Family Meals Focus
The Ellyn Satter Institute Newsletter
Are current guidelines helpful? Do they do harm?
by Ellyn Satter, Registered Dietitian and Family Therapist
Child obesity screening, which leads to trying to get children to eat less and move more, doesn’t work1, 2 and harms children and families. Children feel bad about themselves and react to food restriction by eating more, not less. In spite of finding that even expensive and ambitious policy-drive interventions produce only slight weight loss, a U.S. Department of Health and Human Services task force recommended them still again: screening for children whose BMI exceeds the 85th or 95th BMI percentile, getting children to eat lower calorie food, limiting food portion sizes, and increasing physical activity.
Obesity interventions don’t work
In a November, 2016, review on screening and intervention for child and adolescent obesity, the US Preventive Services Task Force published the daunting conclusion that even ambitious policy-driven interventions for child overweight produce “small and highly variable” weight loss. These ambitious interventions that produced these small results are multidisciplinary, behavioral and even family-based approaches in specialized obesity clinics, and provide at least 26 hours of intervention.2 The panel reached their conclusions after reviewing thousands of journal articles, arriving at over 300 references, and throwing out over 450 published studies. These are very low returns on ambitious and expensive investments of time and effort. However, the panel recommended making the same interventions over and over, and extending the interventions to schools, public health, and community recreation.
Reviewers overlooked harm done by interventions
The task force found no evidence of doing harm with screening and intervention. To state this more clearly, they found no harm in labeling as overweight or obese children whose BMI exceeds the 85th or 95th BMI percentile, respectively. They found no harm in interventions striving to get children to eat less and move more. In arriving at these findings, task force members neglected to review the behavioral and feeding dynamics research. That research shows clearly that children who are labeled overweight, even if they are no heavier than their peers, feel flawed in every way: not smart, not physically capable and not worthy.3 Nine-year-old girls classified as overweight at age five years show increased restraint, disinhibition, weight concern, increases in weight status, and body dissatisfaction.4 Restricted preschool and school-age girls given free access to ”forbidden” food during a sham task ate more than unrestricted girls, felt bad about themselves for doing it and weighed more.5
Conventional intervention not the only or even the best solution
Instead of imposing diagnosis and intervention, we can do an excellent job with feeding and let children have bodies that are right for them.
Does this mean that we do nothing at all? Absolutely not! Instead, we can do an excellent job with feeding and raise children to get bodies that are right for them. Instead of applying arbitrary weight cutoffs and counseling parents on calorie restriction we can 1) Emphasize providing, not depriving 2) Assess children for weight acceleration and do problem-solving.
Emphasize providing, not depriving
Children are born wanting to eat, knowing how much to eat, inclined to move and grow in the way that nature intended and feeling good about their bodies. Good parenting with feeding preserves those qualities.6 Professionals who work with children are in a powerful position to teach and support parents in effective, stage-appropriate feeding and parenting.
To prevent child obesity, follow the division of responsibility in feeding from birth and let children grow according to their own constitutionally driven inclinations. To address existing child obesity, restore the division of responsibility and let children’s own homeostatic processes restore their own optimal growth. For more about following the division of responsibility in feeding and letting children grow up to get bodies that are right for them, see Ellyn Satter’s Your Child’s Weight: Helping Without Harming.
Compare each child with him or herself
Evaluate each child‘s longitudinal growth pattern and distinguish consistent from upwardly divergent growth. Growing out of this individual assessment, childhood nutrition and health professionals can help parents of the large, consistently growing child to accept and support that child’s growth pattern, even when it is outside statistical cutoff points.7 In addition, professionals can intervene early in response to a child’s growth acceleration, identify feeding distortions, and correct those distortions promptly.8 With consistent, properly informed early intervention, minor issues can be kept from exacerbating into seriously distorted feeding and weight patterns.
1. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force. Pediatrics. 2005;116:e125-144.
4. Shunk JA, Birch LL. Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. Journal of the American Dietetic Association. 2004;104:1120-6.
5. Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices promotes girls’ eating in the absence of hunger. American Journal of Clinical Nutrition. 2003;78(2):215-220.
6. Satter EM. Internal regulation and the evolution of normal growth as the basis for prevention of obesity in childhood. Journal of the American Dietetic Association. 1996;96:860-864.
7. Satter EM; Chapter 10, Understand Your Child’s Growth . Your Child’s Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005:323-380 .
For more about following the division of responsibility in feeding and letting children grow up to get bodies that are right for them, see Ellyn Satter’s Your Child’s Weight: Helping Without Harming.
sDOR addresses child obesity
- To prevent child overweight and obesity from birth, support parents in following sDOR.
- To treat child overweight and obesity at any age, restore sDOR and trust the child’s own homeostasis to restore appropriate growth.