Parents Lifelines Series, January, 2023
A Conversation with Dr. Marian Tanofsky-Kraff, and Laurie Freeman, PhD, on Food and Your Child: Navigating Struggles with Eating and Body Image
By Melanie Wells
NYC-Parents in Action serves its community with the belief that communication between parent and child is key to bringing kids to a healthy maturity. But there are nuances to be considered, according to subject. In a detailed conversation between Dr. Marian Tanofsky-Kraff (clinical psychologist; eating disorder and body size researcher) and NYC-PIA’s Head of Facilitation, Laurie Freeman, PhD, parents learned that when weight, size and disordered eating are the focus, good communication may be as much about what NOT to say as what to say. That, and keen observation, are tools parents can use to help prevent disordered eating.
Before posing questions from parents, Dr. Freeman asked Dr. Tanofsky-Kraff for an overview of what would be “helpful for parents to understand about food, weight and body image.”
Dr. Tanofsky-Kraff thanked Dr. Freeman and noted this was a “good time to discuss the subject, given the pandemic.” She clarified that “disordered eating” is an overall term referring to a range of behaviors: constant dieting; body image distress; loss of control (as in binge eating); and hedonic eating (eating for reasons other than hunger, or using food to cope). She added that knowledge about eating disorders has changed over time; first, although anorexia nervosa and bulimia are still here, they’re no longer primarily a problem limited to thin girls. Rather, disorders “manifest in all genders,” and in people of all sizes, including those with either a “healthy weight, or a larger body.” Secondly, “body size and eating pattern are largely due to biological underpinnings, NOT the result of poor parenting” or personal failure. She cautioned against guilt, or taking responsibility for issues around weight or eating, and firmly stressed that parents should avoid commentary on not only their child’s weight, size and eating patterns, but also avoid commenting on anyone else’s.
Body size and eating pattern are largely due to biological underpinnings, NOT the result of poor parenting or personal failure. Dr. Tanofsky-Kraff
Dr. Freeman said parents had submitted many questions, and asked: What about parents concerned that what they’re doing might lead to problems?
Dr. Tanofsky-Kraff: There are “things we can do to help and things we should NOT do.” For example, we encourage parents to avoid commenting on ANYONE’s weight, body size or eating habits. We encourage parents to praise kids for accomplishments NOT related to eating or weight, and do the same when praising others. Dr. Tanofsky-Kraff urged parents to model for their kids by “filling your home with lots of nutritious foods, and do include a few of the less nutritious foods,” so those items “won’t become special or taboo.”
Avoid setting up a “good vs. bad” dichotomy, too, around food. Any food, Dr. Tanofsky-Kraff noted, can be “bad” if overeaten. Just as there are harmful effects from too much sugar, eating too many carrots can create problems; over-ingesting beta carotene can harm the liver. Eating a range of different foods is best.
LF: What about kids who leave junk food wrappers around, even though they’re eating well in front of their parents?
T-K: Parents need to be observant. If you see signals like skipping meals or hiding certain eating or avoiding events where a lot of food will be served, pay attention and look for other clues like the candy wrappers. Look at kids’ behavior at an ordinary meal: what’s their eating speed? Is your child overly focused on the eating? Do they get upset around food discussions? Check for several factors grouping together.
Look at kids’ behavior at an ordinary meal: what’s their eating speed? Is your child overly focused on the eating? Do they get upset around food dicussions? Check for several factors grouping together. -Dr. Tanofsky-Kraff
LF: Let’s say a parent does see signals: eating fast, discarded wrappers, and the child is experiencing shame; then what?
T-K: Ask your child, what’s going on? How’s school? How are you getting along with friends? Are any kids teasing you, being mean to you? Observe mood, see if your child is anxious. Be alert to stomach aches or headaches. Check with the pediatrician, in case medical issues are causing weight fluctuations. Normal growth in children includes weight gain, but at a healthy rate that your doctor can track.
LF: Eating disorders can involve emotional components, but we also know genetics determine size, for example, if the child is genetically predisposed to higher weight.
T-K: Yes, body size is genetically predetermined, although other factors can come in: insulin resistance, compulsive overeating, or skipping meals to lose weight. Children should learn that body shape is largely biologically determined.
LF: How can we help parents help their children to feel good about themselves?
T-K: This is hard. We have the media setting standards, social media adding to that, and we all have peers who may have a “perfect” body. However, for children, parents still play the MOST influential role in how kids and teens view themselves and the world. Our words have impact so try not to talk about people’s body weight, shape, size.
LF: What words should parents choose for a young girl having a hard time at school if she’s hearing kids say she’s fat and then comes home and tells parents, “I’m fat?” The child is already talking about it – what does the parent say?
T-K: In that case, address it, don’t ignore it. Say, “I’m sad you’re feeling this way. I think you’re a beautiful person no matter what size you are or how you look. If you’re having trouble, we should talk to someone about it.” The least little thing parents say can stick with the child for a lifetime, so be careful. If you’re modeling a lack of focus on body weight eating, dieting and food, that will help.
LF : Can a parent say, we can balance your meals differently?
T-K: I’d avoid that. If there’s a medical or psychological issue driving weight gain, making them think they have responsibility may erode their self-image. It may then be harder to get them in to get help. I would have the child talk with a counselor or supportive person. Stress that there are all sorts of body types, and all can be beautiful. The message you want to keep sending is that THIS IS NOT YOUR FAULT, you are not responsible. If you have balanced meals at home and the family is eating healthfully in front of kids, they will eventually take this message in.
LF: How is this issue working with boys? What should parents know?
T-K: The focus can be different than for girls; boys might focus on being lean and muscular, rather than on numbers on a scale. They seek a muscular upper body, and slim waist shape. That’s okay unless they engage in behaviors or use substances just to promote that shape. They may start “bulking and cutting” – bulk up on certain foods to build muscularity, then cut diet way down to remove excess fat. Athletes use this regularly but it becomes problematic in boys who are compulsively focused on appearance, not athletic performance. To address it, use the same focus as with girls – stress values OTHER than shape, size, weight. Say what your family does value – school, animal welfare, etc. – and continue to model healthful choices of foods in the home while avoiding labeling foods ‘good or bad.’ Link healthful eating and activity to feeling good, getting more energy, functioning well. Allow some sugar, just not much of it.
LF: We know that social media affects how kids feel about their looks. What should you say to a teen who is unhappy about appearance?
T-K: Parents should have an honest conversation about how social media imagery is created – people who look a certain way may have all sorts of filters to make them look as they do in the post and there can be a big gap between that and how they really look. Let teen know an image is not real. Let them know that social media recommendations to achieve a look through dieting can work short term, but will be temporary. People may regain weight or move on to an eating disorder. Have frank discussions with kids about this.
Parents should have an honest conversation about how social media imagery is created – people who look a certain way may have all sorts of filters to make them look as they do in the post and there can be a big gap between that and how they really look… have frank discussions with kids about this. – Dr. Tanofsky-Kraff
We all need to feel good about our bodies, but when someone is gaining too much or losing too much, there may be medical reasons for the patterns; we need to take guilt out of this, and let kids know that size, weight, shape are not the values we care about.
LF: For parents, it can be heartbreaking to see the child’s suffering, and we also have our own worries about appearance..
T-K: Whether it’s high weight, low weight or manifestation of depression (which is also genetic) ask what is behind it? Address it from the deep place up, not top down. Addressing issues “top down” (saying, “here’s your diet”) can be unhelpful. Better to look for what’s driving the anxiety from bottom up, and identify underlying issues.
We all have our own struggles. We have issues left from what we heard growing up, things that can create “normative discontent,” i.e., always thinking “I wished I looked a little better.” We need to recognize our own biases. When I was growing up, I’d go to a friend’s house where the mom cooked a big meal, then sat with us but didn’t eat. Try to be balanced about eating in front of your kids, then get rid of guilt. You, too, were born with your own genetics, and you, like your kids, are not to blame. Work to help them understand this.
LF: A child who doesn’t eat enough: how does a parent know whether it’s picky eating, or something else?
T-K: Picky eating is interesting; some people are picky eaters since birth. If kids are growing healthily and are happy, it can be fine, but notice if they start developing restrictive food intake disorder, or if it’s impacting them emotionally. Do they get upset when someone tells them to eat something at another person’s house? Or, are they losing weight and increasing their earlier levels of pickiness? Then it’s time to speak to your pediatrician and/or someone who does family based therapy.
LF: How much weight loss is the signal?
T-K: Talk to the doctor if you see loss that keeps on going. If there’s a psychological component, then bring in an anorexia nervosa specialist. And if you see alarming symptoms, like being cold all the time, or fainting, consult the doctor right away.
LF: What about your child’s BMI?
T-K: Body mass index is simply “a marker” and not, by itself, an adequate indicator of health. The physician should track it, because fluctuations may signal medical issues, but BMI should be viewed in the context of other factors.
LF: What about siblings of different weights – one heavier than another?
T-K: Treat everyone in the family the same, at meals and in what you provide for them, and never point out that one is thinner or heavier. EVERYONE benefits from nutritious meals; both heavy and thin children need that same nutritious balance of healthful food.
Treat everyone in the family the same, at meals and in what you provide for them, and never point out that one is thinner or heavier. Everyone benefits from nutritious meals. -Dr. Tanofsky-Kraff
LF : What should parents say to a chunky child who is skipping lunch along with peers, but also hiding candy wrappers in the house?
T-K: Be careful not to say anything about the eating. Instead, ask first, how are things are at school, how are you feeling? And don’t forget to continue to model eating nutritious meals each day. Avoid connecting food with reward; get ice cream for a treat, not as a reward.
If you see a big weight gain in your child, check with the doctor. Prevention is so much more fruitful than treatment and intervening early can save years of treatment. Have problems assessed early, by someone comfortable working with kids.
LF: So, parents should catch disordered eating signs before it becomes an eating disorder?
T-K: Yes. Each issue involved – early signs of disordered eating, the actual eating disorder itself and weight gain – are all part of the same problem. Act preventively in advance.
LF: I think you’ve offered parents a beautiful way to help children preventively. We should do what we can to not make it all about looks, but about other values.
T-K: Yes! You can say, ‘you look happy’ or ‘you look full of energy,’ instead of ‘you look pretty.’
Dr. Freeman thanked Dr. Tanofsky-Kraff for sharing her expertise and knowledge on this complex subject. On behalf of the NYC-PIA community, she expressed deep appreciation for what we were all able to learn from this conversation.