Kid on a Diet? - Dialogue of a Client Session

I click “begin meeting” and Lauren’s open, pleasant face fills my screen.

“Hi, I’m Noa. Thanks for being here today. You write that you are looking for help with your daughter’s nutrition, because she has been overeating and her weight is off the charts. Can you tell me more?”

Lauren starts talking and I can tell from the tension in her voice that she’s concerned.

“My Zoe is almost ten and is the sweetest most adorable girl. She does well in all areas, but she’s really struggling with food. My husband and I are both on the bigger side, so I’m not expecting these tiny kids, you know?I don’t care so much about her weight but I’ve been watching her lately and the way she relates to food is troubling me.

I am nodding and listening. This mom has a lot to say and her story is as heartbreaking as it is compelling.

“Food is like oxygen for her. She’ll ask me for more, so I’ll ask her gently if she’s still hungry. She always says yes, and then just keeps on eating. Occasionally she’ll even vomit from eating so much. We also find her sneaking food sometimes. I’m not into being a policeman; I’m not into controlling her food. But I just don’t know what to do.”

Lauren fiddles with her ring, cocks her head and is quiet for a moment before releasing the next few words in a rush. : “My mother sent me to a nutritionist at 11 years old”

I stay quiet.

Lauren sighs. “It gave me terrible body image and sent my weight yoyoing for years. After that – I promised myself that I would never put my kids on a diet. But now, what choice do I have?

I shake my head in admiration for this brave mother. “Wow, thank you for this background. I am glad that Zoe has you advocating for her. I try to teach people exactly what you said – that weight itself is not an issue – and due to genetics it’s hardly in our control. We can only control our behaviors, and trust that healthy behaviors will support overall health, which includes regulating a healthy weight.

Lauren chuckles but she sounds frustrated. “Well, I’m happy to hear that you agree with me, but then why is Zoe so out of control with her food? Yesterday, she told me she was staaaarving at lunchtime, so she ate 3 pieces of pizza .”

“That does sound like a lot. Can you tell me what she ate earlier that morning?”

Lauren grits her teeth – “Okay, I’m guilty! Most days, my kids run out of the house without eating breakfast. They never seem too interested. But how is eating more breakfast going to help her eat less?”

“Skipping meals is actually a perfect recipe for overeating later. Making sure to serve a balanced breakfast including a protein, carb and a fruit or vegetable some color will balance her blood sugars and prevent her from being starving later. Adding breakfast doesn’t mean adding more calories overall. Actually Zoe may even come out eating less since she’ll be less hungry for lunch.”

Lauren nods. “That makes sense. I have to make breakfast happen. But here’s another problem: suppertime. Yesterday I made chicken, rice and vegetables. Zoe didn’t want it, and found frozen potato perogies instead. She wanted to make the whole package. I showed her that there are 6 servings in the package but I don’t want to make her feel restricted – so I don’t tell her that she can’t have. She ended up eating almost the whole package.”

I pause. The current food scene that Lauren paints is messy; but I’m wondering if there’s more background that I’m missing.

Lauren fills me in on a visit to a kinesiologist a couple years prior. In order to manage her eczema, Zoe was instructed to cut out dairy and gluten and was very upset that she could no longer have many favorite foods.

“You know, I do wonder if this is really where the food-obsession started..” Lauren trails off, looking pained.

The pieces are coming together and it sounds like despite the mother’ss best intentions, this is a case of a very common issue: subtle restriction. Psychologically, when people are limited or restricted, the resulting deprivation mindset creates even more interest in food.

I smile encouragingly to Lauren as I begin to give her some pointers.

“You are doing so many things right. But I think even pointing out the serving size and asking her if she is still hungry feels restrictive. These comments make her think that you want her to eat less, but actually it does the opposite and makes her want to eat more.”

Lauren is thoughtful. “I guess I still have some anxiety that I’m not doing enough to manage her eating. But you’re saying that my comments are doing more harm than good.”

I nod. “Although Zoe is overeating, I don’t think anything is actually wrong with her hunger and fullness hormones. She just needs to trust that she can have as much food as she needs.”

“It’s scary to let go of trying to control your child’s weight; but what’s happening now is clearly not working.”

Lauren sighs. “I hear you. If I try to control her, she’ll sneak it anyway or overeat the next time. So, what should I do when she wants the whole package of perogies?”

I pause to think.

“Ok, I have an idea. When she asks for the perogies – instead of trying to minimize her portion, can you instead focus on maximizing her nutrition? What can you add? A yogurt, soup, any protein fruit or vegetable? That will help keep her satiated so she doesn’t have to overdo it on the carbs.”

Lauren’s eyebrows perk up and she nods slowly.

I continue: “This way, you are showing her that you are on her side. Not only are you not taking away her food, you are offering her more foods, and making sure that she gets enough to eat.”

“What a concept!” says Lauren. “I’ll try to help her find more food groups to add.”

“Super! We’ll need to wrap up this session but can I have you try this experiment over the next week? No commenting on Zoe’s quantities, help her find a variety of food groups when she is hungry, and add breakfast.”

“Yes,” Lauren smiled. “I will do my best.”

“Great!” Let’s see how it goes and we’ll take it from there next week.”