sing a song, state something to be thankful for, or say grace. Do you need to expend a little energy before settling down to eat? Dance, wiggle, hug or conga line a lap or two around the table. For the next half hour (maybe less, maybe more) commit to putting the stress of the day aside. Tell a joke, or a funny story. Be that family, the one that laughs together at least once each day.

Finding the joy in eating becomes increasingly more elusive as we put more and more focus on food. I learned that if I put at least one item on the table that the less adventurous can eat, the neophobic will always find enough food to enjoy. Never mind if Little Billy eats his broccoli or if Little Sally tries the chicken. Put yourself in their shoes to see how ridiculous this looks and how micro-managing the nutrient content of every bite does nothing but make eating worse, both now and in the long term.

You’ve prepared a delicious and considerate meal for your family. Once you serve it, your time to worry about the food is over. Sit down and enjoy the company at the table. If you are like most modern families, dinner is the first chance you’ve had to talk to each other.

What would you like to know?

Note: There are many benefits to eating at home, but there is also no shame in a meal out or one delivered in. Find a balance with meals that works for your family, and hold the guilt.

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, and 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… not really.

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 little 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.

THERE IS A WAY TO WORK WITH 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 try. Children who plot in the upper percentiles still need to eat.

Feeding children well has very little to do with getting kids to eat healthy foods now, and a whole lot to do with building a healthy relationship with food that will last through their entire lives.

DIETING! DOES! NOT! WORK!

Current dietary policy is focused on “the obesity epidemic,” a problem that sudden changes to BMI cut-offs helped create.

Current anti-obesity policy frequently recommends restrictive feeding practices – eat less of the tasty food to reach a “healthy weight.” What does that even mean? Are we to assume that everybody’s normal weight is in the middle of the bell curve? It also fails to 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 any weight.

If we apply this same logic to the other half of the BMI equation, we would be bombarded with suggestions to make short people 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?

Hey…psst… maybe it’s not the food? If healthy eating was all there was to it, we could all become athletes by sitting on the sofa, eating salad.

IS POLICY BASED ON EVIDENCE OR OPINION? 

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 does not appear to be 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 frequently inconsistent with the reality of many who naturally, normally, and genetically have a weight in the upper percentiles. The S4L video also demonstrates how parents are frequently left to solve problems with feeding without proper support. 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

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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.