Under Pressure

Under Pressure

Lisa’s second New York Times best seller is a celebrated, urgently needed guide to addressing the alarming increase in anxiety and stress in girls from elementary school through college.

Untangled

Untangled

Lisa’s award-winning New York Times best seller–now available in eighteen languages–is a sane, informed, and engaging guide for parents of teenage girls.

Episode 53

Should I Comment on My Child’s Weight?

How do we teach kids healthy eating habits without focusing on calories or portion size? A parent writes in asking for advice about whether she should say something about her daughter's increasing weight. Dr. Lisa explains how to approach the delicate topics of food and weight and what should be discussed. Reena asks what it means to be of a “healthy weight.” Lisa also names the four power struggles that parents will want to avoid - because the kid has all the power.

October 26, 2021 | 26 min

Transcript | Should I Comment on My Child’s Weight?

Ask Lisa Podcast, Ep. 53: Should I Comment on my Child’s Weight?

 

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional

mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being,

consult a physician or mental health professional.

 

REENA: What do you say about me psychologically that I’m that mom who puts out the decorations like a month early? We have like eight pumpkins. I put a scary witch hanging from my neighbor’s tree that my husband said, they’re not going like that. Why are you doing that? That’s not even your tree? I do love Halloween.

 

LISA: I love it. I love Halloween and my kids love Halloween. It’s like, it’s such a great holiday in so many ways. There’s no question.

 

REENA: It is, but I always have this issue of when do I dump the candy and hide it? Now they’re at that age where they know how much candy they have so I can’t, and you can’t take it to work anymore because you’re working from home. I used to dump bags.

 

LISA: Exactly.

 

REENA: We thought this might be a good week to sort of talk about kids and weight, and we got this letter, Lisa, that says: Dear Dr. Lisa, I have an 11-year-old daughter and one of the hardest issues we’ve had to face has to do with her relationship with food. She’s eaten more than ever, she’s already overweight, and I find myself in a difficult situation. If I say something about it, she gets even more anxious or frustrated and eats even more. On the other hand, if I do not say anything about it, I feel I am not helping her. I know she’s not happy about her body, although she never says anything about it, but that’s not my main worry. I just want her to have a good relationship with food. Do you have any words that might help me deal with the situation? Thank you so much.’ We’ve had conversations about food. What do you think in this instance, this mom should do, Lisa?

 

LISA: It’s so delicate, and I am so appreciative of this letter and how thoughtfully it lays out the dilemma this mom feels of worrying about her daughter’s weight, both from I wonder maybe a health perspective, she she uses the term overweight, which raises a question about whether there’s a health question at work here, and also worrying about it from the perspective of how her daughter feels about herself, and yet knowing that if she brings it up, it doesn’t go well, and not wanting to hurt her daughter or hurt her daughter’s feelings, and yet feeling remiss in not saying something, and it’s just an incredible dilemma that this parent is bringing to us, and I think one that a lot of parents feel. It’s certainly common.

 

REENA: How should this mom start this conversation without isolating her daughter?

 

LISA: This question about how to walk up to it, how to actually approach it becomes very tricky. So, let’s take several steps back and think about this from a few different perspectives. So, one has to do with what it means to be a healthy weight, and the reality is that what constitutes a healthy weight is very different from what the culture says you’re supposed to look like, especially if you’re a girl, and there’s very much an important and powerful movement to acknowledge that people can be healthy at weights that are not typically regarded as slim or, you know, culturally approved and celebrated, and so one of the challenges here is disentangling health from cultural standards, and so on that line, what I would want the parents to do would be probably to confer with the pediatrician about whether or not what this mom is calling overweight is really a medical concern or more of an appearance, you know, cultural sanctioning concern because those are two very different things, and when I have talked with my colleagues in the eating disorder world, their take on this is they do fully support this sort of healthy at every weight view of things to a limit and then they will say, but then there are weights that people can get to where health does start to become a problem, and so it’s a delicate dance between acknowledging that you don’t have to be slim to be healthy, which is so powerfully the messaging that is all around us, and yet at the same time there are limits on how much weight a person can carry and not be potentially running into health consequences as a result. So, that’s a place where I’d want the parent to tease this apart with a physician by calling and saying, here’s where things are. Do I need to be worried from a medical perspective?

 

REENA: How do you talk to a child about weight? You know it’s so tricky, right? So, how exactly do you have that conversation about your relationship with food?

 

LISA: It is tricky, and I would say let’s take it as an advantage in this, it’s also a constant, right? It’s in front of us all the time. We are eating all day, we are eating together, hopefully at parts in the day, they’re watching us see, we’re watching them eat, and fundamentally, I know this parent says this in the letter , ike I want her to have a healthy relationship with food, you know, we want food to be a source of pleasure, a source of joy, you know, there’s not a lot of constantly renewable joys in life. Food is on that very short list.

 

REENA: Yeah.

 

LISA: So, part of how we go about it comes from this world of intuitive eating, which I think is really smart, which is to really frame eating as something we do in response to queues we’re getting from our own body, that our body tells us when we’re hungry, our body tells us what we might want, and that we want to tune and into that, and our body also tells us when we’re satisfied, and so one of the ways to drive the conversation there is to not restrict food groups, to not focus on portion size, to never talk about calories because that then starts to have the conversation dictated by external forces that people are, or kids start to watch and pay attention to, when what we really want is kids tuning into, am I hungry? What am I hungry for? Now that I’ve eaten, am I still hungry? And that’s how we want to frame it. So, a way to do that might be if your child is reaching for that second or third piece of cake, to maybe say, are you still hungry? And asking, you know, is that with this is? Are you still hungry?

 

REENA: Oh, interesting.

 

LISA: And then maybe, you know, without saying, well you can’t have all the sweets, don’t have all that sugar because you have to be cautious about how much you restrict or regulate that. I’m saying, you know, I’m wondering if you actually could do something that had a little more heft to it, had more nutrition in it, and if that might help you feel more satisfied. So, do it from the perspective of health and nutrition and satisfaction, not from the standpoint of don’t, don’t, don’t. It’s more about what you do get to have and what your body needs to be healthy as opposed to what you’re not allowed to have.

 

REENA: So, when you’ve got a season like Halloween, Christmas where, you know the sweets just keep coming and coming, how do you deal with that?

 

LISA: Well, so what do you do? Every family has this dilemma, right? And so first of all the kids come home, do your kids sort the candy?

 

REENA: Oh yeah. Who doesn’t?

 

LISA: Okay, so what does the sorting process look like? Because I think that plays into how we answer this question?

 

REENA: All the good stuff is put in one area.

 

LISA: Okay, what makes a good?

 

REENA:Reese’s peanut butter cups, Snickers bars, Kit Kats, you know, those good chocolates, you know.

 

LISA: Chocolate.

 

REENA: Oh for sure. Yeah, and then, you know, sometimes you get the one off, the neighborhood person to put the little baggies together, you know, everything is sorted out. You know and the parents get like the milk duds, the one even a parent doesn’t really want any.

 

LISA: All right, those are the categories. Like the the stuff your kid really and wants, which in my family is also the chocolate stuff, then there’s the stuff that gets pushed to the side, so that tends, in my universe, to be like Starbursts, Jolly Ranchers ,SweeTarts, my kids don’t like those very much. Twizzlers.

 

REENA: Really? That’s prime candy in my household.

 

LISA: Oh, yeah? Your kids like those things?

 

REENA: Yeah. Oh yeah.

 

LISA: Okay, so that’s in their main category. Then, there’s the stuff that the parents can have, the kids don’t care, then there’s the stuff we take. Okay, so what do you take from your kids’ candy? Like what are you waiting for on Halloween?

 

REENA: The Reese’s peanut butter cups and Snickers for sure.

 

LISA: Those are yours. Okay.

 

REENA:The lollipops, they love the lollipops. I want nothing to do with that.

 

LISA: For me, it’s Butterfingers. It’s all about the Butterfingers.

 

REENA: Oh, really?

 

LISA: Yeah, and I don’t buy them any other time but I love them, and so on Halloween, like my kids know like that’s just the price of doing business is that they have to turn over their Butterfingers. Okay, so you end up, then, with a whole lot of candy, and most kids have some candy that they’re just like, I don’t care. You know so that used to be the take to work candy.

 

REENA: Yes.

 

LISA: Or the giveaway or that, you know, some people just trash it, but then they have all this candy. So then what do you do with all this candy? How have you regulated this or managed this in your own home?

 

REENA: So, it goes into place and we decide, okay you could have a couple pieces over the next week. You know now I think now, they’re at an older age where they’re almost done with elementary school, and so I think they’re more aware, but this will be a different year to approach it, to have a conversation with them to be like, okay what should we do? We’re not going to be eating candy for a month. So, what do you guys think is an appropriate way to handle it and then we can donate so we’re not just sugared up for the next six months.

 

LISA: Okay, so your plan is to say to them, all right now we’ve got like a ridiculous amount of candy, and we’re going to do something to keep that from being a constant.

 

REENA: Yeah.

 

LISA: And that seems to me, if they are open to that and that feels comfortable for you and comfortable for them and it’s working, I think that’s fantastic. We have a sweets box, actually, in our pantry.

 

REENA: Oh, really?

 

LISA: Yeah, it’s just a, you know, a container where I keep whatever sweets I’ve purchased and we’ll probably dump what’s left in the sweets box because my kids happen to regulate themselves pretty well it’s not something I feel, they’re pretty intuitive I guess I would say I don’t know exactly how that came to be but I don’t worry that if the sweets are there, they’re going to eat them all at once, but I know some parents do, and I wonder if this parent, who’s writing us, might worry about that.

 

REENA: What should we think about, though, I mean everyone has their own way of dealing with it. What really matters when you’re trying to establish a healthy relationship with food?

 

LISA: Well, so the intuitive piece for sure, right? Of letting one’s body tell you what it is you want and need, and including within that a wide range of nutrition in the name of taking good care of oneself, you know, which is something we talk about all the time, taking good care of oneself, and if you’re eating nothing but sweets, you’re not taking good care of yourself, if you are not letting yourself have any foods that you find delightful and enjoyable, you’re not taking good care of yourself. You know so I think that we want to always frame it in that way. But I do think that what we really want to focus on here, Reena, if there’s one thing that is so central in these questions, is to not get into a power struggle about the food. That to me is top, top here.

 

REENA: What do you mean about power struggles? Do you mean, no you can’t have that, stop?

 

LISA: Well, so I’ve thought for a long time about various power struggles that come up in parenting, and there are four areas, Reena, where the kid has all the power, and if you get into a power struggle with your kid it will go very badly. So, one is toileting, actually. Your kid has all the power, and it’s very right for parents, another is sleep. You can’t make a kid sleep. If they don’t want to sleep, they can usually keep themselves up. A third is food, and then the fourth is actually homework and grades. Kids have all the power there too, and it’s very hard to make them do things they don’t want to do.

 

REENA: No one’s ever put it to me like that. It’s amazing.

 

LISA: Yeah, I know. So, focusing on the idea of food and power struggles. So, one thing I’ve seen parents do sometimes when they’re worried about a kid’s weight and not wanting their kids to eat sweets or treats or things like that, is that the parent takes them all out of the house. The parents stopped purchasing them or, you know, let them have a couple of pieces of candy at Halloween and then the rest is gone, and this is not something I’ve seen go well, and what I think about here is a teenager I cared for where her parent did this. Her parent wanted her to slim down and decided that she would just not have any processed foods in the house at all, and this was a teenager who would then drive to a convenience store and get whatever she wanted, none of it approved by the parent, and eat it and then just throw the wrapper’s away at school.

 

REENA: Wow.

 

LISA: And it was interesting. This was a teenager who was in my practice who felt really ambivalent about doing this. Didn’t feel good about doing it, but didn’t want to feel so totally controlled by her mom, and so she did it anyway. So we need to be aware that if you get into a power struggle with your kid around food, it can take a direction that you truly do not mean for it to take. So, the guidance that we tend to fall back on here is that guidance around a young person’s responsibility to take care of themselves, and the parents’ role as backing that up, and so that means turning into their body and what their body wants and needs, and that means eating a wide variety of things. And so from that framing, it becomes a dilemma between the young person and themselves, not between the parent and the kid.

 

REENA: So, what do you do if you’re a parent who you know may have a complicated relationship with food or weight? Maybe you have an eating disorder, maybe you’re dieting all the time, maybe you’re overweight. It’s harder then, right? To have that conversation?

 

LISA: It’s really hard. It’s really hard. And, Reena, let’s be honest. Do you think there are any women living in the U.S. who did not have, at some level, a complicated relationship with food and weight?

 

REENA: Very good point. Very good point. I agree.

 

LISA: I just, I don’t know that you can live in this culture and not struggle with that. Even if in your actions you feel good about how you live, you know, that you’re good on intuitive eating and you feel comfortable with your body and you like your body and you don’t measure your worth by the scale, even if one has gotten to that place hand has been able to achieve that, it’s impossible for me to believe. I mean I want that woman to be out there, that’s not still somehow done with effort, you know, done against a backdrop of of a world that has, especially for women, but certainly men and boys are not immune to this, since such incredibly powerful messaging around how much we are valued for our shape, vastly more than from what’s inside that shape. So, let’s start with the idea that probably everyone has had to work at this relationship, and people may be in different places in working out this relationship, and we’re parenting as we go. So, what I will say is I’m so glad you’re asking this question because how we’re dealing with this in our own lives is not all separate from how we are dealing with this as parents, especially because, you know, our kids watch us so closely, whether we think they are not. So, Reena, when it comes to dessert for you, and either at your own table or if you’re out, how do you navigate that? How do you do this in front of your kids, as a mom and as a woman?

 

REENA: You know, it’s not just dessert. I find that whenever there is a big moment and, you know, we scored two touchdowns at a Sunday morning football game, I say, let’s go out for ice cream, I’m constantly finding that the reward system is food. Particularly in this pandemic because there’s not so much we can do, right? Go places or whatever. So, I find myself trying to figure out other reward systems so it’s not just food, but with the kids I try to have a conversation with them and as they always say, oh this is Miss Lisa’s words, right? Miss Lisa says this. Miss Lisa says there are sometimes foods and everyday foods and, I think that we can have a sometimes food today. So it’s getting in there, Lisa. Your words have impact in my household.

 

LISA: So, you’re talking about it, right? You’re having an open conversation?

 

REENA: We’re talking about it. Yeah.

 

LISA: And I’ll say, I did this the other day. I got really, really busy in meetings and ended up in the sort of back-to-backs situations where I couldn’t really eat in any way that I wanted to, and then wanted nothing but sugar, and ate a huge amount of sugar just because I just was craving it and I think I wanted that sense of fast energy because I just had kind of a lousy day of access to food that I really would’ve found more sustaining, and then I felt kind of sick, actually, from how I’d gone about it, and I wasn’t deliberately using it as an object lesson, but I did actually talk that through with my daughters that night. I was like, ugh I had the worst food day. I was unable to get to good food all day. I just didn’t figure it out. I didn’t plan well, and then as soon as I could eat I just, all it was like, you know, sugary fast energy food and now I feel really gross, and I just said that, and they know how we live around. We have sweets, they have access to sweets. The don’t have unlimited access, like when the sweets boxes empty it’s empty till I decide to go to the store put more stuff in it, but that felt to me like a place where I could just talk about the way in which food works in our life and the way in which I got myself into a position around food that I didn’t want to be in, but also treated as like, it was a weird day and tomorrow I will be able to do better planning and eat in more sustainable ways. The other thing I think we can do, even as we’re wrestling with their own relationship with food and weight and appearance as members of this culture, another thing that really helps is to move away from the idea of what you can’t have and to really focus on what should center in one’s diet, and you mentioned my old thing that I stole from Sesame Street about sometimes food and anytime food, which I think it’s a really nice way to frame it in terms of sometimes food being processed foods, anytime food being unprocessed, whole foods that kids can, you know, comfortably access and know that they’re really having taken note that they’re really making choices that will take good care of their bodies. Another thing that I’ve taught my daughters along the way is for their meals what they really want to focus on is getting protein, fiber and healthy fats in those meals.

 

REENA: Oh, okay.

 

LISA: And we talk about it from energy sustainability, that those are the things that the body breaks down that will give them a good, solid, steady energy, and then we talk about what makes those things up, you know, so what the various proteins are, those are pretty clear to kids. Fiber, you know, this is gonna be breads, grains, nutrition, nutrients like that, and fruits and vegetables and healthy fats, so avocados, olive oils, nuts, and that, you know, kind of triad is a very nutritious triad, it’s a great energy triad, and I like talking about food in terms of energy and having good energy, and then if their meals are centered on protein, fiber and healthy fats, it makes it a lot easier, then, for them to not do what I did the other day of just craving and eating a whole bunch of sweets because I am so depleted from an energy standpoint. So, I think it’s this ongoing conversation and our north stars in that conversation are self care and energy and intuitive eating and paying attention to what one’s body is asking for, and really not having it be about appearance and weight and scales and value being tied up in how we look.

 

REENA: That’s great because I go back to what this mom was asking, which you just beautifully answered, which is I just want her to have a good relationship with food, which is, you’re right. We’ve got to have these conversations about what healthy eating looks like and why it’s important.

 

LISA: That’s right, and I think that’s the magic word is health, right? This isn’t about appearance. This isn’t about weight. This isn’t about diet. This is about health, our job all the time, for ourselves and our kids, is to be talking about food under that umbrella. That is what keeps us healthy. It is what gives us energy. It is a source of pleasure. It should be enjoyable, and if we focus on those things and then also focus on being active as a family, doing physical things as a family, being, you know, busy in ways that are kids enjoy, going on walks, going on bike rides, you know, playing games as a family, if that’s something that parents like to do, if they like to play tennis, if they like to kick a soccer ball around, to have physical activity be also a pleasurable thing that we do in the name of health, in the name of enjoying, you know, what our bodies can do and also having fun with other people. If we center on that, things tend to go much better.

 

REENA: That’s really great, and it’s a lifelong skill to learn that I feel you’re constantly trying to understand and deal with. So, thank you for that, Lisa.

 

LISA: Absolutely.

 

REENA: We should also mention. We’ve got a couple of episodes that are worth going back to to listen, right?

 

LISA: Absolutely. So, today we talked about a child who may be tipping towards eating more than the parent feels comfortable with. In Episode 11, we talked about eating disorder behavior in the traditional sense of people who may be restricting what they’re eating, not eating enough or doing things to get rid of calories they consume, such as vomiting or excessively exercising. For any child who’s worried about an eating disorder, and the presence of what we traditionally call an eating disorder, Episode 11 may be helpful.

 

REENA: And also wasn’t it Episode 4 that we talked about foods?

 

LISA: We did. You know that was very early in the pandemic and it was very much around how weird those early days of the pandemic were, of just all of us being stuck at home and having nothing to do that felt good at all and the place the food was starting to take our lives, but a lot of that may still very much hold up now, though, happily, the day-to-day of the pandemic feels very different now than it did when we were talking about that in September last year.

 

REENA: How things have changed in a year, huh?

 

LISA: Yeah.

 

REENA: And some things are still the same. But tell us, what do you have for us for parenting to go?

 

LISA: One thing we know and that helps kids to have a healthy relationship with food is to enjoy making food, and part of how we can build a healthy relationship with food is to have our kids cook with us, have them choose what they want to cook, make it possible for them to use our kitchens to cook and support them as they do it. So, that’s something that parents can fall back on at any age as they’re parenting, whether it’s with little kids involving them with cooking or with older kids putting them in charge of making meals and giving them some general parameters around what needs to happen and then letting them do their thing. Kids often take great pleasure in making food and then eating the food they’ve made.

 

REENA: That’s really great. I hope you do find a Butterfingers somewhere along the way this week.

 

LISA: I will be getting my Butterfingers. I can promise you that.

 

REENA: You deserve it. And next week we’ll be talking about how and when you should give your kid a cellphone. I’ll see you next week, Lisa.

 

LISA: I’ll see you next week.