In our continuing series of guest posts by people we admire for their work to help women who struggle with eating, exercise and body image, I’m happy to present Dr. Katja Rowell, MD, the Feeding Doctor.
A family physician, Dr. Rowell was struck by the prevalence of disordered eating and feeding in her patients and began to focus on helping parents establish a healthy feeding relationship.
Her belief: Helping children grow up feeling good about eating and their bodies is preventive medicine. She is the author of Helping Your Child with Extreme Picky Eating: a Step-by-Step Guide to Overcoming Selective Eating, Food Aversions and Feeding Disorders and Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More.
The following post is written by Dr. Katja Rowell, MD.
“Whoa! Look at those shoulders! This Chunky Monkey won’t be a figure skater!”
– Delivery room nurse during C-section to mother of a newborn girl
“I looked at the rolls on her thighs and sobbed; ‘I did that to her,’ I thought. She was only four months old and I was breastfeeding, but her pediatrician called her ‘obese’ and I was reeling.”
– Jemma, mom of Tandy
“I am scared to DEATH of passing on my eating disorder.”
– Isobel, mother of Francine, age five years
As a childhood feeding specialist, I have worked with mostly mothers struggling to raise children who feel good about food and their bodies, children with typical to extreme picky eating, food preoccupation, and mothers who most days just don’t know what to say or do around food.
Most of the moms tell me they wrestle with eating, even eating disorders, and body image to some degree. They describe an almost paralyzing fear of passing on the suffering, “I was terrified I would make her crazy about food, but I also didn’t want her to be fat. I didn’t know what to do.”
The already challenging work of feeding children is made infinitely more difficult in our toxic American culture of: extreme nutrition and food anxiety (close to one-in-ten Americans have orthorexia with higher rates in at-risk populations), panic around childhood obesity, weight stigma, social media (“Here’s Mackenzie drinking her green smoothie, Mama’s doing something right!”), guilt (“I didn’t make her baby food from organic, local ingredients”), and feeling judged (a third of millennials feel judged based on what their children eat according to a Time Magazine survey.)
Outside of the home, our children face additional obstacles to growing up eating competently, with a barrage of dubious messages in schools around what they should and shouldn’t eat, food companies spending millions marketing to children, ineffectual and harmful BMI report cards, a 60 billion dollar diet industry grooming the next generation of consumers, one in five children not having enough to eat, and peers and school staff emboldened to comment on and even take food from children packed from home.
All that hunger, fear and anxiety makes feeding and eating well even harder. It is no wonder that many mothers feel stressed, triggered and unsupported, even thwarted in our efforts to nourish children well.
Supporting Mothers: Where to Start
Recognize that children and appetites can vary greatly.
You may feel anxious if your child’s weight is “too high,” or “too low,” or if your child eats a particularly large or small meal, or more or less than a friend’s child.
Many doctors too seem to have forgotten that children come in a range of sizes, with some children in the “obese” and “underweight” cutoff category thriving and growing in a healthy way, while some children in the “normal” range are not healthy.
“Micah was 85%, sleeping well, eating mostly wholesome foods, he had a six-pack from soccer and wrestling and won the highest award in the school presidential fitness test but his doctor kept telling him he was ‘overweight’ and at risk for obesity and diabetes and wanted Micah to ‘eat less ad move more.’”
Weight is not a proxy for health.* Many health risks that are often blamed on “obesity” are better correlated with factors outside of the individual’s control. (To learn more, check out Body Respect by Bacon and Aphramour, and ACES research on adverse childhood experiences.)
Schools need to be safe spaces for all children.
At a recent workshop with eating disorder professionals, a therapist remarked that every one of her adolescent clients is triggered, and healing is hampered by school nutrition messaging.
Get involved; join wellness committees or email school staff. Schools need to promote health for all children; support healthy sleep (not too much homework), address bullying, promote healthy social connections, support family meals (not routinely schedule sports or meetings into the evenings), provide opportunities for joyful activity (aka recess), and provide satisfying, tasty and balanced meals in supportive settings.
Work on your own eating and body image.
If you are doing pretty well with eating, watch and learn from your children.
I am told over and over again by clients that it was an “ah-ha moment” for their own eating to see their child not finish a bowl of ice cream because she was full, or on another occasion to enjoy a large meal and self-regulate with a smaller meal later in the day.
Watching their child eat in a natural and tuned-in way has helped give many parents the courage to take that final leap themselves, learn more, and become truly tuned-in eaters.
“If my child can do this, I can relearn to as well.”
If you are mired in obsessive thoughts about your body or food here are a few ideas to consider:
- Be open with family helping you feed your children, from partners to grandparents if you can; s/he needs the chance to understand what is going on.
- Learn about healthy eating and feeding (resources below).
- Find help from trained professionals if you struggle or need help with your eating.
- If family meals or certain foods are too triggering, ask a trusted family member or adult to be there for family meals. One client, during treatment, found that her husband was willing to lead family meals that included Mom’s trigger foods (while Mom couldn’t), allowing his daughter to eat as much as she needed.
Plan on offering yourself a variety of tasty foods at regular intervals (meals and snacks).
The good news is that because you are already doing this, or working towards this for your child, you can join in. You, too, have inborn capabilities with food when it comes to self-regulation (eating the right amount for your body) and food acceptance. Those capabilities might be buried from years of dieting, a history of an eating disorder, or neglecting your own needs around food, but those capabilities are there.
It may feel revolutionary (and lonely) at first to step away from the shame, deprivation and black-and-white thinking of “good foods/bad foods” while you learn how to feed your children and yourself in a balanced and healthy way.
When you support your body, eat based on hunger and appetite, and acknowledge pleasure, you are more likely to maintain a stable body weight and enjoy improved nutrition- and to pass those values and skills on to your children.
*Any time a child loses weight, or there is a change in the child’s growth pattern, a thorough history and physical exam are warranted.
A Mother Shares Her Journey with Feeding and Her Eating Disorder (ED)
“Before I had children I was terrified that I would pass on my disordered eating. It was soul destroying. Before I got pregnant I did therapy (again!) to get a grip on my EDs.
When my kids were toddlers, I thought I was doing everything ‘right.’ I made everything from scratch, offered healthy snacks, only milk or water to drink, etc., and used to get very frustrated at the biscuits (cookies in Britain) and squash they ate loads of when we were out (…no warning bells at this point for me though!).
Before long I was hearing, ‘How many spoonfuls of this do I have to eat so I can have pudding (dessert in Britain)?’ and, ‘I’ve eaten everything on my plate. Is that good?’ Suddenly all the warning lights came on in my head. My children were losing the ability to listen to their bodies and were eating to please me/to get pudding. All the things I had sworn I didn’t want my children to grow up with.
I had to find a better way for my children, though I was still struggling with my ED. For example, I was deep down happy to have to restrict my own eating even further when my newborn had food allergies and I had to cut out dairy and wheat.
I tried Baby Led Weaning with my third, which led me to the Division of Responsibility. I give the term control freak a whole new meaning, so this was my worst nightmare. Three meals and two snacks a day, and no commenting on what they eat, or whether they eat at all. It was all so difficult for me!
My daughter didn’t go near vegetables for a few weeks. I had to sit on my hands at times and clamp my mouth shut so I didn’t comment or ask them to try something. I had some great email support at this time, reassuring me that it was all normal.
Now, all three children love trying new foods. Again, often new things are served up a few times before everyone has tried them, but it’s about familiarity and not feeling pressured to try anything they’re not comfortable with. I leave it up to them.
I have finally, started to deal with my own eating and am currently almost three months into recovering from the eating disorder that has been with me for nearly 30 years.
I am starting to apply these principles to myself. Starting with three meals and three snacks a day. Trying to listen to my body and relearn hunger and satiety. I will have to keep working at it, but for the first time ever, I am convinced that I will get there. Thank you so much again for all your support.” —Mira, mother to Thomas and Emma
Excerpted from Katja Rowell’s Love Me, Feed Me (2012)
- Secrets of Feeding a Healthy Family, Satter
- Child of Mine, Satter
- Feeding With Love and Good Sense II DVD from birth to Kindergarten
- Lunchbox card for children’s lunchboxes to decrease interference
- Green Mountain at Fox Run is a place where you can heal and strengthen your relationship with food and your body.
- Talking to Children About Food: Do’s and don’ts basics when talking to kids about food, co-authored with eating disorder specialist Elizabeth Jackson, RD
- Weight Stigma Toolkit in Kid’s Programs and Schools Guide for Parents and Children. Binge Eating Disorder Association (BEDA)
- The Youngest Casualties in the War on Childhood Obesity article outlining potential harm, and questionable utility of school BMI and “healthy” eating lessons
- Raising Body Positive Kids in a Body Negative World Ragen Chastain BEDA blog weight stigma awareness week 2016
- Time for a Cease-Fire Rowell’s ASDAH blog post on harmful nutrition messaging
Dr. Rowell has no financial connection with any of the resources mentioned.