Recap: A child is born with attunement to cues of hunger and fullness, and will naturally eat well if raised in a supportive food environment. A mother?s role is to nurture this inborn ability by creating the right environment. Emotional development evolves in stages, and understanding these stages can help nurture a child physically and emotionally. Here, we describe a healthy parent-child dynamic as it applies to feeding.
This article will provide perspective on weight concerns and nutrition for adolescents.
If a child?s weight is of concern to a parent or clinician, several factors need to be considered. Firstly, some degree of fat increase is characteristic of pre-adolescent body development and the teenage growth spurt. There is a natural tendency for young teens or preteens to ?bulk up? and then stretch out. If the teen is encouraged to react to this fat increase with food restriction, she might not be giving her body enough food to grow taller. Since growing requires energy, it is important for the adolescent to get enough sleep and nutrition. She is best off eating a balanced diet which contains a substantial amount of protein at most meals along with enough carbs and fat to make her feel comfortably full, which will support her impending growth.
Another factor to consider is that every inch of height weighs approximately 5 lbs., so weight gain is expected as long as a child is still growing and developing. In fact, a child who grows without gaining weight is considered to have lost weight, since her weight in comparison to her height has decreased.
Finally, a substantial number of healthy children will naturally have a larger body. Children?s growth charts were made to reflect a span of healthy children and depict the natural range of sizes. This means that we can expect 20% of healthy children to fall between the 80th and 100th percentile. If your child?s growth measurements are consistent and stable in the higher weight/height percentile, it is likely her natural, healthy size. Genetics are a major determinant of body size, and children often follow similar growth patterns to those of their parents.
A skilled clinician can help determine if weight gain in a child is in fact unhealthy. This might be weight gain that is uncharacteristic to a usual weight trajectory or comes along with abnormal metabolic lab values. In that case, it is important to investigate the cause. Weight gain can be a symptom of a medical issue that needs to be addressed. Emotional stress can also lead to weight gain in some children. Finally, poor nutrition or excessive eating can also cause weight gain. This is the area where a dietitian can be most helpful. Although I address the behavioral science of food rather than the nutritional science of food in this particular series, I value good nutrition. Every parent has a responsibility to learn and follow good nutrition practices at home for the sake of their children. This means devoting time, effort and money into making and buying food that is both nutritious and tasty for all their children regardless of their weight status. Let?s take a moment to make a distinction between helpful and detrimental nutritional pursuits.
Simi is in 9th grade and complains about ?being fat? all the time. Her friends complain too. Many of them are actually quite slender, but clearly calling themselves ?fat? is the trendy thing to do in her class. Having a nutritionist and ?diet? is practically a status symbol. During lunch, Simi watches the group of dieters unpack their salads and compare who-can-have-what-and-how-much-on-which-diet.
Simi decides to visit a local nutritionist and gets a distorted message that the less calories she eats, the better off she?ll be. Simi is not one to settle for second best, so she decides to eat as few calories as possible. She eats a yogurt for breakfast, joins the cool ?salad-only? girls for lunch and eats a bag of light popcorn for snack. She diligently weighs her chicken at dinner and measures her rice. Her best friend claims one must never eat after 8:00 p.m., so if she feels hungry after dinner she will chew gum or drink water.
The numbers on the scale go down and the compliments from family, friends and her nutritionist abound. Simi becomes increasingly aware of her appearance and begins to equate body size with self-worth. One night, after following her diet plan for six weeks, Simi feels drawn to the kitchen pantry past her 8:00 p.m. food curfew. First, she chooses gum and then she takes a water bottle. Later, when nobody is around, Simi experiences a loss of control and polishes off two slices of leftover pizza from the counter and a portion of cold fries.
Despite the regret she feels, this scene begins to repeats itself. Simi finds herself raiding the pantry at night and eating until she feels bloated and uncomfortable. Each time, she vows to never do it again and punishes herself for overeating by running on the treadmill for 30 minutes. Simi?s eating becomes erratic; she starts off her day having skimpy portions, but doesn?t realize that food restrictions during the day cause her to binge in the evening. Her weight climbs back up, and she feels worse than ever about her size, as well as her seeming inability to control herself around food.
In the above story, Simi is experiencing a loss of control around food; a binge-eating behavior. Bingeing happens as a biological response to restricted food intake. Similarly, reducing essential food groups such as carbohydrates or fats can also trigger this response, even if calories aren?t limited. The brain reacts to food restriction by creating food preoccupation with heightened appetite and heightened reward and pleasure from food. In other words, the mind and body become food-seeking. Denying yourself pleasure from the food you eat results in feelings of deprivation that can trigger the binge response.
Good nutrition practices do not include low-calorie, low-carb or low-fat diets! Research shows that restrictive weight loss diets are not beneficial in the long term and most often lead to increased weight as well as disordered eating behaviors.  If weight loss is initiated through restrictive diets (low calorie, low carbohydrate, or low fat) in a child or teen, there is a risk of stunted growth and development along with symptoms of malnutrition such as disrupted hormonal functions. This is true even if the child doesn?t appear thin, since the child isn?t getting enough nutrition to support healthy bodily functions. The solution to overeating is not under eating. Rather, it is to make informed, healthy choices with portions that help you become comfortably full.
The odds of maintaining weight-loss long term through reducing calories or food groups are dismal. One study on monozygotic twins found that the twin with a higher incidence of intentional weight loss ultimately weighed more. This demonstrates that dieting can ultimately leads to increased weight gain.
The body has calibrating mechanisms to maintain a preferred body weight. Engaging in a diet that encourages food denial when hungry and meal cessation prior to fullness will tamper with natural food and weight regulatory mechanisms. Ignoring these inner cues and stripping pleasure from eating is not a lifestyle?it?s a futile attempt to defy the natural order of the eating process, and often results in disconnected and chaotic eating habits including binge eating, yoyo dieting or anorexia. Rather than fighting one?s body size and natural hunger and appetite cues, embrace these natural mechanisms of the body and optimize them with gentle nutrition to benefit their health.
Below, I share my vision of wholesome nutrition that will benefit the adolescent inside and out.
Imagine an adolescent who is sensitive to?and aware of?her hunger and fullness signals. She responds to early hunger cues because she notices them. She makes time to eat because she feels worthy of having her needs met. Being in touch with her physical sense makes her more aware of her inner emotional world. If she is upset about something, she can identify the feeling and get support. She doesn?t numb her emotions with food.
The girl and her mother spend time, effort and money shopping and preparing wholesome meals and snacks. The mother is a positive role model for self-care, and her daughter has learned that she and her needs are important. This daughter makes time for scrambled eggs and whole-wheat toast for breakfast, because it leaves her feeling satisfied and energized throughout the morning. She bakes homemade muffins using healthy ingredients as a nutrient-rich option to satisfy her sweet tooth. Her mother buys pre-cut fruit, nuts and avocado even though they are expensive, because these snacks are refreshing and healthy.
Our teenager eats at the table and pays attention as she starts feeling full. She stops eating when she feels comfortably full because it feels unpleasant to be overly full. Sometimes, if the food is especially exciting, this girl will eat until she feels a bit stuffed, but doesn?t beat herself up for it. She takes note of the discomfort and tiredness she feels after overeating and doesn?t do it often. Occasionally, she enjoys doughnuts or chocolate. She doesn?t feel a need to overeat these foods because she knows she can have them when she wants to, and as she feels full, she notices the food no longer tastes as good. She realizes it?s the larger picture that matters, and feeling deprived of a food she enjoys isn?t a sustainable way for her to eat.
This adolescent has comfortable sneakers and plays basketball because she enjoys it. She takes walks outdoors because it makes her feel strong, clears her mind and boosts her mood. If she is larger than most of the girls in her group of friends, it doesn?t bother her, because she feels healthy?and most of all, she feels valued by family and friends who cherish her warm smile, caring nature and overflowing positivity.
Sustainable and positive nutrition focuses on health, as opposed to size. It also honors hunger and fullness signals, rather than counting calories. This way of eating focuses on foods to incorporate rather than on foods to avoid, and encourages joyful movement instead of militant exercise. Most importantly, this approach is inspired by self-respect and self-care, rather than body-shame and punishment.
These elements of positive nutrition are in line with the intuitive eating model. A dietitian who is well-versed in this model will likely deliver nutritional education through a positive, healthy lens.
Good eating habits begin in infancy and develop as a child gets older. If a parent is aware of the principles of healthy eating, they can guide their child through the developmental stages and help them develop a balanced approach to food. We want our children to be in touch with their physical and emotional needs so they can identify these needs and properly cope with them without misusing food as a way to soothe negative emotions. We also want nutrition to be explored out of interest and self-care, rather than be a source of admonishment. Finally, we want our children to be accepting of their body size and feel their intrinsic self-worth.
This is the final article of this series. We hope you found the articles helpful and insightful, and we welcome any questions or comments.?
Brochi Stauber is a Registered Dietitian Nutritionist whose goal is to make healthy living a lifestyle reality for individuals and families. She combines clinical nutritional knowledge with an understanding of the behavioral science of food, enabling clients to sustain healthy habits. Contact her at 732-731-9340 or email@example.com.
Shira Francis is a Licensed Marriage and Family Therapist in private practice in Chicago, IL. She provides guidance and counseling in relationships and self-development. Contact her at 773-971-3388 or firstname.lastname@example.org.
 Rothblum, E.D. (2018). Slim Chance for Permanent Weight Loss. Archives of Scientific Psychology, 6, 63-69
 Pietil?inen, K. H., Saarni, S. E., Kaprio, J., & Rissanen, A. (2011). Does dieting make you fat? A twin study. International Journal of Obesity, 36(3), 456-464. doi:10.1038/ijo.2011.160