Should You Put Your Kid on a Diet? 10 Points to Think About

 

Editor’s Note: Jewish Action seeks to provide a forum for a diversity of legitimate opinions within the spectrum of Orthodox Judaism. Therefore, opinions expressed do not necessarily reflect the policy or opinion of the Orthodox Union. Readers are invited to use this forum to express personal views and address issues of concern.

 

In early August this year, WW, formerly Weight Watchers, launched a weight-loss app designed for kids which caused an uproar, to put it mildly. Some of the leading organizations dedicated to addressing eating disorders, including the Multi-Service Eating Disorders Association (MEDA), the National Eating Disorders Association (NEDA), and Families Empowered and Supporting Treatment for Eating Disorders (FEAST), issued statements expressing outrage and calling the new app “dangerous,” and a plethora of news articles and op-eds were written opposing the app. An online petition to remove the app gathered over 113,000 signatures, as of October 2019.

Parents who want to put their child on a diet may have the best of intentions. They might be worried that their larger-than-average child will struggle with self-esteem issues.They may feel that their child needs restrictions because of the many food-related events that are part of the frum lifestyle like Shabbat, yamim tovim, bar and bat mitzvahs and other semachot. But putting kids on diets is dangerous. Our children are supposed to be growing. Pushing children to obsess about what they eat and how much they eat puts them at higher risk of developing eating disorders and having a dysfunctional relationship with food. It could also lead to a slew of other mental health issues. The American Academy of Pediatrics states very clearly that putting children on diets is not safe1 and should never be recommended.

You want your kids to be healthy and happy; how does their weight fit into the picture? Below are a few helpful ideas for parents concerned about their child’s weight:

1. Understand Your Child’s Weight
Before you decide that your child is overweight, it’s important to understand the influence of genetics on weight. Just as a child has a predetermined height and shoe size, he has a predetermined natural weight range. If your child is growing along his natural curve, then even if he is bigger than the other kids in his class, he may be perfectly healthy.

Your child (or you, the parent) may wish that his weight was lower and might be upset by his size. Especially during times of rapid growth, he may feel uncomfortable with his body. What happens when he says he wants to lose weight before his bar mitzvah, for example? His unhappiness should be taken seriously, but if he’s at a healthy weight, then the distress is the problem, not the weight. Your job as a parent is to help your child learn to manage his emotions surrounding his weight. Yes, it’s hard to feel different. We need to give him tools to effectively deal with those feelings, but we should not try and manipulate his weight to help him feel better in the short term.

In an effort to make children eat more healthfully, parents often unwittingly convey messages that lead to fear and guilt around eating, food preoccupation, resentment toward exercise and body shame.

Just because a practice is accepted within a certain culture doesn’t mean it is necessarily right or good. In China, for example, the practice of foot binding persisted for hundreds of years. It was culturally acceptable for a five-year-old girl’s toes to be broken and bent in order to make her feet smaller. Putting a healthy child on a diet may be culturally acceptable in the United States, but that does not make it right. Moreover, trying to suppress a child’s natural weight is very likely to backfire. If a significant amount of effort is required to maintain a lower weight, that’s a good sign that that weight is too low for that child. The body is going to fight to get back to its natural weight.

2. Excess Weight Gain Is a Symptom
If a child starts gaining weight (or begins to lose weight), have her assessed for an underlying medical cause. Perhaps she isn’t eating well because of behavioral or emotional issues. Similarly, a child who is gaining weight too quickly needs to be assessed for a medical condition that may be causing excessive weight gain. If it is clear that the weight gain is due to overeating, the parent needs to ask, why she is eating too much? Is she afraid there won’t be enough food unless she eats it all now? Is the feeding style in your home chaotic, where she never really knows when the next meal will be? Is she eating because she’s bored or lonely? Is she eating in an attempt to please an adult in her life, such as a grandparent or other caretaker? If she is cared for by more than one adult, is it possible that both of them are feeding her the same meal twice? Do you need more education about the amounts and kinds of food that are healthy for a child?

A pediatrician or pediatric dietitian can help identify the child’s challenges, provide strategies for improving her eating behaviors and support the parents and child in developing a healthy relationship with food and her body. A psychotherapist can help address any underlying emotional issues that are responsible for the overeating.

3. Restriction Is Not Harmless
Dieting doesn’t work any better for children than it does for adults—and the risks are much greater.2 Children who diet are far more likely to end up at higher weights than they would otherwise and to develop eating disorders.

The human body will fight attempts to diet on both physiological and psychological levels. When calories are restricted, the body does its best to keep us going under these undesirable circumstances. This means a decreased metabolic rate and an increased focus on obtaining food. Trying to make a child follow a bunch of food rules will lead him to feel restricted, and food restriction leads directly to food preoccupation.3 Kids who are restricted from food, either in quantity or type, are going to be much more vulnerable to eating in the absence of hunger. When they have access to a “forbidden” food, they will eat much more of it than kids who haven’t been restricted. In the long term, this causes even more weight gain and can set the stage for a lifetime of yo-yo dieting. We have seen many adult clients who were put on diets when they were young and have continued to struggle with their weight for decades.

Dieting is also a gateway behavior to an eating disorder. Not every child who diets will develop an eating disorder, but a very high percentage of eating disorders start with a diet. Dietitian Marci Evans points out that children are more likely to develop an eating disorder than to sustain weight loss from dieting. A striking study from the University of Minnesota followed more than 2,000 teens who dieted and found that five years later, they were at approximately three times greater risk of being overweight than teens who did not diet—and the incidence of eating disorders was higher in the dieting group as well.4

Putting a healthy child on a diet may be culturally acceptable in the United States, but that does not make it right.

An eating disorder is a psychiatric illness, and it is a serious one, with the highest mortality rate of any mental illness.5 How does a diet trigger something so serious? Eating disorders have biopsychosocial origins, meaning they develop as a result of something in a person’s biology as well as in his environment. For example, an individual with a genetic predisposition toward anxiety, perfectionism and people-pleasing tendencies may be more likely to develop anorexia nervosa. Put such a child on a diet, and the counting, measuring and weighing can ignite any obsessive tendencies. The expectations and compliments add additional pressure, and the restriction of calories can cause cognitive changes that put full-blown anorexia nervosa in motion. Another child might feel intense pressure to lose weight but may find himself “cheating” on his diet. His despair might lead him to binge, and he may fall into a pattern of restricting and binge eating, developing a binge eating disorder. If he purges in an attempt to “erase” his binge, he may eventually meet the criteria for bulimia nervosa.6

4. Provide, Don’t Deprive
How does a child know that she is loved? Her first experience of being loved and nurtured is right after birth, when she is held and fed. Being fed means being loved and protected, and when we take away food from a child, she may experience that as a withdrawal of love. You may be restricting food with the best of intentions, but to your child, it could feel like you are withholding love.

The best way to improve your child’s nutrition is by providing instead of depriving. Provide your child with balanced meals and snacks on weekdays and Shabbat too! Have food available at appropriate times instead of too frequently or too sparingly. Teach her to identify physical hunger and fullness so she can learn to eat according to her internal signals and know what it feels like to be pleasantly satisfied instead of uncomfortably full. Being forced to eat food past the point of fullness is one of the earliest consent violations a child will experience. Let your child rely on his built-in mechanism for knowing how much to eat and when to stop. Children are born intuitive eaters, but we can undermine this instinct by teaching them that hunger is bad or that their fullness cues are wrong. Dietitian and social worker Ellyn Satter has written a few excellent books on how to feed a child in a way that respects her autonomy but still provides boundaries [see the sidebar on page 82 for a recommended reading list].

You should also provide your child with opportunities to be physically active in ways that are fun. Offer suggestions on how she can entertain herself when she is bored as well as strategies to manage challenging emotions like sadness or anxiety.

5. Show, Don’t Tell
Diets are all about what’s “good” and “bad,” what’s “allowed” and what’s considered “cheating.” It’s critical to realize that young children are concrete thinkers and therefore take things literally. If you say to a young child, “Candy is bad for you,” he thinks, “I am bad if I eat candy.” A child will most likely continue eating candy, but will now feel guilty about it. He will also be confused—if he gets a lollipop at shul, is the candy man trying to make him sick? In an effort to make children eat more healthfully, parents often unwittingly convey messages that lead to fear and guilt around eating, food preoccupation, resentment toward exercise and body shame. Yeshivot and day schools may also unintentionally be at fault by instituting “healthy snack” rules that limit what kinds of food kids can eat in school; these rules are often presented with language that conveys the message that some foods are good and others are bad. Instead of categorizing food into “good” or “bad” groups, show your child what balance looks like.

Serve a wide range of foods. Take your child grocery shopping. Include a balance of nutrients in your meals and let him help prepare them. Allow him to cook a dish for Shabbat. Include him in the menu planning for a Chanukah party.

6. Don’t Blacklist Foods
It’s not hard to spot the kids who never get candy at home. They’re usually the ones attacking the candy dish at a friend’s Shabbat table or raiding the snack drawer when they go to a play date. The body has a very strong reaction to feeling deprived and it feels a lot like addiction. The more you restrict your child, the more she will obsess about the foods that she wants, which can lead to sneak eating behaviors, stealing food, eating too quickly and binge eating.

Take candy, cakes, cookies and chips off a blacklist and stop assigning morality to what we eat. Food is neither inherently healthy or unhealthy; it is our behaviors over time that contribute to health. Teach your children, in an age appropriate manner, that there are nutrient-dense foods and foods that are less nutrient-dense, but all foods provide energy and can be part of a healthy lifestyle.

7. Singling Out a Child Is Harmful
When you single out a child and give him different food rules than the rest of the family, you send the message that your love is contingent upon his meeting your standards. This creates feelings of shame and isolation. Your child gets the message that he is bad and wrong because of the way he looks or eats. I don’t get to have the food I like. I am a disappointment.

Food is neither inherently healthy or unhealthy; it is our behaviors over time that contribute to health.

Your child may feel like he is being punished for being fat or “overweight.” This rejection increases the risk of developing eating disorders as well as other mental health issues such as depression and anxiety.

8. Weight Stigma Is Real
Parents need to be aware of the impact of fat phobia on a child’s developing identity and psychological health. Kids need to know that our love is unconditional. Making kids and teens feel bad about their weight will not help them develop a better relationship with food, themselves or you. Weight stigma is a significant risk factor for depression, low self-esteem and body dissatisfaction.7

It is important to recognize that weight bias among health professionals exists as well.8 Moreover, doctors still use measurements such as the Body Mass Index (BMI) to determine health, despite the fact that it has long been proven that BMI is not an accurate predictor of health because it does not take into account muscle mass, body composition and distribution of weight, among other factors. And weight is not a good indicator of health because our health is more than just physical. Mental health, financial health and spiritual health all impact our physiology.

When you visit your doctor, have your child stand facing away from the scale numbers and let your doctor know in advance that weight is not up for discussion in front of the child. If your doctor advises weight loss as a response to some other medical concern, ask what he would recommend if your child had the same issue and she was not “overweight” and then tell the doctor you’d like to try that first. For example, if a doctor suggests weight loss as a solution to high cholesterol, ask what he might recommend for a thin person with high cholesterol. Eating foods that are helpful in lowering cholesterol and increasing physical activity are ways one can achieve healthy cholesterol levels regardless of one’s weight.

9. Dealing with Bullies
If your child is being bullied for being “overweight” or “fat,” the solution is not to validate the message of the bullies and put her on a diet. Instead, give her the tools and confidence to stand up for herself. Remind her that all bodies are good and discuss the concept of body diversity. Involve her in activities that allow her to use her body in ways that will increase her self-esteem (such as dance, swim or ball sports) and remind her that she is so much more than her appearance.

10. Confidence Is an Inside Job
Your kids are watching you and they are listening to every conversation you have. If you are weighing yourself, restricting, pinching your rolls, showing disgust for your body, praising thinness and weight loss—know that your child is taking that all in and internalizing it. More important than what you say to your child is what you do yourself. You cannot give your kids what you don’t have. Reject diet culture, practice body acceptance and stop diet talk in its tracks when it comes up.

As parents, our goal has to be to foster an environment that encourages healthy and sustainable eating behaviors and a positive body image. We need to teach our kids to reject the diet culture.  Giving our kids a sense of autonomy and a positive self image are our gifts to them, which will have a positive ripple effect in all areas of their lives.

Notes
1. Neville H. Golden, Marcie Schneider and Christine Wood, “Preventing obesity and eating disorders in adolescents,” Pediatrics 138, no. 3, September 1, 2016, https://doi.org/10.1542/peds.2016-1649.

2. “Dieting young may lead to poor health outcomes later: trends in dieting strategies in young adult women from 1982 to 2012,” ScienceDaily, July 29, 2014, https://www.sciencedaily.com/releases/2014/07/140729224908.htm; G. C. Patton, et al., “Onset of adolescent eating disorders: population based cohort study over 3 years,” BMJ 318, no. 7186 (March 20, 1999): 765-68.

3. J. O. Fisher and L. L. Birch, “Eating in the absence of hunger and overweight in girls from 5 to 7 years of age,” The American Journal of Clinical Nutrition 76, no. 1 (July 2002): 226-231.

4. D. Neumark-Sztainer, et al., “Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?,” Journal of the Academy of Nutrition and Dietetics 106, no. 4 (April 2006): 559-568.

5. J. Arcelus, et al., “Mortality rates in patients with anorexia nervosa and other eating disorders,” Archives of General Psychiatry 68, no. 7 (July 2011): 724-731.

6. C. M. Shisslak, M. Crago and L. S. Estes, “The spectrum of eating disturbances,” International Journal of Eating Disorders 18, no. 3 (November 1995): 209-219.

7. Carissa B. Wott and Robert Carels, “Overt weight stigma, psychological distress and weight loss treatment outcomes,” Journal of Health Psychology 15, no. 4 (May 2010): 608-614; Janet A. Tomiyama, et al., “How and why weight stigma drives the obesity ‘epidemic’ and harms health,” BMC Medicine 16, August 15, 2018, https://doi.org/10.1186/s12916-018-1116-5; D. Carr and M. A. Friedman, “Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States,” Journal of Health and Social Behavior 46, no. 3 (September 2005): 244–59.8.

8. J. A. Sabin, M. Marini and B. A. Nosek, “Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender,” PLoS One, November 7, 2012, https://doi.org/10.1371/journal.pone.0048448; A. J. Tomiyama, L. E. Finch and A. C. I. Belsky, et al., “Weight bias in 2001 versus 2013: Contradictory attitudes among obesity researchers and health professionals,” Obesity 23, no. 1 (January 2015): 46–53; C. H. Adarns, N. J. Smith, D. C. Wilbur and K. E. Grady, “The relationship of obesity to the frequency of pelvic examinations: Do physician and patient attitudes make a difference?,” Women Health 20, no. 2 (1993): 45–57; N. K. Amy, A. Aalborg, P. Lyons and L. Keranen, “Barriers to routine gynecological cancer screening for white and African-American obese women,” International Journal of Obesity 30, no. 1 (January 2006): 147–155; M. R. Hebl, J. Xu and M. F. Mason, “Weighing the care: Patients’ perceptions of physician care as a function of gender and weight,” International Journal of Obesity 27, no. 2 (February 2003): 269–275; K. D. Bertakis and R. Azari, “The impact of obesity on primary care visits,” Obesity 13, no. 9 (September 2005): 1615–1623.

 

Dina Cohen, MS, RDN, CEDRD is a nutrition therapist who specializes in the treatment of eating disorders, chronic dieting, women’s health and pediatric nutrition. She is the owner of EatWellSoon LLC, a nutrition counseling practice in Lakewood, New Jersey.

Rachel Tuchman is a licensed mental health counselor (LMHC) with more than ten years of experience. Her practice is in Cedarhurst, New York.

 

SIDEBAR: Worried about your child’s weight? You should . . .

talk to your pediatrician to assess whether your child is growing along her curve or if she is actually gaining too quickly. Rule out medical conditions that may cause excess weight gain.

examine your feeding practices. Is there too little structure around food or too much rigidity? When it comes to food, your job is when, what and where to serve. Your child’s job is whether and how much to eat.

serve balanced meals and snacks and provide a variety of foods. Your child needs exposure to all kinds of foods in order to learn how to handle them outside the home. Including treats at home helps teach your child how to manage them appropriately.

provide your child with opportunities for fun physical activities. Just like kids don’t want to eat food that doesn’t taste good to them, they don’t want to move in ways that aren’t enjoyable to them.

treat the child the same as your other children. Singling him out won’t make things better.

never shame your child for his weight. Shame does not lead to lasting positive changes. Make it clear to your child that she is valued for who she is rather than what she looks like.

create an atmosphere at home that is respectful of body diversity. A child is more likely to take good care of his body when he respects and appreciates it.

look out for and address any underlying struggles, such as emotional or social issues, which may be contributing to overeating.

take a look at your own relationship with food and consider how your attitudes and behaviors might be influencing your child’s eating.

seek professional help if necessary. If your child continues to gain weight too quickly, exhibits disordered eating behaviors or has low self-esteem, contact a pediatric dietitian or therapist or both. Make sure that the relevant professional has a no-diet approach.

read! Here are some recommendations:
1. Maryann Jacobsen, How to Raise a Mindful Eater (2016)
2. Ellyn Satter, Your Child’s Weight: Helping Without Harming (New York, 2005)
3. Linda Bacon, Health at Every Size (Dallas, 2010)
4. Linda Bacon and Lucy Aphramor, Body Respect (Dallas, 2014)
5. Evelyn Tribole and Elyse Resch, Intuitive Eating: A Revolutionary Program That Works (New York, 2012)

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