Eating Competence in Children - by Lisa Geraud, LMFT, RD

Lisa Geraud, LMFT, RD is the Executive Clinical Director at Eating Recovery Center of Washington. Below she shares her thoughts on eating competence in children.

Young people, from birth through final stages of physical growth as young adults, grow at variable rates, on variable timetables, have varying energy needs and arrive at variable healthy body weights.  So long as one is heeding biological signals for hunger and fullness, eating a wide variety of foods from many food groups and engaging in normal levels of activity, their weight, body shape and degree of fatness can be trusted to reflect genetic endowment and be healthy. Children grow along channels of growth from birth.  Those skilled in nutritional assessment of children and teens understand that some kids grow naturally and healthfully at the 10th to 25th percentile for age while others grow in the same way at or above the 85th percentile. Health may be impaired by deficient or excessive nutrition.  Since weight loss in childhood or adolescence is a concern due to the normalcy of weight gain during this period of life, weights dropping below the growth channel should prompt a nutritional assessment and exercise inventory.  Likewise, since rapid weight gain or weight gain exceeding the growth channel may signal eating that is excessive for the individual or barriers to activity, this occurrence should prompt a nutritional assessment. The important points are these:

  1. Children growing at or above the 85th percentile may be eating very competently and have good health habits.  It should never be assumed that higher BMI children and teens (or adults) are overeating or under-active.
  2. Trying to achieve a lower weight or different body shape through restricted eating and excess exercise will be an eating disorder gateway behavior for those vulnerable. In our thinness-idealizing culture, high BMI children and teens need acknowledgement and support for continued eating competence and support for accepting their natural body.  For those who do not develop eating disorders, chronic dieting may still promote dysregulated eating generally, which may have adverse effects on body image, mood and physical health.
  3. When a nutritional assessment reveals a pattern of eating that is excessive for the individual, i.e. frequent eating when not hungry and frequent eating past comfortable fullness, and possible low food variety – the goal should be to restore regulated eating, not intentionally lose weight. Weight that is excessive for the individual may be slowly lost through restored regulated eating, but it is important to not make weight outcomes the priority.  Establishing regulated eating and normal activity in the spirit of joyful movement – not calorie burning focused on weight loss -- are appropriate goals supporting regulated eating and exercise.

Regulated eating is promoted by the following:

  1. Consistent availability of a wide variety of foods through regular meals and snacks, with adequate food provisions for variety and sustenance.
  2. Eating according to hunger and fullness cues.
  3. Sufficient time to eat so that hunger and fullness cues may be sensed.
  4. Breaks between eating times for other life activities.
  5. Flexible eating that permits spontaneity and eating for pleasure regularly along with eating for nutritional content. Desserts and other pleasurable foods are neutral and have their place in one’s diet along with nutrient-dense foods.
  6. Parents of children and teens are responsible for providing food resources as well as the environment supporting eating competence under the wide umbrella of parenting.

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