Finding the Line Between Promoting Health and Preventing Disordered Eating: Part 2

By Caitlyn Lazorka

Part 2

My Answer

I learned so much practical information by reviewing the literature for best practices and current research. I have summarized my findings into six main points: 

  1. Remove the focus on weight
  2. Avoid moralizing food
  3. Consider the learning development and age appropriateness
  4. Avoid restriction and coercion
  5. Involve the family and divide the responsibility
  6. Ensure adequate duration

Removing the focus on weight

Children experience body changes and a large amount of growth throughout their development. This growth does not look the same for everyone. Interventions focused on weight have the potential to cause unhealthy comparisons, compensatory behaviors, weight stigmatization, and disordered eating. Boutelle’s study showed that overweight adolescents are more likely than their peers to abuse laxatives or use exercise or vomiting to make up for binging. Instead of discussing and focusing on weight, interventions should be focused on knowledge acquisition and changing behaviors (such as being less sedentary), and weight is not a behavior. In one meta-analysis, interventions that focused on behaviors and knowledge rather than weight, and included education geared towards positive body image and self-esteem showed greater success when compared to weight-targeted interventions. 

Avoiding moralization of food

A common theme when educating children about nutrition is to focus on “good” vs “bad” foods. Categorizing foods as either good or bad creates shame around eating certain foods, and a feeling of pride when eating other foods. This can promote disordered eating behaviors. Most adolescents who develop an eating disorder were not previously overweight, however, it is not unusual for an eating disorder to begin with a teenager “trying to eat healthy.” Adolescents and their parents may misinterpret obesity prevention messages and begin eliminating foods they consider bad or unhealthy. Instead of moralizing food, using an all-foods-fit model keeps the tone positive. Educating on the benefits of certain foods rather than the drawbacks of other foods creates a more positive relationship with food. It is very important to avoid creating fear and guilt surrounding food.  


Considering the learning development and age

Cognitive development theory (CDT) suggests that chronological age has a major influence on a child’s ability to categorize, generalize, and think causally. It is not until the formal operational stage, ages 11 to adulthood, that children think more abstractly. This is important to keep in mind when curating nutrition education messages. Many nutrition messages are extremely abstract – ideas such as lower fat and lower sodium are difficult for children to interpret. Telling children some foods are OK in moderation may not be interpreted the same way as it is with adults. Because children think literally, they may think, “If I eat a ‘bad’ food, I’m bad.” Based on this research, I will assess nutrition messaging on portion sizes, red light/green light foods, healthy vs unhealthy foods, and how the food affects the body to determine if it is appropriate for each client or audience. Appropriate nutritional messages for young children could relate to how food is grown, eating a variety of foods, gardening and cooking. 

Avoiding restriction and rewards

Restriction may lead to feelings of deprivation and an increased craving for the specific foods being restricted. Restricting intake or suggesting to restrict intake in the form of dieting has been shown to actually cause an increase of weight gain in the long-term, and does not offer lasting weight loss or health benefits. We want to encourage kids to listen to their internal hunger/fullness cues rather than restrict their eating to fit guidelines. Similarly, coercing or offering rewards for foods also teaches children to ignore their internal cues. Making eating time a game with rewards and/or punishments may create stigmas around eating and can lead to further problems down the line when these children grow up and are in charge of their own food choices. 

Involving the family & dividing the responsibility

Children learn a lot from the people around them, and this is especially true for eating behaviors. Caregivers and family model eating behaviors every day. It is imperative to involve them in nutrition interventions, so that they can reinforce new behaviors. Studies show involving the family in the treatment of both obesity and eating disorders is more effective than focusing solely on the child or adolescent. Engaging caregivers in classes or health fairs, especially when they bring their kiddos with them for cooking, tasting, or nutrition education sessions, is both fun and effective. Another meta-analysis found similar results, concluding that interventions that provide skills and behavior change strategies aimed at parents were associated with healthier preschool children. While providing education to a food secure family, I think it is important to discuss the division of responsibility. In Ellyn Satter’s “Division of Responsibility,” the main point is that in order to help and not harm children, parents and/or caregivers must make providing food for the family a priority, because restricted eating is detrimental to children, and dieting does not work. In this theory, the parent/caregiver is responsible for what, when, and where the child will eat, and the child is responsible for how much and whether to eat the food provided. This prevents power struggles between caregiver and child. Power struggles during meal times can produce unhealthy eating habits and harm the child’s self-esteem and ability to achieve self-mastery and autonomy. Sharing tips for making meal time ‘struggle free’ and calm may help families build healthy eating habits. 

Ensuring adequate duration

Behavior change is a complex process that includes both learning new behaviors and unlearning old ones. This process takes time, therefore adequate duration is an important factor when planning nutrition education and interventions. This includes both dosage and frequency of int. Studies suggest that sessions that last between 30 and 60 minutes long and that are either weekly or biweekly may show significant improvements of nutrition knowledge and healthy eating behaviors. Proper evaluation tools such as questionnaires or quizzes can help gauge whether or not the intervention was an appropriate duration. Evaluation measures should be targeted towards behavior change and knowledge acquisition rather than weight or other numbers.

Conclusion

I learned that developing nutrition education that is age-appropriate and positively worded can lead to better outcomes and help curate a positive eating environment while preventing disordered eating behaviors. Additionally, involving the caregivers and families has been shown to improve outcomes in nutrition interventions. If able, utilizing the division of responsibility can better help children develop into intuitive eaters who have a healthy relationship with food. Avoiding moralizing food and restricting food and/or rewarding food-related behaviors is an important concept for professionals to understand. I believe these concepts will help me develop nutrition education materials that focus on positive food experiences rather than creating a good vs bad mentality. 

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