Medical Professional Publications

Overly Restrictive Feeding Practices May Contribute to Obesity

(From the July 2015 Issue of PediatricsOnline)

It is estimated that by 2020, 16 million kids under the age of 5 will be obese. Currently, most public health initiatives are focused on promoting healthy eating and physical activity to reverse the trend. However, the origins of childhood obesity may be as much about psychology as biology.

“The feeding dynamic between caregivers and their toddlers as a factor in childhood obesity is truly underestimated,” says Ihuoma Eneli, MD, medical director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital. “We’re finding that if mealtime becomes a battleground or filled with tension, it could establish a relationship with food that leads kids to unhealthy eating behaviors later.”

Fighting with a picky toddler about what they eat seems to be a rite of passage for most parents, but Dr. Eneli explains that in a healthy feeding dynamic, parents choose how, when, where and what children eat, without being excessively restrictive and controlling. Within those boundaries, kids choose how much and what to eat, but they can decide not to eat as well. This gives the child a sense of independence, and they begin to learn what it feels like to be full – something that can get hijacked if parents force kids to ‘clean their plate’ or to eat certain amounts of foods.

“When parents are excessively restrictive about eating, two things happen. One, kids learn to eat when they are not hungry. Two, the struggle gives food more power than it should really have – and kids are very intuitive about how they can use that as leverage. The long term result could be dysfunctional thinking about the role that food has in a person’s life,” Dr. Eneli says.

Obese Mothers More Likely To Restrict Kids Eating Habits

There have been few studies on feeding dynamics, and evidence-based practices don’t exist. In a recent study published in Clinical Pediatrics, Dr. Eneli and her team looked at the demographics and characteristics of mothers who engage in restrictive feeding practices with children ages 2 to 5. She found that mothers who were the most controlling and concerned about their child’s food intake were more likely to be obese. Dr. Eneli says that the finding is expected, but also points to the complexity of the feeding relationship between mother and child.

“Of course, obese mothers don’t want their kids to become obese. What was interesting is that the less restrictive mothers were about their own eating habits, the more restrictive they were with their kids,” Dr. Eneli says. “We can begin to see how childhood obesity has to be addressed from multiple angles.”

Single, poor or divorced mothers were more likely to pressure their kids to eat than women with partners. Caucasian women were less restrictive about their child’s eating than both Asian and African American mothers.

On average, women in the study reported that they provided their children with nutritious meals and snacks, kept children on a meal time schedule, and created a pleasant meal time environment. However, the study identified three areas where mothers’ feeding roles were breaking down.

“In our study, mothers reported letting their kids eat anywhere in the house – like in front of the TV. They were telling their kids how much to eat, and if their child didn’t like what was served, parents were behaving like short order cooks and fixing alternative meals,” notes Dr. Eneli, who is also professor of Clinical Pediatrics at The Ohio State University College of Medicine.

Dr. Eneli and her team are using the data collected from this study to help with their current project: testing a feeding dynamic intervention they developed for 3-5 year olds and their mothers.

Putting Food in Its Place

Dr. Eneli, who is also a mother, says she can sympathize with parents who want their child eating balanced and healthy meals. She assures parents that they have the ultimate control because they decide what foods to offer their child. However, giving children the perception that they are in control is important and can help them establish a healthy relationship with food.

Here are a few tips that Dr. Eneli suggests sharing with parents:

  • Take dessert off its pedestal. Try making a small dessert part of the regular meal rather than a reward for eating everything. “Take the crown off the cookie, and make it less sparkly. Yes, your child will eat the dessert first for a week or so, but then it will lose its luster. She’ll learn she can savor it after she’s eaten her meal.”
  • Serve smaller portions of everything. This opens the door for offering seconds on what they want to eat, plus maybe a fruit or vegetable. “The child is learning about feeling full while having her opinion respected, and that grows trust – a very positive emotion to have in relation to feeding.”
  • Let your child choose snack time. After lunch, ask your toddler what time they want to have snack. “If they get hungry, you can remind them that they picked snack time so they feel in control.”
  • Kid spits out veggies? That’s actually progress. Negative reactions (beyond teaching table manners) to the way your toddler responds to new foods can be interpreted as “being bad.” Keep finding ways to introduce the food again – with flavors like butter, salt, or ranch dressing.
  • Only serve food in the kitchen. “I might bend in other areas, but in my house, this is an absolute.”
  • Choose your words wisely. Assess how much time you spend talking to your child about food (this includes talking about healthy foods too!) If you feel it is too often, you are probably right. Doing so may create more anxiety for you and your child. Scale it back.
  • Pick your battles. Always serve at least one thing you know your child will eat. That way, if they choose not to eat anything else, you know they’ve gotten something. “Once your child realizes that feeding time isn’t going to be a battle of wills, they will eventually start eating what you give them. Stay positive and firm, and remember that children have the ability to learn healthy eating if you will just let them.”

Eneli IU, Tylka TL, Watowicz RP, Lumeng JC. Maternal and child roles in the feeding relationship: What are mothers doing? Clinical Pediatrics (Philadelphia). 2015 Feb;54(2):179-182.

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