Raising Healthy Eaters

“Raising a healthy eater takes years. Children learn bite by bite, food by food, meal by meal. The goal of raising a healthy eater is to help your child grow up with positive eating attitudes and behaviors; it is not to get him to eat his peas for tonight’s supper.”

Ellyn Satter, MS, MSSW, RDN

As we discussed previously, what we feed kids is important to ensure that they are meeting their nutrient requirements. But, just as important as WHAT we feed kids, is HOW we feed kids. The structure and environment that parents provide when feeding not only impacts nutrition, but it can also affect weight and behavioral problems. Families who regularly eat together have children who eat more fruits and vegetables, have healthier weights, and are less likely to use drugs, alcohol, or tobacco when they are older.¹

Family meals have many nutritional, social, and emotional benefits. In this section, we will discuss best practices for providing family meals and raising healthy eaters.

The Division of Responsibility

The gold standard for feeding children is Ellyn Satter’s Division of Responsibility (sDOR). Ellyn Satter is a dietitian, family therapist, and internationally recognized authority on eating and feeding. The Division of Responsibility outlines the optimal relationship between parent and child when it comes to feeding: the parent determines the what, where, and when of feeding, and the child chooses how much to eat and whether to eat from the foods provided.²

The parents’ jobs with feeding:

• Provide structured, sit-down meals and snacks at predictable times
• Decide what foods will be offered at meals and snacks
• Make mealtimes pleasant
• Teach table manners
• Only offer water between meal and snack times; no other foods or beverages
• Be considerate of food preferences, but don’t cater to likes and dislikes
• Trust your child knows how much food to eat and will grow into the body right for them

The child’s jobs with feeding:

• Eat the amount of food he or she needs
• Learn to eat a variety of foods that are offered at family meals
• Have good table manners
• Grow into the body that is right for him or her

The division of responsibility is built on the trust that children know when they are hungry and full, that they want to eat, and that they want to learn to eat grown-up foods. Parents can best support their child’s eating by providing the structure of family sit-down meals and snacks and modeling relaxed, enjoyable eating. The division of responsibility is an authoritative approach, providing structure and limits, but allowing the child autonomy within those limits. At meals and snack times, parents promote children’s independence by allowing them to pick and choose foods from what has been made available and deciding how much of each to eat.

As your child learns to eat grown-up foods, every day will look slightly different—some days eating a lot and other days eating very little. Don’t cross the division of responsibility and pressure your child to eat more or less of something; this kind of pressure backfires. Pressure can be positive: praise, rewards, bribing, making special food, playing games, or talking about nutrition to encourage kids to eat more of nutritious foods or less of “bad” foods. Pressure can also be negative: restricting, threatening, punishing, shaming, or withholding dessert or fun activities. Instead of pressure, follow the division of responsibility in feeding.

Eating Competence

Eating competence is an evidence-based model that defines the interrelated spectrum of eating attitudes and behaviors.³ The model is based on the principle that internal cues of hunger, appetite, and satiety are reliable and can be used to inform food selection and guide energy balance and body weight. Satter breaks eating competence down into 4 basic components: (1) eating attitudes; (2) food acceptance attitudes and skills; (3) internal regulation attitudes and skills; and (4) contextual attitudes and skills for providing family meals.

According to Ellyn Satter, “Eating Competence is being positive, comfortable, and flexible with eating as well as matter-of-fact and reliable about getting enough to eat of enjoyable food. Even though they don’t worry about what and how much to eat, competent eaters do better nutritionally, are more active, sleep better, and have better lab tests. They are more self-aware and self-accepting, not only with food, but in all ways. To be a competent eater, be relaxed, self-trusting, and joyful about eating, and take good care of yourself with food.”⁴

Current nutrition advice often focuses on avoidance of foods and reliance on outside indicators, such as diet plans, to guide eating. Eating competence is the opposite. It encourages us to seek food that is enjoyable and to let internal processes such as hunger and satiety to guide eating.

Eating competence comprises both permission and discipline.⁵

• Permission is choosing foods that are enjoyable and eating those foods in amounts that are satisfying, based on hunger, appetite, and satiety.
• Discipline is providing the structure of regular meals and sit-down snacks, and paying attention to internal regulators while eating.

In “Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook,” Satter discusses how the eating competence model is built on trust: “Trust in our love of food and good eating; trust in following our inclinations to eat the food we like in amounts that are satisfying; trust that taking time to enjoy eating is time well-spent; trust that taking pleasure in eating supports being healthy; trust that behaving in such a self-respecting way is legitimate.”

Today’s nutrition advice is often based on control—the opposite of trust. Control is looking to outside instruction for what and how much to eat. It is sticking to a strict macro or calorie count; it is eating food because it is good for you (even though it is not appealing); it is eating a defined amount of food that is not related to hunger and satiety; and it is restricting food. Control often means restrained eating, and restrained eaters actually consume more food when exposed to forbidden foods.6 Also, when food choices are externally dictated, especially when promoting negative energy balance, the body’s physiological and psychological defense mechanisms are activated, which can lead to gaining excess weight and accumulating excess fat after food restriction.⁷

Parents should consider their own eating competence as they work to build eating competence in their children. Do you feel positive about eating and about food? Do you enjoy eating a variety of foods and trying new foods? Do you trust your internal regulators of hunger, appetite, and satiety to guide how much you eat? Do you have structured meals and snacks? It’s much more difficult to raise eating competent children if the adults in the family do not model a healthy relationship with food. Many new parents find that having children inspires them to work towards greater eating competence for themselves.

Meal planning is a good place to start when working on building eating competence. Tips for meal planning:⁸

• Start with what your family is currently eating, and cluster those foods into meals and snacks.
• Try to provide food from each of the food groups for meals, and from 2 to 3 groups for snacks (dairy, fruit, vegetable, protein, and grain). Make sure they are foods you like and enjoy.
• Include bread or similar food like rice at every meal. Bread is always an easy-to-like food that family members can choose when they aren’t excited about other options. Pair familiar foods with unfamiliar foods and favorite foods with not-so-favorite foods.
• Include fat in food preparation to make foods enjoyable. For meals to be sustainable, they must be satisfying.
• Let everyone choose what tastes good to them from what is provided on the table.

The Picky Eater

All young children can be picky when it comes to food and refuse to try new foods; this is normal behavior. It is only a concern when children get stuck with being picky. Follow the division of responsibility and adjust your expectations. Steer clear of the following traps that can limit food acceptance:

• Catering the menu to only child-friendly foods or favorite foods
• Making a separate meal when your child complains about what is offered
• Asking your child what they want to eat
• Pressuring your child to eat
• Offering food outside of scheduled meal and snack time

The biggest goal with a finicky eater is to not make eating an issue, and to have mealtime be pleasant. Provide the structure of scheduled meals and snacks, and the permission for your child to choose from what is offered, with no pressure.

For more information on how to raise a healthy eater check out the following resources:

• Satter, E. (2008). Secrets of Feeding a Healthy Family: How To Eat, How To Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press.
• Satter, E. (2000). Child of Mine: Feeding with Love and Good Sense. Boulder, CO: Bull Publishing Company. Ellynsatterinstitute.org

References:

• ¹Academy of Nutrition and Dietetics. (2019). Family Meals: Small Investment Big Payoff. Retrieved from https://www.eatright.org/food/nutrition/eating-as-a-family/family-meals–small-investment–big-payoff
• ²Ellyn Satter Institute. (2019). Raise a healthy child who is a joy to feed. Retrieved from https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
• ³Lohse B, Satter E, Horacek T, GebreselassieT, Oakland MJ. Measuring Eating Competence: psychometric properties and validity of the ecSatter Inventory. J Nutr Educ Behav. 2007;39 (suppl):S154-S166.
• ⁴Ellyn Satter Institute. (2019). The joy of eating: Being a competent eater. Retrieved from https://www.ellynsatterinstitute.org/how-to-eat/the-joy-of-eating-being-a-competent-eater/
• ⁵Satter, E. (2008). Eat as Much as You Want. In Secrets of Feeding a Healthy Family: How To Eat, How To Raise Good Eaters, How To Cook. (p. 29). Madison, WI: Kelcy Press.
• ⁶Stirling LJ, Yeomans MR. Effect of exposure to a forbidden food on eating in restrained and unrestrained women. Int J Eat Disord. 2004; 35:59-68.
• ⁷Keys A, Brozek J, Henschel A, Mickelsen O, Taylor H. The Biology of Human Starvation. Minneapolis: University of Minnesota Press; 1950.
• ⁸Satter, E. (2008). Feed Yourself Faithfully. In Secrets of Feeding a Healthy Family: How To Eat, How To Raise Good Eaters, How To Cook. (p. 48). Madison, WI: Kelcy.

Images:

• Photo of family meal by National Cancer Institute on Unsplash (license information)
• Photo of girl eating croissant by Анна Хазова on Unsplash (license information)