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Children and Eating
An interview with nutritionist/author
Ellyn Satter, R.D., M.S.W.

By Joan Price

From Radiance Winter 1991

Nutrition expert Ellyn Satter's philosophy of child feeding is as simple as it is radical: "The parent is responsible for what, when and where. The child is responsible for how much and whether." That's it? Yes. Does it work? Yes, insists Satter. She suggests that following this division of responsibility can solve most children's eating problems-and help us understand our own.

Satter, author of Child of Mine: Feeding with Love and Good Sense, and her latest book, How to Get Your Kid to Eat . . . But Not Too Much (both available from Bull Publishing Company), has been a registered dietician for 25 years and a clinical social worker for 10 years. For much of her career, she was a nutrition counselor. But she found that nutrition information alone did not supply the solutions to the eating problems she saw.

"I was confronted with problems that I could neither understand nor resolve working as a dietician. I became increasingly curious about the way people's feelings and interactions with each other impinged on their ability to manage their eating. Emotions and food seemed so intertwined that unless I looked at all the factors, I couldn't be helpful to people."

Satter decided to move into psychological and social counseling, with a specialty in eating problems and disorders. Combining nutrition and psychology has led her to look at eating problems-especially those of children-in new ways. Children need to be trusted, not controlled or forced. If they're not overmanaged, children will eat instinctively in a way that's right for them, using their internal cues of hunger, appetite and sense of fullness.

"Parents are responsible for what is presented to eat and the manner in which it is presented," repeats Satter. "Children are responsible for how much and even whether they eat." This is the core of her message. Parents plan the shopping list and menu and decide what food will be in the house. They determine the structure of meals and snacks-what foods to prepare, when they will be served and where. The child can then choose from the variety of food put on the table and decide how much of it to eat. "Children don't eat some of everything like adults. We do it because we paid for it or because it's good for us. But that doesn't cut any ice with children. They eat only what pleases them on a specific day. They might eat only one or two food items, and that's it. They might eat a lot one day and a little the next. That drives parents nuts." But it doesn't hurt the children!

Satter traces the roots of most childhood eating problems to parents who cross the line of this division of responsibility by trying to dictate the amount and kinds of food their children eat. "I have parents who force their children to sit at the table for an hour to get them to eat their vegetables. Or parents who think their children eat too much and restrict the amount, or who think their children eat too little and try to get them to eat more than they voluntarily will. I see parents who short-order cook for their children, or let their children panhandle all the time." A vicious cycle of tense mealtime battles starts up.

All kinds of eating problems may result or worsen from trying to overrule a child's internal eating cues, says Satter. "Children who are forced, cajoled, enticed or even tricked to eat end up revolted by food and prone to avoid eating if they get a chance." And children whose food intake is restricted in an effort to keep them from getting fat will become preoccupied with food. They will often tend to overeat, fearing they won't get enough.

Satter recommends the same solution for all eating problems: "Establish the structure of meals and snacks, and maintain a division of responsibility in feeding. Present the food to the child, keep the pressure off, keep the mealtime pleasant and let the child take the initiative in eating." That doesn't mean a laissez-faire attitude toward nutrition. It's the parent's job to put wholesome, appealing foods on the table. But don't panic if a child doesn't choose from every food group at every meal. Over time, children will vary their selections. How to Get Your Kid to Eat offers these facts about children's eating:

  • Children will eat.
  • They are capable of regulating their food intake.
  • They generally react negatively to new foods but will usually accept them with time and experience.
  • Parents can either support or disrupt children's food acceptance and food regulation.

Satter is vehemently opposed to depriving fat children of food to control their weight. She sees four ways that children become fat:
(1) Normal: "Some people are genetically predisposed to being fat."
(2) Developmental: "Someone in the child's environment is getting him or her to overeat and doing it consistently and persistently so the child does overeat and gets fat."
(3) Reactive: "A child who gains weight during or in reaction to a stressor, such as a divorce."
(4) Fatness as a result of restrained feeding: "The tactic of withholding food from a too-fat child can not only make her feel bad about herself; it can also make her eat more."

Physicians often mistakenly assume that if a child is getting fat, it must be a result of overfeeding. "Some kids will overeat and some won't," insists Satter. "Some will fight to the death rather than eat one more morsel than they really want. Other children like eating and will eat beyond satiety and not experience discomfort."

Most adults, according to Satter, are "restrained eaters." They chronically withhold food from themselves, trying to eat less than they really want-less in quantity and less appealing food. They ignore and overrule their appetites. Restrained eaters' anxiety about their ability to manage their own eating leads them to overmanage their children's eating, imposing their own expectations on their children.

Most adults have trouble following Satter's cardinal rule: Trust that children will eat the right amount of food to grow well. Isn't this true for adults as well? "Indeed. We've forgotten what it's like to eat normally," Satter explains. "Chronic dieters consistently expect themselves to go hungry and are consistently unreliable about providing themselves with food. Nobody can be comfortable if she goes through life expecting not to be fed."

The hazards of this behavior are both physiological and emotional. "People deplete themselves nutritionally as they go on severe diets and don't get the nutrients they need. Then they go on repleting binges emphasizing high- fat, high-sugar, low-nutrient foods. And there's the whole feeling that their eating is out of control, and therefore they are out of control. Eating becomes a moral issue." Part of her answer to those who are parents is, "If you feed your child well, you'll find yourself challenged to learn how to eat normally also." Like our children, we adults have an innate ability to regulate our food intake.

Satter shares her views through her books, workshops and lectures. She is in demand as a speaker for gatherings of health professionals, who are typically either experts on nutrition or on mental health, but not both. To these groups Satter's views may seem radical, and, in fact, most of her colleagues have different orientations about food and eating.

She says most health professionals focus on food selection and tend to regulate food intake more on the basis of externals than internals. As long as the approach to problems is based on externals, solutions are difficult.

Satter gives an example. She recently treated a child who was brought in because she had started gaining weight rather suddenly. "I looked at the child and the way she was being fed. I discovered that the parents were restricting her food intake, and she was becoming preoccupied with eating. She would overeat whenever she could get the food. We worked on that and resolved the problem to a limited extent, but it seemed like the parents couldn't really change the way they operated. They would do some of what I suggested, but they couldn't really turn the situation around."

This told Satter that something else was going on in the family. The parents, she found, were so involved in their own conflicts that they could not work together to parent the child. Their negative feelings kept them overly rigid and highly critical of their daughter. "She was scapegoated a lot for the negative feelings they had for each other." What started as problem solving about the little girl's eating shifted to couple therapy for the parents' emotional problems.

Though Satter's work with adults predates her work with children, both her books have been on children, and when she talks to groups it is most often about children. She is developing an intensive training for health professionals and mental health professionals to help them work with childhood eating problems. And she is planning a book for adults on food issues.

Satter, who lives and works in Madison, Wisconsin, says she lives her own lessons. "I struggled with my eating when I was younger and it wasn't until early in my career that I developed a different way of eating. I experienced a lot of relief at learning to internally regulate my food intake. I have a personal sense of how nice it is to learn to do that."

What are her dreams for the future? "I'd like to be right here. In deciding to become a psychotherapist, I've taken on a lifelong challenge. It's a constant process of reading and acquiring knowledge, and of self-examination! Nutrition is intellectually challenging. Being a therapist is personally challenging. The complexity is mind-boggling! I'm having such a good time now. I can't even dream of anything better."

A Radiance subscriber, Satter supports Radiance's philosophy of emotional health and self-acceptance. "In this whole area of eating and weight management, there are very few Cinderella stories. My best advice is to live your life as if you're going to be the weight you are right now, and simply go ahead and do what you want to do. The messages I read in Radiance couldn't be more healthy."

JOAN PRICE is a widely published freelance health and fitness writer and a frequent contributor to Radiance. http://fitnesslink.com/joanprice/


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