Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 20. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hi everyone. Thank you for joining me today as always, and if you tuned in last week, thank you for enduring my tangent about home organization. Hopefully I inspired a few of you to go dive into your closets and get purging and organizing. As promised, today we are going to talk about teaching your children healthy habits around food. And even if you don't have children or if your children are grown, I still want you to take the time to tune into the episode today because all of this we can apply to ourselves. I also find that people are most likely to talk to their children in a kind and loving way, which can be really different than how we treat ourselves. Sometimes when we talk to ourselves, we're really mean. We use kind of rude or sarcastic or a cruel voice. And so whether you have young children or not, I want you to imagine the most loving way you can approach this topic and talk about it so that even if you're using these lessons for yourself, you're learning how to talk to yourself in a kind and loving the way you might talk to your own child. I recently read a journal article I wanted to share with you all. I stumbled apart across it as part of my maintenance of certification requirements for the obesity medicine boards. And if you're a physician, you know that over the last few years a lot of us have been rejoicing because every specialty of medicine has its own board exam. And traditionally you would have to sit for that board exam every 10 years. But over the last couple of years, the board exams have realized that one, it doesn't really promote the same ongoing education. You could sort of blow off any education for 10 years and then just cram for the test leading up to it. But also like is it the most efficient way to be taking an exam or to be take like to be assessing your knowledge? And so a lot of board organizations transitioned from requiring you to sit for a board exam every 10 years to instead taking regular quizzes that might be on journal articles or on popular topics in the field. And so for obesity medicine, the maintenance of certification requirement is that we read journal articles and then take a brief quiz asking about that article. I was reading one of these articles recently that was called Caregiver Influences on Eating Behaviors in Young Children. And I was really excited to read the article because so much of what I talk about with my patients is related to our behaviors and our thoughts around food. And even though I primarily see adult patients at this time, most of them discuss the influence of their parents and their families and how they've adopted certain beliefs and continue to hold onto these beliefs well into their adult years. So oftentimes, like we've talked about before, we're sort of working to undo that and people don't even realize sometimes it's an issue, maybe they haven't even questioned if those belief makes sense because it's just what they do or how they believe that it is. And certain themes come up over and over again, especially about around being forced to eat or clearing one's plate using food as a reward, that type of thing. And so as we work to undo these beliefs, we learn like how entwined these are with our relationship with food. So when I read the title of the article, caregiver Influences on Eating Behaviors and Young Children, I was excited because I suspect there's actually real evidence to back what I've been saying for a long time, which is of course our parents influence how we eat. And it turns out I was right. And so I'm gonna tell you a bit about this article. So as you know, overweight and obesity is becoming a problem not just for adults, but for pediatrics, for children as well. And we know that children who deal with overweight and obesity are more likely to continue to deal with those issues into their adult years. And of course for years we've known that what a child or what a person eats in influences their weight. And there's been growing evidence to suggest that how a child eats, so how they eat, not just what they eat also influences their weight, which sure, that makes a lot of sense. And so the question is how can we best support our children to nurture a healthy relationship with food? So bear with me a little bit here. I'm gonna dive into the paper. I don't wanna get too into the weeds so to speak, but it was a really great article and I want to make sure to do justice as I share it with you all. So broadly speaking, children demonstrate an inherent self-regulation. That means that they vary their food intake in response to the caloric density of the food and the energy expenditure needed to maintain a healthy growth. So basically meaning how dense the food is. Are you eating an apple? Are you eating cheese that's gonna have more calories? Have you been really active? Are you going through a growth spurt? All of those things are going to influence how much a kid eats. And I've mentioned this briefly before in the context of my own children. Sometimes they take teeny tiny meals and they'll eat like three bites or zero bites. Other times I am shocked by how much food they can put into their little bodies. And children do still vary widely in the extent to which they demonstrate self-regulation. And this can be influenced by so many factors, whether we're talking about genetics, the maternal diet and weight gain during pregnancy. And this is a developing area of research and it's certainly important, but it wasn't the focus of this paper. And then it's important to point out too, there's certain genetic syndromes like Prater Willie for example, which is a genetic syndrome that has a lot of features, but one of which is specifically related to food. And patients with Prater Willie have severe dysregulation of food so they feel hungry all the time like ravenously hungry. So setting aside genetic syndromes like that and these nuances that we haven't fully studied and don't fully understand yet. Broadly speaking, all children are born with an inherent self-regulation of their food. And some kids may have quote a better self-regulation than others, but all healthy kids do have this inherent self-regulation of food intake. And so as such, the caregiver's overarching goal should be to allow children autonomy over their eating such that the child can start eating and stop eating in response to their hunger and satiety. And the caregiver needs to balance the child's autonomy with providing mealtime structure and healthy food options. So mealtime structure might mean that food is consumed at the kitchen table, for example, as opposed to wandering around the house or eating food on the go. It might also mean having routine meal and snack times so that the child has a predictable routine. And then providing food of course, or providing healthy food rather, is more obvious, meaning having these healthy and enjoyable foods around the house, both for the kid, but honestly for the whole family. And in this article, the characteristics of caregivers in the feeding environment are divided into four categories based on two different things. So one is the caregiver's responsiveness to the child's needs. So this means that the caregiver is warm, they're accepting, they're involved during mealtime and the caregiver's demandingness, meaning the parents have like how much control or supervision of the feeding. And so they're placed into a category of either high or low responsiveness or high or low demandingness. And so there ends up being four different types of caregiver feeding environments. So I wanna talk about those four different feeding environments or those four different caregivers in the feeding environment and talk about how they might show up. So one is an authoritarian caregiver. This type of caregiver has low responsiveness and high demandingness. This means that the caregiver sets all of the rules and boundaries and aims to direct the child how to eat. They might have set meal times and have a routine, but the caregiver sort of takes it to the next level and is also making or forcing decisions about how much a child eats. And so this looks like forcing the child to eat every bite on their plate even if they're not hungry. It also might mean not allowing a child to have a second portion of food, even if the the child is expressing that they are still hungry. And this feeding style teaches a child that they have little or no control over their feeding. They're always looking externally for guidance. Number two is authoritative, so authoritative as opposed to authoritarian in the authoritative caregiving style. This type of caregiver has both a high responsiveness and a high demandingness. So we'll go back to this later, but this is sort of like the ideal caregiver. It means that the caregiver has set rules and boundaries around mealtime, but allows a child to maintain their hunger and satiety cues. Broadly speaking, that means the caregiver chooses what and when the child eats and the child gets to decide how much the next type of caregiver is the uninvolved caregiver. This type of caregiver has low responsiveness and low demandingness. So it means that the caregiver has really very fuel, if any rules or boundaries or any guidance overeating in young children, it can show up meaning like the parent doesn't even realize the child's hungry. So in an infant that they're screaming at the top of their lungs, a toddler's having a temper tantrum because they're hungry and don't know how to express that yet. And then older children might totally fend for themselves. They might not have lunches packed for school when they're at home. They are walking around the house grabbing whatever they want whenever they want, where the last type of caregiver is the indulgent caregiver. This type of caregiver has a high responsiveness, but a low demandingness, meaning that the caregiver is acknowledging the child's hunger, but they have very fuel rules or boundaries around eating. So the parent is there with the child, they're involved in their eating, but the child's the boss. The child's making all the rules. The kid says, I'm hungry, I want to eat cookies. And they have cookies for a snack. The child runs around the house eating in the kitchen, but also in the playroom and the family room or her bedroom. There's no rules or boundaries. They eat whatever they want whenever they want. It's like the parent who's trying to be like the kid's best friend and provides no guidance to them at all. So when we look at those four different types of caregiver feeding behaviors, you can see that that authoritative one stands out as quote the best. This caregiver feeding style is striking a balance between providing guidance but also allowing for the child to have their own autonomy. Caregivers who are authoritative have a set eating location. Everybody eats in the kitchen at the table, for example. They have a routine with set eating times and they provide healthy foods. It doesn't mean they don't give their kids choices. It might mean like, Hey, it's snack time. Would you rather have an applesauce right now? Or would you rather have a cheese stick? And then they also allow their children to start eating when they're hungry and stop eating when they're full. And so I want you to reflect on this a bit. How were you raised? If you have children, how did you or how are you raising them? And how do you eat? Now you can even imagine if your primitive brain is a child and your developed brain or your prefrontal cortex is the caregiver, what is the feeding style that you have for yourself? Because even for ourselves, we want to provide a plan and a structure to our eating environment and listen to our hunger and our fullness signals, which of course it sounds really obvious, but I want you to stop and really think about it. Are you providing an ideal feeding environment for yourself? Do you have structure to your day? Do you start the day with a food plan? Or do you eat just whatever sounds good and whatever's readily available? Do you stop and have a meal at the kitchen table or at a designated eating place? Or do you eat while you're driving or during a work meeting or just if you happen to walk through the kitchen? And I want you to imagine that you have a clean slate, whether it's for you or for your children or for both of you. How would the best version of you show up? How would you like to model eating behaviors to your children? How would you like to talk about food and mealtime and healthy eating? Because one of my favorite things about being a parent is I get to take these teeny tiny little humans and I raise them. I get to shape and mold them and teach them about the world. I can provide structure where they need it and encourage their autonomy when it's possible. And I get to be a role model for them. It helps me reflect on how I treat myself and how I care for myself. And honestly, there's times that parenting has made me more aware of when I'm being hypocritical. You know, I might tell my kids they can't have a piece of candy right now, but then I eat some candy after they go to bed. Or I take the time in the morning to pack their lunches for school, but then it's time for me to eat lunch and I'm scrounging to find whatever I can in the kitchen. And when these things happen, I don't need to beat myself up about it, but I can look at it from a place of curiosity and take the reminder that I want to love myself, just like I love my children. And the loving thing is having boundaries and the loving thing is making decisions ahead of time and preparing food. And I can do that both for them and for I. And in our house, we spend a lot of time talking about listening to our bodies. My kids are young, they're two and four. So we talk about this in the context of all sorts of things for hunger signals and fullness signals. There's lots of potty training going on right now as we talk about it in going to the bathroom or in going to sleep when we are feeling tired. And it forces me to think about it both for them and for their selves. And so I stop and ask my kids things like, is your tummy saying it's still hungry or is it starting to feel full? And saying it out loud helps me think about my own body and my own hunger and fullness signals, and it helps me to acknowledge theirs. When my four year old says I'm full after three bites of food, I listen to that and I acknowledge that he excuses himself from the table and mealtime's over. And that's that. There's no questioning him. Like, oh, are you sure you didn't eat very much tonight? There's no forcing, just a few more bites when he says he's done, he's done. And because we have a set routine around mealtime in our house, he knows that means no more food until the next meal. And do you know what? He's always fine. Like perfectly, totally fine. He's not whining about how hungry he is. He knows how much food he needs and he listens to his body and he expresses that. And as a parent, it's my role to acknowledge it. And sometimes the opposite happens too. Sometimes my kids eat an insane amount of food. Just the other day, my same four year old who can sometimes survive on three bites of dinner, he ate two and a half bowls of oatmeal. And I don't use like teeny tiny baby bowls to feed him from. It was a regular adult bowl and he ate two and a half bowls. That's like a lot of oatmeal. And he eats oatmeal for breakfast most days of the week. So I had prepared his usual amount and he finished the bowl and said, more oatmeal, please. So I made another bowl, which he finished, and then he asked for more. So I made a third bowl and he ate half of it. And then he said, I'm all done. And that was that I didn't make any sort of huge deal about the amount of food he ate. I didn't question if he was sure I made the food choice. You know, obviously oatmeals become a favorite for him, but we prepare plain, slow cooked, rolled oats. There's ground flax seed, there's milk in it. And so I know it's a healthy option. I don't feel like I need to cut him off. It's not like he's having, you know, a dozen cupcakes or something. I chose a healthy rolled oats and flaxseed option for him. And now he gets to choose the amount that he eats. And honestly, this is a big reason why I'm not super into counting calories or counting macros or counting any sort of points because all of those systems teach us to look outwards instead of looking inwards. And there may be reasons to emphasize certain macronutrients depending on your medical conditions or your exercise goals. And let me be clear, if you're doing those things and it's working for you, totally fine. You do you. But sometimes we are so focused on looking outward to calorie goals or macro goals that we don't even bother to pay attention to how we feel or what our body is actually saying. I have patients all the time who come to me and say, I'm following this diet plan. I'm sticking to these calories. Why am I not losing weight? And the answer is, it's because your body is not a perfect math equation. Instead, it's a very complex system with great variation and our hunger signals and our fullness signals might be dysregulated. We might have been ignoring them for so long, we don't even realize our body still sends those signals to us. Or the hormonal changes of overweight and obesity. Things like insulin resistance interfere with how we interpret our hunger and fullness signals. But it's possible that we can find those hunger and fullness signals. Again, it might mean you need to adjust your food plan. It might mean taking medications to help regulate those signals, and it means actually stopping to listen. And it's possible. My goal for myself and for my children, and for my patients is that they can learn to listen to their bodies. That over time they can develop and truly believe something like I know how to listen to my body and choose the right amount of food for me. So whether you are listening as a parent or listening for yourself, I hope you spend some time reflecting on how you eat. What sort of structure do you have? Do you have a structure? Do you listen to your body? And if not, how do you wanna change that? All right, y'all. That's it for today's episode. If you're interested in learning more about me or if you live in Illinois or Virginia where I'm licensed to practice medicine and you'd like to be a patient in my telemedicine based clinic, please check out my website at www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D dot com. If you've enjoyed the episode today, please subscribe and leave me a review wherever you listen to podcast, share it with any of your friends or family or patients who might benefit. Thank you so much as always for joining me today. I look forward to seeing you next week. Bye-bye.