Prevention and Treatment of Child Overweight and Obesity
Step 1: Feed based on the division of responsibility

Although Ellyn Satter has written a book about child overweight, Your Child’s Weight, Helping without Harming, the intervention is simple enough: feed based on the Division of Responsibility (sDOR), then trust your child to eat as much or as little as s/he needs and grow in the way nature intended. The intervention is so pain-free, in fact, that following sDOR may seem like doing nothing at all. In reality, you do a tremendous amount when you follow sDOR and thereby do good parenting with feeding. Because following sDOR is rewarding and supports quality of life, throughout your child’s growing-up years, you will be able to keep up the day-in-and-day-out of pleasant and rewarding family meals and sit-down snacks. Your child will naturally learn to eat and enjoy healthy food. In contrast, the conventional approach would have you control what your child eats and thereby how many calories s/he eats: getting him or her to eat more “healthy” foods such as fruits and vegetables, whole grains, and other low-fat foods and fewer “unhealthy” high-fat, high-sugar foods. As any parents knows who has attenpted it, the conventional approach to weight management interferes with quality of life with feeding, is difficult to maintain, and is likely to cause or worsen the very problem that such intervention is intended to address.

Consider causes

Understanding causes will restore your trust in your child to do her part with feeding. Some children do get too fat: Their weight accelerates off their growth curve. Why does this happen? According to the Satter Feeding Dynamics Model (fdSatter), it is normal for children to eat the amount they need and grow in the way that is right for them. When they don’t, something is the matter. Children don’t just, willy-nilly, eat too much, move too little, and gain too much weight. Something causes their excess weight gain, and those causes must be identified and corrected. According to Your Child’s Weight, chapter 1, “Help without harming,” the cause could be one or any combination of these four errors:

  1. Misinterpretation of normal eating and growth: Even big children who eat enthusiastically, eat a lot, and have obese parents have the ability to eat as much as they need to grow appropriately. A child grows well when his weight follows consistently along a particular growth curve, even a curve above the 97th percentile.
  2. Restrained feeding: Food restriction, whether it is direct (portion sizes or calorie allowances), indirect (emphasizing “healthy” and/or low-calorie food), or inadvertent (food insecurity, unreliable and inconsistent meals and snacks) makes a child afraid of going hungry and prone to overeat when s/he gets the chance.
  3. Mistakes in feeding: The two biggest feeding mistakes are lack of structure with feeding and interference with the child’s job of eating. Errors in feeding can begin at birth and, until corrected, undermine the child’s ability to internally regulate food intake and grow appropriately.
  4. Stress: Errors in feeding teach children to eat for emotional reasons. Children who fear they won’t get enough to eat or who are pacified with food may overeat in response to stress. For a child, lack of structure creates enormous stress.

Division of responsibility-based intervention

Child overweight and obesity prevention and treatment are identical with excellent feeding.You are working toward quality of life: having reliable, pleasant, and harmonious family meal- and snack-times and your child’s feeling good about eating, behaving well at mealtime, and eating in a relaxed fashion. If s/he can do that, s/he will recover the ability to internally regulate food intake, eat the amount s/he needs, and grow in the way nature intended. Keep in mind that even if you do all the right things, your child will not necessarily be slim.

  • Don’t over-react to an “overweight” or “obese” diagnosis by following the conventional approach.  Instead, use it to motivate you to do an excellent job with feeding.
  • Study Ellyn Satter’s book, Your Child’s Weight: Helping without Harming. For the one-minute version, see the Your Child’s Weight handout.
  • Be faithful about maintaining structure. Establish regular, reliable, enjoyable, sit-down family meals that work for you and sit-down snacks at set times. Don’t allow eating or drinking (except for water) between times.
  • Choose family food and have meals that you find richly rewarding to plan, provide, and eat. 
  • Be scrupulous about giving your child independence with respect to determining what and how much to eat from what you make available at meals and snacks.
  • Once you have your structure and your child’s independence well in place, give your child time to recover the ability to regulate. If you have been restricting, at first your child will eat more and be more demanding about food.
  • Know the signs of your child’s self-regulation. S/he will relax at mealtime, not be as food-preoccupied between times, ask for more food but not finish it, ask to save food for later, and begin to leave food on the plate. This will take a few days for infants and toddlers, a few weeks for preschoolers and young school-age children, and a few months for preadolescents and adolescents.  
  • Be prepared for the long haul. Your child will only feel good about eating and eat the amount s/he needs to grow consistently when you continue to feed well.

Trouble-shoot with the
Division of Responsibility. Do problem-solving if your child continues to be food-preoccupied, anxious, and urgent about eating. Either structure is eroding or pressure is creeping in. Are you maintaining quality of life with feeding and eating? Are you faithfully doing your jobs with feeding? Are you scrupulously letting your child do his or her jobs with eating? Are you avoiding food restriction in all its sneaky, devious, insidious ways? Because restraint is such a part of our relationship with food, you may need help from someone who thoroughly understands sDOR in feeding to detect your tactics that continue to activate your child’s fear of going hungry and give rise to negative eating attitudes and behavior. But be careful. Most child overweight interventions use techniques  that cross the lines of sDOR and focus, directly or indirectly, on getting children eat less food or fewer calories.

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