Eating disorders can be physically, emotionally and socially devastating for patients and are difficult for families of those affected. This disorder is the third most chronic condition in adolescents, after obesity and asthma.
Recently the AAP published a clinical report addressing the interaction between obesity prevention and eating disorders. Adolescents can misinterpret what ‘healthy eating’ looks like and thus can lead to an eating disorder.
Hear from Sara Gould, PhD, on how to best manage conversations with teens and providing the right tools on how to live a healthier lifestyles and how the Children’s Mercy Kansas City Eating Disorder Center focuses on the complex medical, psychological, and nutritional issues that contribute to an eating disorder
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Healthy Eating: Easily Misunderstood by Kids and Teens
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Learn more about Sara R. Gould, PhD
Sara Gould, PhD
Sara R. Gould, PhD, is a clinical child psychologist at the Eating Disorder Center at Children’s Mercy Kansas City and is an assistant professor of pediatrics through the University of Missouri-Kansas City School of Medicine. Gould completed her degree at the University of Kansas and completed her Child Psychology fellowship at Children’s Mercy Kansas City in 2011.Learn more about Sara R. Gould, PhD
Transcription:
Healthy Eating: Easily Misunderstood by Kids and Teens
Dr. Michael Smith (Host): So, our segment today is “Healthy Eating: Easily Misunderstood by Kids and Teens”. My guest is Dr. Sarah Gould. She is a clinical psychologist at the Eating Disorder Center and Children's Mercy Kansas City and she's the Assistant Professor of Pediatrics at the University of Missouri Kansas City School of Medicine. Dr. Gould, welcome to the show.
Dr. Sarah Gould (Guest): Thank you, I appreciate being here.
Dr. Mike: So, the American Academy of Pediatrics recently published a clinical report that said something interesting and I'm going to quote this. It said, "Adolescents can misinterpret what healthy eating looks like and thus, can lead to an eating disorder." Can you tell us a little bit more about why kids are misinterpreting what healthy eating looks like?
Dr. Gould: Absolutely. So, one thing to consider is purely developmental level and where kids are with developmental prefaces and particularly cognitive ones and how they're seeing the world which influences how they interpret information. And, so kids, by nature, are pretty black and white thinkers. They're either/or and, therefore, they have trouble with that middle ground with moderation and so a lot of what we know about health, in general, and healthy eating, in particular, is that extremes are the problem. It's that middle ground that's actually healthy and kids have trouble with that. So, kind of over-classifying foods as unhealthy equal bad; healthy equal good and so can go more easily to that extreme things adults can, with their understanding of the moderation piece.
Dr. Mike: Yes. So, how can you tell if you have a picky eater or a child who may truly have an eating disorder?
Dr. Gould: That is a fine line and a question that parents are very concerned about at times, and it is helpful to keep in mind that there is a new eating disorder in the latest DSM, DSMIV called "Avoidant Restrictive Food Intake Disorder" which is kind of multifactoral. A lot of things fall into that, but the biggest presentation, the most common presentation we see is related to either fear of new things. So, restricted diet just because new things are scary or kids have a pretty strong reaction to broadening what they accept as far as their nutrition, or sensory concerns. So, they get kind of stuck on accepting foods of a certain texture but not another, or a certain color but not another and the line between picky eating and problematic eating, whether or not there is a body image piece involved, is really a matter of are kids' diets--what they will accept--so restrictive that it limits their nutrition? So, does it exclude an entire food group, for example, or really limit meeting their body's needs in that way? Or, is it that they're selective? But overall, they're hitting foods in all food groups, their growth is on track as far as their growth history and where it looks like genetically they're built to be, or is growth starting to be impacted? Are their percentiles, for example, for height and weight dropping off? And so, part of where we judge that is on the impact of the eating. And, another thing to consider, too, is the social piece. Can kids go to sleep overs or their class party and eat pretty much like the other kids or does it really limit different aspects of life like that, that they're able to be involved in?
Dr. Mike: Yes. So, you know, something that's going on in our country today, and this a good thing, right? We're trying to educate not just kids, but adults, right, about what healthy eating actually is. For decades, we've been eating way too many preservatives, foods that aren't fresh, a lot of sugar, salts; we know that. So, there's a movement now in trying to help kids and adults identify healthier foods, healthier food choices, but there's kind of flip side that you start to see that, in some cases, that becomes kind of an obsession for some people, even some kids. Do you ever recognize that as a problem and that could lead to an eating disorder?
Dr. Gould: Absolutely and part of that is tied in with our cultural view. We put a lot of morality in food, in particular, healthy behaviors in general, but our food choices, in particular, and thinking about someone on a diet, for example, is seen as having good self-control and good discipline and good self-care, and we talk about it in that way, "Oh, I broke my diet. I cheated." We use pretty negative terms that reflect character, not just the food, and food is actually neutral. It's just molecules piled together and so, that can really heighten that dichotomy and feed into, pun not intended, what you're referring to as that obsession, or that potential obsession that can go into an eating disorder of either type, whether it's anorexia with a lot of restriction, or there's binge eating involved as in bulimia or binge-eating disorder.
Dr. Mike: Yes, that's interesting. Is that an important thing, if you're a parent and maybe you're concerned that your picky eater might be crossing that fine line, that you can listen to the words he or she uses to describe their diet and when they fail that diet. I mean, is that an important cue that we can get in on?
Dr. Gould: Absolutely and diets themselves are problematic. They're a risk factor for both eating disorders and obesity. And so, it's part of that framework as well. How many rules are there? Do I generally eat a good balance with sweets or chips in there sometimes, or do I consider those types of foods forbidden and out of bounds? And so, even that approach, we hear in marketing in all the time, they use the scarcity phenomenon, "Buy it now, limited time only. Soon to run out" as a selling tactic because there is that "Oh, well now is my chance! Well, in case I need it later, I’ve got to get it now," and we can be that way with our food as well if we consider certain foods off limits or not allowed for us, then once we take a bite, we feel like we've already broken the rule and we might as well go all the way.
Dr. Mike: Yes, yes. So, let's talk about kids versus teens for a moment. So, let's first start with the kids, how can you help a child, you know, a child, a pre-teen, make healthier eating habits?
Dr. Gould: Sure. One is to treat all foods as allowed, but remember that parents, largely, control what foods are available and so, that is one way to help kids learn how to eat in a healthy way and in a balanced way, again, with cupcakes or things thrown in there once in awhile, without even talking about it. That's just what they're used to. They're used to grabbing an apple and peanut butter for a snack, for example. Or things like that, so it's just what their habits get to be, what they think of when they think of a snack or a meal. And then, part of it, too, is talking about balance. With younger kids, in particular, it can be helpful to talk about--they will ask you because they hear lots of education one way or another, whether it's at school or on PBS or different avenues, about healthy eating and so they’ll ask, “What part of my body is this good for?” and that can feel a stump when it's chips or something like that. You're like "That's good for our tongue. Food can be for enjoyment, too," and so helping them break down the barriers in that way and then also talking about the flip side of it. “Well, milk is really good for your bones; bread is really good for energy; meat is really good for your muscles,” and helping them tie that into health in a more concrete way because kids don't understand long-term consequences and outcomes very well, and they don't understand those implications. So, tying it to them and their physical experience can be really helpful.
Dr. Mike: And then, how does that differ a little bit for the teen, then, who's obviously a little bit more independent, at school longer. What are some of the suggestions there?
Dr. Gould: Sure. Some of that can be one helpful thing, a protective factor, again, for both obesity and eating disorders is schedule family meals. There's a lot of speculation for why that seems to help. There's not a lot of agreement on that, but it does seem to hold true. So, part of that is likely because, then again, it's a family planning a meal in a balanced way with different food groups rather than teens hitting the door super hungry and grabbing whatever they can from the cabinet and helping kids plans that way, as well. And, for some kids, that means making sure they have a snack between school and their sport so that they're not so overly hungry when they get home, which makes all of us at risk for overeating if our bodies are past that point.
Dr. Mike: Yes. This is really fascinating information and I think I liked what you said, especially with the child or the pre-teen, you know, helping them to relate a certain food group to a certain benefit in the body. I think, to me, that seems like that would really help to clear the misunderstanding that some kids have about what healthy eating is. So, have you experienced that in your practice where if the kids relayed a certain food group to a benefit, that that really is helpful?
Dr. Gould: Yes. It does help. We also have a subset of, I'd say, the middle elementary age, kind of 8-10, probably, in particular, that don't have as much body image concerns when they come to us in our practice, but they have high anxiety and perfectionism and what they're trying to do is they're trying to be perfectly healthy. That's impossible to measure on a school assignment, you know when you've gotten as good as you can get, but with health, you can always keep going or if you feel…because a lot of the message we get is losing weight is healthy, irrespective of what your weight is. And so, if that is the framework--losing weight is always healthy--you could always try to lose more. And so, sometimes, what those younger kids in particular just need is permission to meet their body's needs and reassurance that they can do these other things, these alternatives to the behaviors they're currently engaging in, and those things are what's actually healthy for them. So, they just need some clarification/guidance--partly just information, but partly the reassurance for their anxiety to help them know that they're really okay.
Dr. Mike: Yes and that's really important, too, because that overall marketing message that we all must lose weight, that's not going to go anywhere, right, so we have to really be on the ball as parents, as practitioners, to really educate them about what healthy eating is and so I think the work that you're doing is fascinating and also I want to thank you for coming on the show today. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you go to www.childrensmercy.org. That's www.childrensmercy.org. I'm Dr. Michael Smith. Thanks for listening.
Healthy Eating: Easily Misunderstood by Kids and Teens
Dr. Michael Smith (Host): So, our segment today is “Healthy Eating: Easily Misunderstood by Kids and Teens”. My guest is Dr. Sarah Gould. She is a clinical psychologist at the Eating Disorder Center and Children's Mercy Kansas City and she's the Assistant Professor of Pediatrics at the University of Missouri Kansas City School of Medicine. Dr. Gould, welcome to the show.
Dr. Sarah Gould (Guest): Thank you, I appreciate being here.
Dr. Mike: So, the American Academy of Pediatrics recently published a clinical report that said something interesting and I'm going to quote this. It said, "Adolescents can misinterpret what healthy eating looks like and thus, can lead to an eating disorder." Can you tell us a little bit more about why kids are misinterpreting what healthy eating looks like?
Dr. Gould: Absolutely. So, one thing to consider is purely developmental level and where kids are with developmental prefaces and particularly cognitive ones and how they're seeing the world which influences how they interpret information. And, so kids, by nature, are pretty black and white thinkers. They're either/or and, therefore, they have trouble with that middle ground with moderation and so a lot of what we know about health, in general, and healthy eating, in particular, is that extremes are the problem. It's that middle ground that's actually healthy and kids have trouble with that. So, kind of over-classifying foods as unhealthy equal bad; healthy equal good and so can go more easily to that extreme things adults can, with their understanding of the moderation piece.
Dr. Mike: Yes. So, how can you tell if you have a picky eater or a child who may truly have an eating disorder?
Dr. Gould: That is a fine line and a question that parents are very concerned about at times, and it is helpful to keep in mind that there is a new eating disorder in the latest DSM, DSMIV called "Avoidant Restrictive Food Intake Disorder" which is kind of multifactoral. A lot of things fall into that, but the biggest presentation, the most common presentation we see is related to either fear of new things. So, restricted diet just because new things are scary or kids have a pretty strong reaction to broadening what they accept as far as their nutrition, or sensory concerns. So, they get kind of stuck on accepting foods of a certain texture but not another, or a certain color but not another and the line between picky eating and problematic eating, whether or not there is a body image piece involved, is really a matter of are kids' diets--what they will accept--so restrictive that it limits their nutrition? So, does it exclude an entire food group, for example, or really limit meeting their body's needs in that way? Or, is it that they're selective? But overall, they're hitting foods in all food groups, their growth is on track as far as their growth history and where it looks like genetically they're built to be, or is growth starting to be impacted? Are their percentiles, for example, for height and weight dropping off? And so, part of where we judge that is on the impact of the eating. And, another thing to consider, too, is the social piece. Can kids go to sleep overs or their class party and eat pretty much like the other kids or does it really limit different aspects of life like that, that they're able to be involved in?
Dr. Mike: Yes. So, you know, something that's going on in our country today, and this a good thing, right? We're trying to educate not just kids, but adults, right, about what healthy eating actually is. For decades, we've been eating way too many preservatives, foods that aren't fresh, a lot of sugar, salts; we know that. So, there's a movement now in trying to help kids and adults identify healthier foods, healthier food choices, but there's kind of flip side that you start to see that, in some cases, that becomes kind of an obsession for some people, even some kids. Do you ever recognize that as a problem and that could lead to an eating disorder?
Dr. Gould: Absolutely and part of that is tied in with our cultural view. We put a lot of morality in food, in particular, healthy behaviors in general, but our food choices, in particular, and thinking about someone on a diet, for example, is seen as having good self-control and good discipline and good self-care, and we talk about it in that way, "Oh, I broke my diet. I cheated." We use pretty negative terms that reflect character, not just the food, and food is actually neutral. It's just molecules piled together and so, that can really heighten that dichotomy and feed into, pun not intended, what you're referring to as that obsession, or that potential obsession that can go into an eating disorder of either type, whether it's anorexia with a lot of restriction, or there's binge eating involved as in bulimia or binge-eating disorder.
Dr. Mike: Yes, that's interesting. Is that an important thing, if you're a parent and maybe you're concerned that your picky eater might be crossing that fine line, that you can listen to the words he or she uses to describe their diet and when they fail that diet. I mean, is that an important cue that we can get in on?
Dr. Gould: Absolutely and diets themselves are problematic. They're a risk factor for both eating disorders and obesity. And so, it's part of that framework as well. How many rules are there? Do I generally eat a good balance with sweets or chips in there sometimes, or do I consider those types of foods forbidden and out of bounds? And so, even that approach, we hear in marketing in all the time, they use the scarcity phenomenon, "Buy it now, limited time only. Soon to run out" as a selling tactic because there is that "Oh, well now is my chance! Well, in case I need it later, I’ve got to get it now," and we can be that way with our food as well if we consider certain foods off limits or not allowed for us, then once we take a bite, we feel like we've already broken the rule and we might as well go all the way.
Dr. Mike: Yes, yes. So, let's talk about kids versus teens for a moment. So, let's first start with the kids, how can you help a child, you know, a child, a pre-teen, make healthier eating habits?
Dr. Gould: Sure. One is to treat all foods as allowed, but remember that parents, largely, control what foods are available and so, that is one way to help kids learn how to eat in a healthy way and in a balanced way, again, with cupcakes or things thrown in there once in awhile, without even talking about it. That's just what they're used to. They're used to grabbing an apple and peanut butter for a snack, for example. Or things like that, so it's just what their habits get to be, what they think of when they think of a snack or a meal. And then, part of it, too, is talking about balance. With younger kids, in particular, it can be helpful to talk about--they will ask you because they hear lots of education one way or another, whether it's at school or on PBS or different avenues, about healthy eating and so they’ll ask, “What part of my body is this good for?” and that can feel a stump when it's chips or something like that. You're like "That's good for our tongue. Food can be for enjoyment, too," and so helping them break down the barriers in that way and then also talking about the flip side of it. “Well, milk is really good for your bones; bread is really good for energy; meat is really good for your muscles,” and helping them tie that into health in a more concrete way because kids don't understand long-term consequences and outcomes very well, and they don't understand those implications. So, tying it to them and their physical experience can be really helpful.
Dr. Mike: And then, how does that differ a little bit for the teen, then, who's obviously a little bit more independent, at school longer. What are some of the suggestions there?
Dr. Gould: Sure. Some of that can be one helpful thing, a protective factor, again, for both obesity and eating disorders is schedule family meals. There's a lot of speculation for why that seems to help. There's not a lot of agreement on that, but it does seem to hold true. So, part of that is likely because, then again, it's a family planning a meal in a balanced way with different food groups rather than teens hitting the door super hungry and grabbing whatever they can from the cabinet and helping kids plans that way, as well. And, for some kids, that means making sure they have a snack between school and their sport so that they're not so overly hungry when they get home, which makes all of us at risk for overeating if our bodies are past that point.
Dr. Mike: Yes. This is really fascinating information and I think I liked what you said, especially with the child or the pre-teen, you know, helping them to relate a certain food group to a certain benefit in the body. I think, to me, that seems like that would really help to clear the misunderstanding that some kids have about what healthy eating is. So, have you experienced that in your practice where if the kids relayed a certain food group to a benefit, that that really is helpful?
Dr. Gould: Yes. It does help. We also have a subset of, I'd say, the middle elementary age, kind of 8-10, probably, in particular, that don't have as much body image concerns when they come to us in our practice, but they have high anxiety and perfectionism and what they're trying to do is they're trying to be perfectly healthy. That's impossible to measure on a school assignment, you know when you've gotten as good as you can get, but with health, you can always keep going or if you feel…because a lot of the message we get is losing weight is healthy, irrespective of what your weight is. And so, if that is the framework--losing weight is always healthy--you could always try to lose more. And so, sometimes, what those younger kids in particular just need is permission to meet their body's needs and reassurance that they can do these other things, these alternatives to the behaviors they're currently engaging in, and those things are what's actually healthy for them. So, they just need some clarification/guidance--partly just information, but partly the reassurance for their anxiety to help them know that they're really okay.
Dr. Mike: Yes and that's really important, too, because that overall marketing message that we all must lose weight, that's not going to go anywhere, right, so we have to really be on the ball as parents, as practitioners, to really educate them about what healthy eating is and so I think the work that you're doing is fascinating and also I want to thank you for coming on the show today. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you go to www.childrensmercy.org. That's www.childrensmercy.org. I'm Dr. Michael Smith. Thanks for listening.