Managing high-calorie, low nutrient foods
Family Meals Focus #92
by Ellyn Satter, Family Therapist and Registered Dietitian Nutritionist
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Outpatient dietitian: I diligently teach Satter’s Division of Responsibility (sDOR) to the parents of all my childhood obesity and metabolic syndrome referrals. A pediatrician called today, concerned that one of her patients’ mothers had said, "the dietitian told us to offer unlimited sweets." Based on your article, Using Forbidden Food and your discussion about “controlled substances” in Secrets of Feeding a Healthy Family,1 I explained that I follow sDOR, which stipulates regular family meals and structured, sit-down snacks, and that those unlimited sweets are to be offered at the occasional sit-down snack. She disagreed and wanted me to incorporate portion control. I stood my ground, but I need the research!
High-calorie, relatively low-nutrient foods, such as sweets, chips, and sodas, are a part of our lives, and parents have to know how to manage them on behalf of their children. You are teaching a trust approach; your referring doctor wants you to teach parents to be controlling and restrictive.
The trust perspective: sDOR
In brief, sDOR recommends using “forbidden” food by including these high-calorie/low nutrient foods in scheduled meal- and snack-times. Within that context, children and other people may eat as much as they want. With the exception of the mealtime dessert strategy, which recommends giving only one serving, once the food is included in the meal or snack, parents do not restrict in any way: not by managing portions, not by running out of food, not by giving the child the look.
The sDOR “forbidden food” strategy in based on the principal that when parents do their jobs with feeding, including providing those foods regularly and in large enough quantities so children can eat them until they are satisfied, children become Eating Competent. They establish a relaxed and positive relationship with food in general and these foods in particular. In the process, children demonstrate that, while appetite can be compelling, it can be satisfied, even when a child particularly enjoys eating or has more-than-usual trouble with impulse control. Having developed Eating Competence in this and other areas, older school-age children and adolescents carry their relaxed, positive, and competent relationship with food into the broader food environment.
The control perspective
In contrast, the control perspective appears to be that children have a tendency to eat too much, particularly of high calorie food, and that tendency has to be controlled by food restriction, portion control, and/or strict limits on access to the foods. This outside control is regarded as being particularly important in the context of today’s “obesogenic” food environment. The evidence, however, indicates that such control of children’s food intake doesn’t work, even within the home. Moreover, unsupervised restricted children tend to overeat when those foods are available, a tendency that leaves them ill-equipped to cope with the broader food environment.
Here is more about the research. Restriction increases children’s enthusiasm for and intake of restricted food.2 Moreover, such enthusiasm and intake is exacerbated when children show tendencies for high approach (positive anticipation) and low inhibitory control (ability to resist or delay gratification).2 According to the Eating in the Absence of Hunger (EAH) protocol, which monitors children’s after-lunch intake of freely available snack foods, restricted children eat more and feel worse about their eating.3 Girls deprived of palatable snack foods show relatively high EAH as well as increasing EAH from age 5 to 9 years, a tendency that is higher in “overweight.” girls.4 In contrast, even girls who are given no structure at all, in that they are allowed unlimited access to all kinds of snacks, have moderate BMIs and lower EAH than those whose parents restrict (how much in combination with what and/or when). Girls whose parents restrict high-fat, high-sugar snacks have relatively high BMI and those whose parents restrict all snacks show relatively high EAH.5
The take-home message
The sDOR “forbidden food” strategy works: that is, matter-of-factly including high-calorie, low-nutrient foods in structured meals and snacks and letting children eat as much as they want of them. In the words of a parent on Facebook, “My teens walk by cupboards of chips and treats. They leave half a dessert unfinished because they are full. Their body weight is normal for them.” However, sixty percent of parents enrolled and wait-listed in an obesity management intervention say “I have to be careful that my child does not eat too much.”6 This is despite the considerable evidence showing that restriction and avoidance don’t work and even do more harm than good. We need research with concrete data demonstrating that children who are fed in the sDOR fashion do better. Such a study has just been completed and will soon be published.
- Satter EM. The feeding relationship: problems and interventions. J Pediatr. 1990;117:S181-S189.
- Rollins BY, Loken E, Savage JS, Birch LL. Effects of restriction on children's intake differ by child temperament, food reinforcement, and parent's chronic use of restriction. Appetite. Feb 2014;73:31-39.
- Fisher JO, Birch LL. Parents' restrictive feeding practices are associated with young girls' negative self-evaluation of eating. Journal of the American Dietetic Association. 2000;100:1341-1346.
- Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger. Am J Clin Nutr. 2003;78:215-220.
- Rollins BY, Loken E, Savage JS, Birch LL. Maternal controlling feeding practices and girls' inhibitory control interact to predict changes in BMI and eating in the absence of hunger from 5 to 7 y1,3. Am J Clin Nutr. Feb 2014;99:249-257.
- Sonneville KR, Rifas-Shiman SL, Haines J, et al. Associations of parental control of feeding with eating in the absence of hunger and food sneaking, hiding, and hoarding. Child Obes. Aug 2013;9(4):346-349.
©2016 by Ellyn Satter published at www.EllynSatterInstitute.org. You may reproduce this article if you don't charge for it or change it in any way and if you do include the for more about and copyright statements.