Supporting Healthy Eating and Growth What can we do for kids?
Ellyn Satter, MS, RD, MSSW
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Raise a capable eater Follow the division of responsibility in
feeding Ellyn Satters Feeding with Love and Good Sense II DVD
Parent: What, when, where of feeding Child: How much, whether of
eating
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Haley 10 years Parents: Gained a huge amount of weightshot off
the scale. Sneaks food, eats from lunch counter even after she has
finished her bag lunch from home Parents deny food restriction W/A
2 - 10 yr
FOOD RESTRICTION BACKFIRES Children become afraid of going
hungry and overeat when they get the chance Getting children to eat
certain foods Getting children to eat more or less Depriving
children of certain foods Not letting children eat as much as they
are hungry for
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WHAT DOES THIS HAVE TO DO WITH CHILD OBESITY? Hunger Appetite
Satiety Children who get the message they are too fat feel flawed
in every waynot smart, not physically capable, and not worthy.
Davison & Birch Pediatrics 2001 Girls 5 yr say they try to eat
only a little bit on purpose so they dont get fat. They tend to
overeat, and gain more weight than girls who do not restrict. Shunk
& Birch JADA 2004: 1120.
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AUTHORITARIAN PARENTING: Restricting amounts undermines food
regulation ELLYN SATTERS FEEDING WITH LOVE AND GOOD SENSE: Video
and Teachers Guide The Older Baby
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Children whose food intake is restricted become
food-preoccupied and are prone to overeat when the get the chance
Secrets of Feeding a Healthy Family, Appendix I, Children and food
regulation: the research Ellyn Satters Feeding with Love and Good
Sense II DVD
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Why do children gain too much weight? a)Misinterpretation of
normal growth b)Restrained feeding c)Poor feeding practices
1 -6.5 years. New MD doesnt question weight 3-6.5 yr: Mother in
school; father casually feeding 3-years 6.5 years 8.5 years 10.25
years Haley W/A
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POOR FEEDING PRACTICES Too little support Interference
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Children who are coerced to eat certain foods get turned off to
them and avoid them when they can Secrets of Feeding a Healthy
Family, Appendix J, Children and food acceptance: the research
Ellyn Satters Feeding with Love and Good Sense II DVD
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FEEDING PRESSURE BACKFIRES Forcing, bribing, coercing, nudging,
applauding, rewarding, explaining, teaching, restricting Getting
children to eat certain foods Getting children to eat more or less
Getting children to avoid certain foods
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FEEDING PRESSURE BACKFIRES Forcing, bribing, coercing, nudging,
applauding, rewarding, explaining, teaching, restricting Getting
children eat certain foods Getting children to eat more or less
Getting children to avoid certain foods 90% of parents pressure
children to eat Sherry JADA 2004:215 50% of children have feeding
problems Linscheid, Handbook of Pediatric Psycholgoy, 2003:
481
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FOOD REGULATION HINGES ON THE FAMILY MEAL (AND STRUCTURED
SNACKS) Meals give a context for parental support without coercion
Allows going to table hungry but not famished, eating until
satisfied Keeps food from being a constant issue between times
Toddlers are too busy to eat on demand
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Why do children gain too much weight? a)Misinterpretation of
normal growth b)Restrained feeding and circumstances that mimic
restrained feeding c)Poor feeding practices d)Stress
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3-6.5 yr: Mother in school; father casually feeding 6.5 yr:
Moved. Mother begins rigidly feeding 8.5 yr: MD dont diet but eat
F&V, low fat 10.25 yr: RDFood Guide Pyramid; smart snack
choices 3-years 6.5 years 8.5 years 10.25 years Haley W/A
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7 yr: Moved. Haley sad; mother feeding 8 yr: MD dont diet but
eat F&V, low fat 9 yr: RD dont diet but follow Food Guide
Pyramid 3-7 years 7 years 9 years 8 years
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MOTHER IS RESOLUTE IN ATTEMPTS TO CONTROL HALEYS EATING Drab,
low-fat food that Haley detested One pork chop each, ran out of
rice Use your fork (over and over) The seeds are for the salad
(repeatedly) Get your elbows off the table Eat something else
before you take seconds on bread Remember she showed us a portion
size (broccoli) Hand on wrist and smile (Sadie eating too fast)
Handing her the napkin Use your napkin
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HALEY IS EQUALLY RESOLUTE IN HER AVOIDANCE OF CONTROL Puts down
her fork to pick up the pieces of salad Takes the tiniest amount of
salad possible then puts the seeds in her palm Looks disgusted at
lentil soup Hunches over with her whole forearm on the table Eats
her bread when she wants to Goes back to eating fast Leaves her
napkin on the table
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Stress undermines food regulation Ellyn Satters Feeding with
Love and Good Sense II DVD
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Stress and energy dysregulation How it works Children who are
poorly fed (e.g., restricted, forced to eat, not given structure)
do not get their emotional needs met Childrens unmet food and
emotional needs teach children to conflate eating with emotional
arousal Based on such learning, children respond to life stress by
eating too much or too little
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Causes of Haleys weight acceleration Misinterpretation of
normal growth: High infant weight branded obesity Restrained
feeding: Food restriction initiated age 10 months Poor feeding
practices: Struggles around feeding exacerbated age 12 months. Lack
of structure ages 3-7. Restraint ages 7 plus. Stress: Taught to use
food for emotional reasons. Inconsistent parenting: Mother rigid
& controlling, father neglectful. Parental conflict routed
through Haley.
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CHILDHOOD FEEDING DISORDER Distorted eating/feeding
attitudes/behavior Failure to regulate growth Profound finickiness
Vehement struggles about eating Unconcern about serious problems
Overconcern about minor problems Emotional/social problems
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fdSatter and child overweight Your Childs Weight: Helping
without Harming, Kelcy Press Satter E. The Satter Feeding Dynamics
Model of child overweight definition, prevention and intervention.
In: O'Donahue W, Moore BA, Scott B, eds. Pediatric and Adolescent
Obesity Treatment: A Comprehensive Handbook. New York: Taylor and
Francis; 2007:287-314. Satter EM. Internal regulation and the
evolution of normal growth as the basis for prevention of obesity
in childhood. J Am Diet Assoc. 1996;96:860-864.
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TRIANGULATED CHILD: PARENTS ROUTE CONFLICT THROUGH CHILD
TREATMENT OF FEEDING DISORDERS Eating management Psychotherapy
or case management with the whole family Psychotherapy does not
resolve eating problems
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HALEY - TREATMENT PLAN Parents Jobs Get family therapy to deal
with control issues Initiate eating management after family therapy
has begun Establish and maintain division of responsibility
Identify and D/C restraint tactics Plan good-tasting enjoyable
menus Provide appealing sit-down snacks at set times Expect and
enforce positive mealtime behavior
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HALEY - TREATMENT PLAN Haleys Jobs Go to the table hungry and
eat until satisfied Pay attention while you eat Ask parents to
include forbidden foods at meals and snacks Sneak up on new food
and learn to like it Let parents know when they slip up, but be
patient
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Haley: Once more with sDOR Satter E. Prevention and Treatment
of Child Overweight and Obesity. 2015
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To prevent child overweight and obesity, support parents in
following sDOR from birth. To treat child overweight and obesity,
restore sDOR and trust the childs own homeostasis to restore
appropriate growth.
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Satter feeding dynamics model: fdSatter Parents feed based on
the division of responsibility Children remain/become eating
competent Children grow in the way that is right for them. Satter
The feeding relationship, JADA 1986 Satter. Internal regulation
& child overweight. JADA 1996 Satter. Childhood eating
disorders. JADA 1996 Satter. Moderate view on fat restriction. JADA
2000 Satter. fdSatter and child overweight IN ODonahue, Pediatric
and Adolescent Obesity Treatment. 2007 Danaher, Intervention.
Childhood Obesity. 2011
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Parents have to be good eaters to do good feeding Further
reading and references Secrets of Feeding a Healthy Family Part 1,
How to eat Part 2, How to raise good eaters Appendix I, Children
and food regulation: the research Appendix J, Children and food
acceptance: the research
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Satter Division of Responsibility in Feeding (sDOR) Infant
Parent: What Child: How much
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Transitional child Parent/feeding Still and always responsible
for what Becoming responsible for when and where Child/eating How
much Whether Satter Division of Responsibility in Feeding
(sDOR)
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Toddler through adolescent Parent: What, when, where of feeding
Child: How much, whether of eating Satter Division of
Responsibility in Feeding (sDOR)
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sDOR Parents take leadership with feeding Choose and prepare
healthy food Have regular meals and snacks Make eating time
pleasant Provide mastery expectations Accept and support childrens
growth
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sDOR Parents give children autonomy, support childrens natural
ability with eating Children will eat They know how much to eat
They will eat a variety They will grow predictably They will mature
with eating
The tendency is to slimming Serdula - Children slim down
Infants >75% Preschoolers 59-74% School-age children 37-58%
Whitlock At age 13 years, children >95th %tile W/H have a 50%
probability of adult obesity (BMI >30) Serdula Preventive
Medicine 1993 Whitlock Pediatrics 2005
1 -6.5 years. New MD doesnt question weight 3-6.5 yr: Mother in
school; father casually feeding 3-years 6.5 years 8.5 years 10.25
years Haley W/A
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3-6.5 yr: Mother in school; father casually feeding 6.5 yr:
Moved. Mother begins rigidly feeding 3-years 6.5 years 8.5 years
10.25 years Haley W/A
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8 yr: MD dont diet but eat F&V, low fat 9 yr: RD dont diet
but follow Food Guide Pyramid 3-7 years 7 years 9 years 8
years
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Structure is the bottom line In adult EC In child nutrition and
feeding In child overweight prevention and treatment.
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To be a competent feeder, the parent has to be a competent
eater.
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Satter Eating Competence Model (ecSatter): Inclusive definition
of eating attitudes and behaviors 1.Positive attitudes about eating
and about food 2.Food acceptance skills that support eating an
ever- increasing variety of the available food 3.Internal
regulation skills that guide consuming enough food to give energy
and stamina and to support stable body weight 4.Skills and
resources for managing the food context and orchestrating family
meals Satter, E. M. (2007). J Nutr Educ Behav, 39 (suppl),
S142-S153.
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ecSatter tested using the validated ecSatter Inventory ecSI
2.0ecSI 2.0 Lohse, J Nutr Ed Behav 2007
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The evidence: ecSatter associated with... Superior dietary
quality Greater physical activity Better weight status More
positive parent food behaviors Decreased preschooler nutrition risk
Fewer cardiovascular risk factors Good food management skills
Higher sleep quality
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The point of the fdSatter and ecSatter research? You can
achieve nutrition and wellness goals by focusing on sDOR and Eating
Competence.
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For more... Satter E. The Satter Eating Competence Model for
the autodidact 2015
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For more information
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